There has been a boatload of coverage on HSAs in the media recently. But it seems like it can all be summed up by one Colorado paper, which recently published both PRO and CON opinions.

On the PRO side is Rep. Bill Thomas, who compares HSAs to hybrid cars:

"Here’s how it works: like a hybrid car powered by a combination of gas and electricity, HSAs combine a high deductible health plan and a tax-free savings account."

Rep. Thomas also emphasizes the "you being in charge" benefit. He goes on:

"Today, when you buy a car, you can visit different dealers and compare prices so you can get the most for your money. You should be able to do the same in the health care market. Consumers making choices based on cost and quality also will press the providers of care - doctors and hospitals - to improve their overall care. Choice and information in health care will bring prices down. Reducing costs is essential to reduce the number of uninsured Americans."

On the CON side, Rep. Jim McDermott compares HSAs to pans:

"A fundamental premise of this social re-engineering is that Americans would shop for health care bargains, as if they were shopping for pans. In many newspapers, Wednesday is grocery coupon day. Under the president’s plan, Thursday might become medical coupon day."

He obviously emphasizes the point that middle/lower class folks won't benefit from this at all. He also goes on:

"Do you forgo car insurance and set aside a hundred bucks a month in case you’re in an accident? The idea is so far-fetched that it’s illegal throughout the United States. A bedrock principle of this nation is to pool our resources and share the risk, because it benefits us all. That’s why we collectively support police and fire departments, national defense and a host of other essential services. The alternative would turn back the clock to the early 20th century, when people were wiped out by one moment of misfortune."

To me, I think the dynamic elaborated by both congressmen will come true - it is a matter of what the net effect will be? Will overall healthcare costs go down? I think so - maybe not initially as information still won't be used correctly. But over time, people will start making better decisions about healthcare AND people may actually start taking better care of themselves. Better decisions about healthcare means more fierce competition on price among healthcare providers.

Do HSAs favor the rich? Well, it seems to favor the healthy, rich or not. Maybe it's just not pc to explicitly say that a larger proportion of lower income people are less healthy (I haven't seen data on this, But I'd be willing to bet on it). So, here we are with yet another vicious societal cycle - the healthy, wealthy, and wise get healthier, wealthier, and wiser, while the sick, poor, and foolish only get sicker, poorer, and more foolish.

At the end of the day, I'd have to agree with Brian Klepper guest blogging (Read this 38-comment-thread) on The Healthcare Blog:

When it’s more mature, healthcare consumerism will likely include the mechanisms that help patients become better buyers and impact cost. Until then, HSAs and HDHPs are less expensive, slimmed down, short-term solutions that can work well if you’re healthy or financially secure. But they’ll do little to address our rapidly collapsing healthcare system. And as a national solution, they’re inadequate and oversold.

UPDATE: And while we debate back and forth, it was just reported that HSAs have reached $1B.