Health Savings Accounts Violate Medical Ethics: Do No Harm

by Margaret Stapleton

All those who propose to heal the ailing health care system in the United States should examine their proposals in light of Hippocrates’ 2,500-year-old medical ethics code. Proposals should “be for the benefit of” the patients and “not for their hurt or any wrong.” Health savings accounts (HSAs), President Bush’s sole 2006 health initiative, fail this important test. HSAs will not benefit and will hurt both individual patients and the overall health care system.  Here’s how:

First, HSAs require that families pay the first couple of thousand dollars of health care charges. This will discourage people, particularly the poor, from seeking preventive care and encourage delays in seeking acute care. This results in sicker people, more expensive care, and exposure of others to contagious disease. HSA proponents seem to think that people should shop for health care as if they were shopping for consumer goods. But the idea that we should get our health care from whoever is offering a blue-light special this week is simply bad medicine. The seek-the-cheapest-care incentives of HSAs are contrary to the advice of health experts, who encourage patients to find and stay with a primary care physician. Any health care prescription that asks patients to look to their wallets rather than the health needs of their family fails Hippocrates’ test—it is not for the benefit of the patients, and it hurts them.

Second, HSAs will hurt the overall health care system by taking healthier people out of the insurance risk pool and increasing noncare costs. The people most likely to take up the HSA option are the healthy and wealthy. Their exit from insurance pools will drive up the costs for those who are more likely to need health care services and need conventional health insurance. So who actually benefits from HSAs? Billions of dollars in transaction fees for administering HSAs will go to banks and other financial institutions. This is money that won’t be spent on health care, but on new administrative expenses in a health care system already grossly overweight with noncare costs. Shouldn’t we be wary of health care proposals that benefit banks and wealthy workers needing tax shelters at the expense of the poor and the sick?

While President Bush’s HSA proposal fails the important benefit/harm test, many states are exploring ways to increase coverage for the uninsured, control costs, and improve residents’ health. For example, Maryland now requires large employers to offer insurance or pay into state insurance. Illinois will offer health insurance to all children this year and is developing a plan for quality, affordable health care coverage for all state residents. If the Bush administration cannot advance a better proposal than health savings accounts, it’s time to simply get out of the way—and, at least, do no harm. 

Margaret Stapleton is a senior attorney at the Sargent Shriver National Center on Poverty Law. To comment on this piece, please contact her.