I
diaried last week on Health Savings Accounts, and my experience with my own such account. To recap, I'm extremely healthy, earning well, and thus the perfect customer for such a program. It's
absurdly advantageous for me personally.
My deductible, $3,500 per year, goes into my savings account (a money market account that earns about 3%, compounded quarterly, no fees), and I pay my routine expenses from debit withdrawals from that account. As a 33 year old single woman, my expenses consist almost completely of dental checkups and birth control - about 500 dollars per year. The required premium for my high-deductible insurance policy, a required companion to a health savings account, is about 50 dollars a month, or 600 per year. Entering my third year of this kind of account, the accumulated interest alone is more than my routine health care expenses. By the end of year five, at which time I'll be 36 years old, the accumulated interest will be more than my insurance premiums, too. And finally, by the time I'm 40, the accumulated interest will be more than my annual deductible.
Finally, there's a here and now tax advantage - every time I make that $3,500 annual deposit, I get a tax break worth, to me, about 1,200 dollars. With annual health care expenses (insurance premiums and routine costs) of about 1,100 dollars, thanks to Mr. Bush,
I made money on my health care in year one - about a hundred bucks of tax advantage over what I paid out, plus another hundred bucks or so of interest.
This is my reward for earning in the top 1% or so of George Bush's America - I make a profit on something that bankrupts people who aren't as fortunate. Note to self: avoid getting sick. Avoid getting old too.
Now I don't know what, or even if, George Bush thinks, but it seems to me that this is unfair, and borderline immoral. Like the proposed social security reforms, the Republicans are pretending to offer me more control and opportunity, but what they're really offering is the opportunity to eat all the risk myself. I can probably do that, but my situation is very rare.
HSAs might make sense as a national system if we consumed too much health care. But with so many of us uninsured, it's absurd to assert that we, as a nation, have too much health insurance. It's palpably obvious that we have heartbreakingly too little.
We need to let doctors provide the health care, and make the decisions with patients about what's needed. But we need to share the financial risks among all of us together, and that means private medicine with public financing. Governments don't always excel at providing services, especially when Republicans run them, but they can manage writing checks reasonably well.
There's a good plan circulating in the California Senate described here, and it's not a bad start. I would make one significant change to it, however. Rather than having the financing come out of a new payroll tax, I'd like to see it done as a surcharge to the income tax. This would be less regressive, broaden the tax base to include more non-wage income, and make the fund less volatile to ups and downs in employment.
The question we must always ask ourselves is "Is our country better off?" and never "Am I personally better off?" Because the policies the Republicans pursue are designed to separate and isolate us from one another, and I don't want to live in that kind of America.
From deTocqueville, Book 2, Chapter 5:
Aristocratic communities always contain, among a multitude of persons who by themselves are powerless, a small number of powerful and wealthy citizens, each of whom can achieve great undertakings single-handed. In aristocratic societies men do not need to combine in order to act, because they are strongly held together. Every wealthy and powerful citizen constitutes the head of a permanent and compulsory association, composed of all those who are dependent upon him or whom he makes subservient to the execution of his designs.
Among democratic nations, on the contrary, all the citizens are independent and feeble; they can do hardly anything by themselves, and none of them can oblige his fellow men to lend him their assistance. They all, therefore, become powerless if they do not learn voluntarily to help one another... A people among whom individuals lost the power of achieving great things single-handed, without acquiring the means of producing them by united exertions, would soon relapse into barbarism.