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HSAs to include things like hearing aids and maternity care (which isn't covered by many plans); allowing money to be withdrawn for nonmedical purposes after age 65 (or even better, 55); and so forth.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?
