In the baseball memoir Ball Four, Jim Bouton recalls when his team stopped providing orange juice in the clubhouse. “Well, you guys would just drink it all up anyway,” says the clubhouse guy.
Such is the stunning logic of health savings accounts, or HSAs, which President Bush will tout as his New Big Stupid Idea in the State of the Union address tonight. As Josh Marshall says, they are the solution to the problem of folks having too much insurance. So if you have to pay for it yourself, you won’t have all those unnecessary trips to the doctor, or take those unnecessary medications, or have those unnecessary tests. It’s the ownership society — when it comes to your health, you’re on your own. Fine, huh?
Except that it turns out that folks skip the necessary tests, the necessary medications, the necessary procedures, too. Why? Because we don’t know what’s necessary. That’s a doctor’s job. And as is thoroughly documented in the book Uninsured in America, late and inadequate treatment of disease leads to an economic and literal “death spiral”, as the costs of care rise and an individual’s earning power is crippled by poor health.
The HSA is a health care band-aid, dreamed up by bean-counting accountants masquerading as economists. It displays a blinkered ignorance of incentives, and the fact that health is a longitudinal process: A pinch in time saves nine. HSAs — and indeed our current health care system— discourage the pinch, and encourage the nine.
As if I haven’t flogged it enough, read this article by Malcolm Gladwell(The Tipping Point, Blink) to find out why HSAs are such a lousy idea.
