We’d each be better off if we paid all but the biggest medical bills out of
pocket and saved insurance for catastrophic events. Truly needy people would
rely on charity, not government, because once government gets involved,
unintended bad consequences abound. If people paid their own bills, they would
likely buy high-deductible insurance (roughly $1,000 for individuals, $2,100 for
families) because on average, the premium is $1,300 cheaper. But people are so
conditioned to expect others to pay their medical bills that they hate high
deductibles: They feel ripped off if they must pay a thousand dollars before the
insurance company starts paying. But high deductibles may be the key to lowering
costs and putting you in charge of your health care.
Stossel's explanation for the escalating cost of American healthcare is the typical conservative mantra that Americans consume too much health care. If we could only somehow make consumers directly bear the cost, they would start making smart, rational cost-sensitive decisions and stop consuming so damn much unnecessary health care
Which is stupid on so many levels. American health care is insanely expensive for numerous reasons, but lack of price transparency/sensitivity is not one of them.
The biggest waste of healthcare dollars by far are the structural inefficiencies inherent in the modern health care industry: the fact that doctors & hospitals spend 15% of revenue trying to get paid; that insurers waste 10-20% of premiums on administration; wasted spending on defensive medicine and malpractice; the lack of access to preventive healthcare, etc.
Beyond that, there may be a role of overutilization, but it is just silly to think that by shifting the cost onto consumers, that consumers will cut back on the right items or make more rational decisions. For example, higher deductibles will create a negative incentive for patients to access routine preventative services, which may lead to later detection of disease or poorer control of chronic diseases like diabetes. This would also likely fall heaviest on the economically disadvantaged who are most price sensitive and most likely to skimp on 'elective' doctor visits and tests.
On the other hand, the largest amount of "wasted" dollars is in fact physician-driven, and consumers in general do not have the education or resources to second-guess the advice given to them by their doctors. For example, if you have chest pain, and an abnormal angiogram, and you find yourself in the recovery room talking to a cardiac surgeon who is recommending a bypass, most people are going to be terrified and happy to accept the advice of the intelligent, trusted expert at their bedside. You are probably not going to go home and research the benefits of CABG vs stenting, nor are you likely to look around for the best price, were that information available. Or if you have been suffering from chronic knee and back pain and your orthopedic surgeon recommends an arthroscopy or laminectomy, most patients are unaware of the data showing that many of these procedures are no better than placebo, and even if the surgeon discloses that fact, but says "I think you are likely to benefit because ..." the natural tendency is to trust the doctor and go with his/her recommendations.
Ditto in the ER -- you come in with heartburn, and I see you and wonder if it might be a heart attack or an Aortic Aneurysm (and I hate getting sued) so I recommend a CT scan and and admission for a rule-out MI work-up. People rarely if ever inquire as to the costs, and when they do, I point out the risk to their life, and that tends to end the debate. And when you are 80 and demented but your family it too squeamish to sign a DNR, you can get a week in the ICU for the pneumonia which should have naturally ended your life.
Now, I am not claiming to have an answer for the spiraling costs of healthcare. It seems like a particularly intractable problem. My point, however, is that none of these drivers of health care spending will be affected by HSAs and higher deductibles. HSAs are a scam to let the wealthy (like me) shelter money pre-tax, and to shift some of the cost and risk of health care from Bushco's corporate masters onto consumers.
And, not to beat the dead horse once more, it does nothing to cover the uninsured.