Your Humble Blogger hasn’t read the State of the Union address yet, and perhaps I will and perhaps I won’t, but I’ve been meaning to mention something about Health Savings Accounts, which I understand Our Only President continues to push, although he didn’t make so much of a big deal about them in the speech. The idea of the HSA is to move from an insurer-based system to a savings-based system, where a larger proportion of health costs will be borne by the patient, out of savings, rather than by the insurer, out of premiums.\n
It seems to me that it’s instructive to think about grasshoppers and ants, here. If you give people the option of a good HSA (and I’m leaving aside the likelihood that the HSAs offered will, in fact, be lousy scams), a decent old-fashioned pay-per-service insurance policy, or an HMO, a grasshopper will look at his immediate interests, which involve paying as little out of pocket as possible. Well, the best solution there is to get the HSA, which should have the lowest premium, and then underfund the actual HSA. That leaves the grasshopper with more pelf in his pockets, immediately spent on whiskey, she-grasshoppers and song, and then if he gets sick, well, he’ll be dead and\/or impoverished, but then that’s what being a grasshopper is like. The ant will look at the long-term chances, and be willing to pay more in the short term for better insurance in the long term. Depending on how that’s set up, it’s possible that will be the HSA combined with overfunding<\/I> the account, but then it’s possible that will be the high HMO premiums and unlimited HMO care (depending on your HMO and where you live). Either way, the ant isn’t spending any less money in the short-term, nor is the ant getting any better care. \n
So, how are these really helpful? Well, the people who are already getting extraordinary care have the possibility that, forty years from now, they’ll get a windfall when they are allowed to use the accumulated HSA to buy a new air car. Grasshoppers, who are probably uninsured now, get to pay small premiums for health insurance they can’t afford to use. The idea of our insurer-based health care system, it seems to me, is that when grasshoppers get sick, we aren’t going to let them just be sick, so lets, um, encourage<\/I> them to have health insurance by not giving them much choice about it. Because otherwise, the hospitals are going to give free care to grasshoppers, and that screws up the economics. Or they aren’t going to give free care to grasshoppers, and we’ll have sick grasshoppers all over the place, and that screws up the property values.\n
And, of course, an ant with no capital is a grasshopper, not by temperament, but because you can’t save up nothing all summer and have something in the winter. And, as I am by temperament a grasshopper, I will point out that the ant can save up all summer and get squashed when the leaves fall. The idea of putting money away, tax-deferred, is lovely, but the idea that I will someday get<\/I> that money, or that the money will be useful if I do<\/I> get it, or that the 2045 health care system will be so much like our present one that my plans for those expenses are sensible, well, that all strikes me as quaint and provincial. All of which is merely to point out that any system which ignores grasshoppers is just silly; there will always be grasshoppers, by temperament or by circumstance. We can, and undoubtedly should, encourage people to be ants, but then we should encourage people to be law-abiding charity-giving educated civic participants, too. This is one liberal who doesn’t believe in the perfectibility of human nature, not to put money on it.\n
So. Even though I think a well-designed, honest, careful and moderate HSA system (unlike any I can imagine Our Only President and his cabal of incompetents and crooks proposing, or the corrupt Republican Congressional Leadership passing) has some theoretical merit, I stand opposed to it on the grounds that as a shift from an insurer-based system to a savings-based system, it seems to be unable to deal with those who do not have savings, for whatever reason. Now, I’m agin the insurer-based system for a variety of reasons, mostly that it appears to this grasshopper to be entirely unsustainable over more than a generation, but fundamentally, the answer cannot be a shift to savings accounts, tax-free or no. My own preference would be a state system, for all the problems inherent in that. I know that’s not popular, and I accept that. But neither is the insurer-based system popular, right?\n
chazak, chazak, v’nitchazek<\/I>,
-Vardibidian.\n<\/p>\n\n","protected":false},"excerpt":{"rendered":"
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