When I was 8 years old, I remember being given a brand-new bike for Christmas, a red standard Schwinn. I pounded that bike for a couple of years, left it out in the rain and seldom padlocked it. Finally, it was stolen.

My next bike was a used three-speed green Raleigh. I took great care of my new possession. Why? I paid for it.

Even though we may be grateful for what is given to us, a greater sense of responsibility comes with ownership.

Giving people ownership of their expenses is one key to resolving America’s health care cost crisis. With the exception of making a co-payment, most people today are detached from the real costs of health services. There is no immediate reward for making better choices in terms of well-being or its costs. That dynamic needs to change.

In Maine, 48 percent of the population has health insurance through employers. The normal employee contribution to the insurance premium for a conventional health plan is about 25 percent to 30 percent. But there is a better way for employers to provide coverage that gives people a real stake in the system and the savings it produces: the health savings account.

According to Joel Allumbaugh of National Worksite Benefits Group, the health savings account is a real game changer. With a direct financial incentive for participants to change their behavior, it creates conscientious health care consumers.

Here’s how it works in a simple example: Let’s say a conventional health insurance plan costs $6,000 to cover one employee. That money goes straight to the insurance company, which makes the payments for the person’s health services.

Using a health savings account model, the employer first buys a less expensive insurance policy that covers an employee only for health care services above $3,000.

The employee then gets $1,500 to put in their HSA checking account and pays for the first $1,500 of health services. Any money not spent remains in the account.

If, during the year, the employee spends more than $1,500, the employer pays up to an additional $1,500 through its health reimbursement account. When the employee and employer together have spent more than $3,000, the insurance company picks up the tab.

People who have to write checks for health services tend to ask more questions and spend more time finding the right price and quality to satisfy their budgets. Testing and prescriptions are questioned. Emergency rooms are used for real emergencies.

Given that a huge percentage of visits to the doctor or emergency room turn out to be unnecessary, this model makes those choices have financial consequences.

According to Allumbaugh, the average annual cost in Maine for a person’s health services is about $2,500. So with a $3,000 HSA, the employer would save about $500 per person. That’s an 8 percent savings for the employer, plus the savings from the less expensive insurance policy. Lower operating costs make Maine companies stronger.

Employees who may have no more than an annual $300 physical would get to keep $1,200 in their HSA checking account and add it to the next year’s allotment. Unlike flexible spending accounts offered by some employers, the health savings account is not a matter of “use it or lose it.”

The maximum pre-tax amount an individual can contribute in a year is about $3,000, but there is no limit on what can be accrued over time. If a person wants to have elective surgery that was not covered by the insurance company, the health savings account could be tapped.

Also under the rules governing health savings accounts, the employee gets to take that money when leaving an employer. As long as the money is spent for covered health services, the employee pays no tax on it.

So what gets in the way of adopting health savings accounts? Lack of awareness by everyone. I recently spoke with one of the leading endocrinologists in the world. Even though he is a service provider, he was unaware of health savings accounts. That disconnect among payer, consumer and provider has to be resolved.

Though the health savings account is not a cure-all for the cost of health care, it certainly can reduce the speed at which health care costs are rising.

With health savings accounts and state laws that encourage a competitive insurance market, Maine people could see their health care costs begin to look more like the national average than some of the most expensive in the nation.

Transforming Maine people into conscientious consumers doesn’t take a new law, it is simply a matter of employer choice. What do you think, and what are you going to do about it? 

Tony Payne is a lifelong resident of Maine who is active in business, civic and political affairs. He may be reached at:

tpayne@midmaine.com