According to the Bush Administration and other conservative groups, a single-payer health care system just won't work. The y say that the "free market" is the best way to control health care costs and deliver the best health care to the most people for the least amount of money.
The plan they have come up with is the Health Savings Account (HSA). It goes like this: You buy a high deductable health plan (HDHP) that has an out-of-pocket maximum below a certain level (~$5,000/yr individual/~$10,000/yr family). You pay for your health care costs with your own money until you hit deductable. Then the insurance kicks in and pays above this level. The HSA is available so that the money you use for health care can be saved tax-free.
This is supposed to allow more people to afford health insurance and to allow people to have more control over their own health care.
Well, it just so happens that I have an HDHP/HSA...
I have an HDHP/HSA because it is the only way I can afford health insurance for my family. We are also fortunate enough to be young and healthy. My employer pays for my insurance, but I have to pay for my family with my own money. The advantages of such a plan are greatly overstated. We are paying a little bit less for considerably inferior health care.
One of the supposed advantages of HDHP/HSA plans is that they are supposed to allow consumers to take control of their own health care decisions. Good luck if you try to do that. You see, if you take control of your own health care and go "out of network", the insurance company will only pay a percentage of the service at their negotiated rate.
For example, my plan covers 100% in network, and 60% out-of-network. So if I pay $100 out-of-network for a service that they have negotiated down to $50 in-network, then they will only pay $30, not $60, for the service, and I am on the hook for the other $70. If you have not hit deductable, then only the $30 is put toward your deductable. This is an optimistic scenerio, with my carrier, I am lucky if they pay at all.
Because of this, for all the talk of "putting customers in charge of their health care", people are still as much at the mercy of their carrier as they always were.
HDHP/HSA plans are sold to the healthy. The premiums are lower, which make them attractive to people who rarely get sick. However, what this means is that as more healthy people choose HDHP/HSA plans and more sick people choose comprehensive plans, the comprehensive plan rates will go up until no one can afford them. Then EVERYONE who has health insurance will be on an HDHP/HSA plan by default. The insurance companies will still be collecting plenty of money in premiums, but not paying anything for most people.
Another supposed advantage is that the money is "tax free", however, the "tax free" concept is of little benefit to many working Americans. Thanks to my two cute little tax credits, I have very little Federal income tax liability. Also, those who spend a significant portion of their income on health care already get a tax deduction for it.
In conclusion, HDHP/HSA plans are a gift to the health insurance industry and a good way for employers to dump more of their health care costs onto their workers. (To their credit, my employer is putting the difference in premiums between the comprehensive and the HDHP plans they offer into the employee's HSA. However, I don't know how much longer they will be able to do this.) They are also a nice tax shelter for those who need it. Like Medicare Part D, HDHP/HSA plans are a non-solution to a major problem. The Republican Party hopes no one will notice that they don't work come election time.