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The United States has arguably the most advanced health care in the world. And yet, a large proportion of Americans do not have access to this care due to its high cost. Providers, consumers, and the government have long searched for a way out of this paradoxical situation. HSAs offer one solution.

The American health care system is complex. A part of the population has access to health care through Medicare and Medicaid. Another part simply pays for care out of pocket. A substantial proportion of the population uses third-party payers to pay for care.

Payers have reacted to the rising costs of care by introducing various gatekeeper mechanisms. These have not been popular with consumers who see them as restrictive. The American population is aging and the need for care is likely to increase over the next decade.

While the earnings of health care professionals have been increasing, insurance premiums have also increased. Among hospitals, many are non-profit organizations offering substantial charity care. But for-profit and non-profit hospitals alike must show return on investment to remain viable. Providers must also factor reimbursement policies of payers into their decisions, sometimes even clinical decisions. These groups of stakeholders—patients, providers, payers, and the government—have different goals and different responses to the rising cost of care.

Based on your understanding, answer the following:

• In your opinion, can HSAs be aligned to the expectations of all these groups?
• Do you think HSAs can help improve health care cost, quality, and access? Why or why not?