5 ms·

MSAs were expanded into HSAs in 2003. As of now there are some 8 million enrollees. IMO the most interesting effect of the spread of HSAs is the emergence of

• russell 17y ago
  I am going to argue with you sideways. :-) I dont think Hello Health is an argument for HSA's so much as a streamlined reimbursement system with some kind or reasonable accountability for costs. The current structure optimizes for assembly line medicine rather than good patient care. Most people go with factory doctors, because of the small co-pay. You can go to a doctor outside your plan, but you typically get only 50% reimbursement. My doctor costs me $100 out of pocket instead of $25, but she is worth it because I get a one-hour appointment instead of 15 minutes. On to Milton Friedman. He makes a very good case for single payer health insurance (11% of GDP vs 17%) and then comes to the opposite conclusion. He is drinking the perfect market koolaid. He assumes that, if people have to pay their own money, they are going to make rational economic decisions about health care purchases and will shop around for the best price. This is such utter crap that it is hard to believe that an open minded economist would utter it. Health purchases are not rationally economic. They are made on other considerations like trust in the doctor and increasingly on patient evaluations of treatment options. If you have a kid with a high fever, you dont start googling for the best price. A part of the conservative economic fantasy is that consumers have negotiating power in the market. Yes, I by drugs at Costco because they are cheaper, but that is because Costco has negotiating advantage, not me. A single payer would have a huge advantage in negotiating drug prices. There is a reason that drug prices in the US are the highest in the world. Health care reform in the US is hugely complicated and a simplistic approach is not going to cut it, even a single payer system isnt enough. Drug costs need to be cut. Defensive medicine needs to be brought in line. (Practice to the patients needs not the doctors.) On and on. Hello Health looks to be a good start in the microcosm.
  • jacoblyles 17y ago
    You don't think people respond to prices? Consumers are not perfectly rational, but that's a bit of a straw man argument. On average, in the aggregate, they do respond to incentives. On average, in the aggregate, a first-party consumer payer is more likely to be price sensitive than a consumer purchasing medical care by way of a third-party employer health plan. The fact that most consumers don't fit some perfect model doesn't seem particularly relevant. Finally you say: "Health purchases are not rationally economic. They are made on other considerations like trust in the doctor and increasingly on patient evaluations of treatment options." Purchasing based on quality is not "rationally economic"? Have you studied any economics at all? That's just ignorant. You don't know the meaning of the words you are using. This is why I stopped arguing with people on the internet. Edit: Yes, this is a little mean and not within the style guidelines of Hacker News, but you will have to excuse me if I am not impressed by yet another person "disproving" the entire discipline of economics with the pseudo-intellectual observation that people make decisions on considerations other than price, as if that fact had been overlooked by every economist for the last three centuries.
    • GHFigs 17y ago
      You put the word disproving in quotes, but the parent post did not use that word or claim to be disproving the entire discipline of economics. Your knee-jerk reaction here typifies why so many avoid studying the subject at all. Also, that "psuedo-intellectual observation" won Herbert Simon a Nobel Prize (in Economics) in 1978. I don't see how it's far-fetched or "ignorant" to suggest that healthcare decisions are made by boundedly rational satisficers rather than perfectly rational optimizers.
    • russell 17y ago
      Actually my degree is in economics. When I got it, the arguments were in terms of "utiles" instead of dollars. A utile would encompass quality, but was such a nebulous concept that it was of very little practical use. So when I said "rationally economic" I was speaking in terms of dollars, which you can measure and not utiles or feelies which you cannot. I dont think that giving everyone an HSA is going to give Friedman's desired result of lowering health care costs, because it depends on people making dollar based decisions. I think improvements in the cost structure will be made the monopolistic components of health care, including drug pricing, and reactions to insurance optimizations like factory medicine. I made the decision to switch from economics to programming a long time ago, pretty much for the reasons I gave above. I WAS expecting a scientific approach and pretty much got mumbo jumbo like Friedman's essay. And if you think things are very much better, how come Greenspan and the quants and politicians lead us into this economic disaster we have now. I will admit that my attention to theories economic since then have been superficial, and great strides in understanding may have been made, but I dont see it yet.
• jeremyw 17y ago
  Across a variety of my employers, none (via health providers) have offered HSAs/HDHPs. I can maintain one externally, but the extra tax paperwork to see the same tax-free employer health dollars is painful. My assumption is either most employers are ignorant and/or providers lose dollars when offering them in a stable of employee options. That is, providers offer them to the adamant, but don't do much to spread the word otherwise.