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> FSAs are insane, conceptually.

Indeed. I don’t understand why they cant just make medical expenses tax-deductible up to a certain amount. The effect would be the same. Why do I need a separate account for it, and why do I have to guess how much I’ll need every year (as you pointed out)?

I guess at least part of the answer is that the companies administering FSAs make money out of this system. Sigh.

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> I don’t understand why they cant just make medical expenses tax-deductible

We have that, although the deduction only starts after a certain amount which makes it useless to almost everyone.

The issue is that it only kicks in when you itemize your deductions and it has something like a $10k cap. The standard deduction is 15k for a single and 30k married.

Unless you have a bunch of other things to deduct, it's often the right choice to just use the standard deduction.

Unless your a homeowner with a mortgage, then it's almost always better to itemize

Not so much anymore. The standard deduction for a married couple is now above 30k. It would take a large mortgage to pay that kind of interest in a single year. (Principle is not deductible; only interest)

That's going to skew towards blue states and metros.

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