Because these accounts are being pushed modestly, with no grand Social Security-style talk of remaking the social contract, there's a chance that they'll be seen as just one of various bewildering tax tweaks and slip quietly through Congress.

Umm, SLIP?

They passed in 2003.

It's quite obvious that for young men, these are a huge plus, as currently most of their health insurance costs are truly being flushed down the toilet. It's not so obvious to me that the same holds for women, though, at least those who have any desire for kids. Can someone point me to a convincing case?

Here is the e-mail I just sent Mallaby.

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I appreciated your "Ownership Society Redux" article today.

Though informative and well written, it glosses over an important point.

You wrote: "Or so goes the theory. In practice, probably less than half of all health spending outside Medicaid and Medicare would be affected by the new consumer-driven discipline. Many hospital stays cost more than any deductible, so consumers would have no incentive to bargain; emergency-room patients aren't in a fit state to negotiate prices with their doctors. But consider an even more basic question: Is the ostensible reason for health savings accounts the real one?"

There are three responses to this (and yes, I understand that they are hard to squeeze into an article).

1. As the incentive to get into these plans grows, they will start to make up more than the 1/2 you speak of.

2. The fact that hospital stays are larger than the deudctible is beside the point, given that insurance is there to cover the rest. More important is the point that, after 10-20 years of accumulating, these accounts will give consumers bargaining clout, as well as the ability to pay for more types of services. Couple this with the more empowered consumer driving down prices, and the costs of various procedures will come down.

3. More broadly, the press and media seems to miss the larger point that populations are dynamic, not static. Changes in these laws will change the behavior of consumers, which will generate yet more changes in the industry.

Your point about emergency room visits is instructive. With the internet providing better health information, and consumers having more economic and bargaining power, no one seems to see that the market will almost certainly create new relationships between clinics, doctors, and other providers.

The "Emergency Room" you refer to may well become a far different concept than the one you report on. This is how it should be.

Reporters are very skilled at writing articles about the "unintended consequences" of this or that law after the fact.

Why not take note of the fact that these reforms will have effects we don't know of yet. Some may raise issues that need to be addressed, but most of the results of expanded HSAs will be positive.
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b. Here is the only case you should need.

The current system is unsustainable. Stay on its course and we have national health care, which will hurt women, men, and civilization in general.

No reform is perfect, but that shouldn't stop us from moving forward. Last I checked, women, though slightly different in motivation, respond to incentives, empowerment, etc etc in similar ways that men do.

b:

Ask the next five women you see what their annual health bill is. It hasn't been $5k per annum since birth.

I also like the view that if HSAs put a major damper on only half of medical spending, they're pointless. Yeah, who needs incremental improvement?

oj: The cost for giving birth nowadays is ~$5K, with a C-section it's more like ~$10K (and 25% of births are C-sections, ridiculously).

I have no beef with HSAs at all, and I of course agree with Bruno that putting more power in the hands of individuals is a Good Thing. It just seems to me that men & women do have VERY different expectation of health care costs, and that has to be considered, if for no reason other than politically.

b;

Just another argument for marriage before children, so that the differences even out.

OJ: "Ask the next five women you see what their annual health bill is."

Few people know what their annual health bill is. Lots of (most?) people don't think they're paying anything; "My employer pays for it."

b:

Uh-huh. So there would be three years they'd not get to build up money. Though it probably makes sense for us to just cover the cost for childbirth.

They will never figure him out for the same reason Europe can't figure out why it's going into oblivion.

sneak into canada to give birth for free, if there isn't any ebola outbreaks going on up there at the time. of course once the child is born, the game is up as it is clearly a hardier specimen than today's canadian is capable of producing.