PPACA Versus Defined Contribution Approaches to Health Care Financing

American culture and public policy have long held a split vision about the aged: vulnerability, dependency, and special need for law and policy to act as a protective shield versus the aged as independent, self-reliant, and capable of choice, with law acting as a source of individual empowerment. In terms of health care financing, the 2010 Patient Protection and Affordable Care Act (PPACA) clearly leans toward protecting older persons from risk, rather than empowering them to act autonomously. This article compares the PPACA vision of elder vulnerability to alternative policy proposals for financing health care for the aged that are built on a vision of elder abilities and capacity for self-determination. The author advocates for the latter social vision and associated health care financing policy alternatives, arguing that a rebuttable presumption of elder capacity that recognizes and provides for individual variations better serves important societal values than does the PPACA's categorical conclusion that the aged as a population are unable to fend for themselves.