Survey: Americans Shun Health Savings Accounts

I'm not surprised by the results of a Commonwealth Fund/Employee Benefits Research Institute survey that found just one percent of Americans with health insurance have chosen to open the health savings accounts enabled by the 2003 Medicare Modernization Act. That's unchanged from a year ago, when the two groups did their first poll.

I'm also not surprised by findings that the reason that 7 million Americans with high deductible health insurance plans (where medical bills must exceed $2,000 per family before insurance coverage kicks in) have not opened HSAs is that they don't have the money to put away for medical emergencies.

And while the survey showed that people with these accounts do not skimp on care for chronic conditions (perhaps leading to the uptick in personal bankruptcies caused by overwhelming, unpaid medical bills), it confirmed what most objective analysts have feared from this conservative approach to the health care finance crisis. "Adults over age 50 in consumer-driven plans are significantly less likely than those with more comprehensive coverage to have had a colon cancer screening test in the last five years, and all adults in CDHPs were less likely to have had their blood pressure checked in the last year," the report said.

An ironic note: Adults in CDHPs were more likely to say that they had had their cholesterol checked in the last five years. It suggests that drug industry marketing does work in getting people to ask about treatment for conditions for which there are patented medicines. Most blood pressure control drugs (at least the ones prescribed first by doctors) are generic. So even when there are low-cost solutions available, people on these "consumer-driven" plans don't purchase life-saving therapies because they don't want to pay for the initial visit to the doctor.

This survey suggests that consumer driven healthcare based on high-deductible insurance coverage would be a disaster for preventive medicine.