August 2020 Edition. Volume XX

MSABut200Why would any sane person willingly turn over the responsibility for their health care to a third party whose primary interest was not that individual’s own welfare? In dictatorships or socialized societies the lone individual often has no choice, but, why would anyone, in their right mind, voluntarily authorize a third party, who has a inherent conflict of interest, to hold their health care, and perhaps their lives, hostage? Why would physicians, frustrated with the continued insinuation of managed care and managed care gatekeepers into the patient-physician relationship begin to consider unionization as their only hope of retaining control over a process gone awry? Is it in the patient’s best interest to have their physicians resort to unionization? Is it in the patient’s best interest to be forced to accept managed care or a socialized health care system? Are there better alternatives? Of course there are. They represent any viable arrangement where the patient is placed in the driver’s seat regarding the destiny of their personal health care. One example of an Health Savings Account (HSA) is the Medical Savings Account (MSA). As Steve Forbes has pointed out MSAs are one means of allowing patient independence from a severely flawed system.  Is today’s consumer capable of such a responsibility? One never knows until it’s tried on a level playing field. So far the managed care industry has fought, tooth and nail, to prevent this from happening.

What better incentive than a HSA could a person have to stay healthy? What better incentive could there be for individuals to continue to learn about, and practice, true preventive care (not what the managed care industry thinks it is).

When first introduced in 1966 MSAs (the first HSA) were vigorously opposed by congressional liberals such as Ted Kennedy who did their best to destroy this new concept by limiting the number of MSAs which could be written from then to the end of 2003 to 750,000 policies.  At the end of June 2003 the Congress, reauthorized, renamed and expanded MSAs.  The newly named Health Savings Accounts and Health Savings Security Accounts breathed new life into allowing patients to become in charge of their destinies.  “The idea here is mate an inexpensive, high-deductible insurance policy for serious illnesses with contributions to a tax-free health spending account.  Individuals will have an incentive everyday health care wisely, because what they don’t spend can be “rolled over’ and accumulated to meet the bigger health care costs that generally kick in with age.” (A Comeback for MSAs: Review & Outlook, Wall St. J., June 30, 2003)

So far HSA’s have been “hamstrung” by the present strong opposition of the managed care industry but there is some evidence that change is finally in the wind.

Free At Last
The most important element of the Health Savings Account concept is to place the patient back into the driver’s seat and return health care decisions to someone who really cares.  HSA’s allow tax-free withdrawals for a broad range of healthcare expenses (i.e. dental work, mental health counseling, stress management programs, alternative medicine, eyeglasses, etc.).  It’s up to the individual to determine what constitutes a worthwhile expenditure. It also allows the individual to negotiate price.

Basically HSA’s are the opportunity to create new (and refreshing) health care paradigms.  They return the health care relationship back to the patient and their health care professional (M.D., D.O., Therapist, Chiropractor, etc.) rather than to a third party who has a well-documented conflict of interest and hidden agendas.  With this approach the patient becomes the ultimate purchaser as well as the very best  watchdog on controlling expenditures. A well-designed plan should have associated catastrophic, and other, health insurance attached to it.  Clearly, starting a HSA is a challenge because it’s real value increases with time.  It may not be the right vehicle for a patient who is disabled with a chronic and expensive illness.  It would, however, be a wonderful franchise for the average worker to build on.

The Appropriate Utilization of Individual Health Maintenance Programs

To make HSA’s  work they need to be logically tailored to individual needs. They also need to be provided with better visibility and organizational support. Could the United States government help in this effort? You bet they could, just consider the following scenarios:

When the Medal of Honor is awarded a HSA, with a substantial existing balance, could also be gifted to the recipient so that their future longevity and quality of life will increase.A requirement that after age 18 all American citizens be required to perform two years of public service in some capacity (i.e. military, peace corps, aides in nursing homes, foresters, etc.). Following the successful completion of the two years of national  service the individual could then be awarded a “starter” HSA and taught how to use it. Today’s young adults know that cigarette smoking and drugs are bad. They simply have not yet been exposed to adequate incentivization to apply this information for their own benefit.

The United States government could take considerable pressure off the present health care system by engaging in improved creative action. They could, for example, convert the Veteran’s Administration Hospital system to establishments providing free, government subsidized, infant and child care as well as care for the terminally ill.  If there is any American war veteran alive today who really believes that the quality of VA medicine is better than that generally available in the community they are clearly still suffering from “battle fatigue.”  All veterans would be better served with “chits” for medical care in the existing healthcare system (which they can exert freedom of choice) than the present Veteran’s Administration system.

I’m Alright Jack

The sad truth is that it’s hard for healthy people to even think of being sick or disabled.  If one is blessed with having been seriously incapacitated and then been returned to normal function the lesson learned, in the process, always serves as important education.  The patient usually doesn’t experience the potential horrors awaiting them in the health care system until a crisis arises, and when they need help they often don’t know where to turn.  It is at this point that patients typically “discover” written-in cost-cutting “exclusions” and the adversities that they were not aware of until their need arose.


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