Own the fear

It seems that Health Savings Account, championed by the President as part of his "ownership society," helps them "own" poorer health and greater debt:

With the new plans, individuals typically pay the first $1000, or $2000 for families, spent on medical care each year. The plans are coupled with so-called health savings accounts, or HSAs, which allow patients to set aside tax-free funds to defray health expenses.

But a survey of data from 4,000 adults with health insurance found that about half of patients with a high-deductible plan racked up medical debt and were faced with other billing woes, compared with 31 percent of those with more traditional health plans, according to the research group Commonwealth Fund, which studies health policy issues.

In theory, patients have a "greater financial stake" in their medical spending, control that will lead patients to be more judicious about visits to doctors. Health-care premiums rose five times faster than workers' salaries in 2004, but employers fund the bulk of that and are scrambling for fixes.

The Medicare Modernization Act, passed in 2003, made HSAs much more widely available to Americans. Big HMOs like UnitedHealth Group Inc. are beginning to adopt the plans as well, evidenced by the No. 2 managed care company's recent acquisition of Definity Health, a pioneer of the plans.

But the Commonwealth study also found that high-deductible plans could lead patients to skimp on care due to cost, which experts say can foil the plans' goal to curb health-care costs.

"Health savings accounts coupled with high-deductible health plans have potential pitfalls, especially for families with low incomes or individuals with chronic disease," said Karen Davis, president of the foundation, which studies health policy. "The evidence is that increased patient cost-sharing leads to underuse of appropriate care."