The Push For HSAs Is On

What better place for a Republican to kick off a healthcare campaign than at the corporate headquarters of a fast food restaurant? It speaks volumes, no? Well, today Bush brought his traveling roadshow to a more respectable venue, the Department of Health and Human Services.

Having personally been under the impression that Bush was going to make the pitch during the State of the Union for transitioning the healthcare system away from group insurance towards private Health Savings Accounts, I've already done a lot of writing on the topic. Obviously, I think it's a terrible idea.

But beyond the economics of HSAs and the disastrous effects of pulling healthy, young people out of risk pools, I think the thing that bothers me most about this proposal is the fact that it demands even more sacrifice from the sick. This isn't something that Bush hides from. In fact, he brags about it. Clearly, he just doesn't get what this system would mean for the average American.

"When somebody else pays the bills, rarely do you ask price or ask the cost of something," the president said during a panel discussion on his health care initiatives at the Department of Health and Human Services. "The problem with that is that there's no kind of market force, there's no consumer advocacy for reasonable price when somebody else pays the bills. One of the reasons why we're having inflation in health care is because there is no sense of market." ...

"When you go buy a car you're able to shop and compare," he said. "And yet in health care that's just not happening in America today."

George W. Bush is a son of privilege. I don't care that he wears a cute little cowboy hat while he "ranches" and "clears brush." At the end of the day, he's still the Connecticut-born scion of one of America's most prominent political families. His life was a series of failures and bail-outs, with Poppy's friends always waiting with kind words and big checks.

This is Medicare Part D, writ large over the entire American healthcare system. It's just so easy for Bush to talk about the American people comparison shopping in a magical "healthcare marketplace." But it's not so easy for the average working person to actually go out and do that. Not only do we lack the resources, we lack the time. Of course, the wealthy will have an army of lawyers and health advisers holding their hands and walking them through the ins and outs of the system. But what about those less fortunate? And yet they wonder why there's an increasing sense that the GOP just doesn't care about everyday people.

Tags: Healthcare, HSA, Priorities, Republicans (all tags)



Worst argument ever

There is "no market force" to keep prices down when an insurance company pays the bills?  Gee, how about the insurance company?  Did they get a license to print money when I wasn't paying attention?

The only insurance provider which doesn't negotiate for lower prices is Medicare, because the Republicans won't give them the legal right to do so.

Fortunately, not only is this the worst argument ever, it is the most tone-deaf argument ever.  Most people don't enjoy haggling.  Virtually no one will jump at the opportunity to go haggle with your doctor for lower prices, or maybe call around to 5 or 6 doctors to see who will give you the cheapest flu shot.  People like the fact that the insurance company does your negotiating for you, and they probably wish this could be translated to other walks of life as well.

They should just go back to the line that the reason why health care costs so much is those darn trial lawyers and their frivolous lawsuits.  At least that argument takes more than 10 seconds to debunk.

by Steve M 2006-02-16 12:37PM | 0 recs
Re: The Push For HSAs Is On

I agree completely with your assessment.  Bush has never had to worry about health insurance in his life.

Someone needs to ask Bush the exact date that he will be discontinuing his government provided health and insurance and tell us the exact date and company that he will be purchasing his coverage from.

by RCR 2006-02-16 12:39PM | 0 recs
Re: The Push For HSAs Is On

As Kevin Drum pointed out, when something is wrong with you or a family member, the last thing you want to do is a lot of comparison shopping and treatment-comparing, switching doctors etc.  Explaining just like Bush did (with a few embellishments) will go a long way to sink this program, just like private accounts were sunk in part because of the complexity.  There are times that comparison shopping is fun, but when you or a family member is sick or injured is not one of those times.  

One problem is that the Bush people and a lot of other "reformers" believe that the problem with health care in this country is that people spend too much on services they don't really need.  Ask the public if that is really what they think the problem is.  To me it is uneven delivery of services, large numbers of uninsured, and too many people whose health care depends on their job.

It may be true that some people spend too much.  But most people I know hate going to the doctor and probably put it off too long.  Like many other problems, a small number of people account for most of the health care dollars spent.  Most of these are at one or the other extreme of life.  Some intelligent rationing may be in order here so that extensive, invasive procedures are not performed on people with very low survival chances. For the rest of us, it is more a matter of making basic care readily available at a reasonable price.  HSA's don't help this, as they are most attractive to people who have the least chance of getting sick, leaving the sicker ones in the insurance pool, increasing costs for everyone else in the pool.

by Mimikatz 2006-02-16 12:44PM | 0 recs
Re: The Push For HSAs Is On

You've illustrated the reason that most Americans reject the single-payer option. They don't want to be triaged into oblivion to save money. THAT'S the talking point that sells. "A Socialized plan will deny you treatment to save money." Of course, "Socialized medicine gives inferior service.", works good too.  These were the memes that killed HilaryCare. All they had to hear was "Super HMO". We all know how crappy HMO's are if you need anything other than an immunization or routine examination.

Surprisingly, the public even approves when millions of Medicaid dollars are spent on non-citizens who don't even live in the USA, such as the well-publicized conjoined twin separation last year. So you think they are going to be receptive to having Mom or Dad or themselves or their kids die of cancer to save money on hopeless treatment?

by antiHyde 2006-02-16 02:45PM | 0 recs
Re: The Push For HSAs Is On

I'm probably going to sign up for an HSA, just because I'm a self-employed business owner that already has a high-deductible individual health plan.  I don't believe I have any good-value group plans available to me in the first place.  So for me it's just a matter of choosing to pay my deductible out of pocket, or to pay it from this HSA account that has tax benefits.  Can't think of a good reason not to do it.

So the problem with HSA, in my mind, is more the political problem - that they're being marketed as a health care solution, and as an excuse for Republicans to look like they're solving problems when they're not.  I know that HSA's don't do anything for the people that have already been suffering under the health care system all along.

by tunesmith 2006-02-16 12:59PM | 0 recs
Re: The Push For HSAs Is On

Yeah, for the record, I should say that I wouldn't really fault anyone for opening an HSA as they currently exist if they have that option. If you can figure it out, it's not the worst way to pay for co-pays, prescriptions, etc. But like you said -- they're just a tax-advantaged extra, not a solution to the problems of the American healthcare system.

by Scott Shields 2006-02-16 02:07PM | 0 recs
Re: The Push For HSAs Is On

When Bush first meantioned this in the debates of '04, I thought, "Hey, he's making a new tax shelter for rich people; we're a little short on those these days."  Seriously, that's all that I can think these things are.  If you're wealthy, you just dump money into this account (which is tax-free,) and when you get sick, you take it out for that.  You don't have to deal with the daily humdrum of insurance payments, because you've already set yours aside, and it won't help anyone else, if you remain healthy.

Bad, bad, bad...  Grr...

by nanoboy 2006-02-16 01:43PM | 0 recs
Re: The Push For HSAs Is On

i don't know, as will be evidenced by this post haha.

my own thoughts are basically the same as everyone else's, the problem is rising costs in health care with absolutely no ceiling in sight.  example, a procedure i had recently - a colonoscopy.  yes i'm not too embarrassed to say i had to have one.  the procedure itself cost approximately 800$us to the doctor, and 1400$us to the hospital, for a total of 2200$us.  2200$us ... two thousand two hundred dollars and zero cents.  for what exactly ?  i mean think about what this is .. it's using a camera to do an examination that takes approximately 15 minutes with a mild sedative.  i mean what the hell, you know ... it sure doesn't take many colonoscopies to buy a new yacht, does it ?  or to pay for that golf membership.

and that's not even an expensive procedure or test, that's sort of at the low end (no pun intended).  you can get into some REAL money having other things done, or god forbid you actually have cancer or something, then you move to another level entirely ... a level where the money can REALLY get out of control.

if they find something you're going to have some surgery probably, and be in the hospital once a week, in the front door, treated in turn (after a long wait) and sent home, and back the next week.  and it's going to take you weeks, not months, to run up a bill that exceeds the value of your house.  i mean seriously ... think about that.  to have a human being treat you for a disease, to cut you open with a knife, to feed you some medicines, you are going to have to give them your HOUSE.  a home that probably took you 20 or 30 YEARS to pay for.  20 or 30 years of your work = cancer treatment that probably takes 6 months at most (for better or worse).  is there a problem here ????

sure, medicine is tough work, and we care about our health, etc.  and we all want the best, i suppose.  but trade your HOUSE for treatment ?  what world is this we live in exactly ?  yeah yeah i know, they are specialists who went to a pile of school and recouping an investment and yadda yadda, we got it.  but all kinds of specialists serve us in life, it takes skill and hard work to do a lot of things in the world ... but you don't have to trade your HOUSE for them.  i mean the payment is like an order of magnitude higher than the service, it's just stupid and crazy, and there's no end to it.

and people have to pay in america, because there isn't an alternative.  you can't just go to the corner shop and have the butcher cut cancer out of you, not that you'd want to of course.  but because there is a monopoly on health care there simply isn't any check in place to keep prices low, to even reasonable, or even HIGH ... they can only be INSANE.

and in my opinion the thing that has to change about health care is the expectation about the costs to begin with.  shielding americans eyes from the high costs with insurance plans doesn't do it, because plans aren't magic, they still have to balance the money coming in with the money going out ... and with costs having no end in sight, insurance costs will have no end in sight, and fewer and fewer people will be able to afford them.  so to me ... politically, talking about insurance plans for everybody and that kind of thing won't ever bear fruit, because insurace isn't the problem, the problem is the original cost.  if costs weren't so high to begin with then there wouldn't be a problem with everyone getting/having insurance.  and the reason people are losing their insurance is because insurance is getting more expensive by the day.  and insurance is going up every day because COSTS are going up everyday.  and no ... malpractice insurance costs isn't the worst of it, HOSPITAL costs are!

so i tend to ignore all this garbage about insurance and who will pay for it and whether it will be tax deductible and what have you ... because that's all just blurry vision that can't see the chart that's on the wall.  and that chart says clearly ... PRICES ARE TOO HIGH AND GOING HIGHER.

and it's the consumer who is to blame, a consumer that is willing to pay anything for "the best" level of service, the best local medical facilities, etc, etc ... people who wouldn't pay an extra 1% property taxes to get new computers for kids in the local schools are perfectly willing to let the local hospital pay any amount for the new acme scanner that sits in the corner never getting used.  people who won't give the local fire department an extra couple thousand dollars for a couple of interns are perfectly willing to let the local hospital pay graduate students to do research into all kinds of crazy ass, far-fetched stuff, preparing them for their future in the pharmaceutical industry.

and for the most part the local hospital is not accountable to the local community IN ANY WAY.  they are under absolutely no obligation to keep costs down, under minimal obligation to provide a certain level of service, etc.  well ... that's not entirely true, they'll give you whatever level of service you want as long as you have money.

i'd like to see someone come up with a plan that'll fix all of this, but who will, who can ?

how is ANY insurance plan, national or otherwise, going to control costs ?  answer, it won't.

by Purple Foxglove 2006-02-16 02:02PM | 0 recs
Re: The Push For HSAs Is On

A single-payer plan is a single-buyer plan also called a monopsony, the flip side of monopoly.

Just as a monopoly keeps prices high, a monopsony keeps them low. The single payer controls the market. The danger is that the price will be kept so low that qualified suppliers leave the market.

We DO need a national dialogue on how to replace market price with a fair alternative.

by antiHyde 2006-02-16 02:53PM | 0 recs
Re: The Push For HSAs Is On
All dems have to say is what Josh Marshall suggested:
"Republicans think you have too much health care insurance. We don't think you have enough." That's the difference. Do you really think at a time when we have a negative savings rate that Americans are going turn in health insurance for paying out of pocket?? I don't think so......
by cmpnwtr 2006-02-16 02:08PM | 0 recs
Re: The Push For HSAs Is On

Have you ever tried to comparison shop for health care services?  I have.  The answer you get from doctor's offices is similar to what you get from attorneys:  it depends!  You can't get a straight answer ahead of time about what's included in the fees and what the add-ons might be. Its like the cost of a doctor visit is a guarded secret.  Try it.  Call around in your area and see if you can get prices for a procedure.  An open market depends on informed buyers and sellers.  If you can't get information, you're not informed.  That makes for a closed market.  Again, just like all Bush policies, HSA will not benefit the average worker.

by my2petpeeves 2006-02-17 11:13AM | 0 recs


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