Health Savings Accounts
Sara Collins, writing for the Commonwealth Fund, argues against HSAs (a.k.a MSA plus High Deductible Health Insurance). Let’s look at her main points: “Higher patient cost-sharing is the wrong prescription.” True, we do already pay more than most other countries, but not enough yet to make us price conscious. She then says, this would “lead patients to decide against getting healthcare they need.” Wow! What a patronizing remark! Who decides “need?” Later, she answers this by stating that governments, accrediting organizations, and professional societies “are much better positioned to insist on high performance.” Or, “Trust me. I know what’s best for you.” Somehow, I don’t think the American public is into letting the government make decisions for them. If people skip or delay healthcare that Dr. Collins thinks they should have, I think that’s OK. It’s their decision. She is correct that patients today are in a poor position to make decisions--they don’t have information and they really don’t have the power to make choices. But that doesn’t mean we shouldn’t try. Many of her remaining arguments focus on the fact that HSAs wouldn’t help the uninsured (true) and the tax savings would be of greater benefit to higher paid workers. (Also true). So what! This is not a social program. It’s a step in the direction of making patients more cost-conscious, which will eventually drive down costs for everyone. One of her solutions is to legislate the cost of health insurance premiums. Sure! She does have a few good ideas: networks of high performing providers (if only Medicare had the guts to limit choices to those), disease management, and improved access to primary care. True, if you get sick, your out-of-pocket costs will be higher with an HSA than with and indemnity plan. But most illness today is related to patient choices. (smoking, obesity, inactivity, etc.) Want to reduce your costs? Take care of yourself. [Off to the ASQ Healthcare Quality meeting in Houston]
