One of the tactics that work against Democrats on the issue of health care reform is to let them over reach politically, so that they propose reforms that are too far reaching. This means they will empower the government to step in and interfere with citizens at the most basic level.

Clinton, for example, proposes that anyone who does not purchase health insurance will have their pay checks debited by the government.

This is a politically vulnerable position to take. Opponents can use it as an example of Democrats going too far. Even Democrats, like Obama, oppose the Clinton mandate.

Jacob S. Hacker also understands the political weakness Democrats bring to the table when trying to actually reform health care — as opposed to when Democrats are just merely talking about reforming health care.

He writes, in the liberal AlterNet: “fourteen years after President Clinton tried and failed to achieve universal coverage, Democrats are making the same old mistake of letting technical litmus tests blind them to the larger challenges they face on health care.”

Hacker cites the California attempt to reform healthcare, where the left and right came together, but the entire effort failed spectacularly. The proposal never even made it out of Committee.

Hacker writes, about the effect of including a mandate to buy health insurance on the failure: “Or consider California, where reform efforts fell apart last year. There, the individual mandate turned out to be not the key to compromise, but a major sticking point — with many of the strongest supporters of reform reasonably worried that cash-strapped workers would be compelled to spend a huge share of their income on private insurance that provided them with little real protection.”

In short, Hacker says, “The deeper problem is that Democrats are once again arguing about the least salable aspect of their vision for reform. And they’re fighting over small internal differences, instead of taking on the starkly divergent Republican vision on health care. This doesn’t just mean missing the real challenges that reformers confront. It may mean missing the chance to finally address an issue that has bedeviled Democrats for decades.”

What is interesting is that Hacker does not talk about a real and continuing division inside the Democratic Party over government run health care for all — or a private insurance option, financed by the government for all. It is this fault line within the Democratic Party that really hurt the California effort. It divides their party in half. Further, the Democrats that favor a private option financed by the government have health care industry support, while those who want a single payer, government run health care system do not have health industry support.

In fact, this difference causes such strong infighting among the Democrats that one wag suggested the best way to fight the next series of health reforms is to fund the single-payer, government run health care for all crowd, since they will spend most of their time and money fighting the Democrats who disagree — thus dividing, and ultimately killing the effort from within.

“HSA dreamers in a PPO world”

Max Borders is a policy analyst at the Civitas Institute, and he is a great American. Writing in the North Carolina News and Observer, Borders sums up what is wrong with the current American health care system, and why it is broken at the most basic level.

Borders, after citing a Civitas Institute poll that found 75% of the public don’t know much about Health Savings Accounts, proceeds to describe how having an HSA fundamentally alters his behavior, and his family’s behavior when it comes to health care:

“My family has an HSA with a high-deductible plan (HDHP). That means instead of traditional prepaid health care like a PPO, we pay for our basic health-care needs from a tax-protected health-care account. And what we don’t spend on health care, we save. But since we get to keep what we don’t spend on health care (plus interest), we’re a much more cost-conscious family, which means we save both ourselves and others money.

“For example, instead of asking the doctor for Nexium to relieve acid reflux, we get Prilosec over-the-counter, or Zantac, which is even cheaper. If one of us has a minor infection, we go to the MinuteClinic instead of the M.D. because the nurse practitioner charges only $60 per visit. The doctor charges anywhere from $100 to $250.

“MOST PEOPLE DON’T THINK THIS WAY ABOUT HEALTH CARE, because actual prices never occur to them. They pay their copays, but that’s not the actual price. All that extra money they don’t pay still gets paid — in the form of higher insurance premiums for everyone (which everyone seems to be complaining about lately).

“But what about cost-conscious folks like us who have consumer-driven plans? We’re HSA dreamers in a PPO world. The system is set up for people who shift costs using their traditional insurance plans. Care providers and insurers negotiate the prices.”

But about prices, how can you have a functioning market without the people performing the service knowing what the price is — in Borders’ case, his wife’s doctor.

“My wife, for example, just had a routine examination. Given that we use the HSA, she took great care to ask the doctor how much this would cost — “I’m paying out of pocket,” she insisted. The doctor was able to give her information about the cost of the visit, but he omitted the laboratory test charges that arrived in the mail a few weeks later like unwanted guests. She had no idea. The doctor had no idea.”

It is a great article, and Borders concludes: “Will this be the year of an HSA tsunami? With the costs of traditional insurance premiums going up, and catastrophic premiums-plus-HSAs going down, it looks that way. As more employers come aboard, we may start to see tectonic shifts in the health-care sector as providers scramble to accommodate the consumer-driven wave. Adopting HSAs is just one way we can control costs and put patients back in charge.”

“But it’s not going to be enough. Government is going to have to allow individuals to pool risk, expand choice of insurance providers beyond state lines and offer refundable tax credits to the poor. Until the politicians get it together, it’s time for the private sector to do what it can. HSAs are a great start. Just look out for those lab bills.”

Truckers with HSAs

The point of writing about this press release from First Horizon and how they have “been selected by the National Association of Independent Truckers (NAIT) as exclusive provider of high-deductible health plans and Health Savings Accounts (HSAs),” is to congratulate the Truckers on a wise and valuable choice for their members. Health Savings Accounts will save their truckers an enormous amount of money on their health insurance premiums, and will allow them to build up tax-free savings that can go towards meeting their deductible or to be invested in mutual funds or to go towards their retirement once they reach the age of 65.

For their part, the truckers describe themselves as “self-employed individuals and independent contractors,” which makes HSAs “a perfect fit for our membership base.”

Dennis Tripplett, of UMB, talks about the key issue of the cost of health insurance, in a recent media release, and how HSAs can help: “More and more companies are struggling to provide quality options at affordable rates to their employees. HSAs are an excellent option for employers to consider and have really begun to gain momentum in the past 12-18 months. Not only do most provide preventive coverage below the deductible and lower premiums, they also encourage consumers to become more engaged in their health care decisions, which can result in overall decreased costs for the employer and employee. These points are especially significant in today’s sluggish economy as consumers and companies are looking for ways to address costs without sacrificing basic needs.

“Additionally, HSAs have several other significant financial benefits—they can be used as tax-savings and long-term savings vehicles. The key for manufacturers is to effectively understand and educate employees on these benefits. Employees can use these accounts as an additional tax savings measure as well as another resource for future health care expenses. This provides employers with the ‘peace of mind’ of offering their people quality, affordable health insurance.”