More on health savings accounts

Appropos of our earlier discussion of Medicare health savings accounts, Amy Goldstein wrote in yesterday's WaPo (sub. req.) about the current version of health savings accounts that are underwhelming the nation. The sub-head for the story says that "early reaction is two-sided," but everything that critics have said about the program seem to be being borne out:

• These plans are more attractive to those with higher incomes;
• People in the midst of a health crisis are not likely to be savvy shoppers for cheaper alternatives;
• The "smart shopping" generally translates into doing without health care;
• The plans tend to save money for people who are healthy (i.e., don't need health care).

So why is it that anyone thinks we ought to (re-)impose this policy on the elderly and disabled who are eligible for Medicare? Is it even vaguely possible that someone who qualifies for both Medicare and Medicaid, who can't afford the cost of the current Medicare co-pays and premiums, would be able to start saving for the rainy day on which they might need healthcare? By definition, the disabled who are eligible for Medicare need it--now. The elderly, well, maybe not so much--until they do.

Instead of trying to find ways to wiggle out of paying for treatment for, among others, people with HIV, how about a little more focus on prevention?