There is nothing more enjoyable when researching issues than coming across an article you think you are going to hate, and then discovering you’re completely wrong. I really don’t know why I assumed I’d dislike this column by Mary Jo Feldstein in the Post-Dispatch. Perhaps the opening line led me to make the wrong assumptions about it. But, anyway, it is an excellent article, and sort of a counter to the terrible piece by Bob Herbert that I blogged about the other day.

This is not to say that Feldstein’s column is in full agreement with the health savings account approach favored here at the Show-Me Institute. In fact, she raises some very interesting questions about them:

Research shows patients in these plans, particularly those with low incomes, sometimes avoid cost-effective preventive tests and prescription therapies because of their cost.

There is simply no magic potion to take our health care system and make it perfect. Last night we cosponsored the Steven Levitt (coauthor of Freakonomics) lecture along with St. Louis University, where the event was held. Levitt, in response to a question from a lottery-winning audience member who regularly runs for office, talked about health care. He believes that market pricing has to be put back into the system, and consumers and insurers are going to have to make tough choices about what people can and can not afford.

As Feldstein writes:

Patients should have a financial stake in their health and health care. But plans should encourage, not discourage, the wise use of limited resources.

I see her point perfectly. It is one thing for parents not to take their teenager, who only has a simple cold, to the doctor. That choice allows for more important uses of limited resources. To go further, it is unfortunate — but probably necessary — that dying elderly people do not receive every single expensive treatment possible. Remember when Mickey Mantle got a liver transplant and died soon anyway, after potentially taking away a precious resource (a functioning liver) that someone else may have used to live much longer? (Note: there is no proven evidence that someone other than Mantle died because of that transplant, but the decision to give the liver to him was still very controversial.)

It is another issue entirely for people with treatable conditions not to take their medicine because they are responsible for the first $2,000 of their costs before insurance kicks in, and they can’t afford it. I am not saying HSAs don’t work because of this issue, just that it is a reasonable possibility to consider. The great thing about Feldstein’s column is that it is a well-researched piece about a complicated issue, as opposed to Herbert’s uninformed broadside.