SECTION FIVE: Multi-Year, the Future of HSA
We've spent a lot of time on the 1980 version of Health Savings Accounts. It's already rolling along in action, with only a couple of suggested additions to make it better. The new 2015 version is also before you. But lifetime Health Savings Accounts are only a dream, to be worked on for months or years, because they invade so many turfs, and will require extensive legislation to become a reality.
So that's what I have to offer on Lifetime Health Savings Accounts. It's about as far as a physician ought to go in meddling in related professions. It looks to me as though creating lifetime accounts on a model of whole-life life insurance would be a great improvement over our present term insurance model. But I am quite uncertain whether a project this large should be monolithic or have competition between an organization with experience, like an existing life insurance company, an evolved version of one of our health insurance companies, or an entirely new organization formed for the purpose. This topic alone is worth a debate and a white paper. Several existing professions are involved and may have special legal obstacles, just as they would have special qualifications. Perhaps several demonstration projects should be launched to find out some answers before we get into a century-long, horrendously expensive, failure.
On the other hand, it would appear the financial savings would be too big to ignore. Because it would take ninety years to conduct a full experiment, it would appear fairly clear we ought to test this in component pieces and then figure out how to unify them. If we must make mistakes, let them be fairly early, drop them, and re-direct our efforts. By all means, ask the life insurance companies what their experiences were. How did they overcome the long testing period? What are the problems which term-insurance companies uncovered in their efforts?
In sum, we ought to spend a year debating the issue, several years testing likely solutions, and another year debating what we have learned. Only by following some such path, is there a chance we will end up with something we are proud of.