Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Right Angle Club: 2015
The tenth year of this annal, the ninety-third for the club. Because its author spent much of the past year on health economics, a summary of this topic takes up a third of this volume. The 1980 book now sells on Amazon for three times its original price, so be warned.

Early History of Health Savings Accounts


I soon persuaded the American Medical Association to endorse the plan, John Goodman of Texas wrote a popular book about HSA, which persuaded Bill Archer, the chairman of the House Ways and Means Subcommittee on Health to push a law through, enabling a pilot program. Today, the nonprofit Employee Benefits Association reports 11.8 million people to have Health Savings Accounts, mostly in states without mandatory small-cost coverage laws to hamper the use and pricing of deductibles. Others report a third more. One clarifying example would be mandatory birth control pill coverage, which not only undercuts the purpose of a large deductible but is politically inflammatory as well. Health Savings Accounts are popular in Indiana where Patrick J. Rooney was a heavy early supporter, but HSAs until lately were almost unknown in New York and California, which had extensive mandatory small-benefit laws , sometimes dozens of them. Today, to my amazement, California leads the fifty states in HSA enrollment, and JP Morgan Chase services 700,000 policies.

Originally published: Wednesday, July 15, 2015; most-recently modified: Thursday, May 16, 2019