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A favorite talking point of the anti-market crowd holds that Health Savings Accounts won’t work because they will undermine the beneficial effects of large all-inclusive “risk pools.”
HSAs would, according to the “risk pool” argument, create mutually exclusive insurance markets for the “healthy and wealthy” and the “sick and poor,” allowing insurance companies to pillage the latter. The problem with this meme is summarized by David Gratzer in The Cure:
The flaw in this … argument is that there really is no nationwide pool of insured people that cross-subsidizes each other’s premiums … Insurance companies do not cross-subsidize each other.
In other words, HSAs cannot drain the “healthy and wealthy” from risk pools—because such pools do not exist. In fact, as Gratzer explains, they don’t even exist within individual insurance companies:
Even within large insurance carriers there are separate pools across different states and for various types of customers.
So, the idea that Health Savings Accounts will allow low risk patients to abandon their high risk brethren to the depredations of “big insurance” is based on a myth.