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Jewish World Review July 6, 2000 / 3 Tamuz, 5760

Betsy Hart

Betsy Hart
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Consumer Reports

Accounting for your health -- I JUST FINISHED eight sessions of physical therapy for a shoulder injury I suffered in January. The therapy was enormously helpful, but it was just about obviated when I practically had a heart attack upon receiving the bill for it-- between $125 and $195 for each session. Quivering, I called to remind the doctor's office and that up front I had been promised a much lower price. I was relieved to hear "Oh that's right Mrs. Hart. I forgot your particular arrangement. Your cost was $70 for each session."

That's hardly small change, but it's a lot more manageable. Before I had my third baby, I was told by the two hospitals I was considering for the delivery that the standard cost for a two-day stay for mom and child was about $6,000. But I talked with the Finance Office at each facility, explained my situation, and had one hospital drop the fee all the way to $3,000. In fact, I find that just about all of my doctors discount their fees for my family anywhere between 20 and 50 percent.

So what is this "magic" I'm able to work? It's my government-qualified medical savings account (MSA), and Congress will soon have to decide whether to kill the program, extend it or make MSAs more widely available. That's because in 1996 Congress allowed a small group of 750,000 folks, mostly the self-employed, to become eligible for MSAs in a four-year "experiment." Well, now that that experiment is ending, the Republicans in Congress shouldn't dare consider passing any "Patient's Bill of Rights," currently being hotly debated on Capitol Hill, that doesn't include giving every American the "right" to become eligible for an MSA.

Medical savings accounts work like this: I buy the "catastrophic" health care policy of my choice from an insurance company, meaning it has a high-deductible --- between $3,000 and $4,500 for the family. I'm allowed to put up to 75 percent of the dollar amount of that deductible into a tax-free savings account.

(Legislation currently under consideration would up that allowance to 100 percent and would make the qualifying deductibles lower).

I can then use that account to pay for routine medical expenses until the deductible kicks-in, or allow it to keep rolling over and gathering interest until age 65, when I can collect it like any retirement account.

And since my insurance is only used for big expenses -- just like car insurance, which isn't used for spark plugs and tune-ups -- my premiums are low, $2,167 a year for my family of five compared with a typical employer-sponsored policy of between $5,000 and $10,000 a year for such a family.

Meanwhile I see the doctors I want, get the care I want, and I have an incentive to compare prices, to ask questions about costs, and yes, to bargain. Even considering all of my out-of-pocket medical expenses, I come out way ahead of a typical employer-sponsored plan.

It also means that my doctors don't have to routinely hassle with my insurance company or HMO-- and its bureaucrats. They get their payment directly from me, often up-front. In fact, there's a movement of doctors, pharmacies and other providers seeking out patients who are "self-pay" and offering them steep discounts precisely for this reason.

(The non-profit American Association of Patients and Providers reached at "" is just one such network.)

So why shouldn't every American be eligible for a tax-free MSA account? Why shouldn't all employees be able to use their company health care dollars to purchase an MSA if they so-choose, perhaps putting thousands of dollars a year back into their pockets?

MSAs sure solve the problem of health insurance "portability." And they go a long way toward helping the uninsured -- at least a third of all current MSA policy holders previously did not have any health insurance at all.

MSAs aren't going to solve all of America's health care problems. But we have yet to reap their cost savings and other benefits on a large scale.

Right now less than 100,000 Americans have taken advantage of MSAs because insurance companies can't invest heavily in promoting and expanding a product for which the market remains so small. Thus MSA naysayers, those bureaucrats who have a big stake in making sure people don't get control over their own health care dollars, claim "people don't really want" MSAs. Well then, as the current MSA pilot project runs out, I challenge such folks to a real experiment: make every American eligible for an MSA, and let the results speak for themselves.

JWR contributor Betsy Hart, a frequent commentator on CNN and the Fox News Channel, can be reached by clicking here.


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06/02/00: Federalizing care of kids
05/17/00: The natural food threat
05/09/00: To stop gun violence, keep families intact
05/03/00: Pass the fat, please
04/25/00: Something just for boys
04/18/00: When toleration goes too far
04/10/00: Women warriors
04/05/00: Confessions of a soccer mom
03/30/00: Getting an education about schools
03/22/00: If you're a parent, act like one!
03/14/00: Not child advocates, but self-advocates
03/06/00: McCain not what he seemed at first
02/29/00: An effective answer to social problems
02/22/00: The feminists' newest target: Toys
02/06/00: Harassing the harassers
01/31/00: It doesn't take a village to raise a child --- it takes a scheduler
01/25/00: Psuedo science and global warming
01/18/00: Socially responsible nonsense
01/10/00: Monica may be onto something
12/27/99: Sometimes it matters quite a lot what government thinks
12/17/99: Teens have no inherent 'right to privacy'
12/10/99: Buying a minivan and tossing the SUV
12/03/99: On the mommy track
11/05/99:The waste of recycling
11/01/99: Welcome to Harvard pre-school
10/22/99: No disaster for women that Dole is out
10/19/99: 'Humanitarian' hypocrites
10/15/99: On a first-name basis with a three-year-old

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