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[Tyrone Slothrop]

Originally Posted by sebastian_dangerfield

I'm inclined to agree. I actually looked for something that got into that broader approach. That's how I wound up with the Goldman study.

But I have this suspicion that HC's multiplier might be smaller or more narrow than we think. I say this as someone with numerous docs in the family. I see a lot of the use of products your describe. But I'm not sure that translates as broadly as putting more dollars in average people's bank accounts, where they will spend it in a variety of places. Seems a lot of HC dollars go into savings (specialists making bank). But I'm just speculating there. There is indeed ample evidence out there from which to make the argument that, in aggregate, the economic impact of ACA is positive.

But as I noted, it comes at a cost to others.

You are confusing two different concepts. "Multipliers" are about the dynamic effects of government spending, the follow-on effects on the whole economy. Whether something, government or otherwise, is "zero sum" is a question about the value lost and received on each side of a simple transaction.