Philadelphia Reflections

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

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Co-ordinating Obamacare With Health Savings Accounts

REPLICATED COPYCo-ordinating Obamacare With Health Savings Accounts)

...Also by the same author:

The Hospital That Ate Chicago, Saunders Press, 1980

Health Savings Accounts: Planning for Prosperity, Ross & Perry, Inc. 2015

Surmounting Health Costs to Retire: Health (and Retirement) Savings Account. 2016

Pearls on a String: Further Extending Health (and Retirement) Savings Accounts, 2016

Coordinating Obamacare With Health Savings Accounts (this volume), 2017 ---------------------------------

Ross & Perry Book Publishers

3 South Haddon Avenue

Haddonfield, New Jersey 08033



Coordinating Obamacare With Health Savings Accounts Copyright:




For advice and support about the thrust of this much-revised book, I owe new debts to the many people who read the preliminary versions and commented. The earlier books were written as ideas developed in my mind, and rather in a hurry. Still, later revisions were written so later thoughts could be introduced earlier in the argument. This one was written to influence the twin possibilities that either, the Affordable Care Act would be completely repealed, or it would essentially survive forever. I still don't know its future, whether it is too big to fail, or too big to survive. Either way, I think it failed to reform some things which should be reformed. The best way to defend that position is to propose an alternative which is much simpler, but more radical, and I hope it is both of those things.


Foldback, Front Cover

This and earlier books outline the hidden advantages of Health Savings Accounts, which the author had a hand in creating in 1981, along with John McClaughry of Vermont when John was Senior Policy Advisor in the Reagan White House. HSAs had more advantages than we realized. By turning them into retirement funds at the end, scarcely a word was changed but they created a major new incentive to save. By simplifying reimbursement, they exposed the ineffectiveness of third-party policing and saved money to be multiplied by investment. They were a vehicle for subsidies to the poor, a Christmas savings fund for the frugal, and interstate mobility for the rich. The basic advantage of high-deductible concentration is here newly emphasized.

The idea dawned that such simplicity provided an avenue for the gradual transition to new programs, as well as an escape hatch if they failed. Beads on a string, as it were, with a common retirement fund at the end, as a universal incentive for savings in each program added. It might take fifty years to implement every step proposed. But then, it took fifty years to get into this situation. This volume compares Obamacare and Health Savings Accounts more directly, but concludes the patient has a right to choose and advocates a level playing field for him to do so.


Foldback, Back Cover

George Ross Fisher III M.D.

George Ross Fisher, MD, the author of this book, graduated from the Lawrenceville School in 1942, from Yale University in 1945, and from Columbia University, College of Physicians and Surgeons in 1948. After postgraduate training at Pennsylvania Hospital, Thomas Jefferson University, and the National Institutes of Health, he spent 60 years practicing medicine in Philadelphia and consulting in New Jersey and Delaware. During that time, he spent 25 years as a delegate to the American Medical Association, and as a trustee of a number of medical organizations.

Following retirement, he formed a publishing company, Ross and Perry, Inc, which has published several hundred books, mostly reprints. He is personally the author of eleven books about Philadelphia history, from William Penn to Grace Kelly. He is the author of the following three books about medical economics:

The Hospital That Ate Chicago; Health Savings Accounts: Planning for Prosperity; Surmounting Health Costs to Retire: Health (and Retirement) Savings Accounts


Dedication Page

To Senator Bill Roth of Delaware, who demonstrated the road between private and public sectors, need not be a one-way street.


Book cover back page (Prologue), possibly in conjunction with above box and introduction, discuss:

Health savings account

Pearls on a String

Comparative merits: Obamacare and Health Savings Accounts

Future Directions for Health Finance


From Wikipedia, 2016

, the free encyclopedia

This article is about medical savings accounts in the United States. For international uses, see medical savings account.

Health care in the United States


A health savings account (HSA) is tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP).[1][2] The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), HSA funds roll over and accumulate year to year if they are not spent. HSAs are owned by the individual, which differentiates them from company-owned Health Reimbursement Arrangements (HRA) that are an alternate tax-deductible source of funds paired with either HDHPs or standard health plans.

HSA funds may currently be used to pay for qualified medical expenses at any time without federal tax liability or penalty. Beginning in early 2011 over-the-counter medications cannot be paid with an HSA without a doctor's prescription.[3] Withdrawals for non-medical expenses are treated very similarly to those in an individual retirement account (IRA) in that they may provide tax advantages if taken after retirement age, and they incur penalties if taken earlier. The accounts are a component of consumer-driven health care.


Originally published: Wednesday, October 12, 2016; most-recently modified: Monday, June 03, 2019