Governors, commissions, and legislatures intent on building health care regulatory empires to force larger and larger segments of the U.S. population into depending on government for health care tend to view personal ownership of health insurance as A Bad Thing. This goes double for high-deductible accounts with health savings accounts attached. People with this kind of insurance are routinely called underinsured, are said to have “bad” coverage, and are characterized as deadbeats that create growing problems for the hospitals.

New evidence suggests that the bureaucrats may have a point. In the March 14, 2007 JAMA, Wharam et al. report on 8,724 people who were switched from a conventional health insurance plan to a high deductible plan by their employer. A year later, this group had cut its use of emergency departments from 197.5 visits per 1,000 members to 178.1 visits per 1,000 members. Most of the change was in repeat and low-severity visits. The percentage of people admitted to the hospital through the emergency department declined by about 1 percent. There was no change in visits by a control group.

When people paid their own money, they rationed their own hospital use. Less third-party payment reduces the need for bureaucratic gatekeepers, educators, and utilization review pooh-bahs. If these results hold up, high- deductible accounts could truly present an obstacle for those who hunger for the jobs represented by bureaucratic expansions for the control of the unnecessary consumption of medical care.

(And this study isn’t alone. In 1996, Selby, Fireman, and Swain reported in the March 7, 1996 New England Journal of Medicine that randomly selected Kaiser-Permanente members assigned a copay of $25 to $35 for emergency department use reduced their use of the emergency department by almost 15 percent relative to a control group. Reductions were generally made by people with conditions that were not severe.)