by Patrick Appel

A reader writes:

Just wanted to quickly respond to/distinguish your reader who loved his HSA--specifically, I want to point out that he had *employer-provided* health care. He writes that "the insurance company got the employer contributed portion," so his employer was paying his premiums (a large enough premium that he only had to make small co-pays for doctor visits, as opposed to paying for the entire visit out-of-pocket, which makes it much more attractive and affordable than it is for the self-employed to whom HSAs are primarily targeted. And the reader had a choice--he could have opted for a PPO or HMO at no greater cost. There are obviously significant differences in the HSA experience when you're self-employed or an entrepreneur vs. being an employee.

On the other hand, I agree with him that his current insurance situation is less than ideal. A $3500 deductible, on top of $400 monthly payroll deductions and the need to be clairvoyant about your FSA spending, is a nightmare. So my conclusion remains the same: our system is clearly in need of reform.

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