[try-perforate]

Politics aside, I think HSAs are great. Under a single payer system I would expect payroll taxes to be significantly higher (8-10%). You pay that every month even if you don't use it. In return you get free healthcare when you do use it.

With HSAs in America, you save an amount equal to your tax bracket on expenses up to the lesser of your deductible (if plan pays 100% post-deductible) or the maximum HSA contribution (3350 for singles). You only pay this when you need care. You can also use your HSA dollars for things like glasses, pregnancy tests, and teeth cleanings.

There's added incentive for employers to offer HSAs because it reduces their payroll tax as well.

Granted this is all given that you are eligible, can afford, and have health insurance. And that your provider will cover whatever treatment you're seeking.

However, given my plan, I pay about $60/mo after my healthy life plan savings. I can take the savings from that plan and look at my budget and afford to save $100/mo in my HSA. That's $500 "lost to insurance" each year and $1200 growing tax-free given I have no medical expenses (unlikely). Compare that to a single-payer system with ~8% payroll tax. Given I make $5000 a month, that's $400/mo or $4800/yr that's "lost to insurance" given that I have no medical expenses .

I'm not a great example because I'm young, privileged, and healthy. I'm interested in the economics of this whole thing though.

[lcw]

Define great. Obviously they only benefit, as you kind of noted, people with disposable income. I mean you aren't dropping money into an HSA if you are living paycheck to paycheck. Do you really think we should have health programs that only profit our affluent citizens?