Document ID: ./input/supremecourt_opinions/opinions/boundvolumes/529bv.pdf
Page Number: 764

529US3

Unit: $U55

[09-26-01 13:01:10] PAGES PGT: OPIN

Cite as: 529 U. S. 667 (2000)

689

Thomas, J., dissenting

care. Quality medical care is available only if medical pro-
viders remain ﬁnancially viable. Medicare payments create
demand for medical services and, therefore, provide “bene-
ﬁts” to health care providers. This syllogism, however,
amounts to nothing more than the self-evident point that
Medicare aims to ensure that the beneﬁciaries of the pro-
gram—patients—are able to receive the program’s intended
beneﬁts.
It does not establish that Medicare exists to put
hospitals on the dole.

In short, none of the components of Medicare cited by
the Court establishes that beneﬁts ﬂow to hospitals.
It
is signiﬁcant that, although the Court repeatedly invokes,
mantra-like, its conclusion that Medicare exists for a purpose
above and beyond reimbursing hospitals for treating Medi-
care patients, see, e. g., ante, at 677–678, 679, 680, 681, when
the Court comes around to actually identifying this purpose,
it can only state: “The structure and operation of the Medi-
care program reveal a comprehensive federal assistance en-
terprise aimed at ensuring the availability of quality health
care for the broader community.” Ante, at 680. The Court
cannot bring itself to say, as it must, that Medicare exists for
the hospital.3

3 And even if I were to accept that some provisions of Medicare—the
special treatment provisions, for example—provide a beneﬁt to health care
providers, there is no evidence in the record that West Volusia Hospital
Authority received any such payments. Without such evidence, the
Court’s reliance on special provisions to uphold petitioner’s conviction is
improper. Title 18 U. S. C. § 666(b) is, after all, a jurisdictional provision
that allows federal prosecution only if the speciﬁc organization at issue
received more than $10,000 in “beneﬁts.” The Court treats the provision
It is not necessary, under the Court’s view, to show
as window dressing.
that this organization received beneﬁts.
It is sufﬁcient to show that some
hospitals receive them.

This approach is particularly inappropriate because § 666(b), or some
similar jurisdictional provision, is constitutionally required. Section 666
was adopted pursuant to Congress’ spending power, Art. I, § 8, cl. 1. We
have held that the spending power requires, at least, that the exercise of
federal power be related “to the federal interest in particular national