"Health Savings Accounts" - WTF Good Are They?

[K8-EEE]

Seriously.....does anybody think they are going to put away X percent of their salary, and then if anybody in their family becomes seriously injured or ill that money (that you can SAVE tax FREE, woohoo!) is going to be enough to pay for even a 1 week hospital stay or one surgery? So what if you do manage to save $50,000 and then have a $50,000 illness. Then none of your other kids can get sick or what??

Is that supposed to be instead of insurance? Of course, leave it to Bush to make a dumb idea sound even dumber.

http://www.whitehouse.gov/news/releases/2007/04/20070402-2.html

You know, two years ago there was -- about a million of our citizens had health savings accounts. And today, over 5 million people have health savings accounts -- or nearly 5 million people have health savings accounts. It's up -- actually, you can see from the chart the growth -- 4.5 million people. And that's a 43-percent increase from last year to this year, and the number of people that are beginning to realize the benefits of health savings accounts.

And interestingly enough, of those who purchased -- of individuals who purchased health savings accounts, about 25 percent of them were uninsured. In other words, health savings accounts enable someone who is uninsured to realize the benefits of private insurance, and in an affordable way.

I strongly believe that the United States Congress needs to strengthen health savings accounts, just like they need to make sure that the tax code treats every person in America fairly.

:eyes:

[gollygee]

1. They are nothing like insurance

Nothing at all. We have one that we use for co-pays. We would have gone broke by now if we'd had to pay all of our health costs out of one of those. And we're relatively healthy. But even healthy people have health issues - birth, appendix, gall bladder, etc. Ridiculous to think this is an equivalent to health insurance.

[warren pease]

83. Arguing over the crumbs...

Looking through the posts here, most either talk about HSA's modest benefits, disagree with them because they don't do enough, or simply explain an aspect of these plans.

And this is, as usual, one more example of trying to adapt to a broken system by tinkering around the edges. And it's a way to distract people from the nature of the american health care problem, which is, in brief: We will never achieve a universal-access, single-payer health care system -- such as that enjoyed by all of the industrialized world, except the US, and a lot more who aren't industrialized -- until we completely sever the ties between for-profit corporations and anything even remotely related to delivering or paying for medical care for american citizens. In health care, as in most other areas, corporate objectives and human needs are, by their very natures, in fundamental opposition.

Which is to say, there is unalterable, systemic, hard-wired incompatibility between for-profit corporations' responsibilities under the law and the performance of their stated jobs -- which they still maintain is providing high-quality insurance to pay for health care expenses incurred by their members, somehow managing to contain the giggling until the audience leaves the room.

That's because, like any American publicly held for-profit corporation, the sole responsibility under the law for health insurers is to maximize return on investment for their shareholders. Any other drain on profits including, in the case of health insurance companies, money spent to actually pay doctor or hospital bills for their subscribers, is necessarily subordinate to its fiduciary obligations to its shareholders.

And I stress that that's the law; they have no choice in the matter. Corporations must strive to increase profits and that effort must be documented using industry standard methodologies approved by Wall Street and its cronies in the SEC.

And major shareholders hold considerable power. If a CEO consistently fails to increase profits, the shareholders will revolt and replace him (it's usually a "him," and the parachute will always be platinum) with somebody else who vows to run a tighter ship -- and woe betide the subscribers when they hear that because the ax is being sharpened in the form of premium increases, exorbitant copays and deductibles, non-covered procedures, chiseling on legitimate payments, and so forth.

So the system can't be fixed. It needs to be completely replaced with a tried-and-true single-payer system. Even universal "coverage": isn't enough, because "coverage" implies the continued involvement of for-profit corporations which, as I may have mentioned above a couple dozen times, lie at the heart of the current mess.

I should also note that only Kucinich dares go in this direction. All other democratic candidates propose some form of modification that would bring more people into the current system, but not shit can it as it so richly deserves.

Can you tell I just got my bill for my April premium? A modest $489. Good thing I'm insanely rich or this might really piss me off.


wp

[gollygee]

115. I agree

We're very very lucky to have good coverage, but the sad thing is that good coverage comes with a good job. My husband has a very good job, so we would be able to afford bad coverage. But of course people who get stuck with bad coverage can't afford it at all. There's a sad kind of irony there - the people who can least afford big medical bills are the most likely to get them.

We need to completely take the concept of profit out of people's health care. We pay enough in this country for decent medical care - we just need to stop making huge corporate CEOs and major stockholders rich, and invest in people's health instead.

[Nickster]

2. It's just another way to give a tax dodge to people that need places to hide money.

It doesn't have anything to do with actually helping provide health care to anyone, just giving people who have the money a place to stash just a little bit more.

[RC Quake]

30. It came in really handy for us.

Insurance doesn't cover fertility treatments. This allowed us to put away the thousands of dollars that we needed for treatments, tax-free. Also, when my mother-in-law came to live with us for elder care, we put extra aside for her medical needs not covered by medicare...mainly prescriptions.

[ComerPerro]

71. well, good thing for you that you have that kind of money coming in

Like the OP said, what happens when you, after several years, manage to have put away $40k or $50k, and you have a illness that ends up costing $40k, $50k, or more?

[Show_Me _The_Truth]

34. Too bad you lose the money if you don't use it.

Not much of a shelter now is it?

[Lydia Leftcoast]

42. Actually, an HSA lets you carry the money over, but it's not a good deal if

you don't have the money to contribute in the first place.

You're confusing it with a flex acount, which is provided by employers. The HSA is (really) designed as another tax shelter for wealthy self-employed people.

[Show_Me _The_Truth]

108. Okay then I'll add a

:eyes:

at myself.

[newportdadde]

81. Thats a Flex Account, not a HSA.

I have flex at work.. I can elect at the beginning of the year to withold XXX amount of money that can be used for prescription drugs, doctor visits etc.

Its nice because I can pull 500-800 tax free to help cover copays.

It however does NOT replace my insurance or my insurance premiums.

[antigop]

3. They are great for mutual funds and banks ...

who will be ever so interested in managing that account for you. (Think Social Security privatization -- same idea.)

And the insurance companies will benefit because of the high-deductible policies that the health savings accounts will be coupled with.

If anyone says there is NO difference between the two parties, I point to this as a perfect example of the difference. I know of NO Democrat who supports this cr*p.

[truedelphi]

126. Hmmm. Republican ideas almost always spring forth

From the concept that the insurance companies and banks will benefit (Unless it's miltary stuff that goes to defense contractors)

[uppityperson]

4. They are not a replacement for insurance, but can help.

It can help having to go into debt for minor injuries, major you are going to be in trouble, but for minor things they can help. Mrbush, delusional.

Edited to add, these go along with what my parents used to tell me, save 10-20% of what you make for a rainy day. It can help you avoid debt if you break a leg, but are NO substitute for insurance. I've figured on declaring bankruptcy if something serious happened. Go on whatever public funded things I can find, write off everything I can't. Our problem is the small stuff keeps adding up, the stuff that our insurance doesn't pay for (dental care to keep healthy, for instance). The system is broken and getting worse.

[Gormy Cuss]

9. Yep.

Like flexible spending accounts, they take some of the sting out of costs because of the tax benefit but they are in no way a replacement for health insurance or A FREAKING NATIONAL HEALTH PLAN LIKE MOST WEALTHY NATIONS HAVE.

[liberal N proud]

5. Many companies are forcing their employees to use them

It is a use or lose situation and if you are healthy and can't predict your health cost for the year, it is impossible to put money into an HSA

[gollygee]

6. Yeah - you'd have to know you were going to have a health issue come up

and then know how much it would be, because these are "use it or lose it" accounts. If you don't need the money by the end of the year, you're SOL. I swear they're probably partially in place to force people to use up the money - "Hey, I could use another pair of glasses! Or maybe I'll get that LASIK surgery - after all, I have to use up the money in my HSA or it'll be lost!"

[antigop]

10. I don't think that is correct.....

I think you are confusing flex accounts with health savings accounts. The flex accounts are "use or lose" -- they are not the same as health savings accounts.

Recent legislation allowed employees to roll funds from a flex account to an HSA (health savings account).

The health savings account can roll over from year to year.

[gollygee]

13. Oh well then I've been confused too

I thought it was the flex account too.

[liberal N proud]

18. What our company is using they are calling an HSA

At the end of the year everyone is out visiting the doctor, the dentist and getting prescriptions filled to spend the money.
It may be the company is using the wrong terminology here.

[antigop]

21. HSAs can roll over from year to year

So I don't think you have a health savings account, as Bush and the GOP are pushing.

[Lasher]

I used to work for a company that offered what they called HSAs

And we could not roll anything over to the next year. It was a 'use it or lose it' deal, so I took a pass. The distinction you point out between HSAs and flex accounts might be accurate, but if so the labels are not being universally applied.

[antigop]

46. Yes, I think at some companies they were misnamed ----

Flex accounts came before health savings accounts, but flex accounts were often called "health savings accounts".

They are not the same.

[Lasher]

44. Dupe

Oops

[northzax]

107. no, MSAs rollover

HSAs don't.

I personally just got my MSA, and it really is the best of all possible worlds, for my employer and myself. My employer gets to save 200 bucks a month getting insurance for me with a very high deductible ($1200 in my case) and then puts $1200 of that savings (half of it) into an MSA for me, tax free. My deductable is, therefore, in real terms, zero. if I exceed it, it is covered by insurance, if I don't exceed it, I can either use that money for something else (glasses, a massage, whatever) or save it for next year. the account earns interest (not much, but some, like a regular savings account at my bank) and I have both a checkbook and a debit card to pay directly from it, no getting reimbursed.

what's not to like?

[antigop]

112. Please read the following...................

http://www.usatoday.com/money/perfi/columnist/block/2006-02-27-hsa-grace_x.htm

It talks about the differences between health savings accounts and flex accounts. I think you are confused.

>>
Flexible spending accounts differ from health savings accounts, which also let you use pretax money to cover out-of-pocket expenses.

With health savings accounts, which are being championed by the Bush administration, you can carry over unused money from year to year.

But you can't have a health savings account unless you also have a high-deductible insurance policy, one with an annual deductible of at least $1,050 for individuals and $2,100 for families. Except in limited circumstances, you can't contribute to both a flex account and a health savings account.
>>

[ourbluenation]

24. you are correct. It is a high deductable health insurance policy.

the money in the savings account is to pay the high deductable, and after that, for health related incidentals, or you can save it up and never touch it. Our employer makes the payment each month into our employees accounts, the employees dont. Plus - if they leave our workplace they can cash it out if they want, with a penalty.

[renate]

14. it's a good problem to have, not needing to dip into the HSA money

So I'm not complaining, really. But it's stupid that you can't roll the leftover money into the next year, or get it back even with a penalty. So if you save it and don't use it, it's gone.

(If I'm wrong about the money being gone, yay... but that's what's happened with our account since we've started putting money into it. Now that I think about it, WTH? Who's been getting our leftover money? Not us, anyway.)

On edit--just saw reply #10. Thank you very much for that information!

[jobycom]

7. So 75% of those who opened health savings accounts are INSURED?

The only point is to create another tax giveaway. 75% of the people who have opened them will file insurance claims, anyway.

[salin]

16. the idea is catastrophic coverage (high deductable, low monthly

premium) to go along with the HSAs. The thing is - that if you don't have enough income after paying basics - how does one possibly put enough into the HSA to cover the 1,000 or 5,000 deductable?

[antigop]

22. Exactly n/t

[Lydia Leftcoast]

28. And the premium isn't that low

The premiums for the HSAs offered by the major insurance companies in the Twin Cities are HIGHER than those for conventional accounts with the same deductible.

[salin]

29. Contemporary Insurance Companies = Modern Robber Barons

[jobycom]

32. Instead of regular co-pay type insurance or in addition?

[salin]

54. bushco are trying to push this as in place of regular insurance

and for the individual to assume all of the cost rather than have employers offering it as benefits.

[mentalsolstice]

79. But, but, but...

bushco calls this "ownership"! Yeah right...:banghead:

[salin]

117. he OWNS contemporary irony. the master of irony.

[antigop]

89. Also, a replacement for Medicare, imo n/t

[salin]

120. If they can - they will...

but I think that they are losing this battle of public perception/public conventional wisdom. The talk of universal and single payer is being discussed so much more frequently of late - that I think the idea is finally becoming understood and more commonly accepted and expected.

[Arkansas Granny]

33. You have to be insured to open an HSA.

Who is eligible for a Health Savings Account?
To be eligible for a Health Savings Account, an individual must be covered by a HSA-qualified High Deductible Health Plan (HDHP) and must not be covered by other health insurance that is not an HDHP. Certain types of insurance are not considered “health insurance” (see below) and will not jeopardize your eligibility for an HSA.

I don’t have health insurance, can I get an HSA?
You cannot establish and contribute to an HSA unless you have coverage under a HDHP.




http://www.ustreas.gov/offices/public-affairs/hsa/faq_eligibility.shtml#hsa1

[jobycom]

49. Then what did Bush mean when he said 25% were uninsured?

Does he mean they got insurance and an HSA at the same time?

[Arkansas Granny]

55. Who knows what he meant. I had checked on a HSA for myself

not too long ago and remembered reading that you had to have qualifying health insurance in order to get one. The info I referenced was from the Frequently Asked Questions of the U.S. Dept. of Treasury website, so I figure they are pretty accurate.

[ComerPerro]

yeah, its kind of a way of asking insurance companies to pay less

that is to say, if people are expected to have HSA and insurance, the deducatable can be higher. Hell, the insurance company wouldn't even have to lower rates if they didn't want to.

[Skink]

8. Eventually instead of offering health insurance companies will

put your wages, on a pre tax basis, into your own personal account. Sounds wonderful.

[donkeyotay]

25. Fees. And collect lots of fees. Wonderful, for the banking lobby. nt

[antigop]

26. Exactly -- see reply #10. Also insurance companies benefit from high-deductible policies n/t

[DemReadingDU]

111. No fees, as long as the bank already has your business

Spouse and I have to pay our own monthly expensive health insurance. In order to save on the monthly premiums, we went with a high deductible policy, $5000 for our family.

Because of the high deductible, we qualified for an HSA account. If we had the insurance company set up the HSA, there would be fees. Instead, we went to our bank, and set up the HSA ourselves. Because we already have business at the bank, the HSA has no extra fees.

The advantage of HSA is that we can put in the deductible amount and take if off our income to lessen the total amount that is paid for taxes.

So far we are basically healthy, generally using the HSA account for the occasional prescription. Annual physical exams, mammograms and pelvic exams are covered by this type of plan, in our area of the country.

Whatever is not used in the HSA will carry over year to year. If we had an accident or became very sick, the most per year, that we have to pay is the amount of the deductible, $5000.

Currently, the HSA is setup like a checking account with a debit card to pay for things like prescriptions.

[antigop]

113. depends on the bank....shop around n/t

[TechBear_Seattle]

11. They are an IRA you can use in an emergency

Nothing more. They are an investment plan, not a savings account (the difference is that savings accounts are insured, investment accounts are not) and most definitely not an insurance replacement.

Where they are useful is when you have exceptional, unexpected health problems that are not covered by your insurance or for situations where your insurance gets used up. Most insurance policies have caps on how much they will pay out for a given disease (cancer, organ transplant, etc.) and caps on how much you can get in a period of time. If those caps are hit or your insurance will not cover something completely, you can withdraw money from your medical investment account to cover related expenses without the usual IRA early withdrawal penalty. In short, it is an emergency supply of cash that can be put aside without tax penalty.

If you are young, healthy and very likely to stay that way, they are not a bad idea, as I believe they count separately from your regular IRA (ie contributions to one do not count as contributions to the other, but check with a licensed investment advisor to make sure.) But again, these "savings accounts" are not savings accounts nor are they by any stretch a substitute for regular insurance.

[ourbluenation]

12. hr manager here....

we provide this option - I hate it....the wrong people choose it. sicker, older, poorer.

they will never meet the high deductable if something big were to happen. but it is an insurance policy. at least at my workplace. it just comes with a very high deductable that is constantantly eaten into to pay for medications, etc, throughout the year...

[havocmom]

15. They surly help the institutions holding your money

and investing it along with all the other people's money. Wall Street does better for the money you put in a medical savings account. The CEOs who have destroyed the middle class, the working class, the environment, and most of our national heritage, do better because if the banks are investing YOUR money, the CEOs are selling THEIR stock and they get cool quarterly reports to wave around (and more money to buy more politicians to set even MORE helpful agendas in place) to justify their massive compensation packages as they lay off workers - which also kills their customer base.

As for what happens if you get really sick... not much because the little cash you managed to set aside (IF you could afford to set any aside) won't buy you much health care at all.

[blitzen]

17. we had one last year....just a scam to make whopping deductibles look palatable...

when you pay your deductible out of your HSA, it somehow makes you feel like it doesn't cost as much

but that is more than offset by the fact that you get screwed on your federal income taxes if your employer puts money in your HSA

[antigop]

19. It is the beginnings of a shift from defined benefit healthcare to defined contribution

Just like pensions moved from defined benefit to defined contribution (401(k)), companies are moving from defined benefit healthcare to defined contribution.

If you don't have enough in your account to cover illnesses, well, that's just too bad.

[Lasher]

56. Exactly right, antigop

Junior has had this shell game planned for years. It's his scheme to eliminate employer-provided healthcare. Salin accurately predicted this here at DU over a year ago. Here's a link:

Their goal - END employer paid health care.

I honestly can't understand how people can be so heartless. Our only hope is single provider universal healthcare, AKA medicare for all.

[antigop]

90. Also, establish a "replacement plan" for Medicare n/t

[antigop]

101. More info in post #100 below...... n/t

[Hong Kong Cavalier]

20. Our company was given no choice from our insurance provider.

Change to an HSA or pay all of your health insurance yourself.
HSA's are for catastrophic medical issues, and everyone I've talked to in our company hates it, because they find that since they
pay out of their pocket up to the deductible (which is incredibly high) they tend to not go to the doctor as much. Preventive care is always cheaper than emergency care, but
with an HSA, many people hesitate to get something checked out because they'll have to pay for it essentially out of their own pocket.

I've saved no money with an HSA. In fact, I've lost money, since I still have to pay for my premium and the money I have to put into my HSA. The tax breaks I've received are negligible.

Edited for clarification (first line was somewhat inaccurate)

[Warpy]

23. Translation

"Hey, you 25 year old kids, better start putting every dime into a savings account so you can afford that bypass operation at 60! Go hungry, go without a roof over your head, but make sure the for profit medical centers will get enough money to make saving your life worthwhile!

"Don't worry about having enough to feed your kids, don't worry about saving for retirement. Save for something really important, OUR PROFIT!"

That's what health savings accounts are really for. This country is going to allow employers to duck health care responsibility just like they've allowed them to duck retirement responsibility.

The cruel message to citizens from the Republics? "Don't get old and don't get sick and we'll let you live. If you do either of those things, just bugger off and die quietly."

[The Wielding Truth]

119. Exactly to the reality line of this for many. It will benefit only those of

upper middle and wealthy classes. Nice for those but national health care should still be available for those stuck in bad situations.

[Lydia Leftcoast]

27. Here's how it actually works: (I investigated and rejected the option)

You FIRST buy a high-deductible insurance policy. It costs MORE than a conventional policy with the same deductible. Just any old high-deductible policy won't do. It has to be a specific one designed for use with HSAs.

Then you open an account with the bank that the insurance company designates, and if all goes well, you put in $200 a month--on top of your insurance premiums. You don't have to, and I've read that most people are not able to keep up the contributions.

The contributions are subtracted from your pre-tax income, so if you're healthy and have a lot of spare cash lying around, they're a good investment. They can be carried over from year to year tax free and accumulate.

However, if you have an irregular income, as I do, or an income that is low enough that an extra $200 per month will wreck your budget, they're a bad deal.

[Skink]

35. Still think universal coverage is a bad idea?

that was directed at the Republican monitors.

[Lydia Leftcoast]

39. Glad to hear that, because I know enough about other countries' systems

to be a staunch advocate of single-payer.

[MissB]

38. Dh's employer offers them as well

in conjunction with a high deductible ($3k) health plan. They also offer a free $200 a year if you commit to at least $1k a year and the balance rolls over.

We went for it. The high deductible plan covered preventative care and the monthly savings on the plan worked out to be as much as the deductible (I'm just tossing the extra money into 6 month CDs every few months. We're fortunate to be able to cover the $3k deductible without too much financial pain so I figured I might as well build up a bit beefier of an emergency fund with the health plan savings).

His company also offers flexible spending accounts, which we use to take care of our normal yearly costs (prescriptions, eyeglasses, dental bills, etc).

It works, but only because they're offering it in conjunction with a plan that we can afford. If we were self-employed, or closer to a true middle class American salary, we wouldn't be able to afford it.

So I look at it as beneficial to us, but not beneficial to many of the junior staff and support staff that work for his company.

[KatyaR]

134. Ours is with a high-deductible plan ($5,000/yr indiv, $7,500/family).

The company contributes $750 a year to each employee's fund, but they wised up this year after record-breaking turnover and will only fund them one quarter at a time. So now we're doled out $187.50 each quarter-whee!!!

The bank that has our plan charges a $2 fee each month that you're under the "minimum balance"--funny thing, though--the minimum balance is ALWAYS $2 OVER your balance. (I've tracked my account, and it's true.)

Oh, and there's no drug benefit, so guess where your money goes? I've heard of full-time employees having to fill out paperwork at a pharmacy to get discounted drugs for their kids when they were sick. Disgusting.

And if you want to move to the plan with the drug benefit, you have to APPLY for the plan and they may or may not accept you. If they don't, they reserve the right to not take you back into your old plan. So when you start at this company, you get little to no information about the plan, and whatever choice you make, you're stuck with it.

Of course, the CEO is a god-fearing repuke, so he loves it. Very, VERY small employee premiums (I pay like $11 every two weeks), and very little in the way of coverage costs.

Thank whatever that I only take generic drugs anyway, but I'm what's called "glaucoma suspect" and have to have my eyes checked every six months as well as having a yearly eye exam. And since my company dropped its vision coverage a couple of years ago, if I need new glasses, I have to pay full price. The doctor's been trying to get me to get a new pair for a year, but I can't afford it. My last pair cost me over $400, and that was a basic pair when I had great insurance coverage.

If I were to have a catastrophic illness or an accident while on this job, I'd be screwed every way possible, because we aren't allowed to carry enough leave to cover anything like that. I'd lose everything.

Dirty, rotten, stinking bastards--I hate them all. I hope they rot in hell . . . . .

[ourbluenation]

41. Our employer pays the monthly contribution. The problem is that the employee

eat into the savings to pay for aspirin, co-pay, etc...the balance should be built up so the deductable, which is high, can be met. But our employees eat into it all the time.

[DemReadingDU]

116. In our area, the HSA policy was lots cheaper

we saved $100 per month, and actually received more things covered. see my other response at #111

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=566594&mesg_id=568206

[antigop]

31. My opinion -- this is the GOP plan to destroy Medicare

>>
A Fidelity study released earlier this week said a 65-year-old couple retiring in 2007 will need about $215,000 to cover medical costs in retirement.
>>
http://today.reuters.com/news/articleinvesting.aspx?type=fundsFundsNews&storyID=2007-03-29T193919Z_01_N29310556_RTRIDST_0_FIDELITY-PENSION.XML

Medicare is in terrible financial shape. IMO, health savings accounts/high deductible policies are the GOP plan to replace Medicare. You are on your own.

[Lydia Leftcoast]

37. But Medicare would NOT be in such bad shape if

all the young, healthy people were enrolled in it as well.

And that's not even talking about the obscene waste that is the invasion and occupation of Iraq, costing $250 million PER DAY. You could hospitalize a lot of people for that amount. Hell, I wonder how many hospitals you could build with that.

[antigop]

40. Absolutely! No argument from me. But the GOP needs a "replacement" for Medicare...

and I think this is it.

THey've wanted to destroy Medicare for years, but they needed something to counter universal healthcare.

This is the "plan", imo.

[DemReadingDU]

118. I agree, Medicare is in horrible shape, worse than SS

One of the reasons for privatizing Social Security, was for people to invest in stock market...managed by companies who will make big bucks in fees.

The Republicans thought it would be easier to sell privatizing Social Security first, then move on to Medicare. Money already comes out of a paycheck to go to SS. Not much difference if the same amount of money went to a stock fund instead.

Whereas in healthcare, people who have fulltime jobs usually have some kind of paid health insurance with minimum co-pays. It's a big step to ask people to ante up thousands of dollars to maintain a high deductible health insurance plan. Most people would not do it.

We shopped around and made sure that our HSA account at the bank did not charge fees, because we already do business there.

Personally, we would prefer some kind of national healthcare system. We hate paying so much in monthly premiums for health insurance, but the HSA plan saved us about $100 per month.

[rodeodance]

36. it is a joke from the Elitist WH and their cabel

[antigop]

43. Here is what I tell people -- I'll believe health savings accounts are a good idea when...

members of Congress and state legislatures give up their "gold-plated" plans and are forced to switch to health savings accounts/high-deductible policies.

[Arkansas Granny]

45. Bush needs a crash course on HSA's. He is putting out false

information, according to the U.S. Treasury website.

Bush states: "And interestingly enough, of those who purchased -- of individuals who purchased health savings accounts, about 25 percent of them were uninsured. In other words, health savings accounts enable someone who is uninsured to realize the benefits of private insurance, and in an affordable way."

Per the U.S. Treasury:

Who is eligible for a Health Savings Account?
To be eligible for a Health Savings Account, an individual must be covered by a HSA-qualified High Deductible Health Plan (HDHP) and must not be covered by other health insurance that is not an HDHP. Certain types of insurance are not considered “health insurance” (see below) and will not jeopardize your eligibility for an HSA.

I don’t have health insurance, can I get an HSA?
You cannot establish and contribute to an HSA unless you have coverage under a HDHP.

http://www.ustreas.gov/offices/public-affairs/hsa/faq_eligibility.shtml#hsa1

[RB TexLa]

47. I've contributed the max into mine for the last two years

It's a great deal. I don't go to doctor's, I have the medical insurance in case of catastrophic illness, not sure if I would even use it then, but it let's me get a much higher deductible and lower premiums while the money in the HSA grows.

If you save $50,000 and have a $5000 deductible plan, you pay the deductible, use your insurance and the money left over plus what you are putting in continue to grow.

[antigop]

51. They are not a great deal for many people

First of all, you have to be ABLE TO SAVE money into it.

Secondly, if you have medical problems year to year, you have to pay the DEDUCTIBLE EACH YEAR.

Thirdly, all this is doing (and by design) is siphoning off healthier people into the high-deductible route, leaving less-healthy in the conventional plans, driving up premiums for the conventional plans, because the conventional plans are left with sicker people.

The whole scheme is inhumane -- it forces sick people to pay much, much more -- and it negates the very reason to have insurance -- the healthier people subsidize the less healthy.

[ourbluenation]

60. Our employer makes the contribution on behalf of the employee.

[antigop]

87. Yes, some companies make the contribution on behalf of the employee

But they don't have to.

And if a company has both high-deductible and conventional plans, the younger, healthier will get siphoned off to the high-deductible plans, leaving older, sicker employees in the conventional plan, driving up premiums for the people who remain in the conventional plan(s) -- the ones who need it the most.

As I have said, this whole scheme is inhumane.

[Lydia Leftcoast]

52. This assumes an income that allows you to pay an unexpected $5000

without blowing your budget.

[RB TexLa]

57. the money for the deductable is in the HSA

not from some budget

[Lydia Leftcoast]

65. Yes, which still assumes the ability to set aside $400+ every month

:shrug:

A lot of people don't have that much left over, even if they live fairly modestly.

[RB TexLa]

70. I've just made my contribution into it once a year

[Lydia Leftcoast]

78. Right, which means you have $5000 lying around ready to put in

Bully for you.

Bullshit for the average person.

[DemReadingDU]

121. Same here

see my other response at 111

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=566594&mesg_id=568206

[K8-EEE]

48. Very interesting responses here.....

I'm kind of getting that these are to supplement the increasingly sucky insurance options out there....

Didn't Bush have some kind of proposal to "reward" people for choosing plans that were "less comprehensive?" Like, you get taxed if you have too good of insurance or something?

[ourbluenation]

63. I think HSA's are a good option for young people who's employer makes the monthly contribution

to it on their behalf. Younger meaning it's more likely that they won't have a lot of health problems. But the people who choose it at my workplace are older people with diabetes, high blood pressure, etc...the savings account pays for their portion of the medications they need and often there is a zero balance in their accounts. The downside is that they will personally be responsible for the high deductable should they have anything catastrophic. Ideallly, you would build up the account with a balance that meets the deductable if needed, and then use anything after that to pay for incidentals, medications, etc...

[antigop]

92. NO, NO, NO -- you need the healthy people to help subsidize the less healthy

That's the way insurance should work.

HSAs negate the very essence of insurance.

[Vulture]

106. Technically...

Insurance does not pool risk, it pools capital in proportion to individual risk. If the premium was independent of risk it would no longer be "insurance" in the usual economic sense but a communist (no negative connotations intended) structure of some type, which has a real-world problem of incentivizing "tragedy of the commons" scenarios that pop up like clockwork in practice. Catastrophic coverage is different because no one in their right mind ever wants to use it.


Interestingly, HSAs could actually encourage the healthy to participate in insurance programs. Once you eliminate the mundane uses for medical insurance which incur much of the cost, you still need catastrophic coverage and that is useful for everyone regardless of health. As it is, I only have catastrophic coverage (though no HSA) and pay for most medical-ish things out of pocket. Most medical professionals charge less if you pay out of pocket than if you use insurance, presumably due to less hassle and less overhead.

An HSA plus universal catastrophic is arguably a superior economic model, in that it gives everyone coverage for the really serious stuff but dis-incentivizes frivolous medical expenditures. That still leaves the people that cannot easily afford an HSA, but that problem would be no worse than the current situation, particularly if the net effect was reduced medical costs.


All of which ignores the elephant in the room: there are so many medical options available to people these days that we as a society literally cannot afford to provide all of them (or even most of them) to everyone. Somehow, we have to square the perception that people are entitled to all possible medical options regardless of cost and the fact that we cannot remotely afford it. I guess that is why they call economics the "dismal science".

[antigop]

114. Methinks you need to do some more reading..................... n/t

[gravity]

135. You some good points

This type of plan would be good for those that are able to afford insurance in the first place and lower frivolous medical expenses.

But we still need a plan for people who can't afford insurance in the first place so they can at least have basic medical care.

[Lydia Leftcoast]

67. Ssssh! Don't give them ideas!

:scared:

[Lasher]

75. I'm glad you asked that question

The real intent here is to eliminate employer-provided healthcare. This and Social Security 'reform' are remaining major items on his rightwing extremist legislative wish list.

I believe he's been saying you get rewarded by choosing a plan that is less expensive. But he might be saying 'comprehensive'. Sounds about the same so what could be the difference?

Translation: You'll get a tax break if you pay for a cheap plan yourself. You will be punished with higher taxes if you are currently fortunate enough to have good medical benefits through your current or former employer. That's because these benefits are more valuable (expensive to employers) than he thinks you should have, so he proposes to treat these benefits as taxable income. This will force employees to opt for a high deductible, low premium plan.

He's also saying people should be making their own choices.

Translation: He wants you on your own, negotiating for healthcare with insurance companies, with your employer out of the picture.

Trust me, this is a shell game. The HSAs are little more than a smokescreen that happens to benefit bankers and Wall Street at our expense.

Check out my post upthread here. Arm yourself by hitting the provided link to salin's OP on the subject.

[antigop]

93. You get it, Lasher! But also think "Medicare replacement" n/t

[DuaneBidoux]

50. There is in fact already a similar thing now. My wife and I use it and it is effective.

We identify how much money we think we are going to use on health for the upcoming year and we have that put into an account pre-tax. The biggest restriction is that we have to use all the money by the end of the year or we lose it which is what makes it such a challenge to know what amount to put into the account.

Because of this we usually underestimate what we will use to make sure that we don't lose anything. For us we use it for dental or eyes (for which we have no coverage) or to pay medicine or doctor's copays.

So these work great for us. But, as you alluded to in your post, we benefit and are in good shape to benefit. Why? My wife and I already have great insurance and we also earn over $100,000 so it is easy to have something to save for health in the first place.

This is, of course, the problem with 90% of what the republicans propose: it only helps people who are not really in that much need of help in the first place. Obviously if you have nothing to save in the first place a medical savings account doesn't do a lot of good.

[RB TexLa]

61. that's a FSA not a HSA

[DuaneBidoux]

123. I know that...but the principle is virtually identical.

[antigop]

53. Good info from cbpp.org website -- PLEASE READ

ADMINISTRATION DEFENSE OF HEALTH SAVINGS
ACCOUNTS RESTS ON MISLEADING USE OF STATISTICS
http://www.cbpp.org/2-16-06health.htm


HEALTH SAVINGS ACCOUNTS UNLIKELY TO SIGNIFICANTLY
REDUCE HEALTH CARE SPENDING
http://www.cbpp.org/6-12-06health.htm


INFORMING THE DEBATE ABOUT HEALTH SAVINGS ACCOUNTS:
An Examination of Some Misunderstood Issues
http://www.cbpp.org/6-13-06health2.htm

[K8-EEE]

85. Thanks for this...

Whenever Shrub says "I strongly believe" that something is a good idea, you KNOW it sucks!

[antigop]

88. Health savings account are part of the GOP agenda -- it's right there on the GOP website

Under party platform:
http://www.gop.com/media/2004platform.pdf

>>
Health Savings Accounts (HSAs)
Health Savings Accounts allow people to own and control their health care. They
are an important step toward creating a system of consumer-driven health care that puts
patients and doctors at the center of decision-making – not government bureaucrats.
When consumers make decisions about health care, individuals control their health care
dollars and health care decisions. Health Savings Accounts allow people to save, earn
interest, and spend tax free on their health care needs. HSAs are combined with a lowpremium,
high-deductible health insurance plan to offer flexible, affordable insurance
options for small businesses and individuals. Health Savings Accounts are now available
to all Americans thanks to the efforts of President Bush and the Republican Congress.
The next step, which our Party endorses, is to extend tax deductibility to the insurance
premiums associated with HSAs. We also support efforts to expand the use of Health
Savings Accounts to help control health care costs and give individuals more power in
making important medical decisions.
>>

Now if it's part of the GOP platform, do you think it's good for you?

Ugh. I have to shower after vising their website.

[endarkenment]

58. They are a good distraction.

Keeps people from noticing that their Corporate Health Insurance is going away and that we have an at best a mediocre health care system.

[Lasher]

91. Then keep taking more and more away

They'll never notice.

One really sick part of this is corporations declare profits when they reduce or eliminate employee/retiree benefits. That's because they have already been accounted for on the corporate books as future liabilities. Elimination of a future liability = profit. This was a big incentive to executives when they were destroying defined benefit pension plans.

So the assholes running corporations create an illusion that they're actually effective enough to turn a profit - by preying on employees who actually work for a living - then it's even more obscene compensation all around for the executives! Yay, it's a win-win!

I assure you with absolute certainty, this is just how it works. And it's a big reason Junior's rich backers have been after him dismantle company provided healthcare just like this.

[antigop]

94. BINGO! I'll try to dig up an article n/t

[antigop]

97. Found it -- it's FAS106 -- Ellen Schultz from WSJ

http://www.dukeemployees.com/wsj1.html

Scroll down to:
Companies Transform Retiree-Medical Plans into Source of Profits

[Lasher]

124. Ellen has done a lot of good work reporting this type of thing

I have followed her for years.

[jwirr]

59. $50,000 and you are elderly: hip replacements, knee replacements,

cataracts, gallbladder surgery, diabetes, high blood pressure, breast cancer, Alzheimer's, broken bones, wheelchairs, home health care, nursing home care...... That $50,000 is not going to cover half of this. And this is only when you are older and does not cover the costs of health care for your family when you are younger. Wake up! the only way this is taken care of is a universal single payer health care program.

[ourbluenation]

64. It's not meant for that. It's a supplemental to a regular insurance policy.

[jwirr]

73. And if *ss manages to destroy medicare? He wants to replace all

government run health care programs with private programs.

[K8-EEE]

84. Did you know you're supposed to retire with an extra $200,000

earmarked just for medical?? I mean that's the "advice" they give.

I'm sure it's a good idea in general to just have a gazillion dollars. However how are people supposed to pay today's inflated housing, energy and ins. costs, raise kids, pay a mortgage and end up with retirement funds PLUS $200,000?

[antigop]

102. But the insurance policy has to be high-deductible n/.t

[antigop]

103. And I don't think their entire "plan" has unfolded yet

It's a move from employer-provided insurance to (eventually) the individual market.

[blondeatlast]

62. They are a blessing--but I'd rather have a single payer health care system instead.

My family has good insurance, but I have a chronic health problem and our HSA has been a lifesaver, almost literally.

But there should be no need for them. We need single payer NOW.

[Cassandra]

66. Imagine you're a young couple with a new baby...

born prematurely and you haven't had a chance to put much into an HSA and the baby needs hundreds of thousands of dollars of medical help. Then what good is an HSA?

[K8-EEE]

76. True, the best advice is "don't get sick and don't have sick kids!"

That's the GOP answer to the health care crisis I guess...hey I'd love to NEVER see a doctor or do any of that if I don't have to, but it seems like more and more people are one health crisis away from being completely wiped out....the safety nets are disappearing.

[qwlauren35]

68. I have one.

I think I lose money on it every year. It's not worth the energy to go to the pharmacy and get a printout of prescriptions, or go to a doctors office and get printouts of visits... but I do it, because I hate to see the money get flushed...

A large medical emergency is already a tax deduction. Frankly, I think the savings accounts aren't meant to do anything but cover HMO co-pays, prescriptions, and the average out-of-plan doctors visits.

If Bush thinks they are worth anything more than that, he's nuts. But wait, I already knew that...

[Czolgosz]

69. Ask Bill Richardson; he is a big supporter of health savings accounts.

http://www.ontheissues.org/2008/Bill_Richardson_Health_Care.htm#10

[Lasher]

129. Bill who?

Boy, what a DINO!

[Czolgosz]

131. If you think that's bad, you should see Bill DINO's defense of Abu Gonzales:

Tavis: Alberto Gonzalez happens to be a member of your community. Is this guy gonna survive? He's the first Hispanic to have that job.

Richardson: Yeah, I know. I'm rooting for him, I like the guy, I know him. I hope he survives, but he's got to clean up his act and at least know what's happening in his department. He, at that press conference, said "Well, I didn't know anything about this." When you're heading a Cabinet agency—I did at the Department of Energy—and it's very hard to do that, 'cause you got thousands of people working for you.

But you gotta know what is happening with U.S. attorneys, because these are the top Justice Department attorneys in every state. So, he's gotta get more engaged, he's gotta clean up his act, he's gotta be forthcoming. I think the Congress needs to really investigate, but if I were the White House, I'd say "I'm gonna let Karl Rove testify, I'm gonna put everything on the table, I'm gonna let Harriet Miers, the former legal counsel.

I'm gonna have Alberto Gonzalez. They shouldn't be testifying in private. They should do it openly before the American people. That's a separation of powers. We should do that.

Tavis: It occurs to me now, listening to you talk about your friend who you know, Mr. Gonzalez, it draws a stark contrast between—I haven't checked where all the other candidates are, but I know Obama is on record very clearly saying Gonzalez should step down. I suspect other Democrats running for president are maybe saying the same thing. That's a contrast between you and others on whether or not this guy should step down.

Richardson: That's right. I do believe that it's up to a president to make those decisions about Cabinet members. Obviously, Alberto's very damaged, and he's gotta be frank and testify and do what has to happen. But I think that's up to the president.

Tavis: So you would not call for his stepping down right now.

Richardson: No, no. And you know what? Part of it maybe is because he's the highest-ranking Hispanic ever.


Source: http://www.pbs.org/kcet/tavissmiley/archive/200703/20070321_richardson.html

[Lasher]

132. Bogotry takes on many forms

Wonder why this DINO thinks Speedy should be spared the same treatment that would be afforded anyone else? Could it be because he is the highest-ranking Hispanic ever?

Did you check out his position on Social Security? He has none.

[Czolgosz]

133. There are LOTS of reasons why Richardson ranks with Hillary on my least favorite candidate list (but

I'll hold my nose and vote for the ticket if either Richardson or Hillary wins the nomination).

Here are my biggest beefs with Richardson (besides his support for Abu Gonzales and his apparent racial basis for that support):

1. Richardson’s support for NAFTA and CAFTA;

2. Richardson’s order to shut down presidential recount despite suspicious circumstances (New Mexico had the highest undervote in that nation for the '04 presidential race);

3. Richardson’s support for revenue reduction via tax cuts for corporations and the ultra-wealthy;

4. Richardson’s a favorite of the DLC; and

5. Richardson’s support for mandatory jail time, even for non-violent offenders;

6. Richardson’s support for limiting access to our court system for people hurt by negligent hospitals;

7. Richardson’s support for prosecuting minors as adults;

8. Richardson’s support for eliminating parole for anyone convicted of a violent crime;

9. Richardson’s support for eliminating automatic citizenship for all children born in the USA; and

10. Richardson’s support for the death penalty PLUS his vote to abolish habeas corpus in death penalty appeals PLUS Richardson’s opposition to offering the option of life-without-parole as an alternative to the death penalty PLUS Richardson’s support for expanding the number of federal crimes punishable by death.

[mod mom]

72. If you have kids and can estimate their HC costs ( in our case it's dental + braces)

they allow you to use income tax free. The problem is if you don't use all the money, you don't carry it over you lose it.

Ours also came in handy after my husband required 7 surgeries after getting flesh eating bacteria. We knew what out of pocket costs we were going to occur and had a big deductible per procedure. We still had to pay for the surgeries, but at least the MSA funds were exempt from state and federal tax.

We are not wealthy, but also not living pay check to paycheck. Kids cost alot.

[Lydia Leftcoast]

77. No, no, no--that's not an HSA

An HSA DOES allow you to accumulate the money, IF you can afford the monthly contributions.

What you have is a flex account.

[Lasher]

130. I believe you are technically correct but I think the terms have become interchangeable

With respect to the views you and antigop have expressed on the subject, I think this is starting to look like the argument that .org always equals a nonprofit website, etc. While the initial intent arguably was for there to be a distinction between the two just like you say, corrpution of the rule has by now rendered the two terms interchangeable. You might be wasting your time trying to enforce the rule.

No negative sentiment toward you. Quite the contrary, I am really encouraged to see you and the others weighing in on this important subject. :thumbsup:

[valerief]

74. Big Pharma gets bigger. nt

[salin]

80. Recommend - and ask others to do the same

this is a front of assault that the econoneocons really want to push - to completely put on individuals the cost of insurance (off of business) by pushing high-deductable catastrophic insurance with HSAs which only mean something if one earns enough money to pay all of one's bills and THEN put a chunk aside each month to pay for the couple thousand in health care a family might need before hitting the deductable.

Lets get this on the greatest page!

[Dorian Gray]

82. I wouldn't mind

setting up a health savings account for procedures that my insurance would not cover, but I also don't think that insurance should become obsolete.

[Hubert Flottz]

86. K&R

[newportdadde]

95. Everyone - Flex Savings Accounts and Health Savings Accounts are not the same.

A lot of people in this thread or confusing an HSA with a Flex account... two VERY diferrent animals.

Flex Savings Account - These are actually very nice, they are the use it or lose it accounts. Your covered by your regular employee health insurance, then at the beginning of the year you can elect to have XXX amount in our Flex Account, this money comes out pretax and you pay it back over the course of the year.

Example.. our son was born 3 years ago. We knew my wife would max out 1500 individual on insurance out of pocket. We signed up for 1500. Our son was born in Jan. We get a check for 1500, pretax. The remainder of the year my check got deducted to pay in 1500. I saved approx 500 bucks in taxes if you go with 30%.

These are GOOD, nothing wrong with these.



Health Savings Accounts - You save up in this account - tax free like an IRA. You use the money in them to purchase a high deductible policy. That is the key, they want to get rid of insurance provided by an employer and move to all of us having these crappy high deductible individual policies. You then use your savings to pay out the large bills your going to get for regular doctor visits/ procedures.

These are BAD.

[kiahzero]

96. By the time I'm 45, my prescriptions alone will have cost over 1.5 million dollars.

I don't foresee HSAs being all that useful for me. :eyes:

[antigop]

98. A brief overview of the flaws of health savings accounts

http://www.cbpp.org/pubs/hsa.htm

>>
A Brief Overview of the Major Flaws With Health Savings Accounts
This overview examines several serious problems inherent in recent HSA proposals:

*

HSAs would weaken the existing health insurance system and could actually increase the number of uninsured.

*

HSAs shift risks to individuals, leave less-healthy individuals facing substantial costs, and potentially result in worse health outcomes.

*

HSAs have little potential to improve the health insurance system.

*

HSAs would significantly increase the federal budget deficit, especially in future decades when the nation already will be under fiscal strain.

*

HSAs provide the largest tax breaks to those who least need help paying for health coverage.
>>

[Yavin4]

99. I Have One Simple Question

What's wrong with removing the over 65 provision from Medicare? We all pay into Medicare AS WELL AS for our own healthcare. Just look at your pay stub, there's line for Medicare and a line for your own health care. Why not combine the two lines on your pay stub into one? Most of us will probably end up paying less.

A simple, straight-forward, single-payer system. We all pay in, and we're all covered.

[antigop]

100. Another great article from the CBPP -- it describes the "plan"

http://www.cbpp.org/1-31-06health.htm

PRESIDENT'S HEALTH CARE TAX CUT PROPOSALS ARE LIKELY TO WEAKEN EMPLOYER-BASED HEALTH INSURANCE, PRIMARILY BENEFIT HIGH-INCOME PEOPLE, AND WORSEN DEFICITS
>>
The new health care tax cuts are likely to weaken the employer-based health insurance system through which the vast majority of Americans now obtain health coverage. One tax cut related to HSAs could actually increase the number of the uninsured by encouraging employers to no longer offer health insurance to their workers.
>>

[Lasher]

122. Worthy of an OP, methinks (EOM)

[baldguy]

104. HSAs are good for people who are young & rich & don't get sick.

[antigop]

105. Great article by Krugman -- Medical Class Warfare--describes problems with HSAs

http://www.pkarchive.org/column/071604.html

>>

But for people whose income puts them in high tax brackets, these accounts are a very good deal; making the premiums deductible turns them into a great deal. In other words, health savings accounts will offer the already affluent, who don't have problems getting health insurance, yet another tax shelter. Meanwhile, health savings accounts, in the view of many experts, will actually increase the number of uninsured.

This perverse effect shouldn't be too surprising: unless they are carefully designed, medical policies often have side consequences that worsen the problems they supposedly address. For example, the Congressional Budget Office estimates that one-third of the retirees who now have drug coverage through their former employers will lose that coverage as a result of the Bush prescription drug bill and will be forced to accept inferior coverage from Medicare.

In the case of health savings accounts, the key side consequence is a reduced incentive for companies to insure their workers. When companies provide group health insurance, healthier employees implicitly subsidize their sicker colleagues. They're willing to do this largely because the employer's contributions to health insurance are a tax-free form of compensation, but only if the same plan is offered to all employees.

Tax-free health savings accounts and premiums would provide healthier and wealthier employees an incentive to opt out, accepting higher paychecks instead, and would lead to higher insurance premiums for those who remain in traditional plans. This would cause some companies to stop providing health insurance, or raise employee contributions to a level some workers can't afford.
>>

[REACTIVATED IN CT]

109. Payroll/Benefits Administrator here

HSAs can enable an employer (or a self insured person) to purchase a lower cost insurance coverage (HDHP). I'm very surprised to learn that in some areas of the country they actually cost more than a standard HMO or indemnity plan. Something is not right there. The insurer is taking on less risk, therefore the premiums should be lower - if we are comparing apples and apples.

IMO HSA's are a calculated risk -you are gambling that you will be healthy until you have a good amount of money socked away. The other alternative is to pay more for a comprehensive "first dollar" policy - which you may not collect anything from.

Even if you are lucky enough to have an employer who is funding the deductible in full, you could have cash flow issues if you need high cost medical care such as a hospitalization early in the year. Not everyone has money in the bank to cover that sort of expense. Hopefully you could work out a payment plan with the providers. As each year goes by and more money builds up, that scenario becomes less likely

I don't like to see an employer offer an HDHP/HSA combo as the only option - but sometimes it is the only way the company can afford to offer health coverage today.

Until we get a Democrat in the White House and more Dems in Congress and can spend our tax dollars on things we need like universal health care, HSAs can be a coping mechanism.

[Lasher]

125. HDSA/HSAs can also be used to destroy existing traditional employer-provided healthcare

And that is exactly what is going on. As a benefits administrator you should be keenly aware of that.

[Sapere aude]

110. Like most repuke programs, it does nothing for the ones most needing help.

Wealthy people as well as poor people can put money aside tax free for medical emergencies. The only problem is that poor people don't have the money so it ends up being a tax free savings account for the wealthy who can already pay for their health care. Now they get an added tax dodge.

[bunkerbuster1]

127. No damn good at all.

Since nobody answered your question, I thought I would.

(yeah, I've researched these things myself. It's a typical Republican "free market" solution, one that entails redistributing mo' money from the poor to the rich.)

[Lasher]

128. Glad to see this made the greatest page

I've been out hauling firewood and just got back. Off to get another load.

[eridani]

136. It's like your county property tax office writing you a big fat check--

--because your house didn't catch fire last year. It's a way to take money out of the health care dollar pool used for actual health care and give it to people who are at the lowest risk of actually getting sick.