Saturday, July 5, 2008

Sabotaging health savings accounts

Herre is a copy from the AAPS website, worth repeating here:
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"Sabotaging health savings accounts
June 18th, 2008

Nothing probably shows the potential of health savings accounts (HSAs) better than their enemies’ attempts to wreck them. An attempt to load on costly administrative requirements passed the House of Representatives but not the Senate. President Bush had threatened to veto it. Expect it to come back.

H.R. 5719 would have required every HSA transaction to be reviewed and verified as a legitimate medical expense. Currently, such expenditures are subject to an IRS tax audit, and many are made with a debit card that is only useful at a facility providing medical supplies or services.

A Wall Street Journal editorial called it “Health Savings Sabotage,” with a key player being Rep. Pete Stark (D-CA), who views HSAs as a “weapon of mass destruction.” While Democrats, including Barack Obama and Hillary Clinton, decry the high cost of medical care, including insurance overhead, “Mr. Stark and his friends want to impose the same bureaucratic overhead even on spending that consumers do with their own money” (Wall St J 4/19/08).

Cheating is a nonproblem, the editorial stated: “In any case if people cheat on their HSAs, they are only cheating themselves.”

Lobbying for the provision was EvolutionBenefits, which makes software used for “substantiation” of expenses in employer-owned Flexible Spending Accounts. H.R. 5719 would have enabled EvolutionBenefits to charge twice as much for administering HSAs.

“This is a near perfect example of the corruption of Washington,” writes Greg Scandlen. “A powerful member of Congress using his authority to benefit a single company at the expense of millions of consumers and taxpayers” (Consumer Power Report #123, 4/23/08),

“The message is clear,” writes Dan Perrin of the HSA Coalition, “we (the Democrats) think you cannot make your own decisions, so we are going to force you to pay a company to review your decisions and then we will give you access to your own money but only after we decide whether you made the right choice in the first place.”

Since HSAs were created in December 2003, 3.2 million accounts have been opened, covering 4.5 million Americans, one-third of whom were previously uninsured and bought coverage on their own. Thirty-three percent of new users are small businesses that previously had not offered coverage to their employees.

Consulting firm Watson Wyatt found that average health-insurance costs in the last two years rose 3.6% for employers who offered high-deductible accounts, versus 7% for employers who did not (Wall St J 5/1/08).

According to the U.S. Government Accountability Office (GAO), the number of tax filers reporting an HSA tripled between 2004 and 2007 (GAO-08-474R).

“The take-up rate is the fastest of any benefits innovation of our lifetimes, states Greg Scandlen. “Faster than IRAs, 401(k)s, and far faster than HMOs. The only thing that rivals it may be the conversion of HMOs into PPOs in the mid to late 1990s.”

“Which is probably one of the main factors in pushing H.R. 5719,” writes Frank Timmins. “HSAs are a threat to the SP [single payer] crowd. They need to slowly poison this baby before it grows to maturity.”

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Friday, July 4, 2008

The Car Care Crisis: A Metaphor

I owe this very good illustration and metaphor to a colleague on Sermo - DoctorCottle. Here is the copy of a recent post of his on my favorite website, sermo.

In the ten years since most automobile insurance companies were either bought out by health insurance carriers or reorganized along the lines of the "third party payer" health insurance model, it has become increasingly obvious that a crisis in car care is looming in the country. In the last twelve months alone, the average monthly cost of car insurance has increased by almost 200%.

"The cost to fill up my tank is outrageous," says New Jersey motorist Alan Duke. "A tank full of gas now costs me a $15 co-pay. Who can afford this?" Duke is not alone in his criticism of an automobile insurance system that costs drivers more and more, yet seems to deliver less and less. "I haven't had the oil changed in my car for almost 500 miles," complains Janice Taylor as she waits in a seemingly endless line at service station in her home town of Sacramento, California. Just a few short years ago, Taylor used to get oil changes two to three times a month, but like an increasing number of Americans, she has experienced repeated frustration with obtaining even basic automotive service.

Motorists are not the only ones affected by the failure of our car care system. "This will get rejected," sighs Eric Rasely, the owner and operator of a service station in Dayton, Ohio as he fills out the paperwork for a prior authorization for a wiper blade change. "It'll get rejected and then the customer will jump all over me because he has to pay out of pocket. And besides, he just had the blades changed last month. They're fine." Rasely has had to hire extra personnel over the last several months just to help him fill out and submit prior authorizations, billing claims, and other paperwork that he says takes up more man-hours than actually servicing cars.

Few would dispute that America's car care system is broken, but there is little agreement on how to fix it. Caraid, the federal automobile service assistance program for low-income motorists implemented five years ago by the President and Congress, has been plagued by skyrocketing costs and poor reimbursement for car service providers, prompting many mechanics and gas station attendants to "opt out" of the system. This has given political ammunition to Democrats whose proposed nationalized car service initiative, based on Canada's universal car care system, was rejected several years ago. While opinion polls show that an increasing number of Americans are receptive to the idea of so-called "socialized car care," concerns about waiting lists for brake jobs and rationing of gasoline, tires, spark plugs, and transmission fluid under the Canadian system have curtailed widespread acceptance of a universal car care system.

One radical solution that a small but growing number of drivers have chosen is returning to the old model of carrying catastrophic car insurance that covers only unlikely but serious and very expensive contingencies such as theft and accidents, paying for routine expenditures out of pocket. "To me it makes sense," says Ryan Smith, an economics major at the University of Alabama, as he pays at the pump with his debit card at one of Birmingham's "cash only" service stations. "Comprehensive car insurance premiums would cost me a lot more than I spend for routine stuff like gas and oil changes. I bet you'll see more and more people doing this sort of thing in the future. It just makes economic sense. Heck, I bet it would even work for healthcare."