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By cashout, I meant employers pay cash to people who choose not to have the insurance. It would require some rules that set mins, and for large companies say the value has to be based on the plans people who are using the insurance choose to avoid them creating a shit option just to cash out less.
HSA's aren't what they appear to be. They are actually retirment saving plan for those who can afford to fund them and not use them. They grow tax free, can be invested in the market, and you don't pay any tax if you spend them on medical expenses years down the line. It is also designed to transfer cost from the employer to the employee. Some employers will put money in the hsa to soften the transfer, but many do not.
The only reason I suggest the middle step is to try and protect the numbers of medical professionals. If we just swap to universal, the gov will try to lowball everything. That will cause smart people to avoid the profession. And of course they will probably make striking illegal, so the balance of the union will be mostly gone.
I disagree with HSA being a retirement plan, but yes, they give the person more control, something for the long term. There are some tax advantages to building it as retirement savings that streamers like to focus on, but that really should be a second priority to covering a lifetime of healthcare
Last time looked closely, the tradeoff in my company was that for an identical cost for me, I could choose
That made it very compelling: the coverage should almost always be equal for equal cost. But unusually we don’t need that much medical care so I’d have something left over to help pay for next year. If we were able to start with just a couple healthy years, it would really make a difference in health costs. If you started young, it’s true that you build up a lot of savings for retirement, but it would only take a few healthy years at any age to cover, say a major operation (always in conjunction with HDHP). Or I don’t know if you could use it for COBRA if between jobs, but if you had enough you could cover even uninsured healthcare. The trick of course is how do you keep making an optional contribution when money is tight?
Think of it this way. What is the difference between putting money in a savings accout vs an HSA.
First it is pretax money so you get some savings there. Second no tax on growth.
I am sure you can guess which is a bigger financial gain overall.
But now think about this. You have a $1000 medical bill. Do you pay it from the hsa or you savings account. Well both are getting interest, but the HSA is probably getting a higher rate if invested in the stock market. And the HSA has tax free interest unlike the bank account. So the correct financial answer is to pay it from your savings account, and leave the money in the HSA for retirement. Thus it's really a retirement plan. The key thing is that only people who have the extra money can afford to use it. So poorer people don't get any benefit from it at all.