Left2Right Comments

If the main problem is the timing of the funds, there are many possible solutions. For example, the doctors could be required to submit bills against the HSA accounts for those who have HSA accounts that clearly have adequate funds in them. Sort of like how credit card purchases are allowed for credits cards with balances under the limit and rejected for cards with balances (including the prospective purchase) over the limit. In other words, there's no reason an HSA account couldn't essentially be a debit card for medical expenses.

The specific implementation may have issues, but the concept may still be okay.
 

One of the provisions of current HSA accounts is use-it-or-lose-it. For dependent care or chronic care, it might work, but you can end up gambling and losing a lot of money. Unlike insurance premiums, you aren't sharing the cost across a large group of people, so you're risk of loss large.

I've worked for companies with FSA accounts for many years, but stopped using them for healthcare after the first couple.
 

Anonymous wrote: "One of the provisions of current HSA accounts is use-it-or-lose-it."

I don't believe that's correct. According to a Chicago SunTimes article "If you don't spend the money in your HSA account, you keep it!"

The HSA restrictions are different than the FSA restrictions.
 

Those two possibilities aren't mutually exclusive.