HSA’s are another giveaway to the wealthy

So the end-result of the Parlor problem appears to be that the neighborhood isn’t going to budge on the parking variance, cardiologist check which means that another local business is in danger of going under unless the notoriously neighborhood-friendly Board of Adjustment suddenly becomes more responsible.
The end of the thread on the hydeparkaustin mailing list occurred when a member of the “Circle C in downtown Austin” party commented that a plan (in the works now for a long time and seemingly not close to fruition) to arrange for parking at the State Hospital (across Guadalupe) to be used for employees of businesses on Guadalupe would be the only way out of this mess.
I replied that it was unlikely that any customer or employee of those businesses would find it attractive to park at the state hospital, thumb rx walk out to Guadalupe, psychiatrist wait a long time for the light at 41st and Guadalupe to change, walk very quickly across the street, and then and only then arrive at their destination (as compared to parking on a side street or Avenue A).
The person replied (and was supported by the moderator, who then ended the discussion with the attached unpublished rebuttal in hand) that “the boss can make the employee park whereever they say”. This may be true in an abstract sense, I replied, but it’s unlikely that any such boss would want to spend the energy enforcing a rule which prevented employees from parking in PUBLIC spaces such as on Avenue A, even if they did want to keep employees out of their own private lot.
This goes back to thinking of a type which is unfortunately prevalent here in Austin and among many other progressive cities – that being that people will do things that are good, as long as we provide opportunities to do them. IE, build it and they will come. What you build, given this thinking, doesn’t have to be attractive compared to the pre-existing or forthcoming alternatives; its mere existence will suffice.
For instance, in this circumstance, they think that simply providing available parking in an inconvenient and unpleasant location will get people to park there who would otherwise park on neighborhood streets. Likewise, Capital Metro thinks simply providing any rail will get people to use it, even if the individual incentives are pretty awful, given the shuttle bus transfers.
I have a whole blog category analyzing ‘use cases’ which I think is a far more useful way to look at the problem. In this case, for instance, put yourself in the shoes of that potential parking consumer a few paragraphs back and remember that your boss probably (a) isn’t going to be able to stop you from parking on Avenue A, and (b) probably couldn’t catch you even if he tried.
But like with the naive pro-transit suckers that bought the MikeKrusee ScrewAustin Express, it’s unlikely that it’s possible to get through to these people. And so, the consequence is that another local business which probably would have improved Guadalupe as a place we actually want to be is thwarted. Good work, geniuses.
This is not to say that we should never build transit or highways. What it does mean is that somebody ought to spend at least a few minutes figuring out whether the thing you’re going to expect people to use is actually attractive enough for them to choose to use it. By that metric, light rail in 2000 was a slam dunk, despite the lies spread by Skaggs and Daugherty. But in this parking case and with this commuter rail line, nobody seems to have bothered to put themselves in the shoes of the prospective user.
my sadly now never-to-be-published response (remember, this is to somebody who said “But the Heart Hospital doesn’t let their employees park in their lot!” follows.

Those cases have some clear and obvious differences to the one
we’re talking about here — one being that the employees are being prohibited from parking in a private lot (which is still difficult to enforce, but at least defensible). You’re asking that these business’ employees not only refrain from parking in the business’ lot (private) but ALSO from the public spaces on Guadalupe and the street space on Avenue A. And nobody’s ‘requiring’ those state employees to park in Siberia – if they could find an open metered space somewhere else, for instance, they’re free to take it. Likewise, the Heart Hospital can’t force its employees to mark at the MHMR pool.
So it’s easy to prohibit people from parking in a given private lot. Unless you’re going to turn Avenue A into RPPP as part of this, though, they’d still park there instead of across Guadalupe. And any boss who tried to force them otherwise would probably be experiencing the fun world of employee turnover.

I’ve been on an HSA for about six months now (only choice at current job). Ironically, angina the primary reason I had to leave the last job, pestilence which I liked a lot, ophthalmologist was a benefits cut that hit our family very hard, with no accompanying increase in salary. They (previous company) left us with choosing between a “high” plan which was ALMOST as good as the previous-years’ plan, except a couple hundred bucks more a month; a “medium” plan for a few bucks more in which all copays were nontrivially hiked and coinsurance cut; and a “low” plan which was basically a HSA, too.
The HSA works pretty much like an FSA (which we were already using), except a bigger pain in the butt, since the years’ money isn’t all available on day one, like in an FSA. (In fact, I ‘bounced’ payments-by-mail twice because I mailed in the bill response without double-checking to see how much had flowed in, each time with a delightful $20 charge tacked on). You also get to enjoy looking like a deadbeat to doctors’ offices as you quite frequently fall into the “31-60 days overdue” bill categories since they first have to file with insurance, then insurance tells them what they’re supposed to charge you, and then you get sent a bill. The tax savings are no greater than with an FSA, which is to say that they depend on your marginal tax rate, which for most of the people who were having trouble with health care before isn’t likely to be high enough to be worth the difficulty of setting aside this money in the first place.
Now, for us, it still makes sense (even though unlike most people on HSA’s, we actually hit our deductible last year; i.e., we actually use health care). And it makes a hell of a lot of sense for a high-earning person that doesn’t use health care. But it doesn’t do squat to help out people who are unable to afford insurance today – the benefits disproportionately accrue to those with the highest marginal tax rates, not the poor. The poor, sadly, probably remain better off going to the emergency room than using this thing.
Even libertarians who have been exposed to single-payer or socialized medicine seem to finally get it, as I got it a few years ago. Medicine is not a case where the market works like it does in computers or groceries or whatever else; nor will it ever be. It’s more like providing a police force and firefighters.
And no, switching to an HSA has not given us any incentive to reduce our usage of medical care at all, because, like pretty much everybody who works for a living, I only go to the doctor when I need to because it’s such a pain in the ass. The theory that we can save money on healthcare with this “ownership society” crap rests on the questionable premise that most money is being spent by people who can use HSAs, when, in fact, most money is spent on the elderly, the premature, and other heroic interventions.
This is really becoming an issue in which the center is ready to move, and only the far, far, far right balks. There’s just no sensible reason not to pick the best socialized system (appears to be France or maybe Germany) and just get it over with.

2 Replies to “HSA’s are another giveaway to the wealthy”

  1. Investing 5 grand for a wealthy person who also has to carry the HSA insurance in order to use the money is hardly a giveaway. The amounts are too small for truly wealthy people to be the ones that reap the benefits of an HSA.
    But people like me – an actor,writer, and web designer – benefit immensely. And my income right now probably qualifies as lower class, not even middle, as I lost a couple of major clients last year. HSA’s make health insurance affordable, and if I don’t get sick, it allows me to use the money I would be throwing away as a retirement plan.
    While I agree some poor persons who can’t afford insurance won’t be able to afford this, either, I don’t think that means you do nothing for the people in between like me. A lot of people could benefit and would take advantage if they understood how an HSA worked.
    And as far as the FSA, the huge difference is that you use it or lose it. An HSA stays your money.

  2. “Investing 5 grand for a wealthy person who also has to carry the HSA insurance in order to use the money is hardly a giveaway. The amounts are too small for truly wealthy people to be the ones that reap the benefits of an HSA.”
    The idea is that this is a giveaway for the wealthy employed – it’s essentially a way to either shelter an additional 5K of money per year, or to get a deduction for medical expenses that poor people either won’t be able to get or will get far less benefit from.
    Yes, if you were a wealthy uninsured person before, it wouldn’t make as much sense to jump to an HSA. That’s not what I was talking about.
    As for the rest of it – I well understand the difference between an HSA and an FSA and why an HSA is good. Just because it helps ME (good personal economics) doesn’t mean it’s good POLICY.

Comments are closed.