Ezra Klein compares his views on Medicare to those of a conservative and finds that, while they have similar views on the problem, they differ greatly on the solutions:
What always fascinates when I read right-wing critiques of American health care is how similar our diagnoses are, but how diametrically opposed our treatments would be. For the right, more consumer risk is required in order to encourage wise treatment decisions on behalf of patients. That means, of course, that those who make poor decisions, or simply get really ill, face financial ruin. That seems crazed and cruel to me. While I do think the left needs to take financial incentives more seriously than it does, I’d favor having many more carrots than sticks, and I’d want to separate out poor decisions and behaviors from simple bad luck. HSAs and all the rest punish the illogically stricken as surely — or more surely — than they do the stupid. And I’m not even ready to punish the stupid. So much as I think it inadvisable that half of those with HSAs haven’t deposited a cent, I’ve no interest in abandoning them to the consequences of that oversight.
Ezra has it right, but to that I would add that, when it comes to health care, there are a lot of “stupid” people. Stupid is really the wrong word here because I’m speaking of the attitudes of most people, regardless of intelligence. The average person (and even some of my collegues, but that’s a topic for another day) lack sufficient knowledge to make decisions with regards to chronic and preventative care.
Most people might know to go to see a doctor if they are seriously ill (assuming they aren’t among the growing number who cannot afford it). Far fewer understand the importance of treating problems like elevations in blood pressure, blood sugar, or cholesterol when they have no symptoms. It is far more economical, both for the patient and society, to treat hypertension and diabetes early and aggressively than it is to pay for coronary artery bypass surgery, amputations of limbs, renal dialysis, and long term care following a stroke.
We cannot force people to make wise decisions, but at least we can make the system one which encourages patients to do the right thing. Health savings accounts, accompanied by high deductible insurance policies, lead to people putting off routine and preventative care. Patients are much more likely to seek needed medical care when it does not come out of their own pockets, but do not like to spend either thier own money or money in their HSA. There are many possible ways to make health care more affordable, but in the long run HSA’s are a poor method.