To a large extent, many of the arguments against Social Security privatization in 2005 hold equally true in the upcoming debate over Health Savings Accounts (read Leif Wellington Haase’s piece for an overview of how HSAs work). But there is also a significant difference. Privatization was aimed at a financially sound, effective Social Security program while this time the target (ostensibly) is a dysfunctional health care system.

Here are a few of the main arguments that should work as well against Health Savings Accounts as they did against Social Security privatization:

• The idea is entirely ideological, aimed at weakening government rather than making the lives of Americans better or strengthening the nation as a whole. Nothing connected to real-world experience or logic indicates that the idea would move in the direction of achieving its purported goals. Many of the same think-tankers advocating on behalf of HSAs are applying their same up-is-down, right-is-left rhetorical skills that they used in support of privatization last year.
  
  
• The idea would inevitably make the problems it claims to address worse. The main reason why the U.S. health care system is so screwed up is that it is highly fragmented. As a result, we pay far more than any other major industrialized country on medical care, with a much higher share of uninsured and under-insured citizens, while ending up with middle-of-the-pack health outcomes. Almost all of those other countries with more efficient and effective systems than ours have some form of universal health coverage. HSAs, by trying to peel off individuals from their existing employer-provided coverage, would only worsen the degree of fragmentation—adding further to the share of national income squandered on administrative costs.
  
  
• Where the idea has been tried, it has failed. Just as experiences in Chile and the U.K. demonstrated the flaws with privatized pensions, get ready to hear a lot about what happened in South Africa and Singapore with Health Savings Accounts. The bottom line is that the accounts haven’t controlled costs and they have caused citizens to experience appalling hardships. (In the United States, so few individuals have “taken advantage” of the existing pilot programs that their impact has been negligible.)
  
  
• The idea would further shift risks onto individuals. Under health savings accounts, those risks aren’t confined to financial burdens, as under Social Security privatization. They also would include added medical risks borne by those who are financially deterred from seeking preventive care and taking medications for chronic conditions.

A year ago, many opponents of privatization focused exclusively on defending Social Security and attacking the administration’s plan rather than endorsing any particular alternative proposal. They worried that offering a specific counterproposal with Social Security benefit cuts and tax increases would open the door to a deal where those changes would be packaged with private accounts.

This time around, opponents of Health Savings Accounts really ought to seize on the opportunity it presents to argue proactively for universal health care coverage. Without endorsing a specific plan, the main point is that we need to do the exact opposite of HSAs. Instead of leaving every citizen to his or her own devices, we need to include everyone. To get the most bang for our health care buck, all of us need to be covered together. That’s how insurance works in the real world, as with Social Security or the far more efficient health care systems of other countries.

The stakes are far smaller than they were last year, since the country’s most successful program is not under threat this time. But the debate over HSAs is really a huge opportunity to start laying the groundwork for change that would genuinely make the country much better off.

Greg Anrig, Jr., is vice president for programs at The Century Foundation. This article originally appeared on TPMCafe on January 24, 2006.