It’s that time of year again: mistletoe and carols, Santa and shopping ― and of course, health insurance madness.

Health insurance in this country of ours is always madness. But it’s especially maddening this time of year. For instance, this is when you find out how large your premium increase will be, and how much less your insurance will cover than last year.

Mercer, the human resources consulting firm, does an annual survey and projects that health benefit costs per employee will rise 5.7 percent next year. This will in all likelihood outstrip inflation, as medical costs do year after year. There are other reasons for year-end health insurance anxiety. Claims deadlines might be looming, for example. Or if your insurance plan has a deductible and you’ve exceeded it, you’ll scramble to take care of any medical appointments before a new deductible must be met in the new year.

But the worst form of year-end health insurance mania has to do with those absurd flexible spending accounts, which help Americans fob off some of their health-care costs on one another. Few features of our health care system showcase its maddening complexity and cost pressures more effectively.

The health economist Uwe Reinhardt wasn’t just whistling “Dixie” when he said of FSA plans, “I can’t imagine anything more harebrained.”

FSAs are diabolically effective at empowering users to conscript others into our grand enterprise of driving up medical costs. If you have an FSA, you fund it by having money withheld from your paycheck tax-free. Then you use this dough for medical expenses. Great ― except the tax exemption means everyone else chips in. Absent such a program, after all, you’d have paid the tax on the sum that would have gone into the FSA. It’s a classic government “tax expenditure,” and not a very smart one.

For one thing, the higher your income, the greater your gain from an FSA, since the deduction is worth more to high earners thanks to our moderately progressive federal income tax rates. Worse yet, your FSA is “use-it-or-lose-it,” which means that each year you have to divine in advance how much you’ll spend on care ― and that, as Dec. 31 approaches (some plans offer a grace period lasting into March), you’ll probably spend the money on just about anything rather than forfeit it to the plan administrator for use in running the program.

The result? Right about now you’re running around frantically looking for ways to spend what’s left. Eyeglasses are a favorite ― you can always use some fashionable new frames or prescription sunglasses ― and at my optometrist’s office they tell me this is a busy time of year. But elective medical care of all kinds is popular (although cosmetic surgery isn’t covered). No wonder Mercer finds that, in surveying large employers, people end up forfeiting only 4 percent of their FSA money.

The silver lining of use-it-or-lose-it is that it discourages participation in FSAs. Mercer’s survey found that 85 percent of large employers offer one, but the average participation rate is only 22 percent. I for one am thankful. If the program were more popular, it would only be that much more effective at driving up costs, burdening taxpayers and delivering disproportionate benefits to those who least need help.

Medical care is like college: It’s way too expensive, but you can’t make it cheaper by having government subsidize consumers, unless government can also set prices. Otherwise the subsidy just ends up driving costs higher ― and this time of year, making a holiday gift to health care providers. Surely we can all think of better ways to dispose of a few bucks.

By Daniel Akst

Daniel Akst, a columnist for Newsday, is the author of “We Have Met the Enemy: Self-Control in an Age of Excess” from Penguin Press. ― Ed.

(MCT Information Services)