The BMJ has a very nice editorial on the consequences of a second Bush term for the health of the United States and the rest of the world. On the health savings account:
An individual enrolled in a health savings account receives coverage for catastrophic illness. Other health care must be paid first by the individual, up to a defined limit (typically several thousand dollars), after which they can draw on the tax free fund into which they and their employer have paid. Any money in this fund that is unspent at the end of the year is rolled over to provide, hopefully, a reasonable pool for any future needs. Accounts appeal to wealthy people, who are likely to leave existing schemes. Those remaining will be disproportionately poor and unhealthy and will face higher premiums because of the loss of cross subsidy, which will further increase the number of uninsured people.
