The media is always touting the fantasy that Obama is a Constitutional lawyer, but, I believe, he was an "adjunct professor of law." It didn't take me more than five minutes to find the relevant "holdings" on the issue of Congress and the control of Medical practice. The earliest one is from 1925, Linder vs. US, 268 U. S. 5 decided by a majority vote (9-0) and the Opinion written by Justice James Clark McReynolds: "Obviously, direct control of medical practice in the states is beyond the power of the federal government."

Dr. Charles Linder, a physician, had been prosecuted for distributing narcotics to drug addicts, and sent to jail. Upon appeal to the Supreme Court in Spring 1925, the Supreme Court noted that the federal government had overstepped its Constitutional authority, when it had used the taxing act, called the Harrison Act to prosecute Linder, because they felt it was an unethical medical procedure. It's "holding" (conclusion) was: "Any provision of an act of Congress ostensibly enacted under power granted by the Constitution, not naturally and reasonably adapted to the effective exercise of such power, but solely to the achievement of something plainly within the power reserved to the states, is invalid and cannot be enforced." (ibid).

Obviously that was 84 years ago, and a lot has happened since then. Some of Linder has been reversed and superseded. However, as recently as 2006, the "holding in Linder" was used against Alberto R. Gonzalez, US Attorney General, when he challenged the "assisted Suicide Act" of Oregon, or the Oregon Death with Dignity Act, which had been ratified by the citizens of Oregon in 1994. "On November 9, 2001, Attorney General John Ashcroft issued an Interpretive Rule that assisted-physician suicide was not a legitimate medical purpose, and that any physician administering federally controlled drugs for that purpose would be in violation of the Controlled Substances Act. "

"In a 6-3 decision written by Justice Anthony Kennedy", which cited Linder V. US, the SC decision was "to limit federal power to regulate medical practice" in Alberto R. Gonzalez et al V. State of Oregon, with Roberts, Scalia and Thomas dissenting.

Even as late as March 4, 2009, in Wyeth v Levin, the Supreme Court found that a local jury in Vermont could topple the FDA. The Supreme Court decision was 6-3. Justice Clarence Thomas concurred and quoted Joseph Story, one of our first Justices,: "3 J. Story &1831, at 694:  "Actions of the Federal Government "which are not pursuant to its constitutional powers, but which are invasions of the residuary authorities of the smaller societies' are not "the supreme law of the land. They will be merely acts of usurpation, and will be treated as such".

The holding in Wyeth v. Levine was written by Justice Stevens: "Federal law does not pre-empt Levine’s claim that Phenergan’s label did not contain an adequate warning about the IV push method of administration.” Diana Levine had received an IV injection of Phenergan, an anti nausea drug and subsequently, developed gangrene in her arm, so it had to be amputated. The federal court in Vermont later awarded Levine, a musician, 6.7 million dollars, and had some "unintended consequences" that banned "prescription data mining" and drove down prescription costs for the Vermont population.

As you can see in the little cartoon, if Congress wants to cite the "Interstate Commerce Clause" of Congress as the Constitutional basis of the Health Care Reform Bill, why don't they just allow interstate competition between the Health Insurance Companies? Right now, insurance companies are prohibited from selling to customers in a different state, so, that obviously dampens competition, which would, most likely lower premiums.