Once consumers have “skin in the game” through HSAs linked to high deductibles, they become prudent in using their own money, They shop for care. Savings for retirement are encouraged as money not spent is rolled over into the next year. Evidence to date indicates people with HSAs overwhelmingly prefer HSAs to traditional health plans. Health insurance agents and banks support HSAs. HSAs give agents another product to sell and banks another product to manage. HSAs are equivalent to Individual Retirement Accounts (IRAs) and operate by many of the same rules. Proponents claim HSAs encourage individual responsibility and choice.
They present evidence that consumers at large have little interest in taking responsibility for reducing costs (“Consumers Don’t View Curbing Costs as Their Job in Choosing Treatments,” March 13, Kaiser Health News. Consumers equate expensive care with good care. They feel insurance entitles them to unlimited care. They do not want doctors to consider cost when advising treatment. In general, people don’t want the cheap test, e.g. a CT scan versus an MRI, or a generic versus a brand name drug, even though the cheap drug may be just as effective.
Opponents of HSAs tend to be financial executives with health care institutions and progressives who feel that government experts and private elitists know best, that patients do not have sufficient intelligence or information to make their own health decisions, and that they have a paternalistic duty to protect patients.