No, Really — You Have a Point

Matthew Holt of TheHealthCareBlog.com devotes a lengthy post to criticizing my (much lengthier) paper, “Health Savings Accounts: Do the Critics Have a Point?

Holt – who has an HSA himself, as I understand it – is not entirely critical. For example, he calls Cato “the sensible libertarian’s think-tank.” As for the uncomplimentary parts, I found them odd.

For example, Holt accuses me of concluding that no, critics of HSAs do not have a point. Yet the paper has an entire section titled “Criticisms That Raise Serious Issues” (pp. 11-22) where I validate many criticisms of HSAs. In particular, I agree that in some instances people with high-deductible insurance might skimp on care in ways that harm their health (though there is scant data to demonstrate that this actually happens). Thus, I agree with the Commonwealth Fund that HSAs should be liberalized to allow people to choose insurance with coverage below the deductible.

Also, Holt accuses me of ignoring the fact that risk segmentation results in reduced subsidies to the sickest insureds. Yet that is a central theme of the “students & professors” hypothetical (pp. 6-8). And on page eight I write:

Though HSAs may reduce hidden subsidies to sicker workers, they do not preclude subsidizing those workers in other ways.

I could go on. From his criticism of it, it doesn’t appear Holt read the paper very closely.