William E. Morgan, D.C.

The U. S. health care system seems to be suffering a major disconnect. It leads the world in scientific discoveries and the availability of new technology, and it should lead the world in health care quality. However, poor management of resources has lowered the quality of health care in America . In fact, if we compare the United States with other developed nations, we find that it is near the bottom of good-health indicators-but at the top of health care costs.

What is driving this crisis? The demise of doctor-patient sovereignty is affecting health care choices. The management of health care has shifted from doctors and patients to the bureaucracies of state and federal governments, employers and managed care organizations. These bureaucracies have hamstrung the health care system. Add to this broken system the increasingly litigious nature of our society, and we find that providers now perform more and more tests for "defensive" reasons rather than for medical necessity. The hidden costs of defensive medicine, delayed health care, and the stratospheric rise in the cost of hospitalizations and medications are all passed to the American consumer. These factors reduce the availability of health care resources.

The current dysfunctional health care system is adversarial to integrated patient-centered care. Bureaucracies by nature are impersonal and uncaring. So how can we restore the doctor-patient relationship within this system? One answer is patient-directed care epitomized in the Health Savings Account (HSA). HSAs empower patients with choice, flexibility and portability. The patient and the provider chart the course of care instead of an impersonal bureaucracy that is mainly interested in its bottom line.

HSAs allow patients to carry high-deductible (catastrophic) major medical insurance plans for a low rate, while funding a health savings account with tax-free money. The health savings account is used to pay the high deductible for the major medical insurance plan. Any unused savings stays in the account from year to year, earning tax-deferred interest. The unused savings can continue to grow until later years when health expenses increase; after age 65 the remaining funds may be used for any reason without a penalty.

These accounts are flexible and portable, but most importantly, they allow patients to make their own health care decisions. There's no need for a chiropractic-specific benefit: if patients need chiropractic care, they go to the chiropractor of their choice and pay with their HSA debit card or check. There's no need to join a managed care organization or seek approval from insurance companies for chiropractic services. There are no gatekeepers.

The current limits for annual contributions to an HSA are $1,400 for an individual or $3,375 for a family. When using the HSA, you pay for your health care expenses directly from your account until your yearly deductible is met. Once the deductible is met, the major medical insurance pays 100 percent of the remaining covered expenses. The list of allowed expenses is broad, so this type of program allows for integration of many specialties and modalities.

This type of health coverage is not without controversy, and it may not be appropriate for all of our patients. Those who do use it will find that this program greatly enhances their ability to direct their own health care, and it greatly simplifies the process of collections for doctors. Furthermore, this innovative health coverage tool bypasses the greatest obstacle for full integration of chiropractic: managed care organizations.

For more information regarding Health Savings Accounts, visit: http://www.forhealthfreedom.org/Publications/HealthIns/MSAs.html