HSA's on the March

This LA Times article on the rise of Health Savings Accounts in employer-offered health plans is the most important piece you'll read this week. Corporations, tired of paying out the nose for health care, are pushing the cost onto employees. Employees, sick to death of huge premiums, are taking them up on it. The catch? HSA's look cheap upfront, but when you actually start going to the doctor or having health problems, the cost makes your premiums look meager.

The sick, of course, know that they can't afford HSA's. So only the healthy use them. But subtracting the well-off from the risk pool and leaving only the chronically ill shoots premiums ever-higher, making health care prohibitively expensive for both the ill and the old. This means that HSA's are not, as a health care consultant in the article admits, a cost control. Instead, they're a cost shifting device. Employers are trying to escape the bills for health insurance and so they're enticing workers into programs where upfront cost is low, but the actual cost is high. All this, of course, comes after the bankruptcy bill, which made bankruptcy harder to declare. Bankruptcy, of course, is generally declared after health emergencies, and often by people with preexisting health insurance. Get ready for more of them. It's like the bill was a preemptive strike.

What it all means is that the safety net's holes are getting larger. They're being widened by legislation, widened by employers, and widened by rising costs. In the past, government has tried to counterbalance the other forces by controlling costs, offering subsidies, or legislating programs that helped working families bear the load. The Bush administration, however, has done the opposite. In the Ownership Society, you own all the risk, and combined with the other forces massing against working families, that's a lot of risk.