Comments on: HSAs Explained

By: Non-Transparency : Colorado Health Insurance Insider

Non-Transparency : Colorado Health Insurance Insider — Thu, 28 Jun 2007 22:50:04 +0000

[...] This is a perfect example of the point consumer driven health care (CDHC) advocates are trying to make. Here is an exerpt of a post called “HSAs Explained“, from the “Father of Health Savings Accounts”, The John Goodman Health Blog: Suppose we passed a law tomorrow prohibiting all insurance companies (including Medicare and Medicaid) from paying any medical bills less than $5,000. What would happen? [...]

By: I Got the Bill : Colorado Health Insurance Insider

I Got the Bill : Colorado Health Insurance Insider — Thu, 28 Jun 2007 22:20:45 +0000

[...] No wonder consumer directed health plans aren’t getting any traction. What was the point of calling around to get the best price? Was she just making it up off the top of her head? We have a long way to go before healthcare is an actual “free market” system. In order for this whole “free market” idea to take hold, I really think it would take government intervention like John Goodman, the “father of health savings accounts” used in his example. Hmm… free market requires government intervention. There’s no way in hell people are going to just voluntarily switch to high deductible health plans in this kind of environment. [...]

By: Bob

Bob — Thu, 17 May 2007 21:29:18 +0000

Amazing what rational thought can provide. However, I have a problem with physicians posting prices for services. Especially for primary care. This could reduce the quality part of the equation to a price war without regard to knowledge, training, experience, wisdom, commitment, sensitivity, etc.

At the primary care level, to practice medicine properly, it is necessary for a physician to listen to his patients without regard to checking the timeclock every few minutes. Medicine should be practiced and physicians should be rewarded by who can do it better rather than who can do it cheaper.

Primary care is still very much an art as well as a science. My education and training ($25/mo as a house officer at Yale) should not put me at a level of all pediatricians whose value only responds to a price war. I don’t have the answers, as quality at the primary care level is very difficult to track, as opposed to those procedure driven specialities.

By: Vijay Goel, M.D.

Vijay Goel, M.D. — Wed, 16 May 2007 03:21:44 +0000

John, interesting take on what the world would look like if insurance backed away from small dollar care and returned to “insuring” the unpredictable.

I’m curious about your statement (quoted below):
“Of course in principle you can use your HSA to pay for telephone and email consultations, electronic medical records, patient education, etc. But since none of these expenditures count toward your deductible, doctors have weak incentives to change the way they practice medicine.”

Do you believe the deductible is the limitation? Seems that deductibility limits would pale in the provider’s mind to cold, hard cash. In my mind the major issue is the mental limits imposed by patients not knowing the services are possible and providers limiting their revenue to fee-schedules and per-visit co-pays. These types of e-communications seem to be proliferating in the concierge practices. If consumers asked (at some reasonable scale) for these services and paid a small fee, don’t you think they’d become more available?

By: Stan Alekna

Stan Alekna — Thu, 10 May 2007 10:32:01 +0000

HSA's are not a pancea but are a fine step toward solving our health care insurance problems while protecting the finest health care delivery system in the world. That must be our goal. If we destroy the quality and accessiblity of our health care via socialized medicine, we will have accomplished nothing beneficial. HSA's are not available to those on Medicare…. go figure. Stan Alekna, Cornwall PA

By: Dave Racer

Dave Racer — Fri, 04 May 2007 16:11:11 +0000

John, appreciate this. I have looked at HSAs as a transitional stage.
Maybe bring a little comfort to Americans who have become risk aversive. But after a few years of seeing how they could hold down spending, let their HSAs build up, perhaps they could see how to live without them. I keep looking forward to the day when I can buy a $25,000 deductible because I have the cash in the bank to cover the rest.

By: John R. Graham

John R. Graham — Wed, 02 May 2007 16:51:43 +0000

Plus: if you have an HSA there is still no price transparency because you have to go to an in-network PCP in order to have the payment attributed to your deductible without wasting time and resources with the insurer.

By: Richard E. Ralston

Richard E. Ralston — Wed, 02 May 2007 14:48:25 +0000

Thanks. This is the clearest statement I have seen on this issue.

Richard E. Ralston
Executive Director
Americans for Free Choice in Medicine

By: Sandra Crosnoe/ACA

Sandra Crosnoe/ACA — Wed, 02 May 2007 14:44:18 +0000

Just added your blog to our website http://www.acainfo.net
(drop down under blog tab).

Hope you are doing well and really appreciate all your
efforts for saner government policy. I believe you
have had a really positive impact and will continue to
do so and am remiss to tell you that over the years.

Blessings,
Sandie

==============================
Sandra Crosnoe
scrosnoe@actinfo.net
Associated Conservatives of America
http://www.acainfo.net
==============================

By: Uwe

Uwe — Tue, 01 May 2007 18:53:11 +0000

In his "HSA Explained" and his "Making HSAs Better," John Goodman illustrates the torturous thinking behind the HSA movement. In "HSA Explained," John uses the acronym HSA to describe something altogether different: health insurance policies with high deductibles or other forms of heavy cost sharing by patients. For the life of me I cannot figure out why anyone would describe such policies by the acronym HSA. Would we describe the Interstate Highway by the acronym XYZ? As I understand it, HSA stands for "Health Savings Account." It is not an insurance product at all. It is a savings account in a bank or similar instution. Deposits into it happen to be tax-deductible to the owners of the HSA (or deposits into the account by emploers are not tax deductible income to the owner) if the account owner uses the money in a away big daddy government (speak President Bush) wants them to use the account. In this case, it means the account holder must buy an insyrance product of which Big Daddy Government (President Bush) approves — a high deductible policy. It is nothing other than unbridled paternalism. In "Making HSAs Better" John laments that "the curent HSA law's primary problem is that decisions the market should make have been made by the tax writing committees of the Congress." But hat else could Congress do? Does it not, by necessity, have to specify what can and can not be financed out of the tax favored HSA? If Congress did not specify it, would "recuperative" trips to Hawaii or Monaco qualify? What would stop anyone from spending the money any way they wished? John could get the government off our back if he pleaded for the removal of the tax preference to HSAs and, at the same time, worked to eliminate the tax preference now extended to employer paid healht insurance. One could start by adding the employer-paid premium to the employee's W-2 for any employee earninbg more than, say, $100,000. In other words, one could get rid of the tax preference by some progressive scaling back. So here's the mental confusion of the HSA folks: One the one hand they plead that big government give a tax break to those Americans who pick health insurance that big government (and the high-deductible afficionadoes like John) want them to pick. Having succeeded at that task, they then turn around to lament that big government writes the rules around this tax handout. It is nothing if not vaguely amusing. Best regards, Uwe Reinhardt Princeton University