Dating from the 1930s, many Court decisions allow for the federal government to have a much larger role than was contemplated at the beginning of our republic. It is interesting that this was upheld on a taxation basis rather than the Commerce Clause. Because health care is so heavily regulated (by both state and federal governments) the market applies very little to health care. Very few advocates want to alllow for easier use of medical equipment and drugs. The costs of these kinds of things are artificially high because there is so much red tape necessary in order to be able to sell/use new devices for medical treatment. Technology should have caused a reduction in medical costs -- but regulation has prevented that.