Blowing the HSA wad

The Wall Street Journal has a thoughtful panel discussion on consumer directed health plans. One of the participants, National Center for Policy Analysis President John Goodman is asked a question I've raised here: won't consumers just focus on small expenses since big-ticket items like surgery will blow through their HSA and put them back into traditional insurance. He answers:

Currently, deposits to Health Savings Accounts are relatively small. However, over the course of a work-life, the balance of these accounts will grow quite large, and HSAs will potentially be a factor in every healthcare decision --even for the most expensive services.

There's some truth to that, but it will take a lot of years of excellent health for an account to grow big enough for that to be the case. Even then, as Urban Institute President Robert Reischauer says:

[T]hose needing major interventions are usually in no condition to "shop around"

Consumer driven care is no panacea, so maybe we should start looking for another one.