For most Americans, health care policy isn’t a frequent topic of thought. And honestly, there’s no real reason to dwell on it. Every year, they feel it—when premiums rise, deductibles increase, and chunks of their paychecks vanish into a system that often doesn’t benefit them.
The American healthcare landscape is not just costly; it’s also confusing and somewhat disempowering. Money flows from workers to employers, insurance companies, administrators, and finally to healthcare providers, but rarely stays in the hands of those who actually earned it. When families get bills, they’re told what they owe without consideration for what they’ve managed to save.
A system that keeps people from saving for their health needs doesn’t protect them. It protects its own interests.
This should cause concern.
Health savings accounts (HSAs) were initially aimed at addressing this imbalance by giving individuals a rare form of ownership in modern healthcare. With an HSA, people can save money for medical expenses, invest as needed, and carry it over from year to year. The funds are theirs—no expiration dates or unnecessary controls from educational institutions involved.
Having ownership shifts behavior. Those managing their own funds often have a different approach. They ask questions, think ahead, and refuse to be passive participants in a system that treats them merely as expenses rather than decision-makers.
However, millions of Americans are restricted from opening an HSA.
This isn’t about whether they need medical care or if they can afford it. It’s simply a matter of legal constraints.
Federal regulations from over 20 years ago link HSA eligibility to specific types of insurance plans. Consequently, more than 140 million Americans—many with traditional employer insurance and facing increasing out-of-pocket expenses—can’t save for healthcare costs the way they do for retirement or education.
In any other area of American life, the notion of “you can keep spending, but you can’t save” would be unacceptable.
No one should be barred from contributing to a retirement account based on their employer’s pension plan, nor should anyone be prevented from saving for college depending on the institution their child chooses. Yet, in healthcare—arguably the most unpredictable and significant expense for families—ownership is conditional.
This reality isn’t happenstance; it’s the logical outcome of a system structured around organizations instead of individuals. Complexity benefits certain intermediaries, who profit while the public is left to navigate the convoluted landscape without genuine control over their contributions.
Often, price transparency is absent until after care is delivered, with families only discovering costs when they receive bills—which is far too late to make informed choices.
The result? A system characterized by rising costs, dwindling trust, and far more discussions about prevention than actual preventative measures.
While expanding access to HSAs won’t resolve all healthcare issues, it would tackle a fundamental problem: the absence of true individual agency.
This change isn’t complex; it merely requires trust in people with their own finances.
Every American should have the opportunity to open an HSA, free from the constraints of their insurance type.
This isn’t about advocating for new rights or governmental programs. HSAs are individually owned accounts that depend on personal responsibility, not mandates. They’re based on the belief that if people are empowered with control, most will manage it wisely.
Such assumptions might seem old-fashioned in today’s policy discussions but actually align with the American ethos. People save for retirement, education, and unexpected expenses. Healthcare should not be the sole exclusion, particularly when costs are high and personal stakes are involved.
A system that prevents individuals from saving for their healthcare needs doesn’t serve them. It prioritizes its own interests.
If we aim for lower-cost, more effective healthcare, the solution lies not in increased control but in enhanced ownership.
The real question isn’t about whether Americans can be trusted with their health insurance savings. Perhaps we’ve just convinced ourselves for too long that they cannot.
