Agreed, we do not have health insurance. I would assert that we never had it. What we used to have was personal catastrophic event insurance. Being healthy and breaking your arm are separate categories.
There is also evidence that emergency medical insurance, as opposed to “prepaid health plans” (which is really what the basis of what we call healthcare insurance today is), is a more efficient means to keep costs down. The data I’ve seen so far indicates that those with HSAs spend less overall and much less on unnecessary expenses. It also indicates people with an HSA pay more attention and are better educated on their options.
Now, the rub here is that we can not yet say with certainty that it is a causal relationship. It could be that people who are more critical and analytic about their medical care are inherently more biased toward selecting an HSA. I can say in my case that is true, but that I also know people who selected it and then become more critical.
The rationale behind HSAs being the driver is that people do pay more attention when they have to pay for it, even if it gets reimbursed via taxes. I don’t think we can discount it, but the self selection is also strong I think. In either case I think the evidence for it being more efficient than what we have now is pretty strong.