How often do you use your car insurance? Fire insurance? That's because insurance is designed to never be used, by most people. Health insurance has been unfortunately recast into comprehensive health care, with disastrous results. But the system is very entrenched now.
http://www.theatlantic.com/magazine/archive/2009/09/how-amer...
If you think of it as a 401k - put money when you're young before you need it - I think it is viable for many people under in their 20's and early/mid 30's.
But HSA's were eviscerated until Health Care "Reform" so it probably doesn't matter now anyway..
While I'm sure no system under the sun could be made universally fair, it seems particularly unfair to saddle people with vastly different costs based on purely external factors. With nearly every other expenditure I can think of, a person has a choice whether to pay it or not, or at the very least whether to pay more or pay less. If I wind up in the hospital, there are a certain number of things that need to be paid for no matter what. My employer gives me an option for a regular PPO and an HSA-based PPO. The latter would have cost me several thousand more a year.
And all of this notwithstanding, this methodology of health care payment doesn't appear to me to work for people who actually have no or very little money. I'm fortunate enough to not be one of those people at the present, so I couldn't say for sure how an HSA-based health care system would be any better or worse for them than our current system.
Of all the things I'm thankful for, being thankful that it's not my job to try to figure this stuff out is near the top of my list.
The major reason employer-provided care is dominant is that employer care is guaranteed-issue and automatically deducted. Employees of large companies are not screened or given physicals before insurance is extended.
Under PPACA, all health insurance is guaranteed issue. And while enrollment isn't automatic, it's enforced; you're fined if you don't get insurance.