I find this the most baffling line of argument:
"One of the reasons we have a healthcare crisis is because, as a consumer, I don't have that much skin in the game," said Arkansas GOP Gov. Mike Huckabee. "A lot of us feel there needs to be a transformation from a third-party [insurance] system to more [financial] participation by the [patient]."
This "skin in the game" phraseology has emerged the leading trope of the HSA-movement, so much so that it was a running joke throughout a recent health policy conference I attended. But its weirdness transcends its linguistically resemblance to George Allen's politics-as-football-metaphors language. In health care, all your skin is in the game. If you don't seek out the right care from competent professionals in sanitary environments, you...die. And if the threat of death, or illness, or amputation (as seen in the negligent self-care of many diabetes-sufferers) doesn't put your "skin in the game," Huckabee thinks moderate financial exposure will? Just how greedy are Republicans?
But sometimes, it doesn't matter how vulnerable you are on the field, the play's already been called and you rapidly learn that you're a) not the coach and b) ill-equipped to call an audible:
Magdalene Adenau, who is 29 and single, ended last year with about $700 left in her health account. And when she needed a chiropractor, she went to one who charged about $60 until she shopped around and found one who charged about $30. "There's a real benefit to you if you use the money smartly," Adenau said.
But when his son was hospitalized, said Meschke, the Minnesota professor, "I realized that I neither had the bargaining power nor mental capacity" to influence the price of Jason's chest X-rays, intravenous fluids or antibiotics. The hospital staff he asked about the charges had no idea, he said, "and you are kind of overwhelmed with the medical aspects of this. If you're negotiating a car, you can always say, 'I'll walk off the lot.' If your 1-year-old kid has an I-V in his arm, you don't have the same situation."
A survey last fall by the Employee Benefits Research Institute found that people with HSAs were more likely than those with other health plans to delay or avoid care when they were sick.
And Meschke's experience with his son demonstrates the central flaw of the skin-in-the-game theory: It's when you're most vulnerable -- when you have the most "skin in the game" -- that you're least likely to make the decision on your own. Those are the moments when you defer to the doctors and health professionals with decades of experience and an interest in seeing your son pull through. You may decide to call your own play to save thirty bucks on acupuncture, or delay your own care because treatment for your hypertension would keep you from paying off the car, but HSA's sure as hell aren't changing attitudes towards your kid's chest x-rays.
