[PBzeer]

Health Savings Accounts. My prescription for health reform.

Fleshing out the details. What would an Health Savings Account look like?

First of all, the mechanism is already in place from the Bush Administration. So we aren't creating another government agency. There are though, qualifications that need to be changed. (In this respect, I feel the government does have a role, if not consistent with the Constitutional role, at least with current government practices.)

Like SS, everyone will have an HSA. (again, while I deplore the addition of yet another government mandate, it's the only practical solution, so I'll live with it.) Contribution limits (max and min) will be based on family size, and minors will be able to contribute to their HSA while still covered under their parents. Monies may be disbursed for any immediate family member (great grandparents through great grandchildren) above a certain minimum level of coverage for the one sharing. In other words, if you have, for example, 5k in your account, any amount above that can be used to assist immediate family member expenses.

Also, any amount above minimum can be invested in government debt vehicles. In other words, we buy our debt, rather than sell it to foreign countries. Once these investments reach a defined minimum, per person under the HSA, they can be used for specific purposes (purchasing a home, education or applied to one's catastrophic insurance premiums). Any and all monies are applicable to medical expenses at any time.

Catastrophic insurance will be the responsibility of the insured, with premiums to be from gross income as an incentive (tax free in other words). Employers may contribute to premiums, but aren't required to, and doing so would come with no tax advantage for them. (So, instead of being tied to a job by insurance, it would be simply an incentive to work for a particular business like wages are.) Employers would be able to make tax free contributions, ala 401k's, to an HSA.

Catastrophic insurance will be available nationwide and portable, regardless of employer or employment status. The only two regulatory provisions will be a basic coverage level and no restriction for pre-existing conditions. The insurance companies though, will be free to offer higher coverage, exclusionary plans, though they will be based solely on the consumers choice to pay for them, IF, they offer a basic non-exclusionary plan. In other words, they can't cherry pick their pool of participants to lower their costs, vis-a-vis those only offering the basic plan. (Of course, I don't hear a lot of outcry about auto insurance picking their pools, or charging higher premiums for even non-driving related reasons, ie: credit status, as well as on driving record.)

So, we have actual incentives that can actually control costs by making medical expenses the direct concern of the consumer rather than a third party. We have also introduced true market competition for those consumer dollars that can't be equaled by government "competition". But, beyond that, we have government creating equal opportunity, which is it's province, rather than trying to provide some unattainable equality of outcome, which is not it's mandate.

As an added benefit, if they just address the issues I've outlined, we're talking a 10 page bill as opposed to the 1,000+'s one's now being debated.