The Agenda

Avik Roy on the Future of the Affordable Care Act

Avik Roy has written a post arguing that the Affordable Care Act (ACA) has the potential to dramatically change the generational politics that shape the American social safety net:

Obamacare will destroy the old individual insurance market, leaving the uninsured with no recourse other than the subsidized exchanges. Simple Medicare reforms, such as raising the retirement age, will be used to fund the growing number of people on the exchanges.

If Obamacare’s exchanges do end up conquering Medicare, there will be no shortage of ironies. The Obamacare exchanges use a means-testedpremium-support system that is to the right of the one proposed by Mitt Romney, Paul Ryan, and Ron Wyden for Medicare. Obamacare’s premium-support payments grow at a specified rate, one that may not keep up with health-care inflation: theprecise criticism that Democrats leveled against Paul Ryan’s old Medicare plan. And similarly, it might be Obamacare—the bane of Republicans’ existence—that ends up replacing Medicare with a system much like the one favored by…these very same Republicans.

Or, we could just keep spending infinite amounts of money on both programs until we go bust.

In case you couldn’t tell, Avik is not in a cheerful mood, but his thoughts are very much worth reading.

Reihan Salam is president of the Manhattan Institute and a contributing editor of National Review.

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