Observation: There's adverse selection at work. People do the economics and look at their expected medical spending with both low and high deductible plans--t

Observation: There's adverse selection at work. People do the economics and look at their expected medical spending with both low and high deductible plans--those not expecting substantial bills generally choose the high deductible plans. Insurance companies observe the results of this--those who choose low deductible plans end up costing more. I've done the math most years and I have yet to find more than a narrow window where you're better off with the low deductible plan than with a high deductible plan and putting aside the savings. Typically there's no window at all, the high deductible plan is always superior. (Note that this generally changes in situations where you pay a *percentage* of your premium, such as subsidized ACA plans.) If we want to move away from high deductible plans the only way is for Congress to impose it, market forces will always drive it as high as it can legally go.