We need bigger reform than HSA improvement

The July 23 guest column by Janet Trautwein supporting the Bipartisan HSA Improvement Act is in need of a larger perspective.

Health Savings Accounts, or HSAs, are touted by Ms. Trautwein as a way to "incentivize people to secure care … that give(s) them the biggest bang for their buck." She touts the "skin in the game" theory that patients will shop around more if they have to spend their own money.

Ignored in this rosy scenario is the fact that the majority of Americans have less than $1,000 in total savings, and almost 40 percent have no savings, according to a report from CNBC. Tens of millions of households live from paycheck to paycheck. Forbes reported in 2016 that just 37 percent of Americans had $500 saved that could be used for an emergency. The idea that these families would have thousands to place in an HSA is a fantasy.

The assertion that consumers shop around for care is contradicted by a large body of evidence. Multiple studies indicate that Americans utilize less care when out of pocket costs are higher. The fact that our health care system performance ranks below dozens of nations supports the idea that decreased utilization is harming and killing people.

Of course, as most large health insurers are publicly traded for-profit companies, their primary goal is profit maximization. One way to achieve this is by shifting more costs to patients in the forms of higher deductibles and copays. Therefore, they and related groups such as Ms. Trautwein's National Association of Health Underwriters will support the concept of HSAs, as it will improve their bottom line.

We are in need of a much more fundamental restructuring of American health care: a single-payer system, which will eliminate hundreds of billions in administrative costs every year, while providing more comprehensive coverage.

John Perryman

St. Charles