# Trump: "Repeal ACA and replace with tax free health savings accounts" **URL:** \ **Category:** Politics & Elections\ **Created:** [November 1, 2016, 8:38pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400 "2016-11-01T20:38:28Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![HeatherPA](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/heatherpa/32/3072_2.png) [@HeatherPA](https://boards.straightdope.com/u/HeatherPA)\ **Post date:** [November 3, 2016, 1:46am UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/61 "2016-11-03T01:46:28Z")
> [@Typo\_Negative](#): > > Yeah, they don’t give estimates. I was in the hospital 5 days last February. I am still getting bills from doctors I never saw. Yep, no estimates given. They don’t even give you a chance to refuse ridiculous charges. My husband was in the hospital 2 days in May, two bills recently arrived, $497 each for two different doctors. Neither was billed correctly as they sent them to Medicaid, not Medicare, then billed us full price because Medicaid denied them. Uh, duh. (It was before my employer coverage kicked in) Oh, and what feats of medical wizardry did these two doctors perform? Essentially, they handed us their business cards. I have “good” employer provided coverage and still spent two weeks in a panic because the insurance was showing that they were going to deny his 2nd and 3rd days of chemo (of 3 days total) and we were going to owe the equivalent of two years of our total household income. Sorry, it’s hard to save that into an HSA. However, it’s easy to understand how we fit into Trump, or any Republican’s plan… not being wealthy, we should just die. ---
**Author:** ![Miller](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/miller/32/481_2.png) [@Miller](https://boards.straightdope.com/u/Miller)\ **Post date:** [November 3, 2016, 2:46am UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/62 "2016-11-03T02:46:17Z")
> [@puddleglum](#): > > This is because the insurance company pays the price. Do you think they know the price of each procedure? > Everyone who has to pay knows the price and since most americans only pay the deductible, that is the price they know. When I smashed up my car about two years ago, the mechanic didn’t seem to have any trouble telling my how much it would cost to fix before they did anything, even though my insurance was going to pay for almost all of it. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 3, 2016, 2:51am UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/63 "2016-11-03T02:51:28Z")
> [@Shagnasty](#): > > People can defend the ACA (ObamaCare) all they want but the real-world effect for millions of people like me is to disable routine health insurance almost completely, force us into very high deductible plans that have little practical use except for catastrophic emergencies or chronic diseases and force us to pay hundreds of dollars a month extra for the privilege while we simultaneously have to save for the health care that we actually use because insurance isn’t going to pay for that. Just to be clear - I am NOT defending the ACA. It sucks. It sucks really, really hard. What I want, and wanted before the ACA was passed, was genuine universal health care like civilized nations have. ---
**Author:** ![Shagnasty](https://avatars.discourse-cdn.com/v4/letter/s/9dc877/32.png) [@Shagnasty](https://boards.straightdope.com/u/Shagnasty)\ **Post date:** [November 3, 2016, 2:58am UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/64 "2016-11-03T02:58:50Z")
> [@Broomstick](#): > > Just to be clear - I am NOT defending the ACA. It sucks. It sucks really, really hard. > > What I want, and wanted before the ACA was passed, was genuine universal health care like civilized nations have. I know that. I was just speaking in general. I am just irritated this week because I found out I am getting a raise but my net pay will actually go down because I have to start paying a lot of money for insurance I will likely never be able to use because my deductible is so high and my employer will have to pay even more. For my personal healthcare, I have to save, save and save some more and pay for it myself disregarding the absorb amount that both me and my employer are already paying (it is over $12,000 a year combined for no benefit other than rate negotiation that shouldn’t be an issue in the first place). That doesn’t count. You still need lots of hard cash to go to the doctor. That is definitely not what was promised a few years ago. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [November 3, 2016, 6:04am UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/65 "2016-11-03T06:04:59Z")
I’ve been following this thread and reading all these posts and just barely understanding the details of what y’all are talking about. And as a Canadian, all I can say is: God bless Premier Douglas, the socialist who implemented single-payer in Saskatchewan; God bless Justice Hall, the conservative who wrote the Royal Commission report recommending that the Saskatchewan model be implemented nation-wide; And God bless Prime Minister Mike Pearson, the liberal who got his cabinet, his caucus, and a minority Parliament to implement Medicare for all Canadians. Rest in peace, gentlemen: you done good. 🙂 ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [November 3, 2016, 7:00am UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/66 "2016-11-03T07:00:01Z")
Smug bunch of bastards, aren’t they? Let’s raise their rent. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 3, 2016, 3:36pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/67 "2016-11-03T15:36:55Z")
> [@Anny\_Middon](#): > > Another point about HSA’s – they don’t necessarily keep you from having to pay out significant money for health care, in addition to the amount you are paying for your insurance premiums. > > The [average employee cost for family coverage](http://kff.org/other/state-indicator/family-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D) in 2015 was $4,710. This is in pretax dollars (I’m pretty sure) so your taxes do go down somewhat. This is for overall health insurance – I didn’t have time to find what high-deductible plans cost. But let’s assume (based on no data) it’s 50% of this – $2,355. > > The maximum contribution to an HSA for 2017 for family coverage is $6,750. In [2014 employers paid an average of $890](https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/hsa-contributions-vary.aspx) of this – let’s assume that number still holds true. > > OK, another assumption – you are in the 25% tax bracket. Your costs are then $1,766 for premiums and $4,328 for the HSA, for a total of $6,094. None of this applies to the health cost deduction on your taxes. > > Your HDHP has a maximum out-of-pocket amount of $13,100 (see first link above). Suppose you have no carryover from previous years’ HSA contributions (which would be the case if it’s the first year you’re on the plan). If you are unfortunate enough that someone in your family needs a lot of health care and you reach the maximum out-of-pocket, and you devote every penny of your HSA to health costs, you will still owe $6,350 for these costs. If you are in the 25% tax bracket, this is probably not enough to qualify for a deduction on your taxes. > > So your total costs for the year: > > $1,766 – health insurance premiums > $4,328 – HSA contribution > $6,350 – out-of-pocket health expenses > Total amount $12,444. > > There are a lot of families that really can’t afford this amount. > > (OK, I’m counting on Dopers to let me know if I got any of this wrong.) What this gets wrong is that the employer contribution is not actually being paid by the employer. The employer is engaging in tax arbitrage and the incidence of this falls on the worker. Under the current system the worker does not pay $4,710 but whatever is left after taxes on $12,612 plus the $4,710. Since the average tax rate is around 15%, the average current cost is $15,530. I don’t have the inclination to check your math but if it is correct then the average cost will be much lower under the new system, and that is if all of the money in the HSA is actually spent. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 3, 2016, 3:39pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/68 "2016-11-03T15:39:50Z")
> [@Dogzilla](#): > > But you said, > > So, you’re acknowledging that there’s no possible way to get cost estimates and shop around with an HSA? > > Note: I’m under the understanding that the ACA was also supposed to provide negotiation leverage to reduce pricing. Does anyone know, was that bit carved out of the bill to get it passed, or did the negotiations fail, or have HC costs actually dropped since the inception of ACA? In the current system it is very difficult to shop around because the system is not designed for consumers to do that. That is one reason the system needs to be changed. If you change the system so the consumers are incentivized to do it then healthcare providers will have to do so as well. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 3, 2016, 3:46pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/69 "2016-11-03T15:46:46Z")
> [@Broomstick](#): > > Right - because when you are literally having a heart attack you have so much frickkin’ time to go comparison shopping! :rolleyes: High deductible home insurance is impossible because when your home is on fire you have so much frikkin’ time to go comparison shopping. High deductible car insurance is impossible because when your broken down by the side of the road on a dark and stormy night it you don’t have the frikkin time to comparison shop. Not every trip to the doctor is for a heart attack. Emergency care only makes up between 2 and 10% of healthcare spending. If we can get the costs down in the other 90% it would still be worth doing. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 3, 2016, 3:51pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/70 "2016-11-03T15:51:10Z")
> [@Miller](#): > > When I smashed up my car about two years ago, the mechanic didn’t seem to have any trouble telling my how much it would cost to fix before they did anything, even though my insurance was going to pay for almost all of it. There are many different types of car insurance, some people only have liability others have high deductible plans. The existence of these people means that they can shop around and pick the cheapest option. This means more transparent pricing. The last time I took my car to the shop I paid cash and this was not seen as odd by the shop. I have never done that in a medical situation and our current system is designed so that I never would. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 3, 2016, 4:04pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/71 "2016-11-03T16:04:33Z")
> [@Broomstick](#): > > When I entirely without health insurance and I was, indeed, the one paying the bills I still could not get a straight answer on price. Even when I negotiated a lower price for paying up front in cash I’d get bills claiming the original price, run-arounds and told there was no discount even when I had it _in writing_, bills for services and doctors and all sorts of things tacked on without informing me ahead of time even when I specifically requested to know all costs ahead of time, and so forth. > > No, in actual fact _no one_ knows what a medical procedure costs before it actually occurs, and often not for some time afterward. It’s a fucked up mess. > > Also, EVERY insurance company seems to negotiate it’s own price for everything, then will try to disallow and argue down the price further. Again, it’s a fucked up mess. The current system is designed to making pricing hard to find out. Insurance companies negotiate discounts for their networks while doctors try to jack up the initial price so they can make the most money. I had a medical procedure at an out of network provider and had to pay $500 out of pocket. I then had to convince my insurance company to reimburse me and after weeks of back and forth was able to convince them to give me $80 which is what the allotted for that procedure in network. So the actual price is not what the practice expects to be paid but rather there initial offer in a negotiation with the insurance company. If a consumer finds their way into this situation then they can normally get a discount if they press hard enough but the doctor does not want the insurance company to know they are giving out better deals. Medicare and Medicaid add another complicating factor as they mandate that no one get a better deal than they do. The system is byzantine and desperately needs to be changed to empower consumers and make pricing transparent. Unfortunately, Obamacare went in the opposite direction with networks becoming thinner and pricing still opaque. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [November 3, 2016, 4:41pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/72 "2016-11-03T16:41:28Z")
> [@puddleglum](#): > > High deductible home insurance is impossible because when your home is on fire you have so much frikkin’ time to go comparison shopping. High deductible car insurance is impossible because when your broken down by the side of the road on a dark and stormy night it you don’t have the frikkin time to comparison shop. Your comparisons are not appropriate. In most of the United States, e.g., you don’t have a choice of fire department anyway; when your house is on fire, the responding department will be whichever agency serves your area. (I’m not aware of ANY location where you have a choice of which 911 operator to call, but I suppose there could be somewhere where there are competing fire departments.) When you go to rebuild, then you can do comparison shopping, but by then the emergency is over. Similarly, if your car is broken down by the side of the road, you have an extremely limited selection of responding agencies; most likely, you are going to call either AAA or the roadside assistance plan for your car manufacturer or insurer. With medical emergencies, you’ve got a bit different situation. Depending on where you live AND what insurance you have, you may be offered a choice of hospitals, but you’ve got little or no way of knowing which is cheaper or better at the time. Moreover, once you are in the middle of receiving care, you are probably mostly stuck with your initial choice. St. Francis Hospital may have cheaper X-ray and imaging services, but if you are being prepped for surgery at Stormont-Vail Hospital, they’re not taking you to another hospital for the CT scan. Similarly, if you are being treated for a heart attack at Stormont’s ER, you’re going to be admitted to Stormont’s cardiac ICU and then Stormont’s cardiac rehab program–changing horses mid-stream is not encouraged. > [@puddleglum](#): > > Not every trip to the doctor is for a heart attack. Emergency care only makes up between 2 and 10% of healthcare spending. If we can get the costs down in the other 90% it would still be worth doing. No, these are estimates for EMERGENCY ROOM care, which is not at all the same thing. The ER is but a portion of total emergency spending. For example, cancer is among the most expensive medical conditions, and any diagnosis of aggressive cancer certainly qualifies as urgent (and probably precludes spending weeks and months trying to track down costs), but very little cancer treatment is provided in the ER. Meanwhile, the research to balance cost versus effectiveness is a bit different too. There’s not that much difference in quality between oil changes at the dealership versus oil changes at the quick-lube, but there can be an enormous difference in quality among surgeons and hospitals–a “low-cost” provider with a significantly higher rate of complications or patient mortality isn’t really a bargain. ---
**Author:** ![Anny\_Middon](https://avatars.discourse-cdn.com/v4/letter/a/bc79bd/32.png) [@Anny\_Middon](https://boards.straightdope.com/u/Anny_Middon)\ **Post date:** [November 3, 2016, 6:30pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/73 "2016-11-03T18:30:45Z")
> [@puddleglum](#): > > What this gets wrong is that the employer contribution is not actually being paid by the employer. The employer is engaging in tax arbitrage and the incidence of this falls on the worker. Under the current system the worker does not pay $4,710 but whatever is left after taxes on $12,612 plus the $4,710. Since the average tax rate is around 15%, the average current cost is $15,530. > I don’t have the inclination to check your math but if it is correct then the average cost will be much lower under the new system, and that is if all of the money in the HSA is actually spent. I know I’m often pretty dense about this sort of thing, but I’m not following. When you say the employer contribution is not actually paid by the employer, are you talking about the employer contribution to the HSA? Because we have an HSA through my husband’s employer, and they deposit $1000 to our account – $650 at the start of the year and $350 in June. We pay the remaining amount through payroll deduction. That’s in pretax dollars, of course. ---
**Author:** ![Anny\_Middon](https://avatars.discourse-cdn.com/v4/letter/a/bc79bd/32.png) [@Anny\_Middon](https://boards.straightdope.com/u/Anny_Middon)\ **Post date:** [November 3, 2016, 6:36pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/74 "2016-11-03T18:36:50Z")
> [@slash2k](#): > > With medical emergencies, you’ve got a bit different situation. Depending on where you live AND what insurance you have, you may be offered a choice of hospitals, but you’ve got little or no way of knowing which is cheaper or better at the time. Hijacking this for a moment– A good friend of mine is a nurse who specializes in rehab, particularly rehab after a stroke. She suggests everyone find out which hospitals in your area are stroke centers, and if you or a loved one may be experiencing a stroke, try to get the ambulance to take you to a stroke center. I believe this isn’t as urgent as it once was – more hospitals are equipped these days to deal with strokes – but it may make a significant difference in how much function you can recover post-stroke. ---
**Author:** ![Anny\_Middon](https://avatars.discourse-cdn.com/v4/letter/a/bc79bd/32.png) [@Anny\_Middon](https://boards.straightdope.com/u/Anny_Middon)\ **Post date:** [November 3, 2016, 6:42pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/75 "2016-11-03T18:42:21Z")
> [@Shagnasty](#): > > People can defend the ACA (ObamaCare) all they want but the real-world effect for millions of people like me is to disable routine health insurance almost completely, force us into very high deductible plans that have little practical use except for catastrophic emergencies or chronic diseases and force us to pay hundreds of dollars a month extra for the privilege while we simultaneously have to save for the health care that we actually use because insurance isn’t going to pay for that. That is just a massive wealth redistribution scheme on several different levels. > > I am glad that millions of people that didn’t have health insurance before have it now but where do you think that money is coming from? Take one look at a paystub for someone like me and it is instantly obvious. Here is the thousand dollars or so a month that you and your employer are paying just for you but forget about that. That isn’t really for you. It for the really broke people somewhere else. Most of their stuff will be covered. You have to save up for your own healthcare expenses and pay for them with a debit card created especially for that purpose. Don’t worry though, you won’t be quadruple charged because you don’t have to pay federal income tax on some of your savings. I take that back, your annual deductible is $5000 and the limit for an HSA is $3000 for a single so you you will just have to take it out of your checking account if you go over the $3000. Sounds look a good and fair plan doesn’t it? I think it’s sort of comparing apples to oranges, but according to [this article](http://www.cnbc.com/2016/07/27/average-health-insurance-premiums-fell-after-obamacare-took-effect-study-says.html) > [@](#): > > The average premiums in the nation’s individual health insurance market “actually dropped significantly” in 2014, the year that the Affordable Care Act took effect, “even while consumers got better coverage,” according to two health-care analysts whose findings challenge a popular narrative about Obamacare prices. I say apples to oranges, because that’s for individual policies. I’m uncertain as to why employer-provided plans have increased in price so sharply. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 3, 2016, 7:10pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/76 "2016-11-03T19:10:23Z")
> [@slash2k](#): > > Your comparisons are not appropriate. In most of the United States, e.g., you don’t have a choice of fire department anyway; when your house is on fire, the responding department will be whichever agency serves your area. (I’m not aware of ANY location where you have a choice of which 911 operator to call, but I suppose there could be somewhere where there are competing fire departments.) When you go to rebuild, then you can do comparison shopping, but by then the emergency is over. > > Similarly, if your car is broken down by the side of the road, you have an extremely limited selection of responding agencies; most likely, you are going to call either AAA or the roadside assistance plan for your car manufacturer or insurer. > > With medical emergencies, you’ve got a bit different situation. Depending on where you live AND what insurance you have, you may be offered a choice of hospitals, but you’ve got little or no way of knowing which is cheaper or better at the time. Moreover, once you are in the middle of receiving care, you are probably mostly stuck with your initial choice. St. Francis Hospital may have cheaper X-ray and imaging services, but if you are being prepped for surgery at Stormont-Vail Hospital, they’re not taking you to another hospital for the CT scan. Similarly, if you are being treated for a heart attack at Stormont’s ER, you’re going to be admitted to Stormont’s cardiac ICU and then Stormont’s cardiac rehab program–changing horses mid-stream is not encouraged. > > No, these are estimates for EMERGENCY ROOM care, which is not at all the same thing. The ER is but a portion of total emergency spending. For example, cancer is among the most expensive medical conditions, and any diagnosis of aggressive cancer certainly qualifies as urgent (and probably precludes spending weeks and months trying to track down costs), but very little cancer treatment is provided in the ER. > > Meanwhile, the research to balance cost versus effectiveness is a bit different too. There’s not that much difference in quality between oil changes at the dealership versus oil changes at the quick-lube, but there can be an enormous difference in quality among surgeons and hospitals–a “low-cost” provider with a significantly higher rate of complications or patient mortality isn’t really a bargain. I know a family whose house burned down. They were out on the lawn with no home, no food and no clothes. Hardly a time to shop around. Yet because they had insurance, they were able to get a hotel room, and money for food and clothes. This is because insurance companies prepare for this outcome. Likewise, a person who has a heart attack does not need to shop around, they could have a prearranged relationship with a provider. As you say most emergency room care is not an actual emergency and many urgent medical procedures are not in emergency rooms. I was responded specifically to a claim that shopping around could not be in healthcare because people have heart attacks. When my father was diagnosed with cancer my grandmother was able to contact a niece in the healthcare business to get a recommendation as to who to see. So it is possible to shop around even with serious diseases. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 3, 2016, 7:16pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/77 "2016-11-03T19:16:08Z")
> [@Anny\_Middon](#): > > I know I’m often pretty dense about this sort of thing, but I’m not following. > > When you say the employer contribution is not actually paid by the employer, are you talking about the employer contribution to the HSA? Because we have an HSA through my husband’s employer, and they deposit $1000 to our account – $650 at the start of the year and $350 in June. We pay the remaining amount through payroll deduction. That’s in pretax dollars, of course. The employer contribution to the health insurance plan either an HSA or traditional insurance is not actually paid by the employer. The employee ends up paying for it all. For example, an employer can either pay 50 grand a year or 40 grand a year with a health plan that is worth 10 grand. In the second case the employee is paying regardless of who actually sends the check to the insurance company. Because health plans are not taxed like salary the employee who accepts a compensation package with healthcare included can increase their take home pay significantly since they would have to buy an equivalent plan with after tax money. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [November 3, 2016, 9:33pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/78 "2016-11-03T21:33:53Z")
> [@puddleglum](#): > > I know a family whose house burned down. They were out on the lawn with no home, no food and no clothes. Hardly a time to shop around. Yet because they had insurance, they were able to get a hotel room, and money for food and clothes. This is because insurance companies prepare for this outcome. Likewise, a person who has a heart attack does not need to shop around, they could have a prearranged relationship with a provider. I’m sorry, I’m still not seeing how getting a hotel room for the night is like getting treatment for a heart attack. Did this family actually call Holiday Inn and Ramada and Motel 6 and Super 8 and Days Inn to get the cheapest rate? or did they just pick somebody, anybody, out of the phone book, or perhaps just go with whatever hotel chain had prearrangements with their insurance company? And as far as making pre-arrangements, doesn’t that pretty much require that you know what your health problems are going to be? For example, in my town one hospital has an advanced stroke center, the other has a specialized cardiac ICU. Which one do I want to have a prearranged relationship with? (And if I’m out doing my Christmas shopping 20 miles up the highway, neither of those is really an option; I’m going to be taken to Lawrence Memorial.) > [@puddleglum](#): > > As you say most emergency room care is not an actual emergency and many urgent medical procedures are not in emergency rooms. I was responded specifically to a claim that shopping around could not be in healthcare because people have heart attacks. When my father was diagnosed with cancer my grandmother was able to contact a niece in the healthcare business to get a recommendation as to who to see. So it is possible to shop around even with serious diseases. That’s nice. Did this niece recommend the BEST doctor or the CHEAPEST doctor? Did she even know when she was making the recommendations which one would turn out to be the lowest-cost? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 3, 2016, 10:03pm UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/79 "2016-11-03T22:03:59Z")
> [@puddleglum](#): > > High deductible home insurance is impossible because when your home is on fire you have so much frikkin’ time to go comparison shopping. High deductible car insurance is impossible because when your broken down by the side of the road on a dark and stormy night it you don’t have the frikkin time to comparison shop. > Not every trip to the doctor is for a heart attack. Emergency care only makes up between 2 and 10% of healthcare spending. If we can get the costs down in the other 90% it would still be worth doing. You want to know another difference between the car mechanic and the hospital? What the car mechanic charges for a “procedure” doesn’t change based on my insurance, or whether or not I even have insurance. I don’t get taxed differently to fund the fire department based on what home insurance I have. _You can’t comparison shop for healthcare because you can’t get a straight answer on cost_. And yes, I’m aware that the “retail” price is jacked up just so the insurance companies can argue it down again. Here’s where another problem kicks in: As someone _completely_ uninsured I was often able to negotiate down to half the original “retail” cost when necessary… but friend of mine with crap insurance policies were often stuck paying “retail”, or some other price higher than mine because that’s what their insurance negotiated for and they were out of luck regarding further negotiating. And that’s why saying “make people more responsible for their healthcare” and “make them shop around” doesn’t work - because there is _no fixed price_ on anything! ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [November 4, 2016, 2:00am UTC](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400/80 "2016-11-04T02:00:14Z")
> [@Broomstick](#): > > … And that’s why saying “make people more responsible for their healthcare” and “make them shop around” doesn’t work - because there is _no fixed price_ on anything! I agree that this is problematic. However, in the large scheme of things there are much more fundamental reasons that these right-wing mantras don’t work for health care, so that in a sense the lack of definitive pricing is almost a minor technicality – one can imagine that problem fixed but all the other problems persisting. One could literally write a book about what those other problems are – quite a large book, actually. Definitive pricing aside, there is no means of cost control so gouging is the norm, partly to make up for losses from insurance companies who won’t pay and patients who can’t, and for the enormous administrative costs of dealing with insurers. Few who have not actually experienced the workings of single-payer appreciate just how simple it is. The “health savings account” is just a creative right-wing fiction that basically means, “you’re own your own, pal”. So people don’t take care of themselves or their children with preventive care and early diagnosis, and lack of preventive care and/or just bad luck can lead to major acute or ongoing health issues. One can see a kind of superficial merit in HSAs linked with catastrophic or high-deductible insurance plans, but it quickly all falls apart when one looks at how health care really works, the economics of cost control and the necessity for broad risk sharing, and the basic conflict of interest between the private-enterprise profit motive and the essential nature of health care and the inevitability of the need for it. [Previous page](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400.md?page=3) [Next page](https://boards.straightdope.com/t/trump-repeal-aca-and-replace-with-tax-free-health-savings-accounts/770400.md?page=5)