In between making plans to nuke Iran and fending off irate real estate salesmen, President Bush of late has been riding his favorite healthcare "reform" hobby-horse: HSAs, or health-savings accounts. For those of you unfamiliar with HSAs, here's the scoop, as explained by UPI:
"HSAs allow individuals to save money tax-free that can be used to pay health expenses. The accounts are coupled with high-deductible catastrophic insurance that is used to pay large costs associated with serious illness or injury."
I feel qualified to speak about this "reform" because it is what currently (sort of) covers our family. DH's employer switched to the HSA model in part because they were backed into a corner by evil Blue Cross Blue Shield, Montana's virtual monopoly insurer, and in part because I truly believe they thought it would be a better deal for their (mainly young, mainly healthy) employees.
But here's the trouble with HSAs: They work well primarily for single, healthy men in their twenties who only need medical care when they crash on their snowboard or stumble off a porch drunk after a particularly long night of drinking. They don't work for women, because we have these pesky persistent medical needs for our lady business, and they really don't work for families with kids, because what two-year-old doesn't have three bouts of croup, a case of RSV, two falls resulting in runs to the emergency room, and the heartbreak of eczema?
When we go to the doctor for any and all of those things, we pay the entire cost until we meet the (exceedingly huge) deductible. When we fill a prescription (and Chip and I have two that need to be filled monthly), we pay the entire cost of that prescription. The bastards won't even put my birth control pills toward the deductible, although I'm fighting that now. As you might expect, last year we spent all but $10 of our HSA but never did reach that magic deductible amount. Some people would say that's just how it's supposed to work out, that we were helping to control the spiraling cost of healthcare by taking ownership of our healthcare costs, but to that I would say, "Bullshit."
It's a nice idea, that people will be more judicious with their "own" money than an insurance company's, but what it really means is that people don't see the doctor when they probably should. They wouldn't put my annual lady part exam toward the deductible because it led to my prescription for contraceptives. A friend of mine on the same insurance was denied coverage for a mammogram. Chip went in for a routine physical for which there was supposed to be a followup exam, but we had run out of HSA money. After age two, well-child visits are no longer covered. Not covering preventative care is possibly the best way to drive costs up, and it's exactly what HSAs do.
The other big fallacy is that HSA owners will be able to comparison-shop for their healthcare. Maybe it's possible to do that when you live in a city with dozens of hospitals and thousands of physicians, but when you live in a one-horse town, you're pretty much stuck with the rates offered by the horse. And even for those who live in larger cities, how easy is it to find out how much a certain procedure or visit costs? It's not as if those are posted on a menu board. As most of us know, the insured pay a different cost than the uninsured, and the insured pay a different cost than those insured by other insurers, and so on.
Don't get me wrong. I'm grateful to have any coverage, given the state of health insurance today and the fact that Chip and I were both turned down for individual coverage before he got his job after we returned to the U.S. in October 2004. But HSAs are not going to save American healthcare. If we want to try something common-sense that would reduce people's everyday costs, why not tell Big Pharma it has to take those disgusting Cialis and Levitra ads off television and out of magazines and start spending its money on research? It's the direct-to-consumer marketing costs that make a three-month supply of Yasmin here cost about what a year used to cost me in Prague.
But that's not going to happen. At least not on Mr. Personal Responsibility's watch. But we can hope that his HSA push goes down in flames bigger than his Social Security "reform" plan did.