The "Galen Institute" is pushing some studies
here
that make pretty questionable claims that
Consumerism is working in the health
sector, with a number of studies showing that companies and individuals who move to Health Savings Accounts and similar plans experience lower costs while maintaining access to needed
health care.
I have no problem with HSA's. I just don't like the way they are sold as "insurance" or as an alternative to insurance - or even worse, by the Bushites, as a solution to the health care crisis. This article is just very questionable numbers trying to push that agenda.
I talk about why on the inside ...
An HSA is a tax-free savings plan. Period. It doesn't pay anything
for you. It is
your money you're spending. I can't stand when people tell me how great it is that they can roll over the money at the end of the year. I say "you mean your employer is letting you keep your own money? How amazing!"
When a company takes away insurance and gives you an HSA, they're basically saying: "now you can pay for your health care with your own money". How is that a better deal than insurance?
(Yes, I know that some employers contribute to the HSA account. They consider that part of your wages and so should you. It's still your money.)
Here are my specific problems with the studies in this article:
- Every study is performed by a company that sells HSA's. Not exactly objective. And most of the companies are trying desparately to find a product that will steer small businesses away from traditional carriers so they can grow their own business (for instance, that's e-healthinsurance.com's entire business strategy, and they did one of the main studies quoted here). So there is a huge incentive to make HSA's look good for these companies. If e-healthinsurance.com can convince small businesses that HSA's are good ideas, they can sell more HSA's to companies who currently deal with the big brokers or directly with the big boys (Cigna, BlueCross, etc.)
- The studies claim that HSA's "save costs" for companies. Well of course they do! They cause employees to spend their own money on care. It's the employee's money that's in that account. It's deducted from their paycheck.
- The studies tout the "benefit" of "flexibility" for employees using HSA's as opposed to traditional insurance. Well, again, of course it should be flexible: it's MY money! I should be able to use it however I want! And note: it shouldn't be an amazing benefit to be able to use your health plan to see a specialist you need to see - the problem is that insurance doesn't allow that.
- The studies rave about how the "critics were wrong", and HSA's are not just attractive to the rich - poor people are purchasing them too. The main stat is "40% of HSA-eligble plan purchasers earned $50,000 or less annually."
Now, a "HSA-eligible plan" refers to a high-deductible insurance plan which is paired with an HSA. These plans are way cheaper than lower deductible plan, for the obvious reason that they are terrible plans because they only pay out after you spend a lot (I think $2000, but maybe $1000) of your own money. SO: they are surprised that
poorer people are purchasing
cheaper insurance? Wow, what a shocker.
5. They make a lot of claims about increase in preventative care among HSA users, and even quote participants who supposedly chose to start taking care of themselves because, for the first time, they realized it would save them money.
Maybe this is true, but I find it incredible. This is claiming that people are motivated by cost savings of a MAXIMUM of $2,000 / yr (max of HSA $) - assuming that through healthy living they can drive their utilization to ZERO.
And they're claiming that the same people were never motivated by a desire to live longer, feel better, avoid debilitating pain of heart attacks, stroke, liver failure, etc.
It just doesn't add up. I want to talk to one of these people. Note: the study doesn't say what types of preventative care and how these folks are going to save all this money.
The article does have interesting, but conflicting, information about the affect on utilization. Most data on this is from the Aetna study. It claims that HSA's preserve "access to needed health care", but cites "lower use of inpatient, laboratory, and primary-care hysician visits." It claims "Health measurements were stable for members with chronic conditions" without defining "stable". It says "those with chronic conditions, such as diabetics, continued to seek necessary care."
The most interesting finding, to me, is that members were "much more likely to visit an urgent care center than a hospital room." They cite this as an example of how HSA's cause consumers to make more cost-conscious treatment decisions.
That's BS. Anybody would want to go to an urgent care center instead of an emergency room. It's faster, cleaner, and friendlier. Regardless of the cost. But many insurance companies don't contract with urgent care centers. So you can't use them if you have insurance, but you can if you have an HSA. That is probably the reason for the change, and it has nothing to do with "cost-consciousness."
Overall, the entire idea that people are out there getting lots of extra health care because it's fun and they don't understand the cost is just stupid. Who does that? Find me somebody who's getting chemo for kicks, or enjoys waiting in line at the emergency room while missing a day of work. It doesn't happen.