Today, the Cato Institute releases a poll of public attitudes toward health care financing and health savings accounts (HSAs). From September 2 to September 13, Cato and YouGov fielded an internet survey of 2,000 adults age 18 and older.

The results (toplines, tabs) reveal U.S. adults do not grasp the extent to which the U.S. tax code violates their health care rights, but do support restoring those rights by improving HSAs to make them work for everyone.

The most important health care right is the right to make one’s own health decisions, including the right to choose one’s health insurance plan. An essential component of those rights is the right to control one’s income. The U.S. tax code violates health care rights by threatening workers with higher taxes unless they let an employer control a large portion of their income and choose their health plan.

Many call the “tax exclusion” for employer-paid health insurance premiums a tax “break.” In fact, it denies workers control over an enormous share of their earnings. It coerces workers into letting employers control roughly $1 trillion of their earnings each year as well as their health insurance. Along the way, it leaves workers vulnerable to losing coverage when they change jobs, divorce, or retire. Economists agree employers fund those payments by reducing workers’ wages. Firms that offer health insurance reduce wages an average $16,000 for each worker with family coverage and $6,000 for each worker with self-only coverage.

The Cato/​YouGov poll results demonstrate U.S. adults do not grasp how much control over their earnings they lose due to this tax penalty:

  • Half of U.S. adults (49 percent) do not know employers fund employee health insurance by reducing wages. A third (36 percent) incorrectly believe employers fund those payments by reducing company profits or executive compensation.
  • More Democrats than Republicans know employers fund those payments by reducing wages (56 percent vs. 46 percent).
  • A majority (78 percent) incorrectly believe employers pay less than $16,000 toward family coverage.
  • Nine out of 10 U.S. adults (91 percent) underestimate by an order of magnitude how much employers pay toward employee health benefits.

In the United States, half of health care spending comes from government. When one includes government-compelled private spending, the OECD reports 83 percent of health spending in the United States is compulsory—among the highest levels in advanced nations. U.S. adults are unaware that government controls more health spending in the United States than in most other advanced nations:

  • A majority of respondents (78 percent) incorrectly believe that in Canada, Denmark, and/​or the United Kingdom, government controls a larger share of health spending than in the United States.

If U.S. adults understood how much health spending government controls, they would describe the United States as having a government-run health system.

  • A majority (61 percent) indicated that when government controls 50 percent of a country’s health spending, that country has a government-run health system.
  • Five out of six (84 percent) indicated that when government controls 75 percent of a country’s health spending, the country has a government-run health system.

U.S. adults are broadly in agreement that workers have a right to control those earnings and to make their own health care decisions without government penalizing them:

  • Two thirds (69 percent) adults favor eliminating the additional tax workers must pay if they want to control their health care dollars.
  • Four fifths (80 percent) support removing this tax on workers whose employers do not offer health insurance.

Health savings accounts allow workers to control their health care dollars without penalty and have broad bipartisan support:

  • Significant shares of Democrats (16 percent), Republicans (14 percent), and independents (11 percent) report having an HSA.
  • Large majorities of Democrats (73 percent), Republicans (74 percent), and independents (65 percent) view HSAs favorably.

U.S. adults support eliminating restrictions that limit HSA eligibility to just a small share of workers and that limit HSAs to allowing workers to control just 4 percent of those trillion dollars of their earnings:

  • Large majorities of Democrats, Republicans, and independents (76 percent, 80 percent, and 72 percent) support letting workers put all $16,000 in an HSA tax-free.
  • Among low-income households, 78 percent favor the idea.

Government should not bestow preferential tax treatment on any particular uses of income. Congress can restore health care rights and improve health care by making health savings accounts work for everyone.