This is the final essay for my English class this semester. I was initially going to refute an essay about the United States having the best health care system in the world (we do NOT) but decided this would be easier to do in only 1200 words or less.

In the corporate health system of the United States, Americans who do not have private insurance or other health coverage often cannot afford basic medical care. J. Patrick Rooney states in an interview with Jerry Geisel that the best answer for the uninsured in America is to have health savings accounts or medical savings account, abbreviated as HSAs and MSAs, respectively. The general idea behind these accounts is that an employee will contribute a certain amount of their paycheck, and employers can also opt to contribute. Both contributions to HSAs and withdrawals used for medical expenses are exempt from taxes. HSAs under current law are linked to high deductible insurance plans, and workers use the accounts to cover deductibles and expenses not covered under regular insurance. Theoretically, since greater financial responsibility is borne by individuals, they will be more careful about choosing providers and services, saving money for everyone involved. Rooney clearly has good intentions, but he fails to recognize that the root problem is not simply Americans not having health insurance. The issue is socioeconomic inequality and the ability to pay for medical care, and HSAs would do nothing to solve problem of the millions of Americans who cannot afford a simple doctor's visit. Americans should be concerned about this because not only is it morally wrong to have a nation stratified by health as well as wealth, but also because even those not immediately affected by this health disparity will have to pay for it in the long run.

One basic problem with Rooney’s argument is that many who do not have insurance are also unemployed, and even those who are employed and uninsured would scarcely benefit from these accounts. Rooney argues that "an enlightened employer will want employees happy and satisfied with the health care plan," but in 2005, twenty percent of working Americans with moderate incomes did not have health coverage (Agovino). There is little reason to believe that firms who won’t provide insurance for employees will freely contribute to HSAs; in fact, one report by the Center on Budget and Policy Priorities states that currently, "more than one-third of all firms that offer high-deductible policies with HSAs make no contributions to the HSAs, and... the average contribution among firms offering HSA plans appears to be significantly lower than the average deductible for the insurance attached to those plans" (Park and Greenstein). Jonathan Gruber, a health policy analyst with the Massachusetts Institute of Technology, projected that expansion of health savings accounts would actually increase the number of uninsured in America (Chen). He points out that employers are under no obligation to contribute to workers’ accounts, and proliferation of HSAs would likely encourage companies to justify dropping insurance plans altogether in order to cut costs (Chen).

Rooney also overlooks the fact that workers who cannot afford insurance premiums are unlikely to be able to afford to contribute a significant amount of money to these accounts. A low-income single parent would scarcely have the ability to set aside a reasonable amount of her paycheck into an HSA (Westgard). Furthermore, while most HSA funds roll over from year to year, if a person has no other coverage and depletes the funds in their account (for example, due to a catastrophic illness or injury), they are out of luck; coverage ends when the account runs dry. This would be particularly devastating for low-income households without a“nest egg” to make up for the deficit, quite possibly leading to families declaring bankrupcy or having to go on social assistance as a result.

Another analysis by the Center on Budget and Policy Priorities criticizes that HSAs would lead to many, especially low-income individuals, “forgoing cost-effective medical services, including primary care, prescription drugs and preventive services” (qtd in Chen). We need only look at the current system to predict the outcome this would have. A study conducted by the Commonwealth Fund found that fifty-nine percent of uninsured Americans who had chronic conditions skipped doses of their medications or went without the drugs entirely because they couldn’t afford them; one third of this group found themselves in an emergency room or inpatient in a hospital as a result (Agovino). The same study also found that the uninsured were more likely than their insured counterparts to forego preventive cancer screenings or have a regular physician, which also increases their risk of developing more dangerous -- and expensive -- illnesses down the line (Agovino). How is this a problem for their fellow citizens? If a person cannot afford a simple doctor’s visit, they are not likely to be able to afford a hospital stay or trip to an emergency room. When facilities are not compensated for services, they are often forced to shift the financial burden to paying customers, driving up health costs for everyone else, or appeal to the government, which is taking away taxpayer’s money. Since HSAs often do not cover preventive care, they would perpetuate rather than fix the problem.

In a country where five percent of the citizens own fifty percent of the wealth, there are clear socioeconomic inequalities, and Dr. Rudolph Mueller notes that because the wealthy have more financial resources to pay for doctors and medicine, health care disparity is intimately tied with the chasm between rich and poor. He states that "for the elite of America and the fully insured, the treatment available may be the best in the world. But the system fails so many others and leaves a massive underclass of patients. Continuing our present system is far too expensive and incredibly unjust." Health savings accounts do not address the moral issue of health disparity (Westgard). Workers with higher incomes would have more money available to put into their health savings accounts, and thus more money at their disposal to pay for medical care. Moreover, tax benefits associated with HSAs overwhelmingly benefit those in higher tax brackets (Park and Greenstein). Senator Edward Kennedy in his condemnation of HSAs cites an estimate by the Congressional Joint Tax Committee that a mere one percent of tax benefits associated with these accounts would go to Americans with incomes of $30,000 a year or less, whom the HSAs are allegedly supposed to benefit most (Cohn and Kennedy). Health savings accounts, then, not only fail to solve the disparity in American health care and economic status, but would actually serve to exacerbate it.

Health savings accounts are, in the long run, just as difficult for the uninsured to afford as health insurance. Those who cannot afford care are more likely to become sick later on and be an even greater financial burden on the healthcare system -- and on other Americans -- when they cannot pay for treatment. Furthermore, economics should not be the only factor taken into account. Professor emeritus Arnold Relman of the Harvard Medical School states quite rightly that Americans ought to "accept the notion of health care as a social good rather than an economic commodity” (qtd in Cohn and Kennedy). While it is true that the current system is not working for many in America, there is no reason to believe that health savings accounts will do anything to help those who need it the most.

Works cited