Response to comments on HSA article in St. Louis Dispatch

Here is my response to the comments posted about the article “Personal HSA Plans May Yet Survive” by David Nicklaus on the St. Louis Dispatch website.

We should clarify the difference between health care and health insurance. There was a time when people bought the services of a physician directly. Health insurance (then called hospitalization) was bought cheaply on the market to only cover catastrophic claims.

But later, when health insurance was purchased through one’s employer, Americans were sheltered from the true cost of health insurance premiums. Low co-pays for day-to-day medical expenses turned health insurance into prepaid health care. The line between health care and health insurance blurred.  The health insurance industry was more heavily regulated. Medicare, Medicaid, and SCHIP programs dictated low provider reimbursement, forcing private carriers to pay more to make up the difference.

So, you’re right about a lack of free market, but we do see a form of free market in health insurance in the purchase of personal, private health insurance plans where individuals select an underwritten plan and pay the full premium. Those who choose HDHP health insurance experience some transparency in the “health care” market. They can usually find out the cost of procedures in advance by checking the carrier’s website. In answer to your question, my doctor charges $65 retail for an office visit, but with my carrier’s discount, I pay $45. 

There is free market in health care for those who doesn’t have health insurance; they can call the physician’s office and ask for the retail charge. We see that at the mini-medical clinics.

Standardizing medical charges and imposing maximum charges for all items, would be the opposite of free market. This would be considered price fixing in any other industry. It is not the government’s place to require schools to accept applicants.

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