Written by Bernie Saks MD

The Intelligent HSA

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Mr. George Will
Syndicated Columnist

October 29, 2008

Re: “The Intelligent HSA”

Dear Mr. Will:

My wife (a trustee on the Board of the University of xxxxxxxx) and I had the opportunity of meeting you for dinner prior to your keynote presentation and listening to that presentation about the entitlement mentality at the Universityof xxxxxxxx  last year. I had the opportunity to speak with you again at the book signing after the lecture. I am a physician and we spoke briefly about a business model that I have developed to help solve some of the health care problems. I had told you that I would correspond with you about this model and I have been terribly remiss in this regard.

This business model which I call “The Intelligent HSA” encompasses the philosophies which you espoused in your keynote presentation but adds some additional features to make this an effectively workable system. Earlier in the year on a multi-college alumni expedition, I had the opportunity to be with ex-US Representative Tom Campbell. Mr. Campbell was the Republican Representative from Silicon Valley and currently serves as the Dean of the UC Berkeley Haas School of Business. He is a Harvard trained lawyer, a PhD. from the University of Chicago under Milton Friedman, was a Clerk in the Supreme Court under Byron White, served as an Assistant White House Counsel, a tenured Professor of Law at Stanford and was Budget Director for the State of California under Governor Schwarzenegger. I paraphrase some of his comments about the meeting:

“It was a delight to meet you, and best of all, to get the benefit of your clear thinking. I understand your suggestion and I like it. The medical coach is a neat idea. In other proposals, including Sen. Clinton's (when she was first lady) a government actor (a regional health care board served this role). In the proposal of Bob Burnett, former Chair of the Santa Clara Medical Society, it's a federal agency created to be independent, like the Federal Reserve. That still might be what develops. What you do is to respect the individual, but recognize the need for expertise as well. One might tweak your idea with a mandatory consultation with a medical coach, cost to be paid out of the total pool of premia. And we need to be clear about those who choose not to insure. You address that by universal coverage. Sen. Clinton does by an employee mandate, including garnisheeing wages. Sen. Obama and Gov. Romney use an employer mandate, but leaving some uncovered…. The candidates, both state and federal, have their positions on health care plans, and the sides are hard to change. I think Gov. Schwarzenegger and Speaker Fabian Nunez deserve great credit for working together, but even they failed. The Presidential candidates are already heavily locked in; there might be a way to get to them, but I'm not able to do so. The only way I have to implement your idea is in a campaign of my own. I'm right now deciding whether I run for [prominent political position] in California in 2010 or not. If I do, I'd advance a health care proposal early and prominently. If I won, I'd have a good argument that this was a big part of winning, and that would help me get it passed. (Also, it's Democratic in being universal, Republican in including MSA's--so you've hit a point of potential compromise between the parties' positions.) … My suggestion--continue to pitch this wherever you can….

I am including the summary paper that I presented to Dean Campbell after our meeting for your review. I believe that everybody in the United States needs health care, but I do not believe in the current health insurance model. I believe that individuals need to be in control of their own health care and health care expenses, but need expert advice in discharging that function. I believe that health care costs will only be controlled when we control utilization.  However, if utilization is controlled externally it is called “rationing”, but when controlled individually it is called “conserving”. I believe that we will only begin to conserve when the individual is immediately and directly rewarded for such behavior. That reward occurs in the HSA model, but does not occur in the traditional indemnity health insurance entitlement model.

I hope that you will take the time to review my summary correspondence to Dean Campbell. I would be honored to take the time and discuss this with you at length, if you like. I hope that you will see that “The Intelligent HSA” agrees with your views on the entitlement mentality and presents your feelings about HSA’s in an effective working model. I look forward to hearing from you.

Warm Regards,
Bernie Saks, MD