Pearlstein Live
washingtonpost.com
February 8, 2006
Steven Pearlstein writes about business and the economy for The Washington Post. This is from a transcript of his online discussion.
Washington, D.C.: I’m hoping you can clarify a key point during your discussion. Nearly every newspaper article I’ve seen recently reports that there are now 3 million HSAs (this is based on a recent survey of health plans conducted by AHIP and has been cited by the White House). This is misleading. AHIP’s study found that 3 million lives were covered by a high-deductible health plan (HDHP) that is COMPATIBLE with an HSA. HSAs must be opened by a bank or other qualified trustee. Based on some early data we’re compiling, it looks like about 1 million HSAs (the actual accounts) have been established as of Jan. 1.
Steve Davis
Managing Editor
Inside Consumer-Directed Care
Steven Pearlstein: Thanks for that clarification.
http://www.washingtonpost.com/wp-dyn/content/discussion/2006/02/07/DI2006020700721.html
Inside Consumer-Directed Care is an industry publication:
http://www.aishealth.com/Products/NewsICD.html
Comment: By Don McCanne, M.D.
CDHC advocates (consumer-directed health care) are using AHIP’s report (America’s Health Insurance Plans) on three million HSA-compatible (health savings account) HDHPs (high-deductible health plans) to “prove”
that they’re not only for the young and wealthy. Their claim is that many older individuals with more modest incomes are turning to HSAs.
Higher-income individuals welcome the tax advantages and the opportunity to expand their pensions through the HSAs. Lower-income individuals are more desperate and are seeking health care coverage with lower premiums.
Higher-income individuals also welcome the HDHPs as smarter insurance when paying up-front costs is no problem, but lower-income individuals lack the discretionary income to fund the HSAs.
We do not yet have the data defining the income levels of the one-third opening HSAs and of the two-thirds selecting only the HDHPs but not the HSAs. But if the studies show any other trend than the blatantly obvious, the news headlines should reflect the view of a nation gone mad.
I checked eHealthInsurance for HSA-compatible plans in my zip code, and the lowest deductible I found for a family of four was $3500 individual/$7000 family, and the lowest premium was $2448. Median household income in 2004 was $44,389. Calculate the cost of housing, food, clothing, transportation, and other essentials, and then add the cost of HDHP premiums and the deductibles required before health care coverage begins, and then see how much you have left to deposit in a health savings account (even if you gave up computers, television cable, cell phones, etc.). It is no wonder that the nation’s savings rate is now a negative.
The CDHP advocates claim that these policies are great for older, lower-income individuals. To be fair, they are not quite countering our argument that they’re for the healthy and wealthy. They avoid using the spin that they also work for the sick and poor, substituting, instead, older and with lower incomes. But ignoring the needs of the sick is the fatal flaw in their proposal.
There is an important consequence of the HDHPs, intended or unintended. Only individuals with health care needs will be contributing to the health-cost-related expansion of the negative national savings rate. The majority of us who remain healthy will not have to share in this particular burden, at least not until the cost-shifting exceeds our discretionary income.
Okay. So young or old, sick or healthy, high-deductible health plans work for you as long as you qualify on the basis of wealth.