And how will HSAs benefit our health system? I actually see HSAs as an evolutionary change in health coverage. Again, critics claim that high healthcare utilizers won’t choose these plans. That conclusion makes two assumptions. The first is that the current coverage options will be available. There is no guarantee of this. Insurers have been developing consumer-driven plans like mad and it is only a matter of time before employers start offering them and before HSAs start replacing plans that are higher cost to employers. This is going to change the calculus of health care coverage. When a full-coverage PPO is not an option, then the good old “it’s covered” approach to healthcare decisions won’t be sufficient anymore. The “risk” of HSAs may look a little different in this light.
A second assumption is that employers have an obligation to subsidize healthcare costs (and therefore always will). To the surprise of some, my strongest reason for supporting HSAs is not that they create a more efficient market-driven healthcare system. I think that there could be benefits from a more market-driven healthcare system, but I have a firm belief that, as a society, we have become too dependent on someone else paying our healthcare bills. If I utilize healthcare services, I should pay for them. They benefit me and my family. This doesn’t mean that I believe a heart surgery should put a family in the poor house, but lets recognize who is truly responsible for the paying the cost of care – the individual who utilizes it. To the extent that they benefit my employer and my employer wants to help subsidize the cost, great. To the extent that society is improved when its members (especially those with less means) are healthy and productive, then let the government chip in with our tax money. To the extent that the cost of catostrophic risk can be minimized through high-deductible risk pools (i.e. - insurance), then lets do that.
I believe the time of corprately micro-managed healthcare decisions is coming to an end. HSAs make the patient the payer and the ultimate decision maker. That is how it is in almost all other facets of our life and that is how it should be in healthcare. There are certainly other fixes our health system needs, but this is a re-alignment that needs to happen.