National Nurses United

HSA 2:3 9/30/08 2:23 PM Page 17 cover every American. Instead of focusing on creating backup retirement accounts for the wealthy, healthcare policy in this country needs to focus on creating a way to ensure that everyone can get quality healthcare that isn't prohibitively expensive, he said. HSAs will fail in the long run, an Employee Benefit Research Institute report issued in August confirmed. Even if individuals save the maximum allowed each year, those funds will be woefully inadequate for covering the costs of healthcare premiums and out-of-pocket health expenses during retirement, the institute concluded. "HSAs are not a solution at all to the problems we have in healthcare," McCanne said. "The problem we really have to address is we want everyone to be able to access healthcare without having to face financial hardship." Another primary challenge of HSAs is that they are predicated on f anyone has tried to make an HSA work, or take "responsibilthe idea that the account holder will save money every month. At a ity" for healthcare, it would be Emily Reece. time when the cost of everything from food to gas is on the rise, The 58-year-old San Francisco resident suffers from peripheral wages have stagnated, and the mortgage crisis is robbing homeown- neuropathy, restless leg syndrome, chronic pain from fibromyalgia, ers of their equity, saving is unlikely. Cumulative American consumer and post-traumatic stress disorder—all of which she tries to manage debt rose to $904 billion in 2007—an increase of 6 percent over just under a high-deductible plan, a health savings account, and about the year before, according to the Federal Reserve System. $8,000 a year in income. Like many Americans, Reece needs medicaThree out of every four people who file for bankruptcy have tion and regular visits to the doctor to manage her health. health insurance, said Pollitz. It only takes abut $12,000 in debt to Reece, who asked that we change her name because she is involved in bankrupt a family, she added. "If you have a $10,000 deductible, it a disability lawsuit related to her healthcare, estimates that she spends 10 doesn't take much work to get to that $12,000," she said. hours a week on the phone, in doctors' offices, sending e-mails, and talkIn one study, Pollitz found the cost of an average pregnancy and ing to lawyers to line up treatment and medication she can afford. To stay birth was about $10,000 — and almost all of those services were paid healthy, she said, she's dependent on the generosity of doctors who somefor out of pocket by people who had not met their deductible. times refill her prescriptions with free samples or medications other "There's a misnomer," she said. "People call high-deductible plans patients have returned. She sighs and says it feels like a full-time job. 'catastrophic coverage.' But I don't consider pregnancy a catastrophe. Rifling through her bills, Reece fished out the most recent stateDo you?" ment from the bank that administers her HSA. In total, her bank Lastly, HSAs do not work for the majority of people in the United charges her $3.95 a month in fees. After funding her HSA with a States because, for them, healthcare is about treating their chronic $1,500 gift from her partner in December 2007, the account was conditions, not the occasional flu shots and annual exams covered by empty by June. high-deductible plans, said Pollitz. Actually, it's worse than that. One in three uninsured Americans has a chronic disease like diabetes, "I got this thing. Let's see, what do I owe them now?" she mutheart disease, or hypertension. Just in the last decade, the average num- tered. "Here it is: I owe my HSA $8.47. I'm going to cancel this thing ber of medical visits by Americans increased by a quarter, from an average because now it's costing me money. I just don't make enough money of three to an average of four annually, according to a report by the U.S. to use it as a tax write-off." Centers for Disease Control. Half of all physician office visits were made And after two years on her plan, what does Reece think of by people with chronic conditions. McCain's proposal to encourage HSAs and high-deductible plans as a "Managing chronic conditions requires regular medical care. It just way to solve the healthcare affordability crisis? does," said Pollitz. "If you have diabetes, you need to be testing your She guffawed and lost her breath. blood three to five times a day. That's expensive. Those test strips are a "[McCain's plan is] so silly. That's ludicrous. Those of us who are buck each. That's hundreds a month. The research litlow income are so far away from — you know, most of erature shows that when people have to pay out of us are just trying to pay the rent and keep groceries To learn more about the pocket, they don't manage their health as well." around. The HSA, for me, has just become one more presidential candidates' Managing health is the whole point of health insurdebt, and one more complicated, bureaucratic system healthcare platforms, see ance — a point HSAs miss, said Don McCanne, a doctor to deal with. I'd rather deal with the IRS than deal "What's at Stake in and member of Physicians for a National Health Prowith this thing." I November on Healthcare" gram. PNHP has partnered with the California Nurses in the July|August 2008 Association/National Nurses Organizing Committee issue of Registered Nurse. Heather Boerner is a freelance health and medical writer in to support a single-payer, "Medicare for all" system to San Francisco. I SEPTEMBER 2008 W W W. C A L N U R S E S . O R G REGISTERED NURSE 17

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