Re: The PPACA Thread Part III - Let's have a healthy debate!
Health savings accounts have three fatal flaws (literally, as in people will die): 1) they ignore the fact that a significant percentage of the population has no money to save, 2) even those who have the money to save can't schedule their illnesses to occur when the money is actually saved, and 3) people are idiots and won't necessarily save even if they have the time and money to do so.
we agree that they are not for everyone. Is that any reason to take them away from those who do know how to use them effectively? the more people who do use them well, the less strain on the system overall. Also, if I were in marketing, I'd market HSA / health insurance coverage in tandem, and not stand-alone: you could have low-deductible insurance of $xxx per month, OR for the same $xxx per month, you could have medium-deductible insurance AND put $yy into a healthcare-only savings account too! In that context, I think it would be pretty well received in today's environment: after all, you can roll over an HSA when you change jobs, even if you can't keep your employer-sponsored plan, no matter how much you like it.
And if those high risk pools were so great, why was medical treatment the leading cause of personal bankruptcy in this country? (It may still be, though I know it's come down since the ACA has come in to force).
I worked for a bankruptcy attorney for over a year, the leading cause of bankruptcy among his clientele was uninsured medical bills. I would have to assume that 100% of those people were not covered under high-risk pools. They were non-high risk people with really bad luck, and often just bad timing.
ACA exchange policies do absolutely nothing to change that: they all have high deductibles and substantial co-pays. Having uncapped medical bills, or having $7,500 out of pocket before an ACA exchange policy kicks in, makes very little difference to someone already teetering on the verge of bankruptcy to begin with.
Our problem, as you obliquely mentioned, is the conflict between free will / government coercion, and the "free rider" problem. As we can see from the data, people are very resistant to government coercion, millions of people are choosing to pay the "tax" on being uninsured as cheaper than purchasing an ACA policy. So what to we do with them?
"Single payor" is a mirage, there is
always rationing of scarce goods. If you don't want to ration by money, then you ration by time. there is no escape. either people get the healthcare that someone is willing to pay for, or people do without, under the guise of waiting in line.
As I said before, I'd much rather just give poor people pre-paid, healthcare-only debit cards (no doubt even then there would be plenty of fraud as people then just sell them on the street...) and let them make their own purchasing decisions than to have a centrally-planned, centrally-controlled "system" that only benefits those running the system.
The first rule of government is always first to take care of the people who work for government; everything else is an afterthought. You consistently forget that.
