If I understand correctly, Massachusetts has nearly made HSA’s illegal in that state. You can’t have an HSA at all unless you’ve got high-deductible health insurance. I don’t recall how high is “high”, but you can’t contribute more to an HSA in a year than the deductible – so at best you can put in $2,000 a year. That will work for people who are pretty healthy, so they can just keep building up money in the account until there is a medical emergency – but if you routinely run $2,000 in expenses a year, you might as well be on a full-pay insurance plan and nothing else.

Personally, I feel better knowing that my health problems aren’t going to be forced on other people.

“The government will pay amount $X OR 80% of the lowest price you offer to anyone else.”

Then the insurance companies and HMOs take that same price list (since the government publishes it) and say, “We’ll pay you 120% of what Medicare is going to pay you for this procedure.”

Thus the whole craziness of Medical Billing Codes arises, because doctors can only make money by charging for every, single little thing that they do. Because Medicare’s payouts are too low and the doctors are barely breaking even. But if you went to your doctor and said, “Hey, I’m paying this with this here credit card” (HSA or not), perhaps they’ll charge you full price for your procedure, but drop all of the other nitpicky things from the bill.

The nice part about a high deductible plan with an HSA is you still pay the insurance company’s contracted rate for out of pocket expenses with in-network providers.

I do agree with Knox, health care is the only industry that cannot seem to get transparent, consistent pricing. Because the vast majority of the market is third party payer.

Jeff

But the thing that seems screwed up about the free market with health care is that I understand that HMO’s negotiate prices TEN TIMES less than a cash payment. I don’t think Hertz gets their cars for 10% of what I pay. The thing that seems broken about health care is the huge difference between paying in cash and paying through an HMO.

At least when states experiment with intervening in the health care market, it can be compared to other states and see how it works. Let’s at least keep the Federal government out of it.

In an email to Michael Tanner, I asked the following question :

“…Not only will every resident of the state be required to have insurance by July of this year, but by January of 2009, no one in the state will be allowed to have insurance with more than a $2,000 deductible or total out of pocket costs of more than $5,000….”

I suspect that ‘total out of pocket costs’ doesn’t include the insurance premium itself, so my question is as follows:

With my current MA non-group, non-deductible, drug benefit, age 60 single policy premium of $800 + per month and rising at ~ 14% per year, will the effect of the new law be to :

a. cause my policy to be eliminated for legality reasons

b. cause my policy to be eliminated for cost feasibility reasons

c. increase the cost of my policy to me.

d. effectively reduce the quality, choice and availability of provider services

e. All or most of the above and the kitchen sink as well.

I have previously had Massachusetts legislate a non-group policy out from under me, so the threat is real.

Regards, Don

Here’s an HSA blog I came across: http://www.health–savings–accounts.com/hsa-weblog/