Episode
The Man Who Invented the HSA Thinks We're Still Doing Healthcare All Wrong
- Published
- Jul 9, 2026
- Duration seconds
- 3557
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Summary
What if the most powerful tax-advantaged account in your financial life was designed by one economist with a better idea, and the full version of that idea was never actually implemented? You've probably heard of the Health Savings Account. You may even have one. But the man who invented it says the version Congress passed is a watered-down shadow of what it could be. And that's just the beginning of what's broken. In this episode, Larry Kotlikoff sits down with Dr. John Goodman , the Wall Street Journal's "father of HSAs," author of 16 books, Bill Buckley's primetime debate partner, and one of the four most influential figures in post-war American healthcare policy. This is a high value conversation between two economists who've spent careers trying to fix the same broken system with notably different tools. What You'll Learn: [00:09:06] The HSA origin story — how a Cato Institute assignment in 1990 produced the idea now powering 37 million accounts, and why every special interest in Washington opposed it [00:10:13] The design flaw Congress built in from day one — and what a "Roth HSA" would actually look like [00:19:16] Why Medicaid patients visit the ER 40% more after enrolling — and the HSA-based fix that hospital lobbyists killed before it got a hearing [00:34:43] The LASIK principle — why cosmetic surgery gets cheaper and better every year while everything else in medicine doesn't, and what that tells us about markets [00:36:24] The California reference pricing experiment — how one insurer drove hip replacement costs from $100,000 down to $30,000 statewide in just over a year [00:44:51] Why your employer plan was designed, possibly by accident, to attract healthy people and repel sick ones [00:21:17] The Columbia dissertation that caused a nea…