High deductibles are a fact of life. They are becoming higher and more prevalent with each passing day.

A Kaiser Family Foundation study finds that about half of all people with employer provided coverage have a deductible of at least $1,000 . An Avalere study finds that the average deductible for silver plans in the (Obamacare) exchanges this year is almost $4,000. Some employers of fast food workers are only offering plans with the maximum out-of-pocket exposure Obamacare regulations will allow. Currently, that’s a $7,150 deductible for an individual and double that for a family.

There has been a sea change in the way the health policy community thinks about this. When Gerald Musgrave and I introduced the idea of Health Savings Accounts 25 years ago, the reaction was almost uniformly negative – in the health insurance industry, among the professional societies, among the hospitals and in the academic world.

The prevailing view at that time was that patients are incapable of making good decisions about how to spend health care dollars and that these decisions should instead be made by managed care professionals. Today we find even liberal Democrats defending extraordinary out-of-pocket burdens faced by people who get insurance in the exchanges they helped create.