HSA QUESTION….We’ve been hearing ad nauseam for the past couple of weeks that George Bush’s domestic centerpiece for this year’s State of the Union address will be Health Savings Accounts. Fine. But what exactly does that mean?

The reason I ask is that we already have Health Savings Accounts. They’ve been around for a couple of years now (or even longer if you count their predecessors, Medical Savings Accounts). So obviously Bush isn’t going to propose that we create a new and wonderful thing called an HSA. Instead, he’s going to propose some kind of expansion or modification of HSAs.

But what? I haven’t even heard any speculation, and it’s an important question since ? as an emailer reminded me last week ? since there are plenty of proposals Bush could make that would be pretty popular among people who already use HSAs. For example: increasing the contribution limit; expanding the range of services covered by HSAs to include things like hearing aids and maternity care (which isn’t covered by many plans); allowing money to be withdrawn for nonmedical purposes after age 65 (or even better, 55); and so forth.

My point here is mainly a political one. Fighting HSAs on philosophical grounds is one thing, but people who already use them would be pretty pleased to see some concrete, money-saving improvements to HSAs ? and wouldn’t much care about their abstract virtues or defects. If we’re going to fight the HSA-ization of healthcare, we’d better be prepared to be on the opposite side of some motherhood and apple pie proposals from the White House that might sound pretty good to current users. I’m not quite sure how we plan to do that.

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