First of all, I wanted clear up the statement that: “One of Bush’s proposed alternative solutions is Health Savings Accounts, which makes no sense to me.” The basis of my understanding of HSA was President Bush discussing it in Ohio. I have a much better understanding of it now than I did yesterday in that in order for it to work it is coupled with a High-Deductible Health Care Plan. So, individuals would have a tax-vehicle for spending on health care on a reoccurring basis. Overall, this is part of consumer driven health care policy where individuals keep costs down via the direct impact on their ability to save/spend.
Malcolm Gladwell wrote an excellent piece for the New Yorker debunking the underlying thinking behind Health Savings Accounts (please read before commenting). From my perspective, I am not the best judge of my health; a doctor is. Unless I have some reason to believe my doctor is incompetent, in which case I’ll find a new one, their advice is probably best. I might question them on particular topics that I might have read about my condition elsewhere, but I defer to their opinion. If I strongly disagree with their diagnosis and don’t agree with the treatment, the rational thing to do is get a second opinion, not to weigh the educated opinions of the medical community against my under-informed own. Therefore, I would rather the cost controlling mechanisms in this case be controlled by bureaucracy of health professionals rather than every individual left on a proverbial island.
The market is not magic, and it can be gamed. Part of the field of marketing is about how defeat rational behavior and drive appeal for products based on psychological factors. Health care is not a commodity, and individuals are actually pretty poor at determining the quality of care that they’ve received. In short, many of the factors needed for an efficient free-market economy, which is the basis of consumer driven health care model, simply aren’t present. As I have pointed out before, if you are not mindful of prerequisite conditions, it will lead to incorrect results. Crossing your fingers and hoping things will work out is not good public policy and it is more likely that HSA’s will exacerbate many of flaws that we are already experiencing in America’s health system. Nor does it address the insurance companies retroactively canceling people’s insurance.
In short, I want people in our society to be able to live by best knowledge we have available for their well-being. Much like education, I do not think it should be completely contingent on their ability to pay. This thinking is present in medicare and medicaid and I don’t see a good reason why it should not be pursued to its logical end, much like it is in the vast majority of other industrialized nations.