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They can't answer these questions because the options are either 1) these plans would still work like the ACA and would thus barely be any cheaper, or 2) they'll be eliminating extremely popular and important consumer protections for health insurance that will leave millions of people uninsurable.

A continual theme with Republicans pushing the HDHP+HSA idea is how vague they are about the most basic details of how these HDHPs would work. What would be covered as catastrophic? How would age be underwritten? Would there still be guaranteed issue for pre-existing conditions?

In which case this entire proposal is just a fancy way of saying, let's make it legal to drop people with pre-existing conditions again.

You'd just get plans that are slightly cheaper from not having to cover preventative care, and that savings would probably be offset by more claims from preventable illnesses.

Of course the elephant in the room is, the GOP has not made any promise their plans WOULD be guaranteed issue.

If HDHPs were guaranteed issue and pooled risk by age, and if the HSAs were subsidized, ultimately it's not clear it would even be that much cheaper than the ACA. The main driver of health care costs, catastrophic care for older people, would still be basically unchanged from our current system.

The fact is, we don't really have a perfect solution for deciding what care is necessary and what isn't, but having a well-informed, well-regulated insurer do it — whether that insurer is private companies or a single public payer — still seems to be the least-bad way to do it.

But it just doesn't work, because if you directly give patients the incentive to control their own health costs, they're going to cut the cheapest, most cost-effective care first, and we'll just be saddled with *more* of the critical illness care that costs millions of dollars for unclear benefit.

Again, Republicans pushing the HDHP+HSA idea are trying to solve a real problem that has frustrated policymakers for years: there's no cost control incentive in the system, and an incentive that works at the patient level seems less toxic than having "death panels" or whatever.

In many ways, that is the system we had before the ACA. We had nothing that clearly incentivized people to seek preventative care. And that led to serious, preventable illnesses that made people ineligible for coverage once they actually needed it.

Many, many, MANY medical conditions can be prevented, or are easier and cheaper to treat if caught early.

We don't want a health care system that punishes people for doing checkups, having recommended screenings, or taking their prescriptions as frequently as directed.

The much bigger problem with this idea is it doesn't just create a financial incentive to discourage unnecessary medical care, it discourages ALL medical care. It financially penalizes you for going to routine physicals, filling scrips, getting vaccines, just basic preventative stuff.

...to solve this issue by saying, we'll just take the money we're currently spending on ACA subsidies and just cut everyone a check to put in their health savings accounts.

I guess that's at least an improvement on their past plans, but that's only one of the issues here.

Unfortunately, there are several problems with this idea that just make it completely unworkable.

First, and most obviously, not everyone has the disposable income to squirrel away a bunch of money in a personal health care fund. Now, this time around Republicans are trying...

So I do completely get the appeal of a system that incentivizes people to lower their own health care costs without some government bureaucrat or insurance adjuster making the decision from on high who gets care and who doesn't.

Let me first say that I understand the logic behind this idea — I myself have talked several times about how overtreatment and a total lack of cost controls is rampant in the U.S. health care system and it's *the* main reason we haven't been able to achieve universal health care.

...deductible if you have one of those big, life-altering medical emergencies that your barebones insurance plan covers.

IN THEORY, this would let you get any care you need, while discouraging overtreatment and almost always being cheaper than comprehensive insurance.

These plans would have dirt-cheap premiums but super-high deductibles.

Meanwhile, you'd sock away a few hundred dollars a month in a tax-exempt savings account that 1) lets you pay out of pocket for everything else, like checkups, prescription drugs etc., and 2) pays your...

For those who aren't familiar, here's the basic premise.

Everyone would purchase a barebones insurance plan that only covers very, very serious and expensive stuff like heart failure, cancer, things that would cost tens or hundreds of thousands of dollars to treat.