The Bush administration is selling consumer-directed health savings accounts (HSAs) as a way to reduce health-care costs, but whether Americans are buying is another question.

Greer businessman Ben Waldrop says HSAs are enabling him to continue to offer health insurance to his employees.

Lib Street of Easley says that after seven months with an HSA, she's going back to a standard plan.

And Greenville social worker Marie Richards says she's not sure how her plan will shake out.

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Meanwhile, some leading medical economists say these plans, along with tax credits for medical expenses also highlighted in President Bush's State of the Union speech last week, won't do much to rein in runaway costs in the nation's $1.9 trillion health-care system.

Touted by the president as the latest way to control spiraling health care costs by making consumers more aware of spending, consumer-directed health care consists largely of tax-exempt health savings accounts and high-deductible insurance coverage.

Typically, consumers, their employers or both contribute to an HSA, and that money is used to pay for doctor visits, drugs and other medical expenses. It's coupled with high-deductible insurance -- often $2,500 for an individual and $5,000 for a family -- so that when purchases reach that point, insurance begins to pick up the tab.

But only four out of 10 people enrolled in these plans are satisfied with them, according to new research from the nonpartisan, nonprofit Employment Benefits Research Institute and the Commonwealth Fund, a nonpartisan foundation that funds health policy research.

Street, an administrative assistant, is among those who are dissatisfied. Her plan has a $1,500 deductible, then an 80/20 split for subsequent medical costs. She says it's tough to come up with the full cost of health care up front.

"It has not worked out very well," said Street, 52. "I probably didn't pay less (with the other policy), but it was less out-of-pocket initially. Now I have to have $100 to pay the doctor. With co-pays, it was $20."

Street says the plan would work better for higher-income people with few health problems who can benefit from the tax break and who don't have a problem making the contribution and paying the medical bills, too. As a single person, she says that's been an issue for her.

Waldrop, co-owner of Century Printing & Packaging Inc., says an HSA plan has helped his company continue to offer health insurance to its 15 employees. With standard insurance, he said, costs were increasing 10 percent to 15 percent a year. Now, those increases are single-digit.

"It's important to us to be able to offer a health-care package to retain employees and make sure our employees are taken care of," he said. "Yet the increases were becoming extremely expensive, especially as we got more employees."

At 26, Richards was enrolled in an HSA at work last September.

It's nice not paying premiums, she says, although the $2,500 deductible is intimidating. With her old policy, though, she paid a premium but no deductible.

"Because I am young and healthy," she says, "I pay a lot of money for services I don't use."

At present, only about 1 percent of Americans with private insurance are enrolled in a consumer-directed plan with a health savings account, according to the EBRI-Commonwealth Fund research. Another 9 percent have high-deductible plans but no savings account.

Supporters say that by placing more costs on consumers, the plans will prompt them to be more judicious in their purchases, thereby slowing the pace of health-care spending.

Critics say high out-of-pocket costs will force people, especially lower-income people, to forgo medical care they need. What's more, they say, consumers don't have enough information about costs to comparison shop for the best prices.

Even if consumer-directed plans reach 15 percent of the market, they won't curb health-care spending because they do nothing about the reasons costs are increasing, according to DiamondCluster International, a global management-consulting firm.

And Princeton University political economy professor Uwe E. Reinhardt says health savings accounts and tax credits will widen the gap between the haves and have-nots while doing nothing to reduce health-care costs.

High deductibles are unlikely to change how a family with an annual income of $200,000 spends its health-care dollars, he argues in a paper examining these policies. But those same deductibles would significantly impact the spending of a family earning just enough to pay the bills.

Twice as many people in consumer-directed plans as in standard insurance put off needed care, and they were typically the sickest and the poorest, according to the EBRI-Fund survey.

They spent more, too. In the past year, more than 40 percent of those in high-deductible plans and nearly a third of those with HSAs spent 5 percent or more of their income on out-of-pocket costs and premiums. In standard plans, the survey reported 12 percent spent that much.

Dr. Georges C. Benjamin, executive director of the American Public Health Association, said the nation's goal should be to make health care more accessible and affordable.

"We must ensure that these proposals are more than window dressing for our nation's pressing health challenges," he said.

And Reinhardt said that by shifting to individual insurance, employer-sponsored coverage would eventually disappear, and that would eliminate the savings realized by spreading the financial risk over large groups.

That, in turn, would leave consumers with much more expensive individual plans, which would price middle- and low-income Americans, and those with serious or chronic illnesses, out of the market, he said.

Waldrop says that despite his $5,000 annual family deductible, he enjoys controlling how the money is spent in his plan -- paying for nontraditional expenses, like his wife's braces, for example, out of his health savings account.

Anyway, he says, something needs to be done to curb the cost of health insurance.

"The current U.S. system cannot keep going the way it's going," he said. "Small businesses like ours cannot afford the big increases we're having."

Benjamin says the country needs a more comprehensive shift in policy.

"Unless we seriously address the problems of increasing cost, inadequate quality, decreasing access and eroding infrastructure," he said, "we are destined to fail."