What this boils down to is the meaning of "general welfare" and if you are believer in the 20th century view that was ruled on by the court in 1936 i.e. United States v. Butler
This ruling reveresed the long held premise of limited Govt. and it's definition of the general welfare according the the father of the constitution James Madison in favor of that made by Hamilton.
In his 1791 "Report on Manufactures," Alexander Hamilton asserted the general welfare provision conferred a power separate and distinct from the specific grants of legislative power contained in the Constitution. He also claimed the specific grants of legislative power did not qualify or limit the meaning of the general welfare phrase. Therefore, Congress, according to Hamilton, had an independent and unspecified power to tax and appropriate money for the general welfare.
This view since 1936 has been the view that the courts generally favor of those of the Madison even though Madison is considered the father of the constitituon. I think it worth noting though what Justice Roberts who was a part of this ruling had to say about this in 1951.
The Supreme Court had no opportunity to interpret this clause until 1936, in United States v. Butler. In striking down the Agricultural Adjustment Act of 1933, Justice Owen *Roberts, writing for the majority, held with Hamilton's view, saying that the Taxing and Spending Clause was indeed a separate grant of power to Congress. Because the Court could determine for itself whether a particular tax or expenditure was in the general welfare of the country, however, Roberts read the clause as limiting Congress's reach to matters of “national, as distinguished from local welfare.” The limitation proposed by Butler remained hypothetical, however, since the Court struck down the statute in question on other grounds.
In 1951 the same Justice Roberts wrote the following;
"Looking back it is difficult to see how the Court could have resisted the popular urge ... an insistence by the Court on holding Federal power to what seemed its appropriate orbit when the Constitution was adopted might have resulted in even more radical changes to our dual structure than those which have gradually accomplished through the extension of limited jurisdiction conferred on the federal government."
Baily V. Drexel
Taft argued the law describes a set course for businesses and when they deviate from that course, a payment is enacted. Taft said “scienter is associated with penalties, not with taxes.” “The court must be blind not to see that the so-called tax imposed to stop the employment of children within the age limits prescribed.” Taft said that the court must commit itself to the highest law of the land and the duty of the court, even though it requires them to refuse legislation designed to promote the highest good. He went on to say that the good sought in unconstitutional legislation leads citizens and legislators down a dangerous path of breaching the constitution and recognized standards. In addition, Congress could take control of many areas of public interest, which the States have control over reserved by the Tenth Amendment, by enacting regulating subjects and enforcing them by a so-called “tax.” This would break down the constitutional limitations on Congress and eliminate the sovereignty of States. A tax is a source of revenue for the government, while a penalty is a regulation and punishment for a certain behavior.
While this case was just prior to the former it shows a view prior to the adoption of the Hamilton view than many see as the meaning of what the clause means.
One thing people seem to get caught up with in this over reach view of the general welfare clause is the following.
The enumerated powers are a list of specific responsibilities found in Article 1 Section 8 of the United States Constitution, which iterates the authority granted to the United States Congress. Congress may exercise only those powers that are granted to it by the Constitution, limited by the Bill of Rights and the other protections found in the Constitutional text.
It' fairly obvious that if the framers of the constitution had intended the meaning of general welfare to confer powers to the Federal Govt. that unlimited in scope then they would not have bothered with a a bill of rights. In fact why have the 10th Amendment at all if you confer powers upon the Federal Govt. if you run to the "general welfare" clause as a broad all encompassing meaning. In fact could it that general welfare means as it applies to the taxing provisions of the amendment rather than a broad all encompassing provision that can circumvent the rest of the constitution. In fact the constitution has a mechanism to provide for those that wish healthcare to become as much a right as free speech and thats called the Amendment process. I have long felt that those that advocate mandated coverage for all should go down this road rather than further circumvent the constitution that began with FDR. In fact the commerce clause can give those that advocate healthcare reform as it applies to regulating the healthcare industry and I fail to understand why the congress does not apply it's power under this clause to reform healthcare costs and make it available for those that need it and want it.
