I have an article today over at The Weekly Standard online, wherein I praise my wife, admit to my own vulnerabilities, call my friend a sissy, and offer some advice to those who fear health savings accounts (HSAs) and the outrageous prices doctors charge.

An article in today’s Wall Street Journal will no doubt have opponents of health savings accounts (HSAs) hyperventilating about how HSAs have failed. But the difficulties that consumers are experiencing are predictable, if not welcome, and some dissatisfaction with HSAs is no doubt a good thing.

Vanessa Fuhrmans writes [$]:

President Bush and many big employers have hailed “consumer-directed” health plans and savings accounts as an effective weapon in the battle against runaway medical costs. But several years after the plans got off to a fast start, the approach appears to be stumbling — largely because of consumers’ unease in using them…

[L]ow enrollment and low satisfaction among workers who are offered them raise the question of whether consumer-directed plans will stall before they ever hit the mainstream.

In a paper responding to common criticisms of HSAs, I argued that some of the inevitable consumer dissatisfaction is necessary, but much of it can be mitigated by expanding HSAs:

There are good reasons not to draw any firm conclusions based on current survey research…First…none of the surveys measures consumer satisfaction with HSAs alone, or at their full potential. Second, some dissatisfaction inevitably stems from unfamiliarity…This source of dissatisfaction can be expected to dissipate over time…

Finally, HSAs may be unpopular for reasons that should not sway policymakers… HSAs are designed to eliminate inefficiencies and hidden cross-subsidies. If that causes some dissatisfaction, it means that HSAs are achieving their purpose, not that they should be abandoned. If we stop robbing Peter to pay Paul, Paul’s dissatisfaction should not persuade us to change course…

Nonetheless, HSA supporters should be very concerned about the frustration HSA holders feel with (1) the lack of information to help them be cost conscious consumers and (2) the complex rules and restrictions that come with HSAs…

HSAs will have to reach a critical mass in the marketplace before they can be expected to effect a systemic change like widespread transparent price competition…The quickest and surest way to build that critical mass and a political constituency for HSAs would be to allow them to be coupled with any type of health insurance…

To open an HSA, millions of Americans would have to give up their current health insurance. HSA supporters can and should make HSAs simpler by removing that requirement.

None of the consumer satisfaction surveys tells us what we need to know most: the types of insurance and medical care consumers would choose if they controlled all their health care dollars and all their health care decisions. To find those answers requires expanding HSAs and removing all restrictions on HSA holders’ insurance choices.

It’s also worth noting that lots of people love their HSA:

A survey by the Blue Cross Blue Shield Association found that individuals with HSA-compatible insurance were consistently more satisfied with their coverage than those in traditional plans.

And many people support the HSA concept even if they’re dissatisfied with their particular HSA product. I fit squarely in that camp.

But the most telling line in Fuhrman’s article might be this one:

Enrollment [in HSAs] is growing faster on the individual market and among sole proprietors, but that may be because the plans are often the only affordable option.

And what might that tell us?

Michael Moore’s new film SiCKO praises the government-run health care systems of such countries as Canada. Moore claims the film was warmly received at Cannes by Americans from both sides of the political aisle. 

Canadian journalists, however, were a little more skeptical. Here’s how Peter Howell, a film critic for the Toronto Star, described their response to SiCKO:

Michael Moore is handing out fake bandages to promote his new film Sicko, an exposé of the failings of the U.S. health care system. But he may feel like applying a couple to himself after the mauling he received yesterday from several Canadian journalists – present company included – following the film’s first viewing at the Cannes Film Festival.

“You Canadians! You used to be so funny!” an exasperated Moore said at a press conference in the Palais des Festivals. “You gave us all our best comedians. When did you turn so dark?”

We Canucks were taking issue with the large liberties Sicko takes with the facts, with its lavish praise for Canada’s government-funded medicare system compared with America’s for-profit alternative.

While justifiably demonstrating the evils of an American system where dollars are the major determinant of the quality of medicare care a person receives, and where restoring a severed finger could cost an American $60,000 compared to nothing at all for a Canadian, Sicko makes it seem as if Canada’s socialized medicine is flawless and that Canadians are satisfied with the status quo…

Other Canadian journalists spoke of the long wait times Canadians face for health care, much longer than the few minutes Moore suggests in Sicko. Moore, who has come under considerable fire for factual inaccuracies in his films, parried back with more questionable claims…

Sicko, to be released in North America on June 29, is by turns enlightening and manipulative, humorous and maudlin. It makes many valid and urgent points about the crisis of U.S. health care, but they are blunted by Moore’s habit of playing fast and loose with the facts. Whether it’s a case of the end justifying the means will ultimately be for individual viewers to decide.

On June 21 — the day after the D.C. premiere of SiCKO – the Cato Institute will help viewers decide when it hosts a screening of clips from SiCKO and short films by independent filmmakers who are more critical of Canada’s Medicare system. Click here to pre-register. And arrive early: seating is limited. 

First it was Mitt Romney supporting a HillaryCare-style health care reform in Massachusetts. Now Tommy Thompson, who as secretary of health and human services was responsible for the Medicare prescription drug debacle, is attacking Missouri governor Matt Blunt for cutting Medicaid spending. Thompson told the Associated Press that states should expand access to Medicaid because the federal government pays most of the cost.

Thompson apparently has not read Michael Cannon’s terrific paper, Medicaid’s Unseen Costs, that shows how increased Medicaid spending drives out private health insurance, increases dependency on government, and drives up costs.

With Republicans like this, who needs Democrats?

So says Matthew Holt of The Health Care Blog. 

Although, I’m not sure I wrote what he’s crediting me with writing. Specifically:

[T]he only rational way to start groping towards a management of the insurance market that makes some kind of logical sense…must by definition involve a mandate and severe restrictions on the cherry-picking activities of insurance companies.

So I’m going to assume that Holt meant I’m dead right when I write that Jonathan Cohn is dead right when he writes that RomneyCare and HillaryCare have a lot in common.

Oddly, Holt thinks that forcing consumers to purchase health insurance is an important part of making sure no one takes advantage of them. Funny — I think that if I wanted to take advantage of consumers, the first thing I would do would be to take away their right to say no.

Last Wednesday the House held a surprise vote on Rep. DeGette’s (D‑Colorado) Human Cloning Prohibition Act of 2007. The bill that would prohibit reproductive, but not therapeutic cloning was defeated by only nine votes. That same morning, the White House issued a “Statement of Administrative Policy” declaring “The President unequivocally opposes all forms of human cloning” and that the President would veto any bill that allows even therapeutic cloning. The good news is that the House bill did not pass. The bad news is that Congress, the President, and a dozen or so states would like to ban at least some forms of cloning.

The Act would have prohibited human cloning which it defines as “the implantation of the product of human somatic cell nuclear transfer technology into a uterus or the functional equivalent of a uterus.” It would have prohibited both actual human cloning and any “attempt to perform” human cloning. The bill did not define “equivalent of a uterus” or what would constitute and “attempt” to perform human cloning. Vagueness is a problem in all efforts to ban cloning because of the possible chilling effects such prohibitions can have on scientific advancements. Ten years in prison or a ten million dollar fine would be a harsh penalty to pay for a misunderstanding of scientific motives.

Science is no longer something done in the basement of a mad scientist’s mansion. Scientific inquiry requires teams of researchers with universities or research institutions to back them. It is possible to conceive of one mad scientist or even one mad scientist who convinces another to go along, but a whole team of mad scientists? That is not only highly unlikely, but nearly impossible. The only way something that horrific could conceivably happen is if government sponsored a highly top secret project. No one in the private sector could command that amount of secrecy without the public finding out what was going on.

This isn’t the first time there have been efforts to ban new reproductive technologies for fear of mad scientist and monster babies. There were cries to ban in vitro fertilization (IVF) in the 1970s, but Congress never passed any such laws, and the research proceeded without the creation of any “monster babies,” only millions of happy infertile couples who now have children — children, who by most estimates, have fewer birth defects than children born without the assistance of reproductive technologies.

Cloning is an integral part of several potential medical advances. It is essential to embryonic stem cell therapies, potential infertility therapies, and possible genetic therapies. The best course of action for the federal government is no action at all. If we are lucky, Congress and the President will remain at loggerheads long enough for cloning to continue to play its part in the advancement of science. But, what might happen at the state level is another story.

There’s good news tonight:

The rate of death from heart disease in the U.S. was cut in half between 1980 and 2000 thanks to better medical treatment and a reduction in the incidence of some risk factors, a new study shows.

That’s wonderful news, the kind that ought to be celebrated. We hear about threats and dangers and cancer clusters and transnational viruses and flying TB carriers, and many of those are real concerns. But the big picture, as Indur Goklany demonstrates at great length in his new book, is — well, let his title explain it: The Improving State of the World: Why We’re Living Longer, Healthier, More Comfortable Lives on a Cleaner Planet. 

But this great news about heart disease appeared on page D4 of the Wall Street Journal and on page 13D of USA Today. As far as I can tell, it didn’t appear in the New York Times, the Los Angeles Times, or the Washington Post at all, nor on any NPR program. Though on the NY Times website, you can find an article the same day on the tiny increase in deaths from West Nile virus. And the heart disease story can be found on the Post website, though not in the print paper.

 More details appeared in the Journal’s Health Blog:

The decline in heart disease, reported in the current New England Journal of Medicine, saved an estimated 341,000 lives in 2000 compared with the number of deaths that would have been expected if the levels of heart disease in 1980 persisted.

341,000 fewer deaths from heart disease in one year! There’s good news tonight — even if you won’t find it in the newspapers.