In an amusing sign of the times, John Boehner promises to deliver a Republican answer to Democratic proposals for healthcare coverage. I don’t have any inside track on this but we can safely rule out any proposal that involves expanding Medicare or SCHIP or implementing a program that models the VA. If Boehner drops even a hint of government-managed healthcare in his proposal the base will eat his liver. We can also rule out mandates that will piss off the insurance biz, e.g. adding new regulations that block insurers from dumping risky individuals.
What does that leave? The most obvious answer is for Boehner to endorse the Giuliani plan of paying for everyone’s health care through tax credits, but that faces the problem that Giuliani’s “plan” isn’t really a plan. Until Giuliani explains how he plans to deal with people who pay mostly payroll taxes and what sort of “plan” those tax credits will go towards paying he just has a few moderately interesting bullet points.
My money says that Boehner will reach deep into the box of failed Republican ideas and bring back “health savings accounts.” It covers the rightwing agenda points as effectively as privatizing Social Security, and like Social Security privatization the public hated it. Individualizing healthcare costs glosses over the simple fact that the few people who come down with expensive or chronic diseases will burn through a pitiful Health Savings Account in the time it takes to finish one round of chemo. God save those with the bad luck to get sick young when there isn’t much in the account. It shouldn’t be hard to remind people why the idea died in utero the first time it came up.
Heck, maybe I’m wrong and Boehner will find some new way to combine tax cuts, reduced government care and industry giveaways. But if I’m right, super. Nothing would make me happier than watching the GOP flame out on yet another topic of major national importance.
whippoorwill
“My money says that Boehner will reach deep into the box of failed Republican ideas and resurrect the old “health savings accounts.” It covers the rightwing agenda points as effectively as privatizing Social Security, and like Social Security privatization the public hated it”
It must be hard being a conservative republican politician with so little room to maneuver and so many corners to paint yourself into.
And to beat all, many of the screaming wingnut purists are average middle class Joe blows who seem to not see their pockets being picked by their big business masters.
srv
I enjoyed how excited Boehner was this weekend. He could barely contain his excitement over bringing out all the “New Ideas” that the Republican party has for next year.
You’d think they’d been out of power for a generation or so.
Billy K
I predict “Health Savings Accounts” and “Social Security Accounts” combining into big slushy individual accounts for the fund managers to…ahem…”manage” for us.
It’s perfect! We put our money in, they make a profit from it! Why bother investing their own bajillions when they can use ours!?
Jess
I think its over at Kevin Drum’s blog that they’re talking about another looming 1929-like crash that’ll be caused in part by unregulated hedge funds. These sorts of accounts will be yet another way to get screwed…
ImJohnGalt
The whole point of this is to give the media another opportunity to say “The Republicans have a competing plan to the Democrat (sic) one – who knows which one is better?”
It’s only a defensive ploy to try to suck the life out of the clear advantage that the Dems have on the issue.
grumpy realist
I wouldn’t worry about the hedge funds–they go up, they go down, anyone who has $$$ in a hedge fund should know damn well it’s funny money. They are far riskier than actual supposed percentages show due to survivor bias. Guess a lot of groups will learn about risk again….Unless they pull another round robin LTCM mess with 150:1 leverage games I doubt we’ll see problems from that end.
The problems are with the subprime mess and how it has mucked up everything–they’re now all realizing that risk isn’t what they thought it was, a lot of those “AAA”s slapped on CDOs mean absolutely zilch as to real risk levels, so everyone’s jittery, and everything’s contaminated with potential mines lying deep within otherwise solid-looking financial products.
mk
re: hedge funds as the new S&Ls of the 1980s see Paul Krugman’s blog.
Their own private S&Ls
http://tinyurl.com/2zknrn
TR
By the looks of Boehner, I bet it’ll involve some sort of tax credit for tanning bed time.
Hey, if you look healthy, you must be!
jake
A good bet. As an added bonus every MD on the planet would fight over who gets to eat his liver [insert fava beans/nice chianti joke here].
The only other thing I can think of is giving HICs another tax break or financial incentive that is linked to providing coverage to a wider group of
prolespeople, perhaps with some sort of sliding scale based on income.Which will be verified by on-site inspections of
sorry beggarspotential beneficiaries’ kitchen counter tops.Not only would this make the HICs happy, it would sound good to the not too curious average person (making big companies play fair). When it turns out that only .0001% more people qualify for the new plan, so much time will have passed that the Congress Critters who backed the turkey will be able to shrug and say Who me? before going back to their jobs as “consultants” for AHIP.
jcricket
Yes, the solution to ever increasing healthcare costs, worsening coverage, rampant unnecessary bureaucracy and insurance companies that regularly deny legitimate claims is for people to take on more costs themselves.
Much like the magic of tax cuts ad infinitum paying for everything, I regularly see libertarians and conservatives arguing that if only we paid more directly for every bit of healthcare, everything would work itself out. Yes, we’ll all become master negotiators and control our healthcare spending perfectly, because healthcare is just like buying clothes or dining out or any other optional item you can budget for and cut when you don’t need it. Healthcare is not like other markets, frankly, it’s not even like other insurance markets (auto, home, etc). Anyone who fails to see that and proposes simple market-based solutions is a fucking moron.
HSA and high-deductible plans are basically OK for young healthy people, but poison the entire insurance model by removing the people who spread out the risk pool, thus also increasing costs for everyone else. Oh wait, even for the people that theoretically don’t need that much healthcare, the HSA model encourages them to put off preventative checkups and seeing the doctor (lest they use up their “health savings”), likely costing more in the end once they do get sick. And guess what, coupled with a high-deductible plan, if you do use up all your savings one year meeting that deductible, guess what happens the next year? No savings and the same deductible! WOO-FUCKING-HOO!
Let’s all make sure not to make the bad choice of being born with genes that give you cancer or MS or that you get injured in an industrial accident and are in chronic pain. Having an HSA means you’ll make sure not to fuck up your health in your next life, because you know what the consequences are.
To be fair, HSAs are good for Republicans because people would suffer and go broke – that seems to be the Republican agenda these days. That and supporting things that the American public likes less and less the more they find out about them. Go Wide Stance!
jcricket
Oops, bad close bold tag! No soup for me tonight.
mk
I sincerely hope that universal health care/non-deniable insurance comes before science has fully mapped the human genome. I’ve no doubt that insurance companies will find a way to hold the insults to your grandmother’s genes against you as a pre-existing condition. It now appears that it is not just insults to your own genes, or your mother’s genes that put you at risk, but your grandmother’s genes as well. None of us has a way to mitigate mutations which ocurred before we were even conceived.
mk
Damn. you’re not alone jcricket. no soup for me, either! :(
St Wendeler
Ummm, actually most HSAs are only used for regular, predictable healthcare expenses and are paired with a High Deductible insurance. Thus, if you get a terminal illness, your High Deductible insurance will kick in and you it’s not necessary to sell the house or file for bankruptcy.
Add to this the fact that most HSAs cover 100% of preventative care visits and physicals and they really are a good deal. Add to this fact that those who enroll in HSAs when they are young (and healthy) can often save up sufficient funds to cover their potential future expenses well beyond the deductible and they are very attractive.
But hey… let’s just all turn our healthcare over to the government. Sounds like a great idea, but I’m concerned about where all the Canadians would go for emergency care?
And, I know that you’re all big fans of W. and the GOP. Do you really want them to be in charge of your healthcare? Even if the Dems take the White House and retain the Senate & House, don’t you think that the GOP will regain power at some point?
I can’t imagine letting either party manage my personal health care decisions…
jcricket
mk – don’t think the thought of the whole “let’s start denying people because of their genes” angle hasn’t been thought of and worried about (by people who actually care).
Also, 15 minutes doesn’t go by before I prove my point about private industry not always working out so good for healthcare. Ezra Klein’s comments:
Again, good for Republicans. No matter how poorly they organized or funded it, if a government program fails, it proves their point that government is useless.
St Wendeler
I sincerely hope that universal health care/non-deniable insurance comes before science has fully mapped the human genome. I’ve no doubt that insurance companies will find a way to hold the insults to your grandmother’s genes against you as a pre-existing condition. It now appears that it is not just insults to your own genes, or your mother’s genes that put you at risk, but your grandmother’s genes as well. None of us has a way to mitigate mutations which ocurred before we were even conceived.
Yeah, the government would never do something like that, either. You trust the government to not snoop on your healthcare, but you probably don’t want the government to listen in on a cellphone call that you receive from Afghanistan.
jcricket
Thus if you get a non-terminal illness that requires prescription drugs forever, you get to pay that high deductible every year, forever!
Bonus time!
St Wendeler
Yes, deductible of $1k would be applicable each year. And, actually, prescription drugs that prevent the reoccurence of a disease are typically covered.
But, you obviously don’t understand the point of insurance. It’s to protect against an unlikely future event. Today we have health insulation, not insurance. It insulates us from the costs of routine medical care, not just insuring us against catastrophic (and hopefully unlikely) events. Ask anyone what a doctor’s visit costs and they’ll tell you their copay.
When no one knows how much something costs, what incentive is their to make sure that a fair price is involved. “Have a beer… don’t cost nothing.”
And keep in mind that most health problems are related to poor lifestyle choices – smoking, drinking to excess (*BURP!*), lack of exercise, etc, etc. HSAs with HDHPs typically pay for smoking cessation programs, prenatal and well-visit childcare, weight loss programs, etc.
Or, is your position that with universal care, costs disappear? Or that they will magically be negotiated lower by government edict and government efficiency?
Bob In Pacifica
The good thing about being poor and unpropertied is that I have only a very short distance to fall. The bad thing is that it will be very crowded under the overpass.
St Wendeler
The poor children (and many adults) are already covered by S-CHIP. The veto was about not expanding coverage to families which could afford (or are otherwise already paying for) private insurance.
And yes, you certainly sound poor. I hear that pacific coast and San Fran area is cheap cheap cheap! Not as cheap as the midwest…
but of course… poverty is relative.
John S.
Um, not really.
I have an HDHP/HSA plan and my insurance covers preventative care. Even if it didn’t, I could still tap my HSA for those expenditures.
I think you’re missing the point. I know what my annual deductible is ($3000), therefore it is my responsibility to fund my HSA with at least that much. So far this year, I have spent 1/3 of my HSA, which means I have a few thousand left over. I’m not worried about going into next year with a zero balance, and I am allowed to contribute more than double my annual deductible if I wanted to.
An HSA must be paired with an HDHP insurance plan. I do not think you can open one without it.
Prescription drugs are covered and apply towards your deductible. And like any other insurance plan, acquiring even a serious illness won’t cause your rates to spike – so long as your coverage doesn’t lapse. My policy also has a lifetime benefit of $5 million, so even should I end up with something horrendous, I shouldn’t run out of insurance.
At the end of the day, an HDHP/HSA plan is great for anyone who is young and healthy. I realize that doesn’t cover everyone, for those of us that it does cover, it is a fantastic option. Just about the best option out there, AFAIC.
St Wendeler
and jcricket…I bet you don’t even know how much your doctor charges for a visit. People don’t have to be master negotiators to have an impact on costs – they just have to ask the @%#^ing question – and how much does it cost to see you for 5 minutes?
My mom visited a doc and ended up seeing an RN for 5 minutes. b/c of a change in insurance addresses, the bill got sent back to her directly… the cost for the 5 minutes? $325. She visited the billing dept at the doctor’s office and said that she didn’t think the price was acceptable. The clerk looked at her like she was from Mars. She took the bill and said she’d correct the error in the address. Since it “wasn’t my mom’s money” she didn’t waste her breath.
I bet you also have no clue what your employer pays for your health insurance plan. HSAs often come with employer contributions to your account, so you start to see that help build up your account.
And, keep in mind that HSAs are tax free contributions AND tax free payments to the docs.
If you don’t care about the costs, you won’t even ask how much. What other service do you purchase which you don’t ask for the price?
And don’t say, “what about a car accident or some other catastrophic incident! that’s different!!! People shouldn’t have to worry about high cost of health care or dying!!!”
Yeah… that’s why there’s a High Deductible insurance plan.
Gus
Holy shit. Two trolls in one day linking to the National Review as if they have any fucking credibility whatsoever.
The Other Steve
A couple of facts to inform the trolls. My girlfriend has an HSA, because that’s what the company she works for stuck them on last year. It was universally hated, and now they’re going back to a PPO.
They were given $700 to put into their HSA each year, and then there was like another $1500 deductible on top of that, and then it’d cover 80% until you were like $5k in deep.
Sounds great.
One doctors visit costs $300. That’s 15 minutes consultation with a doctor. The tests are extra… A blood test was $150.
That’s not even anything serious. She was having stomach pains for a week and wanted help. The solution was a prescription to Prilosec at $25/month. (that’s not really a solution, but it made her go away for a bit)
The Other Steve
Yep, fantastic option for healthy people… or really sick people.
Not so great for the rest of us with minor ailments who see a doctor maybe once or twice a year.
The Other Steve
The system is fundamentally broken.
That’s the sad thing. Since the Republicans are not interested in fixing it. (like say stopping the practice of drug companies advertising… that seems to be when our costs started skyrocketing, when they allowed that) What’s going to happen is their worst possible dream.
Socialized medicine.
Quackers
I’ve got a question for you St Wendeler: What about the people who have NO money to put into an HSA? Believe it or not, there really are people out there who just don’t make enough money to save anything at all. Where does this plan leave them besides out of luck and uninsured?
jake
No, no, all of those huddled masses will keep you warmer.
So does my traditional health insurance and as an added bonus my physician doesn’t hate it with the same hot burning heat they reserve for HSAs. Do you have a point you wish to make? No? Oh well, what else? Ah, there’s this gem:
Yes, because there are not now nor have there ever been crappy areas in and around San Fran. I have it on good authority that all of the kitchens have marble counters. And anyway, everyone who isn’t rich should move to the middle of the country where prices are lower. Just like the wages. Hmmm… But why worry about such niggling details when one is busy spreading a thick layer of truthiness?
Proving even the biggest idiot will occasionally trip over the truth. Unfortunately the impact of his fall always renders him unable to appreciate the full import of his discovery.
Jesus Christ on an AbLounge(TM) is it any wonder these people get taken for spoofs?
r€nato
Here’s the Boehner money quote:
translation: more “Ownership Society” bullshit.
The Other Steve
Billy K had it right. “Ownership Society” means introducing a corporate middleman and funneling all the profits through them.
You know what happens when companies get a 1% management fee? They operating inefficiently to the level of their funding.
TenguPhule
JFCNTZYM! John S. really tops out as one of the top pisspots when it comes to Rightwing Bullshit.
One serious extended illness requiring any major surgery + rehab + drugs and you’re plain fucked.
TenguPhule
And what happens when people can’t?
Just fuck them because you got yours?
TenguPhule
The Harder Boehner tries, the more Boehner fails to score.
Perry Como
St Wendeler Says:
Well, doesn’t really matter what you say. How’s it going Darrell?
St Wendeler
Yes… very thoughtful comment. What a waste of bits. Perhaps you could actually argue the issue based on facts instead of simply discounting any counter argument which doesn’t agree with your worldview. How closed-minded.
Look at that! The Other Steve doesn’t just know what a visit to his doctor costs, but he also now knows what a visit costs for his girlfriend! How many of you with other forms of insurance are as well informed about the costs of your girlfriend’s health plan? Thanks for making my point about cost consciousness of HSAs…
Steve – $700 tax free is a good start; Add your monthly premiums that you would’ve paid for an PPO style coverage (let’s stipulate ~$100/month?) and her HSA account at the end of the year would be $1900. And nevermind the tax benefits of contributing to the HSA.
So far, it appears that her health care expenses have run $600 (assuming she stays on brand name prilosec for a full year)
The next time that your girlfriend needs to see a doc, do you think she’ll just go back to the same guy or will she contact some other provider to see what the potential cost might be first? Will she continue with the prilosec or will she find a cheaper generic? If she’s not going to change her choices, she’s not very smart. (Choice… wow… what a novel concept!)
Actually, it’s perfect for someone who only sees a doc a few times a year. In all likelihood, you’d end up building a decent, tax free HSA.
I believe there’s a social safety net for a reason… my point is that we don’t currently have a private or a socialized system. We have a system today which has no features of a free market system (such as consumer awareness of costs, information regarding quality of the services, etc).
Expanding S-CHIP to cover families making $80k seems to be expanding a safety net to cover people who currently have the capability to purchase their own insurance in the private market. The claim that Bush wants to kill kids or remove coverage for poor kids is disingenuous, as Bush is not vetoing continuation of S-CHIP; he’s vetoing the doubling of the maximum income threshold for S-CHIP (and is also calling for S-CHIP to focus on insuring children as originally intended, instead of also covering adults as many states are currently allowing).
You need to face the fact that there is no such thing as infinite resources. Once you admit that fact, the question becomes how best one can allocate those resources to benefit as many people as possible.
My biggest concern is that the cost consciousness which does not exist in today’s system will only worsen as the system is brought under more government control. The reason for my concern is well founded from past experience with government programs and their inability to stay within budget, the budgeting process of the government, the annual lobbying interests which always have one hand out and the other hand in the politicians pocket.
That you would turn over your health care to the government is amazing to me. If you truly are one of the sick people who thinks that an HSA system would crush you financially, I recommend that you live in Canada for a year and spend 48 hours waiting to be seen in the emergency room. or be told that there’s a 10 month wait for a neonatal icu bed throughout canada for your high risk pregnacy (which of course will only last a max of 9 months).
Try reading this article written in Canada’s Western Standard. (I know you won’t regardless of the facts discussed, since it’s not written by someone who you approve of)
Here’s an excerpt:
Read the rest as it’s quite interesting for those who aren’t closed-minded.
Tim F.
Wendeler, you continue to miss the point that many people in America cannot get health insurance at any price. The insurer simply will not offer you a quote if you have any of a growing list of preexisting conditions. Unless you want to propose that the government make it illegal to dump or refuse undesirable applicants, nothing you have proposed can possibly provide universal healthcare in America. You also seem to miss the point that people with less disposable income who are able to save less will just have to hope that they need less healthcare.
Also, your last comment is a classic argument by anecdote. Fine with me if you want to go down that route. I nearly lost the vision in one eye because of crappy care in a rural clinic. Does that mean that America’s eye care is run by poorly trained physicians who take forever to see you and then misdiagnose the problem? No, it means that I had a bad experience. Plenty of waiting happens in America today. People without access to insurance wait forever. Unless you can provide some actual comparative statistics, spare me the sob stories. Every country has those.
merlallen
Did he cry when he proposed it? That dude is the biggest crybaby I’ve ever seen. And I have a 6 year old granddaughter.
John S.
Hey, fuck you.
I’m the furthese thing from a right-winger, and I’ve been posting here for years. Ask the moderators if you don’t believe me. The fact is, most of you have no fucking clue what you’re talking about. Don’t tar me with your bullshit because you disagree with me. That’s real right-wing bullshit.
Bullshit. An HDHP/HSA plan doesn’t require you to never get sick or go to the doctor. It’s the same fucking coverage as a PPO, just with a high deductible that you cover with a tax-deferred account. The only time the premiums get pricey is if you have a pre-existing condition like any other fucking type of health coverage that exists. That is where the government really needs to step in, on behalf of the ‘ininsurable’ (like the Frosts).
No, like I said, I don’t subscribe to FYIGM. Those folks need help. For the rest of us, there are options.
TOS-
I don’t know what kind of plan your girlfriend had, but it sounds like it sucked. Most plans (includinjg mine) covering 100% of expenses after the deductible in-network (which is never a problem with Blue Cross), and only out-of-network requires a 20% co-pay. And if that were the case, $700 towards a $1500 deductible isn’t that horrible – in fact, it is half of what she would ever pay out of pocket for the year. Almost every individual plan I saw had a $1500 annual deductible (family is $3000), and after you ocover that insurance picks up everything else. When you factor in that the monthly premiums are half what a PPO costs, I can’t see how you come out ahead with a PPO.
My math worked out to be the following:
HDHP/HSA
$480 x 12 + $3000 HSA funding and fees = $8810/yr.
PPO
$870 x 12 = $10440/yr.
That’s $1600 in straight up savings a year, and doesn’t include the savings if I roll over any money. Considering that the coverage is identicle to the PPO (which I know because I was on the PPO and switched to the HDHP), I fail to see how I come out on top. Oh, and of course, all my payroll deductions to the HSA are done pre-tax which also saves me some money.
John S.
Oh, and I forgot to mention that tapping into the PPO yields extra expenses for co-pays. My wife had our son while on the PPO and fucking hospital co-pay alone was $600. Every doctor visit is $20. Every prescription is $15-$30. A lot of the pre-natal testing wasn’t fully covered because of our deductible. Those costs add up, and make the PPO a shitty option by comparison, and even more costly than the HDHP. Sure, you pay for everything yourself, but your premiums are far less and there are no hidden costs.
If anything, for catastrophic care a PPO doesn’t even come close. You’re going to have co-pays out the ass in addition to the deductible you need to meet. With the HDHP, after the annual deductible is met, everything is covered 100%. The lifetime maximums are the same, too. A PPO will generally only cover $5 million – just like the HDHP.
John S.
Oh, and Tim F. –
That’s not really true. I agree that an HSA is not even an option for people that are older or have pre-existing conditions. Something does need to be done to help them, and HSAs or tax credits is NOT the answer.
But for young to middle-aged people in average health (which is a pretty fair chunk of the population), if you have an HDHP/HSA in place and “come down with expensive or chronic disease”, you will be in pretty good shape from an insurance standpoint. You will certainly burn through your annual deductible, but I’m pretty sure one round of chemo doesn’t cost $5 million. I can only refer to my policy, but after I meet my deductible all my healthcare is covered 100% (up to the lifetime maximum). If I burned through that lifetime amount, then I would fall into the category of people for which the HDHP/HSA is not intended, and like I said, there definitely needs to be a better safety net for them.
The difference between me and a right-winger is that just because I got mine doesn’t mean I think everyone else can go fuck themselves. I recognize that there is a dire need for better healthcare options – especially for the uninsurable. But I think people also needto recognize that absent a major reform in healthcare, the HSA is a pretty decent interim solution for a lot of people.
And by the way, I do not work for an HSA or anything. I’m just an art director an at ad agency who really likes his HDHP/HSA and can’t stand seeing people reject it out of hand based on misinformation (or the fact that republicans came up with it).
Lee
I hate to break the news to those still fighting some sort of government intervention into the healthcare system, but it is pretty much game over for you guys. The sweet irony is that your continued rolling over for the current president everytime he wanted to expand the government and the executive branch these last six years has pretty much paved the way for the upcoming change.
Tim F.
Well then we don’t disagree at all, do we? If you won’t contradict the fundamental basis of my criticism then I don’t see any point in quibbling. You and I both think that HSAs are a nifty accounting trick that can’t and won’t offer universal healthcare access to Americans.
Lee
I’ve got a question to those with an HSA.
The last time I looked at one (10 years ago or more) you lost any money that was left in the account at the end of the year.
Is that still the case? Or is that something set per plan?
Tony
…many people in America cannot get health insurance at any price.
Why is universal, single-payer health care the solution, as opposed to figuring out a way to insure that minority within the population?
Decided FenceSitter
Because the minority can’t get health insurance because it isn’t profitable to do so. There is no practical amount that they can pay that would pay off for a “for-profit” company to cover them.
The best way to cover everyone, from the sickiest to the wellest, is to share the cost among everyone. That way, the fact that I’m 28, in reasonably good shape and health (I go to the doctor’s twice a year, one for a check-up, and generally once because something bad happens to me – flu, burstitis, etc); and pay for the person who needs chemo, or repeated surgeries, or even diabetes.
Tim F.
It takes an understanding of the market to answer that question. We could forbid insurers from dropping or denying applicants for example, but that kills most of the business sense of offering private insurance in the first place. Alternatively we could offer a fallback government plan for the people who insurers won’t take. Of course that would incentivise insurers to drop anybody who might theoretically cost them any money at all, resulting in a ridiculous system where the government basically subsidizes insurance companies’ profits forever by allowing them to only keep the patients who don’t cost them any money.
Or else…what? The currently uninsurable are precisely the people for whom HSAs not backed by private insurance don’t make any sense. There really isn’t any way around the problem that the only sensible way to cover everybody is for the government to sponsor a minimum universal care. Private insurers can offer bonus coverage for anybody who wants better care, more choice, etc., like they do everywhere else.
st wendeler
average emergency room wait time in the finest hospital in Montreal, Canada: 48 hours.
Listen to any Prime Minister’s Question Time in the UK and you’ll inevitably hear some MP ask the Prime Minister about reducing wait times or increasing the number of beds in some NHS hospital in their local jurisdiction. If this is what you want your federal government involved in on a regular basis, then we’re clearly at odds.
And Lee, you were looking at a Health Care Spending Account (HCSA), which was a pre-cursor to HSAs. In HCSAs, it’s a use it or lose it provision, which is just idiotic unless you are looking to pay for anticipated health care expenses with pre-tax dollars.
HSAs allow you to keep whatever you don’t spend, so it’s ideal for those who are very young and just starting to work. They build up tax free money in an interest bearing account for when they need it later. And, because you get to keep the money (something which the federal government budgeting process doesn’t allow), you have a vested interest in understanding the costs for procedures, doctor’s visits, etc. Asking the question of “how much?” is not something that happens in the health care industry today – and that’s a major force behind the rising costs.
With regard to the problem of pre-existing conditions or the very poor who cannot afford insurance, these situations certainly need to be (and are being) addressed. And, keep in mind that the entire point of insurance is to cover you for some future (and hopefully unlikely) possibility (disease, earthquake, fire, flood, car accident, etc). If you are not insured against floods (by choice) and your house gets flooded, it’s difficult for you to give me a sob story about how the big, mean insurance company isn’t rebuilding your house. Of course, in dire (most) situations the government ends up providing assistance to those that are not insured. But, these are the exception, not the rule.
Again, most health problems are the result of lifestyle – too much smoking, booze, food, and too little exercise. When people have a personal and an economic interest in staying healthy, they’ll be healthier. The High Deductible insurance covers that unseen, unpredictable, and debilitating ailment that strikes out of nowhere (cancer, kidney failure, etc).
Finally, it’s important to remember that Chimpy W. McBushitler isn’t trying to ax S-CHIP – just not expand it to those making $80k a year. If you’re making 80k a year, you probably can afford a policy that has premiums of $75-$100/month. But to completely socialize our health system because a segment of the population chooses not to buy insurance is ridiculous.
And the 45million that are not insured are not who you think they are:
Let me break that down for you…
56%, or 25.2 million of the 45 million make $50k or more a year. Are these people in desperate need of government assistance (except for those unfortunate to be born with pre-existing conditions)?
33%, or 14.85 million, could be covered by a government program today, but for some reason have not enrolled.
And finally, 20% of the uninsured, or 5 million, are illegal immigrants – not citizens of this country.
How ’bout them apples?
Billy K
See, I remember a time….OK, I remember reading about a time when we had HSAs and private Social Security accounts. They were called…Savings Accounts. The great thing about these “Savings Accounts” was they could be used for more than just retirement or health care. They were managed by you and there was little or no government intrusion.
Of course, this was before insurance companies, drug companies, etc. stuck their fingers in the pie and colluded with government to make health care cost 10 times what it once did.
I know it’s radical, but I say bring back Individual Savings Accounts and make health care affordable again! Who’s with me?
Tim F.
How does this argue in your favor? If you acknowledge right off the bat that people with pre-existing conditions (I hope you realize that a person does not have to be born with one) cannot get insurance at any price then you and I see entirely eye-to-eye. More than half of America’s uninsured are priced out of insurance, a common problem for small business owners and employees, or cannot get it at all. Either you think that those people should piss off and die or you agree with me that something other than private insurance-backed HSAs needs to be done.
We have not yet gotten to the millions of Americans who theoretically have insurance but find themselves denied critical care when they suddenly need it. Children die because their insurer won’t cover emergency care at their nearest hospital, college age women die because their insurer declares that they are too young to have the tumor that they were just diagnosed. If you want to trade anecdote for anecdote we can go on like this for weeks. Provide me actual statistics that don’t come from a single hospital in Canada, because I promise you that I can match every scary anecdote of yours with an outrageous example of death by spreadsheet here in America.
Tim F.
Funny, that sounds to me like the government responding to patients’ needs. Most sensible people would prefer that to the lovely American tactic of patient dumping.
st wendeler
There needs to be a safety net for the poor and/or those with pre-existing condition. Keep in mind that adults with pre-existing conditions today who cannot find insurance either 1) didn’t purchase insurance and then developed a condition (which isn’t too smart); or 2) had insurance but then lost their job which provided insurance, didn’t opt for COBRA continuation and developed the disease in-between jobs), which is a travesty explained by our employer-based insurance system which dates back to the FDR administration. Portability is something that needs to (still) be addressed when the system is reformed and HSAs, with their accumulating account, are a step in that direction.
Today, in addition to the consumer not having any idea of the cost of the actual health care service, the consumer also has no idea what their employer is contributing for the insurance in the first place. Thus, those that are insured don’t see the costs for the insurance, nor the service which the insurance is covering. Being totally blind to either costs is the worst possible situation.
Most of these examples are from HMOs who (like the government) will be look at limiting treatments as one way to control costs. When an individual has an HSA, they will choose what treatment to get and when they hit the max out-of-pocket, insurance kicks in.
You obviously don’t understand much about HSAs. And why would you want someone (a bureaucrat from an HMO or the government in middle of a conversation between you and your doctor).
My concern is that we no longer will have a safety net, intended to protect a person who is falling from hitting the ground and experiencing a traumatic end… the safety net is intended to provide protection short-term and bounce them back into action.
Instead, socialized health care will be more like a fishing net, with all of us trapped inside.
I predict that if we do get socialized medicine (and if we do, I predict that it’ll be right around the time that the European countries are abandoning it), long lines will establish and the clarion call from the Left will be that we don’t spend enough on health care. Day after day and week after week, the primary issue that politicians will address will be the amount of funding of this or that local clinic and how the system can be tweaked to “fix” the problem – always with a demand for more money.
Meanwhile, slowly but surely the quality of care and the innovation in the health care industry that we’ve seen over the past 30 years will start to diminish… and we all won’t notice, because the equality of crap will overwhelm us.
Again, let’s pool our resources to focus on those that really require assistance, not the middle class who could be insured if they decided to forgo the 150 channel HD package from DirecTV and the flat panel tv. Or if they would perhaps forgo the monthly cell phone or internet bill…
Looks like I’m in the majority on that opinion.
JF_Lovely
From st wendeler:
“Since my wife’s experience, the average wait time in Montreal emergency rooms has apparently gone up to 48 hours. …”
You linked to a scurrilous expat Canadian scumbag to prop up your straw man argument. This is a writer that actually suggested that surviors of a mass shooting were cowards for not disarming the gunman armed with a .223 Ruger.
http://article.nationalreview.com/?q=YzEzYzQ0Y2MyZjNlNjY1ZTEzMTA0MGRmM2EyMTQ0NjY=
This fucker is out off our country and he should not come back. He should be rendered to third coutry for coercive interrogation.
For a more balanced view of North American health care try:
http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared
John S.
No, the money rolls over from year to year.
farmgirl
st. wendeler:
What makes you think COBRA is “available” to everyone? My co-worker’s daughter was quoted $1,600 a month for COBRA when her recent job ended.
Also, you haven’t addressed Tim’s question of what is to stop the for-profit insurers from refusing to cover anyone who threatens their profits and throwing them on the government.
John S.
On a minor point we do, Tim. When you said:
You seem to be implying that an HDHP/HSA will not cover someone who ends up with a catastrophic health situation. That is simply not the case. It will cover them just as effectively (if not more so) as a PPO plan will.
st wendeler
Whether you realize it or not, the $1,600 a month for COBRA is the total cost of your insurance policy that your employer was paying. That was compensation to you that you never saw a dime of.
As I said, you don’t see the true costs of the insurance, nor the health care that it provides for.
That’s why I consider our current system not to be health insurance, but health insulation. We are completely insulated from the costs and the result is that costs have spiraled.
The fact that we have employer-based health care system is one of the major problems, since losing your job often means you’re exposed to risk that you would otherwise be covered for. I know, I left my job after 10 years and was (technically) uninsured while between jobs. (I wasn’t unemployed for that long, so could’ve made a COBRA payment and been covered if something happened.)
It’s also a problem in that one reason people stay in cr@ppy jobs today is that they don’t want to risk losing their health care coverage. Eliminating the employer-based system would not only be helpful to those that find themselves between jobs (b/c they would own the insurance, not their employer), but it would also increase the amount of labor movement (ie, I have nothing to stop me from considering a higher paying job somewhere else).
Umm, while I’m familiar with the horror stories of patient dumping of homeless individuals, I’m not familiar with the specifics of the case which Tim links to. However, I should point out that: 1) this is considered news, which means that it’s not something that is standard practice within the health care industry; 2) Kaiser Permanente is facing criminal prosecution, because… you know, it’s against the law.
Homeless people are poor and should be covered under the safety net principle. And the particular situation of a homeless person requiring medical attention does raise a troubling question – to whom and to where do you discharge them? Or, once they come down with something, are they supposed to be given permanent housing within the hospital? It seems to me that the issue isn’t that they didn’t receive care, it was that they were discharged in an inhumane fashion. I would suggest that an arrangement with a charitable mission be established so those patients have an actual destination when they leave the hospital.
Again, it seems like everyone is throwing up the worst possible case scenarios to argue that people making $80k a year should be receiving government health care services with the ultimate goal of a completely socialized medical industry. Not exactly a worthwhile argument…
Jake
Followed by MILES of screed.
The irony. It hurts.
The most amusing thing about this comment section? People falling over themselves to defend HSAs because Tim F. guessed that Boneher might suggest HSAs as the “solution.” We’ll see if they hold to this opinion if Boneher suggests something completely different.
Tim F.
Wendeler, you seem like a reasonable enough guy and I want to give you the benefit of the doubt, but some things really scratch my head. For example:
If you won’t agree to the basic terms of the discussion then we’re really not discussing at all, and I don’t enjoy watching two people talk past each other.
The entire premise behind currently proposed healthcare fixes is that we do not have a safety net in America. If you are priced or frozen out of private insurance and you get sick then you’re done. Cooked. Either the hospital declines to care for you and you simply die (see that dumping article I linked above. many, many more examples available on demand) or the hospital does care for you and you spend the rest of your life in penury trying to manage the bills. Thanks to private insurance and that stupid bill health costs are the primary cause of bankruptcy in America today. Or they were before the subprime mortgage crisis hit.
You have just described a system that gives a person control over minor medical decisions but hands decisionmaking right back to the beaurocracy as soon as a crisis hits. After all very, very few medical emergencies resolve themselves today for less than the average person will have in his or her savings account.
When an HSA holder gets in trouble the same beaurocrats who kill Americans every day through profit-driven mismanagement will be right back in the driver’s seat. I can see how HSA’s would improve on certain existing private plans and I have no problem with anyone advocating them on that basis. However they neither solve the mismanagement problem nor offer any hope for offering security to currently uninsurable Americans. As such the HSA approach doesn’t offer much to the current debate.
Tim F.
As Wendeler pointed out HSA plans have evolved since the last time I paid much attention to the issue. My response from the above comment:
El Cruzado
A few notes on the debate:
– Notice how all critics of national healthcare single out the UK? That’s because the UK’s NHS sucks. You won’t see them comparing with France or Germany or even, god forbid, my 2nd world bull-running neck of the woods (according to the US view of it) Spain.
– Even then, you’ll pry the NHS out of the dead, cold fingers of the UK voting public. Even Margaret Thatcher dared not touch it.
– In my experience, a nationalized healthcare system is a lot like public schools. They both will always either suck or be completely a non-issue, yet they are both something the citizenship will not renounce to. Both will create their own little political debate ecosystem.
– No one is discussing not having a private healthcare system in addition to whatever the government pays. I’m all for the rich having state of the art stuff if they want to pay for it and they work great for specialized stuff (i.e. in my hometown the best trauma hospital is a private one and any factory or workshop worth its salt will have an agreement with it for care in case of workplace accidents and the like).
– Waiting periods always exist, since the government won’t spend more money in equipment and people than required (funnily enough, the same motivation exists in the private sector). Waiting periods don’t exist when you’re dying though. As a way of an example, my father had to wait over six months for cataracts surgery (he hadn’t reached the point where it affected his regular life either) yet he got prompt and efficacious treatment (i.o.w. he’s alive and well) when he got run over by a car.
Hope that helps.
jcricket
And as you’ve pointed out, for many people even a $1k deductible is out of range. BTW, most HDHP I’ve seen have far greater than $1k deductibles (which can easily be the deductible in your average PPO these days).
Failing to understand that single-payer healthcare provides universal coverage at a lower cost (both individually and society wide) is just ignorance. The mountains of evidence from every country is overwhelming and irrefutable.
What’s not perfect about each of those countries can easily be fixed here, if we actually cared to try. In Japan they overprescibe prescription medication. In Britain they have some tax-base issues. Etc. But in none of those countries is the proposed solution going with the system we have. No one would dream of it.
st wendeler
I’m trying to be a reasonable guy and back up my arguments with facts because flame fests back & forth accomplish very little. Similarly, a comment thread that is simply an echo chamber results in the most ridiculous positions or is extremely boring.
While I’m taking the approach to demonstrate that free market forces (great video on healthcare at that link), if actually implemented within the health care industry, would provide a substantial improvement over the current system, Paul Krugman and Ted Rall simply argue that the GOP wants to hurt or kill kids.
Now, who’s being disingenuous and who is arguing rationally?
I make a comment about how simply discounting anything I wrote is not an informed comment… and get ridiculed because I provide “miles of screed,” ignoring the fact that the “miles of screed” are actually arguments I’m making in this debate.
I don’t think the dumping article mentioned anything about the care that the homeless people received, but rather the way that they were discharged – left in an unfamiliar part of the city and not being discharged in an inhumane way.
And, if you have a pre-existing condition, let’s say.. cancer.. you can get coverage. Scroll to 4:00 remaining on this video. When you get to 2:03 remaining, you’ll see that Vicky can get government coverage by getting rid of her assets. There is a safety net, despite what you say. A Safety Net is not a safety net if it’s used to cover people who can afford to pay – it’s something entirely different.
But, again… most pre-existing condition issues are when people do not have insurance and then try to get coverage after they are diagnosed – this is a problem related to our employer-issued insurance system – not that the “free market” is being mean to Vicky. If we eliminated the employer-based system and expanded the use of HSAs (perhaps make it mandatory? did I just write that?), pre-existing condition issues would be reduced significantly.
Also, regarding HSAs – scan to near the end of this video where they interview how Whole Foods (they’re Lefty’s, correct?) and how they switched to an all HSA plan and the employees are happy.
Since the claim rejection rate is with all of the known issues in those systems, seems crazy to me.
st wendeler
That’s what has been implemented in Canada… and yes, the NHS does suck.
and we see how great that turned out here in the US? and everyone said, “We need to spend more money!!!” (despite the fact that the education budget has more than doubled since 2001.
Hmmm… but, waiting doesn’t seem to be a big problem in private healthcare systems. So… your evidence is?
Emergency room waiting average in canada is 48 hours to be seen by a doc. Nowhere near that in the US.
no.. we wouldn’t create our current system if we had to do it from scratch. As I said, it needs to be changed b/c it’s evolved over the past 70 years and is less free market than it should be. The government (state & federal) is the largest spender in terms of health care in the US, so it’s difficult to claim that we currently have a purely capitalistic system.
HSAs are a step in the right direction. Increasing government’s involvement isn’t.
fine
Tony
Agreed. The issue is always incentives, as you point out. But the government creates incentives, too. Employer-based health insurance is the prime example, as has been mentioned. For people who like to change jobs frequently, this is the worst-case for them. For people who lose their job for whatever reason, it’s the same problem Yet, government perpetuates it.
It’s also useful to mention mandates. How many states mandate that insurance policies must include coverage for anything and everything? Increase risk by mandate and costs will increase.
I’m not silly enough to deny that there are incentives for insurance companies to deny coverage. But there are also incentives to not deny coverage. The insured are customers. The insurance companies need them, too. We can debate the power each party wields, but we can’t pick and choose which exists.
I’m not really tied to HSAs, specifically, although I suspect that HSAs with high-deductible insurance for catastrophes is the way to go. But we haven’t explored private insurance fully, thanks to generations of government interference. Maybe the market could make HSAs work. Maybe it would figure out another solution. We don’t know because we haven’t completely tried. Instead, we’ve imagined that they’re driven by short-term profits exclusively, which isn’t based in economics. It’s a bit premature to say that the government is the only sensible way to cover everyone.
Government bureaucrats wouldn’t fall into the same trap? All evidence I’m aware of suggests that is a faulty assumption. Increase profit and decrease costs are essentially the same argument.
Even if we focus on the more common bankruptcy, these types of situations is why we have bankruptcy laws instead of debtor’s prison. I don’t know of anyone foolish enough to suggest that poor people shouldn’t get care. But to protect everyone from financial pain just because bankruptcy is awful is not a sane long-term health policy. Life involves risk, including and beyond whatever consequences are tied to own individual life choices.
st wendeler
I apologize for not responding to to this earlier:
and what does a position on the VATech shooting have to do with a possible 48 hour wait time in an emergency room in Montreal, Canada?
I mean, if you want to debate gun control, I’m sure John will have a post on that eventually… but again, a position on VA tech has nothing to do with wait times in socialized healthcare utopia that is Canada.
That the target emergency room wait time is 12 hours should be all you need to know about the quality of care in Canada. If they hit that average, it’s LaBatt’s all around, I suppose. Good job, guys!!!
WOOOOOOOOOOT!!!
puhlease
Zifnab
Currently, the hold up on this bill isn’t some vast Republican obstruction effort. It’s a handful of Republicans – some ten shy of a veto override – who are holding the bill back from passing. If SCHIP was such a disaster waiting to happen, you’d think more Republicans would be voting against it. Especially in the Senate.
HSAs don’t work if you don’t have the money to save. They rarely work when you do. Operations and treatments for ailments like cancer or car wrecks cost in the hundreds of thousands of dollars. If my HSA was big enough to cover a $100,000 accident, why the hell would I still be working? Why isn’t that in my retirement account, or my kid’s college education savings?
The whole reason we have insurance is to defray the cost of catastrophe. Telling people to save up in the event of emergencies is tantamount to telling poor people to fuck off.
I would absolutely love to see the free market innovate its way into a solution. But insurance works by pooling risk. You can’t go it alone with disaster coverage. Insurance exists because of this fact.
Tim F.
Wendeler,
You have said much that deserves a response and will get it when time allows. Day job and all that. For now I am simply curious to know why you insist on Canada as the only possible basis for comparison. You have not presented any comparative statistics to support your nightmarish claims, but assuming that you eventually do, why the focus on Canada? France spends less than we do and provides model care. Sweden, Spain, Germany all offer dramatically more cost-efficient care for their citizens, cover everybody and somehow manage to meet or exceed us on most independent metrics. Our infant mortality scores are nothing short of a disgrace. It disturbs me that you think that if we implement national health care we must automatically model it after the worst systems out there.
John S.
Agreed.
Most individual HDHP plans have a $1500 deductible. Most family HDHP plans have a $3000 deductible. When you consider that the premium on an HDHP can be half what it is on a premium for a PPO, there is really no comparison.
Take for example a family of four:
HDHP/HSA
$600/mo. + $3000 deductible funded by HSA = $10200
PPO
$1000/mo. + $1000 deductible (out of pocket) = $13000
Thisexample also assumes that you have to fund your HSA fully (which after the first year, you shouldn’t) and that the PPO doesn’t have additional costs in the form of co-pays (which they all do).
Sorry, but I do not see any argument where an average person who is insurable benefits more from a PPO than from a comparable HDHP/HSA plan.
John S.
Zifnab-
You don’t seem to understand how the HDHP works. Your HSA only needs to cover your annual deductible and other mediacal expenses NOT covered by your insurance plan. The maximum lifetime benefit is usual in the millions.
If you got really sick and your expenses totaled $1 million, in a typical HDHP plan your maximum out-of-pocket expense would be your annual deductible ($1500 for an individual or $3000 for a family). Afte you meet that, your expenses are covered by the insurance with no further co-pays or expenditures required.
The HSA isn’t the insurance, it’s just an account linked to the HDHP insurance to cover medical expenses which generally don’t amount to more than your annual deductible (unless you use it to pay for something not covered under your insurance like eyeglasses or orthotics).
Zifnab
You seem to be intent on emergency care. We are totally in agreement that emergency care in Canada is a disappointment. However, if I’ve got emphazima or diabetes or lukemia, my biggest concern isn’t the ambulance ride. I’m worried about the long haul. Right now, we see rampant abuses in our system of people having their insurance canceled after they become sick.
Which, if you don’t mind me asking, is worse? Slow treatment or no treatment?
Insurance companies are abusive, aggressive, and occasionally just incompetent.
So we can trade horror stories about medical treatment around the world, but the bottom line is that the system in America is broken and requires repair. HSAs don’t repair the damage or more people would actually use them. HMOs don’t fix the problems. And while you may need to wait a few days to get real treatment in France, for some reason the French still seem to have the highest satisfaction with their health system. Riddle me that.
John S.
st wendeler-
I’m not sure we’re arguing the same point, but your above statement should be revised:
HSAs are a step in the right direction.
For insurable people that are not considered a high risk.
Increasing government’s involvement is a step in the right direction.
For uninsurable people that are considered a high risk.
There is no model I am aware of in a for-profit private insurance model that allows for reasonable coverage for high risk patients (not even the HDHP/HSA model). It defies the very concept of the system, and even asking an actuary to try and define such a parameter would probably make their head explode.
Zifnab
Which doesn’t do you a lick of good if you don’t have any coverage to begin with. The SCHIP program gives insurance where none existed before. HSAs, as you pointed out, don’t fill this gap. They don’t solve the root problem of not having any insurance to begin with.
And while cheaper, $10200 / year is still a quarter of the Frost family’s income. I don’t know how you budget your money, but I can say straight out that if I was paying $10200 / year purely in insurance costs, I’d still be living with my parents. Hell, at $10200 / year, my parents might still be living with their parents. That’s an obsene amount of money for someone on a $30-40k / year salary.
John S.
No, they do not solve the problem of the uninsurable.
However, I suspect more people don’t take advantage of HSAs (particularly judging from this thread) due to lack of information or understanding of how they actually work in conjunction with HDHP insurance.
st wendeler
John S – You’re also leaving out the tax benefit and the employer contribution to the HSA.
Actually, HSAs come with high deductible health insurance which covers that car accident, terminal illness, debilitating disease, etc. Learn about HSAs and HDHPs before you discount them.
Watch the video available at this page to learn more about free market practices in healthcare… It even features Michael Moore, so bonus for you! Michael Moore even argues that cell phones haven’t improved over the years. :-)
Tim – I’ve mentioned Canada primarily because it is the closest G7 country with socialized medicine. That and the fact that it’s also pointed to by proponents of socialized medicine as “the way to go.” I also point to the UK because, like it or not, we’ve got a common historical foundation in terms of economics, cultural, political, etc. (Same also applies to Canada.) I think we could learn from other countries as well, but each of them have problems. The French system included:
So, it seems that they are having similar problems to the US. And, as stated in the article, they don’t have the lawsuit-itis that is prevalent in the US.
And doctors on strike for better pay isn’t going to help anyone…
John S.
I certainly have mentioned the tax benefit of the HSA contributions (as well as on interest earned and withdrawls) – that’s one of the best things about it.
I didn’t mention employer contribution because for me that doesn’t apply. I pay for my own HDHP/HSA because my employer does not cover my health insurance. I think that is the case for a lot of people these days, and I want to make it clear that the HDHP/HSA is an attractive option even when you have pay for the entire thing yourself – without any help from an employer.
If you do have an employer cover part of your HDHP deductible annd throw some money into your HSA, that’s just icing on the cake.
Tax Analyst
Yes, and you forgot to mention that folks there are “paid in gold just to babble in the back room all night and waste their time”. OH…wait – that’s not reality, it’s a lyric from “Royal Scam” by Steely Dan.
Jeez, I wonder why that song suddenly came into my mind? “Royal Scam”…what relation could that have to our current situation?
st wendeler
Ahh, this just in… more glories of socialized medicine.
Get out the pliers!
Jake
The two aren’t always mutually exclusive.
Zifnab
So… how is that system different than the current US system, wendeler? Are you suggesting that without dental insurance and / or a large sum of money, I could have my teeth pulled in a free-market system on the cheap?
Tax Analyst
Good point.
John S.
Well, I can’t argue with you on the cost. My policy is actually closer to $5000/yr. for the premium and then $3000/yr. into my HSA (which is still not cheap). But thankfully, my wife and I each make around $45k a year, so it’s a whole lot easier to budget.
On the flip side, $700/mo. is a lot cheaper than a PPO would be for the same coverage, and I do get a little tax-free savings on the side. Unfortunately, for a lot of people that don’t have a household income of over $75k a year, it’s probably not very feasible.
That’s where government needs to step in (or healthcare needs a serious rate adjustment).
Zifnab
I mean, don’t get me wrong. If HSAs can work, then by all means we should add them to the pile of tools we use to reform healthcare in America. I haven’t seen HSAs in action before. The reason I’ve always heard is that they are penny-wise and pound-foolish. Roths and CSAs are much more effective, and once you’ve maxed them out, the extra $300 / month to fill the HSA seems somewhat out of reach. I would like to see Roths, CSAs, and HSAs rolled together into one generic savings fund.
But universal health care coverage isn’t ment to solve the problems of the wealthy and affluent. If you can afford an HSA, you’re not on the SCHIP program. In that sense, I can see why a guy using an HSA would recoil in horror at the idea of a single-payer system. But even Hillary Clinton, easily painted as the most draconian and militant of the health care reformers, has abandoned the idea of single-payer. Read her plan. It’s the poster child for insurance choice. You can choose to keep your plan between jobs, take the plans available to Congress, or keep your HDHP/HSA or PPO if you prefer. The regulation comes entirely on the side of the insurance companies, and won’t have any direct impacts on emergency rooms or doctors’ offices.
craigie
You left out bombing. No Republican’t idea is complete without bombing someone.
TenguPhule
You’re right, I was an asshole. That was uncalled for and I’m sorry.
I still think Health Accounts are not a good idea.