> Essentially every high dollar professional in America takes full advantage of this offering as we all expect to have out of pocket medical expenses and it makes no sense to pay them with taxed dollars instead of pre taxed dollars.

Not really. HSAs are common for sure, but people with high incomes often can afford lower deductible policies. You can't open an HSA unless you have a high-deductible health insurance policy.

I've done it both ways, and I personally prefer paying more for a better insurance policy and not having to bother with HSA paperwork.