Douglas A. Kahn & Jeffrey H. Kahn
The Patient Protection and Affordable Care Act of 2010 has
stirred considerable controversy. In the public debate over the program, many
of its proponents have defended it by focusing on what is sometimes called the
“free-rider” problem. In a prior article, we contended that the free-rider problem
has been greatly exaggerated and was not a significant factor in the congressional
decision to adopt the Act. We maintained that the
free-rider issue is a red herring advanced to trigger an emotional attraction
to the Act and distract attention from the actual issues that favor and
disfavor its adoption.In a recently published
article, Professors Nicholas Bagley and Jill Horwitz responded to our article. For the sake of convenience, we will
sometimes refer to the two professors collectively as “the professors.” In
addition to addressing the free-rider issue, they also made a number of points
in defense of the Act. We will concentrate on responding to those items that we
discussed in our prior article and deal with only some of their broader points. While not mentioned by the professors, one matter worth
noting is the effect that the cost of implementing the Act may have on the
economy. While cost is not the only potentially unfavorable feature of the
medical care program that the Act creates, its economic impact should weigh
heavily in evaluating its merits.
A major objection to the Act is the belief that it will
impose a huge cost at a time when the government should be reducing
expenditures. Proponents dispute this objection: based on a set of assumptions
as to future events and behavior, the government maintains that the program will
generate a surplus. We are not alone in believing that the assumptions on which
that projection is made are unrealistic and that the program will greatly impair
the economy. For example, the Act requires a
reduction in Medicare disbursements and anticipates those savings will offset
some of the Act’s costs, yet there are reasons to suspect that the proposed
cuts in Medicare will never materialize or will be repealed when the
consequence of making them surfaces. While we also will not grapple with that
issue, we are deeply skeptical of the government’s contention. For this reason,
we choose to refer to the Act as the “Unaffordable Health Act” (or the “Act”).