I am the shadowy figure behind the frosted glass reception window. For the past four summers, I have interned at an orthopedic surgeon's office. As an intern, I have worked a myriad of positions: patient check-in, medical records clerk, insurance and billing.

On occasion, I must refuse service to people unable to pay for care. My best advice is to visit the emergency room or apply for Medicaid. Those solutions are part of the problem -- a health system increasingly unable to cope with rising costs and an aging population. Transparency and shared responsibility are necessary reforms; Health Savings Accounts are the solution.

I have answered hundreds of calls from patients confused about their bills. Few patients clearly understand their insurance coverage; fewer still understand how medical offices and insurers calculate and pay medical bills. Doctor offices have whole insurance departments to decipher the insurance claims mess.

Every patient demands the best care at the best price (read: no out-of-pocket costs). Patients see the newest medication or diagnostic test on the television and come into our office demanding it. Hypochondriacs cost everyone money. With medical reimbursement rates so low, doctors are willing to oblige. The high costs of running a medical office, maintaining training with Continuing Medical Education credits and rising malpractice insurance rates stifle the medical profession.

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Expectation of unlimited care through health insurance or the government has created a crisis. Patients feel entitled to care regardless of their ability to pay. HSAs are a great way for patients to save for health costs without tax penalties. Where I work, we have always given discounts to patients who had to pay for care themselves. These patients often take a more concerned approach to their care and health costs. With an aging population, it makes sense to allow people to save money for future health problems without tax disincentives or the need to rely on the government for often partial care.

HSAs encourage people to save money, spend wisely and choose their own practitioner. But is it wise to treat a trip to the doctor like Wal-Mart? Why not. Instead of wastefully spending insurance money to get an extra brace so that your accident insurance will pay out more money, health consumers will buy what they need. Choice lowers costs.

The days when consumers rely solely on insurance for all their costs are at a close. Rising costs from misuse of services and increasing demand make health insurance a heavy burden for American companies.

Recent legislation made HSAs easier to obtain, but they are not available to all Americans. Last year, a third of all HSA recipients had incomes below $50,000, and a third of small businesses offering HSA insurance plans had never previously offered insurance for employees. President Bush proposed that the government should make it easy for low-income families to purchase an HSA plan by making tax credits available to these families. Every person has a vested interest in their health and should save for the unexpected and the routine.

Concerns that HSAs will increase health-care costs should be addressed. Doctors have a responsibility to ensure that patients receive proper care and do not forgo a necessary operation. Furthermore, HSAs will not replace insurance. Instead, the savings accounts will allow consumers to set aside money to pay for costs not covered by their plans, such as glasses and medical equipment. I have dealt with multiple patients at the office who have canceled surgeries because they cannot pay their deductible. That would not be a problem if they had an HSA.

The lure of free care has created an imbalance. HSAs must be economical to work. Americans should save for health care better than they do for retirement. To work, HSAs should be coupled with a decrease in Medicare benefits for rising generations to provoke savings.

Medicare, which will run out of funds in 2020, is unable to adapt to a changing America. Can Medicare handle 78 million baby boomers? No. But if we make HSAs widespread, middle-aged workers can "catch-up" and set aside extra tax-free savings and decrease the burden. Because insurance carriers can charge lower premiums, the long-term effect of HSAs is that insurance becomes more affordable since people pay only for what they need.

Consumer driven health care has the potential to transform how Americans are treated. Cost consciousness will decrease waste, lower costs and remove the opaque window separating patient and doctor. Every American should have access to health care. HSAs will help make that possible.