HSAs Centerpiece of Bush Health Care Agenda

The New York Times on Thursday examined health savings accounts, which have become a "cornerstone" of efforts by President Bush to address "runaway medical costs." According to the Times, "so far there is little evidence that the approach is helping many consumers come to grips with the high price of health care."

Supporters of HSAs maintain that the accounts benefit consumers through lower monthly premiums and the "ability to put pretax dollars into a savings account that grows tax free" and that they benefit employers through increased "responsibility to workers for thousands of dollars in costs," the Times reports. However, according to the Times, "workers ... have been slow to embrace" HSAs, although some have "signed up not because they are eager to direct their own medical spending but because the plan looked cheap or they had no other insurance option."

Many employees who have enrolled in HSAs have not contributed to their accounts. In addition, employers "have been slow to offer" HSAs, and those that do offer the accounts "have been reluctant to encourage worker participation by contributing money" because they "figure that 'portability' means that their money will go out the door with the workers who leave," the Times reports.

According to Daryl Richard -- a spokesperson for UnitedHealth Group, the largest provider of HSAs -- about 654,000 of the more than 24 million UnitedHealth members have the accounts, but only about half of those members have made contributions (Freudenheim, New York Times, 1/26).

Summaries of recent opinion pieces addressing HSAs appear below.

• David Gratzer, Wall Street Journal: Although Bush in the State of the Union address will "outline steps to strengthen" HSAs as a "remedy" to increased health care costs, "he is unlikely to mention Medicare reform -- and that would be a mistake," Gratzer, a senior fellow at the Manhattan Institute, writes in a Journal opinion piece. According to Gratzer, "Washington has debated the size and scope of Medicare expansion, ... but the program itself has yet to be fundamentally rethought." He writes, "It needs to be, because faced with Medicare's rising costs over the past four decades, the only real response has been a bipartisan exercise in wage and price controls," adding, "The results have been dismal" (Gratzer, Wall Street Journal, 1/26).
  


• David Wessel, Wall Street Journal: Bush plans to "experiment with market forces to solve this problem: that Americans aren't getting their money's worth for the $1.9 trillion a year they spend on health care," and he "reasons that if Americans had to pay more out of their pockets ... they'd use health care more judiciously," Journal columnist Wessel writes in an opinion piece. However, Wessel writes, a "bigger problem is that too many healthy (for now) Americans go without preventive care, and too many chronically ill Americans don't get care that would avoid costly, painful complications later." According to Wessel, "HSAs don't help there" because the "costs of a mistaken decision to avoid a doctor visit are greater than choosing the wrong cell phone plan" (Wessel, Wall Street Journal, 1/26).
  


• Robert Samuelson, Washington Post: The health care proposals Bush has made "may or may not have merit, but they surely won't fix the health system in any fundamental way" because "most Americans don't want to fix the system in that sense," Post columnist Samuelson writes in an opinion piece. According to Samuelson, most U.S. patients "are satisfied with their care" and "don't see (or directly pay) the vast majority of their costs," but a "health care system that satisfies most of us as individuals may hurt us as a society." Samuelson adds, "The changes we truly need are political," but "these changes won't happen because people don't want to see the costs." He concludes, "We don't have the health care system we need, but we do have the one we deserve" (Samuelson, Washington Post, 1/26).