Mackey says the HSA-plus-high-deductible structure makes people “careful” about how they spend their healthcare dollars. I would say this just is rationing, except that it is the sick person who is now burdened with the decision to seek care, knowing exactly how much that care is going to cost out-of-pocket. Gee, if I’ve got an infection but my kid needs soccer shoes and vegetables for the week, what am I going to do? I think I’m going to let that infection alone, to heal or fester as it will, and buy the kid what she needs. The whole point of healthcare reform is to minimize the situations where this sort of choice is unavoidable. Under the HSA-plus-high-deductible scheme, corporations will continue to enjoy tax relief for offering even insufficient healthcare plans to their employees (and then only to some of them), and insurance companies still enjoy the premiums paid by said corporations.