Mon, 1 Mar 2004
Conservatives using HSAs to prevent a “socialized system”
Medicare’s Hidden Bonanza
By Michael Scherer
For conservative leaders, the best part of the Medicare bill President Bush signed in December had absolutely nothing to do with Medicare. Rather, the provision that House Speaker Dennis Hastert calls “the most important piece in the bill” and former Speaker Newt Gingrich considers “the single most important change in health care policy in 60 years” is a little-noticed tax rebate set to cost the Treasury $6.4 billion over the next decade. The measure allows Americans to open tax-free “health savings accounts,” which can be used to pay medical bills-in effect removing their owners from the shared risk that has been the core of the health-insurance system since World War II.
For conservatives, a key selling point of health savings accounts is the potential effect on the future of health care: In making their case to lawmakers, (Golden Rule Insurance Co.’s Chairman Emeritus J. Patrick) Rooney’s allies cited polls showing that two-thirds of Americans support government-run, universal health care. By giving a large segment of the population the option to withdraw from the health-insurance system, they argued, health savings accounts could serve as a poison pill preventing another “Hillarycare” debate. “It’s going to be real hard to socialize the system if everybody has their own account,” explains John Goodman, head of the conservative National Center for Policy Analysis.
Comment: There is no question that the agenda of the conservatives is to shift the responsibility for funding health care away from collective pools, whether public or private, and onto the individual patient. They correctly perceive that health savings accounts will create a formidable political body of individuals who will have been able to reduce their health insurance premiums, funds which would otherwise be lost forever, and deposit the savings into their own personal accounts.
Because of the regressive tax policies of HSAs, higher income individuals will even receive taxpayer assistance in paying for their health costs. And if they remain healthy, they can eventually use their own accounts as a retirement plan. For the large sector of our society composed of relatively young, healthy individuals who have decent incomes, HSAs are a very good deal, providing adverse medical events do not occur.
But is this really a formidable force that will inevitably oppose universal coverage? HSAs that are not depleted become almost identical to individual
retirement accounts (IRAs) at age 65. What would be the response of this group if we adopted a universal health insurance program and told these individuals that their HSAs would no longer be exposed to the risk of medical bills but would be converted into permanent IRAs? The mere establishment of HSAs does not preclude political support for universalinsurance.
In the interim, funds that will be diverted into these accounts will have been removed from the collective risk pools. Funds to provide care for those with health care needs will be even less available. The crisis in health care funding will increase in intensity. More suffering will occur as health care becomes less and less affordable for individuals with needs.
We really do need to fix the funding of our health care system now.