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January 31, 2006
Three Million HSA Users Can Be Wrong
I really don't know what Kevin's concerned about here:
there are plenty of proposals Bush could make that would be pretty popular among people who already use HSAs. For example: increasing the contribution limit; expanding the range of services covered by HSAs to include things like hearing aids and maternity care (which isn't covered by many plans); allowing money to be withdrawn for nonmedical purposes after age 65 (or even better, 55); and so forth.
My point here is mainly a political one. Fighting HSAs on philosophical grounds is one thing, but people who already use them would be pretty pleased to see some concrete, money-saving improvements to HSAs — and wouldn't much care about their abstract virtues or defects. If we're going to fight the HSA-ization of healthcare, we'd better be prepared to be on the opposite side of some motherhood and apple pie proposals from the White House that might sound pretty good to current users.
There are -- top estimate -- 3 million users. 1 percent of Americans. If Republicans can be on the wrong side of the 45 million uninsured folks, we can go against the interests of the few HSA users even paying attention.
The answer to Bush's marginal tweaks on HSA's is pretty simple. Kate had it earlier today. "Small fixes won't work." Republicans had no end of fun painting Democrats as stewards of broken, aged ideas. Democrats can have a similarly enjoyable time lashing Republicans to the busted status quo on health care. Premiums are skyrocketing, hundreds of thousands die from medical errors, doctors have yet to discover computers, we pay twice as much as any other country...and Bush wants to tweak the tax deductibility of care? Does Frank Luntz know?
January 31, 2006 | Permalink
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Comments
I don't think you will do well campaigning on American health care sucks. First, it sounds very negative, and people like positive visions (Obama anyone?.) Second, and perhaps most importantly, even if it is true, most people don't believe it and probably won't. They may be unhappy at what they are paying, or wishing that they could afford insurance, but the don't think the whole thing is a mess.
From my perception, they are willing to live with the expense and the number of uninsured rather than risk changing how healtch care works in this country dramatically. The challenge in getting single payer, is concinving people that you won't mess everything up by doing so. Saying that the whole thing stinks anyway is hardly a good way to inspire confidence in that.
Perhaps you see the best path as convincing everyone the whole thing stinks anyway as a means to overcome this caution. I highly doubt that such a strategy will be successful. In fact, I suspect that it will be incredibly, spectacularly, unsuccessful.
Posted by: Dave Justus | Jan 31, 2006 4:09:17 PM
Might want to check some polling on that, Dave.
Posted by: Ezra | Jan 31, 2006 4:34:00 PM
Damn, Ezra, its no fun when you cite polling FACTS on public opinion on our health care non-system. (LMAO)
Fundamental change can sold, however, only if the plan passes the venture capital business plan elevator test: it must be able to be understood in the few minutes it takes to get from the ground floor to the destination floor on the elevator.
It must be straightforward and easy to understand, like:
- All citizens will receive healthcare insurance from the USA (as in Medicare Part A, and standard Part B), and be able to use any healthcare providers. Premiums for the insurance for those under 65 will be set taking into account the ability to pay, based on income.
Posted by: JimPortandOR | Jan 31, 2006 5:00:00 PM
addition to my elevator explanation: Prescription drugs are included in the insurance automatically.
Posted by: JimPortandOR | Jan 31, 2006 5:02:50 PM
Ezra, your position seems to me to be completely rebuild, which has 38% support and I expect that that number will not be growing.
You might also want to remember that some of the 'fundamental change crowd' is probably for laissez faire, rather than universal health care.
The wording on the question strikes me as somewhat poor, but for the sake of argument I will accept is as accurate.
I remain convinced that you would be more effective if you focused more on how your propossals would strengthen the positive aspects of the system, rather than a sales pitch that boils down to 'it sucks, and it sucks so bad that there is no risk.'
Posted by: Dave Justus | Jan 31, 2006 6:24:41 PM
Do you understand the difference between evolution and revolution, Dave ? Even nature culls the dead ends.
Posted by: opit | Jan 31, 2006 9:37:46 PM
On HSA's and Bush's speech, which has begun I guess, who is going to care besides us? 1% of Americans have them. In fact, I'm one of that 1%, I read this blog, love to debate health care policy and I don't frickin' care about whatever Bush says about them.
"Heh. There's these here HSA's's. That stands for Health Spending Account. Heh. Whatcha do is take money out from your paycheck, see, and put it in this spendin' account, and when you go to the doctor, you gotta get a receipt, fax it in ta the company that does the re-im-burse-ments and then wait 5 days for your money to get back to ya. But a regular credit card receipt won't work. Ya need ta have your name on it, the doctor's name, the date, the reason ya went, and a description of the care ya got. Heh."
Yeah. That'll really win over Joe Sixpack, who's been told by the GOP that 1 hour to fill out his 1040EZ is once a year is just too damn long.
Posted by: Stephen | Jan 31, 2006 9:53:17 PM
Just heard the speech...what a letdown.
I mean, exempting HSAs from state regulations and some kind of portability tweak?
I was so pumped for this fight-I thought there'd be new tax credits and refundable credits and seeded accounts and new qualifying expenses, and the ability to borrow against an HSA and, hell, a free toaster with every new account. I was raring to go! But this...it's just sad.
I feel like I went out and got me a new dress, got my hair done, and even picked up some fancy high heel shoes, and George showed up in dirty work clothes and took me to McDonald's. The drive-through.
Posted by: theorajones | Jan 31, 2006 11:09:35 PM
Although the point on the numbers is a good one, the only relevant political questions for the Democrats is a) how many current Republican voters switch sides and b) how many non-voters are persuaded to vote Democrat. It might be that the overwhelming number of the 45 million unisured are non-voters or super reliable Democrats. It might also be that amongst the 3million current HSA users, plus the x million, close-to-HSA-and-will-now-take-HSA people, there are a large number of hair-trigger marginal voters.
Put another way - the 45 million are largely poor, and are therefore screwed over in so many ways by Republican fiscal/economic policies that it would be silly for them to change their vote based solely on an amelioration of only one part of aforementioned screwing.
(Potential) HSA users, on the other hand are probably youngish and middle-class - prime targets for nice little handouts leading them to the GOP
Posted by: JohnTh | Feb 1, 2006 9:54:20 AM
The challenge in getting single payer, is concinving people that you won't mess everything up by doing so.
Oh, Dave. Ezra doesn't believe that at all. All he ever states are the estimated cost reductions of a single-payer big government solution. He thinks that is the one and only issue to be consideered and he is mystified why everyone is not on board with his most excellent ideas. Of course, he is wrong.
Posted by: Fred Jones | Feb 1, 2006 11:37:18 AM
Count me as another HSA consumer who would be pleased to see the damn things go away. I have a $2500 deductable, put aside $2500 a year, and spend $2800 a year on prescription drugs--meaning I wipe out my account every year.
Now, I'd go so far as to say I'd be okay with limits on some of the drugs--I pay $200 a month for Strattera to control ADHD. If you wanted to put that in a class I have to pay for out of pocket and/or HSA while I get my antibiotics paid for, that would be a reasonable discussion--one I could even get behind.
But in general, HSAs suck. And I don't see their expansion as a benefit. I don't know as single-payer is the solution, but it seems to work in every other western democracy; it certainly couldn't be worse.
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