One thing that's hard to understand from the outside is that almost nobody actually pays those mind-blowing $200K hospital bills. US hospitals charge on a sliding scale based on the applicants' families' ability to pay.
(I don’t mean to belittle your comment about universities which is factual and helpful. I’m just pointing out that US education system is just as fucked up as the US healthcare system the OP is talking about.)
Even people in the US don't understand why those $200K hospital bills aren't real.
Insurance providers (including government programs) have a fixed limit for what they pay for procedures. They pay min(billed_amount, allowed_amount) so providers don't want to risk leaving money on the table by having billed_amount < allowed_amount. To ensure this doesn't happen, they bill an arbitrarily high number with the expectation that insurance will lower it down to some much smaller number.
So every time you see posts on the internet where people talk about their "$200K hospital bill" they're always talking about that arbitrarily high value. If you have to pay cash for some reason, they will reduce the value to the cash pay amount which is in line with the insurance paid numbers.
Nobody ever pays those high hospital bill amounts.
That depends a lot on your insurance. For example, our out of pocket for my son's birth was somewhere in the neighborhood of $10k after insurance. I've met tons of people who would be bankrupted by that amount. What you're describing isn't true for people on High Deductible Health Plans, and those plans are a bit of a racket because they're frequently paired with HSAs where the employer gets to pocket anything left in the account at the end of the year. My son was essentially unplanned, in the sense that we gave up on trying to have a kid but weren't using birth control because over the previous 3 years we had not had a successful pregnancy. So an HSA would have been no help for us.
HSA funds are meant to roll over. Your employer generally should not be pocketing whatever's left over in the account. The idea is that many (most?) people are better off with a lower premium and higher deductible given that most years (for most people) aren't characterized by high medical expenditures; HDHP+HSA is closer in nature to actual "insurance", rather than a structured financing plan for health care.
HSAs are triple tax advantaged retirement accounts. Not taxed on contribution, gains, or withdrawals for qualified expenses. In the worst case it becomes like a pretax IRA because after age 65 you will not pay a penalty on non qualified expenses - but qualified expenses tend to increase with age. For many it should be their primary retirement account.
Even for people with certain chronic conditions (not in perfect health), depending on how good/expensive the PPO offered by the employer, it might still work out better to do HDHP/HSA.
You can get as many basically free HSA accounts from Fidelity.
HSA is your money like a retirement account is. It’s one of the most tax advantaged ways to save money.
More or less all high income earners who do not have a chronic health issue are better off choosing a HDHP paired with a HSA - especially if the company provides any sort of matching benefit. Keep that account as an additional retirement account and pay out of pocket for most healthcare needs.
Think of it also as actual insurance vs. a pre-paid health plan.
The math of course changes for folks who are not highly paid, or have expensive chronic health conditions that would result in maxing out the deductible each year.
You are likely thinking of a FSA which is use it or lose it.
FSA is just a 30%-ish discount on medical expenses. It is useful for eye glasses and such. A lot of QoL services qualify for FSA, including weight loss coaches and therapy.
Heck my (prescription) meta ray bans were paid for in part with FSA funds.
You are I are both commenting on a subthread started by a comment that included "What you're describing isn't true for people on High Deductible Health Plans, and those plans are a bit of a racket because they're frequently paired with HSAs where [...]", none of which is true. I don't care about FSAs and am not trying to argue with anybody about them, but that preceding comment is very wrong about HSAs and HDHPs.
Note that another word that straightforwardly describes this behavior is "fraud". Medical bills aren't like a bill from a car mechanic where there is a contract (either written or at least implied because the mechanic will readily give you estimates and quotes).
In the medical context, the only contract in the picture is possibly between the medical provider and the healthcare management organization. It would be fine if providers only sent the fake bills to them as they're both willingly playing this perverse game.
But the problem is when they send their fake numbers to patients as if they're some kind of legitimate bill. Medical bills to patients are presented on a "cost reimbursement" basis - helping you cost them this much, so you are responsible for reimbursing them. By inflating the numbers 3-5x they are straight up lying about the costs they incurred. That's fraud.
(I don’t mean to belittle your comment about universities which is factual and helpful. I’m just pointing out that US education system is just as fucked up as the US healthcare system the OP is talking about.)