Are HSA’s a Capitalist Scam? I Think So.

Published at 10:28 on 13 October 2013

One of the propaganda pieces in favor of them, which alas I can’t seem to find on the web, shows someone in a grocery store where prices are not marked on anything yet where the clerk occasionally mentions things like “Oh, that’s sure an expensive item.”

The customer asks to see the prices, and is condescendingly scolded “Oh, that’s called ‘shopping’ [complete with air quotes]. We don’t do that here.”

It’s a profoundly dishonest statement of the problem, because the setting implies the unstated premise that the prices being charged are as simple, straightforward, and easily comprehensible as they are in a grocery store. When it comes to health care, nothing could be further from the truth.

One of the biggest sources of waste in the US Medical-Industrial Complex is how both providers and insurers employ vast armies of paper pushers. Providers employ them to come up with new ways of billing and charging insurers. Insurers employ them to come up with new ways for disputing and refusing charges.

Neither side’s paper-pushers contribute one iota towards providing actual health care, yet of course they must be paid wages and benefits. It’s the main reason why the USA both spends more per capita on health care than any nation, yet covers a smaller fraction of its citizens than any other developed nation.

It may be wasteful, but at least the battle of the paper-pushers the status quo represents is a fair fight. But with the new high-deductible plans, I am now expected, mostly on my own, to match my wits against an army of creative billers with centuries of collective experience in coming up with ways for separating payers from their cash.

Can you say “unfair match?” But, hey, what would the insurance industry care? They are not going to be the ones conned into paying more. In fact, quite the contrary: providers will naturally focus most of their energies on creatively billing consumers who haven’t yet reached their deductibles. Con artists always go after the easiest marks, after all.

So insurers get to both outsource a good chunk of their labor and they make the remaining billing disputes they don’t outsource easier for themselves. Such a deal. For them, that is.

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