A simple minded approach

The Affordable Care Act was a famously complicated bill, but at a very simple level, its intent and effect were to drive more economic activity into the health care sector. Young people and the near poor, in particular, would get more treatment, because the bill would use carrots (the subsidies and Medicaid expansion) and sticks (the mandate) to get them insurance. In fiscal terms, the bill raised taxes on the rich to pay for the subsidies and Medicaid expansion.

So at a basic level, the question for everyone about the bill was (and is), was American economic activity in 2010 insufficiently focused on health care? Not whether any individual deserved more care, but whether in aggregate we were spending enough.

If you read what Peter Orszag or other wonks in the Administration were saying at the time, the intent of the bill was to bend the cost curve and reduce total expenditure by limiting what Medicare reimbursed, using various pilot programs to find out what kinds of treatments were ineffective, get some death panels up and running, and so on.

But that’s bullshit. You made more money available, so more money was going to get spent.

The death panels were real, of course, but they were mostly for young people instead of the old, as it turned out.

 

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