Opinion: Republicans, HSAs fall short on health care

DELRAY BEACH — Imagine it’s 3 a.m. and your stomach aches. Not the kind of ache that you’ve endured before. Something far more severe. It’s as if someone put your body in a giant vise and turned it and turned it well beyond the point that you can tolerate. You toss, you turn. You take aspirin. Nothing gives you relief, and in fact the pain only grows more intense.

Heart attack? Maybe. Appendicitis? Maybe. Perhaps it’s something you ate. Perhaps it’s something that will go away on its own. Your mind races with the possibilities.

What do you do? Drag yourself somehow to the nearest emergency room? Or get out the Yellow Pages and start calling emergency rooms to get an idea of what they charge for diagnostic procedures you might need based on the symptoms you give them. Oh and don’t forget what the physicians charge, and you might want to inquire about room rates in case you’re admitted.

Most sane people would take the first option and let your insurance company worry about the expenses. After all, that’s why you have insurance in the first place.

Republicans, however, might expect you to choose the second option. That’s because they want you to have a high deductible insurance plan with a health savings account attached to it. They want you to know what the real cost of all those procedures and tests doctors and hospitals want to run on you.

Republicans believe we’re overly insured. Overly insured to the point that we’re out of touch with the market for health care and it’s economics. We have no idea of what an x-ray costs or a body scan costs or that pill the nurse asks you to take when she wakens you in the middle of the night. Did you really need it?

Their solution: the high-deductible insurance plan with health savings account. The employer-based model generally comes with a chunk change, a few thousand dollars to seed the HSA. You’re responsible to cover most medical expenses out of pocket until you cover the deductible, usually in the thousands of dollars, and coverage kicks in. Because you’re responsible for covering a bigger chunk of medical costs out of your own pocket, you become more price sensitive. And price-sensitive consumers can help contain health care costs that are surging far beyond the rate of inflation.

Anything you don’t spend remains in your account, which moves with you if you change jobs. Because they generally come with lower premiums, they can be a good deal — if you don’t get sick.

There is some logic to the idea that we need to be better consumers. When we shop for other things, say a car or house, we don’t shop blindly. We know how many rooms a house has, the square footage, it’s general features. We hire inspectors to find whatever flaws might exist that our eyes can’t detect so we know what we’re buying. We know the asking price and negotiate the final price. Don’t like the seller’s bottom line? Move on.

Same with car shopping. We know what features are standard on a particular model, what the options are and what those options cost. We have a general idea of the quality of the car based on who made it. We can research online, read reviews. We test drive it. If we don’t like what we hear at one dealer, we chose another. Or consider another model or another brand.

The market works there. But health care is obviously different. If you, your spouse or your child is in pain, you’re not going to be focused on costs (are you going to ask for the cheapest pain killer, or the one most effective? Or perhaps none at all to save a few bucks?). If you have a life threatening condition, are you going to choose the most cost-effective treatment, or the one most likely to keep you alive? You’re told you need a triple bypass. Do you ask the surgeon to do only two arteries as a way to keep costs down?

The problem is that when it comes to health care, outcome is always going to trump cost. If you wake up in the middle of the night with severe abdominal pain, you just want the doc to find out what’s wrong and make it go away (actually you want him to make it go away first, then worry about the cause). You worry about the cost when the bill comes in the mail (which might cause you a different kind of pain, but that’s another story).

And forget about it if you have a cronic condition that needs continual care, diabetes, say. High deductible policies and health savings accounts are fine for some, especially for younger workers; but as a bulwark of a health care reform, they fall short. Even combined with other major Republican ideas — allowing consumers to buy insurance across state lines (never mind the regulatory complications involved) and tort reform (most malpractice litigation takes place in state courts, not federal) and you get only 3 million more Americans with health care coverage and tens of millions without.

Our suggestion: If Republicans are serious about health care reform, they should work with congressional Democrats and President Barack Obama to improve the Affordable Healthcare Act rather than to repeal it, which is not going to happen even if they capture the White House and the Senate in 2012 (filibuster anyone?). That might not score points with their rabid base but it would with most Americans.

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