Problem with the cash option is, the system is an extortion racket. Costs are out-of control.
Wife went into a clinic to deal with a fever and verify whether or not it was H1N1 so we could isolate her as applicable. We thought "yea a clinic is much more sensible than an ER, as she's not dying and we could probably save money". Well, goes in, gets a nose swab, one blood draw and gets told she doesn't have H1N1 but a generic virus. Gets some Tylenol and a Rx for antibiotics (unnecessary but whatever) and sent home.
Bill arrives 3 weeks later. $400. ***. There is no reason that visit should cost that much. They settle with my insurance provider (tricare) and the bill gets settled to $116. ***. Tricare subrogates $20 out of pocket to me, YET assigns none of it towards the yearly deductible, and the facility was in-network. Had it been out of network, the difference between 116 and 400 would have been added as out of pocket. ***.
As you can see, it's not about plans or HSAs, it's about outright costs and rent-seeking (doctors, nurses, administrators and insurance industry) in the healthcare industry. I consider tricare to be an alright option for insurance, but the moral of the story is that if the freggin' facility had billed me $116 instead of $400 I wouldn't need insurance in the first place!!!! This is the crux of this whole debate. I could have covered this visit with one month premium, which would put me ahead of the curve at the end of the year. As it stands, these plans are de facto catastrophic plans, and they pick and choose what is catastrophic expenses and what are yearly deductible expenses, at their convenience, ergo it's a racket.
Again, I say this recognizing tricare is not a bad option available, and I am content with having govt subsidized insurance, but for the millions of folks getting reamed with worse private plans this is just another illustration of our broken system.