Yes. Millions of relatively wealthy Americans are getting Medicare and Medicaid benefits. ACA expands the latter without many controls to make sure the money goes to the right place. The general concept of SS is the same as MED or ACA.
If we're talking about shaving benefits for people who can afford various kinds of health care coverage by themselves, then I'd certainly be down with that. But what are we defining as "relatively wealthy Americans?" What percentage of "entitlement" spending goes to each quintile? Which provisions of the ACA lack means-testing controls? What is the "right place" for the money to go, in your view? These programs cover different groups of people, though some cross-sections are duel-eligible, but they're only "the same" in the sense that they're social insurance programs.
Anyway, if we're doing three things simultaneously in the foreseeable future, namely increasing utilization, not controlling health care cost inflation and not broadening the tax base intelligently, then we're heading for lots of problems with health care costs in the country, as if we didn't have enough already.
This is not a true statement. Bending the cost curve was always one of the Affordable Care Act's main objectives. There's a pretty contentious debate over whether that effort has been successful and about how much of the recent slowdown in cost inflation is attributable to ACA-related reforms. This would not be a debate if the law was not addressing cost inflation at all.
I'm aware of the debate, though I don't know if we've had enough time to collect data given that much of the law didn't get implemented until recently and there are parts still awaiting implementation. There are also shifting large-scale economic factors to account for as well. It may very well be that new numbers of enrollees, decreased claims during the recession or due to better health of newly retiring baby-boomers, dropping Medicare Advantage subsidies in the recent past and other factors have decreased the amount the federal government is spending on health care costs. I'd be happy if the ACA bends the cost-curve long-term. I also wouldn't mind so much the money the fed spends on health care if our national defense budget also didn't account for so much, but it does and there's no signs of that changing soon. But I was thinking not just about how much the fed spends on health care, but a bunch of factors related to the total system; the tendency of health care cost inflation to outpace general inflation 3-1 in recent decades, the patterns of premiums to rise rapidly every year, and all the insane cost-shifiting that goes on in the American system because of its peculiarly fragmented nature. The whole thing really sucks up a lot of our economy, and we can't seem to come together to get our hands around it as other nations have.
