“Since an HSA requires a large deductible, they are best when combined with a form of catastrophic insurance; that is, medical insurance that pays only for large, expensive, and unusual medical problems. For this reason, and to cut down free riding by the uninsured on taxpayers, I believe everyone should be require to have catastrophic medical insurance–with the very poor covered by Medicaid. The premium on such catastrophic coverage might be allowed to be deducted from taxable income, the way HSA contributions are”. –Gary Becker, Nobel Prize winning economist, discussing his views on health care over at the Becker-Posner blog