This is true but I think misses the spirit of the criticism Imagine an alternative world where health insurance acts more like a mortgage with an amortization

This is true but I think misses the spirit of the criticism Imagine an alternative world where health insurance acts more like a mortgage with an amortization schedule. when youre young (and have low savings) your premiums act like they do now - simple insurance. But as you age, your payments are split gradually between pure premium and an HSA. The amount you’re personally liable for increases as you age, but so does your ability to pay out of pocket. For high earners this scheme makes a lot more sense (because youll have a few hundred thousand in health savings by retirement). Most people actually do the above but clumsily and also in the opposite order - HDHP plans are more broadly useful when youre young and healthy because you probably wont have high medical costs so you just save on premiums.