32 million people have a Health Savings Account with more than $100 billion in balances. And they love them. They would love them even more if we could dispense with the across-the-board, high deductible requirement and let the account be perfectly flexible with respect to their health insurance.
Hard to believe that anyone today opposes them. But Sherry Glied and her colleagues have done just that in a Health Affairs article.
It’s fairly obvious that Glied, Remler, and Springsteen suffered from a pre-existing condition—opposition to HSAs. They just decided to round up whatever suspect evidence they could manufacture to augment their main grievances—that HSAs are a regressive tax benefit for wealthier individuals and (unstated) that they get in the way of the health policy reform plans of others, by allowing too many free-range humans to stray from the main collective herd. For example, they criticize HSAs for dampening any initially higher cost consciousness, even while writing “Whether or not such cost-consciousness is desirable is debatable.”
Ironically, the ideological blinders on the authors kept them instead from (1) understanding and explaining the most powerful sales pitches for HSAs, which have “evolved” over time and (2) offering some useful reforms to address remaining substantive concerns.