In other words, if society, through its elected government, has undertaken a commitment to provide Good X to everyone, then it can reasonably require everyone to buy Good X (or insurance that provides Good X) in advance–in order to ensure fairness and efficient allocation of X.**** You may not like this principle, it may be a lousy principle (I disagree)– but it’s still a principle, and a limiting principle, because there are only so many (in fact, precious few*****) goods that society and Congress will agree to provide to everyone. Ah, but that’s “bootstrapping,” you say–Congress, by guaranteeing X to everyone, is creating this prerequisite for the extension of it’s own commerce power. So it is. So what? It’s still a limiting principle because the legislature cannot and will not bootstrap in this manner without limit. …******

d) Constitutional Equality: I think there’s finally a more abstract, constructed argument Justices could persuasively cobble together from the notion of formal equality inherent in the Constitution’s structure (and brought most clearly to the surface in the “one man, one vote” line of cases). There’s a reason, after all, why we give people with heart attacks health care but don’t give broccoliless people broccoli. ****** They’re individuals and under the constitutional principle of equality they have as much right to live as anyone else. But without this particular good–medical attention when needed–every individual will suffer a harm that is immutable and extinguishing. Death, in other words. Just as similar judge-identified factors (immutability, invidiousness) once marked legislative classifications for “strict scrutiny” under the Equal Protection clause, these three factors–the universality, immutability and extinguishing quality of not having medical care–can identify it as a good suitable for both government provision and government mandate. Again, you may not like the limiting principle, but it is a principle and it limits. It’s the sort of principle Supreme Court justices pull out from under their robes all the time.