This site has not been active for some time. Those who still find it  may want to advance to my new site at:

www.myphilosopher.wordpress.com

Topics more central to our well-being and happiness will be discussed. Some of the material here will eventually be included.

In 2003 federal law replaced “Medical Savings Accounts,” which could be offered only by small employers, with Healthcare Savings Accounts. These allow every citizen to establish an account with pre-tax money, and to remain its owner. The un-spent balance rolls over annually, so it accumulates from year to year, and the account’s income is not taxed. An HSA must be in conjunction with a qualified High Deductible Health Plan.

Money in the account can be used for any “qualified medical expense,” essentially deductible medical expenses. For those 65 or older, or unemployed, it may also be used for health insurance premiums. If used for other than medical expenses, income tax and a 10% penalty must be paid. The penalty increases to 20% in 2011. The penalty is waved for those aged 65 or more, or disabled.

In 2011 the maximum HSA contributions will be $3050 for individuals and $6150 for families, but any smaller amount may be deposited. Contributions may be made by the owner and/or the employer. Those over 55 may make an extra annual catch up contribution of $1000. A start-up contribution can be rolled over from an IRA. Maximum contributions will be indexed for inflation.

The premium for a HDHP together with the HSA contribution is about the same as the premium for regular health insurance, so there is financial incentive to switch since you keep all your HSA contribution that you don’t spend. Premiums for regular health insurance have risen faster than those for HDHPs, so with time the incentive to switch will likely increase.

The new health care law, Public Law 111-148, limits contributions to Flexible Spending Accounts (FSAs) to $2500 per year and deductibles on regular health insurance to $2000 per person and $4000 per family, effective January 1, 2014, but makes no major changes in HSAs.

About 10% of employers offer such plans. In 2008 about 8% of workers were enrolled. Those enrolled were 20% more likely to follow treatment carefully, twice a likely to ask about cost, and three times as likely to choose the less expensive option. In 2005 the average deposit was $2100 and average withdrawal, $1000. No withdrawals were made by 41%, and withdrawals greater than deposits by 21%. In 2007 a subsidy was provided for HDHPs for the poor.

When medical expenses exceed 7.5% of Adjusted Gross Income allowable medical deductions include: payments to doctors, dentists, surgeons, chiropractors, psychologists, counselors, physical therapists, osteopaths, podiatrists, home health care nurses, cost of care for chronic cognitive impairment, premiums for medical insurance, except when paid by another, or with pre-tax money, premiums for qualifying long-term-care insurance, when age qualified, cost of prescription drugs and insulin, cost of devices to treat or compensate for a medical condition, such as crutches, wheelchairs, prescription eyeglasses, hearing aids, mileage for travel to and from doctors and medical treatments and necessary travel expenses.

Non-deductible medical expenses include: over-the-counter medications, health club memberships for improve general health & fitness, cosmetic surgery, except to restore normal appearance after an injury or to treat a genetic deformity.

* * *

This information was found on Wikipedia and other internet sources, such as the US Treasury Dept:

http://www.treas.gov/offices/public-affairs/hsa/

A bank offering HSAs:

http://www.hsabank.com/hsabank/Education.aspx

Google HSA to find a selection of HSA providers, and consult local banks and insurance agents.

If health insurance premiums continue to rise, as some predict, an HSA may become our only affordable option. And the more popular they become the more willing Congress will become to enact incremental enhancements.

What do you think is the potential for everyone to eventually establish a HSA?

Pretty good

Possible

Marginal

Pipe dream

When I began to advocate that we more actively promote Healthcare Savings Accounts, I had no idea some would not understand that this is the most effective thing we can do to preserve traditional medical practice.

If everyone had a HSA it would be just like the good old days, only better. Everyone would write a check when they went to the doctor, and the checks would be good.

The HSA law of 2008 was a big step toward establishing a rational and effective system. The new law reduced the tax deferred contribution a little, under insurance company pressure, no doubt. But it is not necessary to have a tax deferral to start your own HSA. Just put money in the bank, in the tradition of having “something for a rainy day.” This kind of rainy day account has the advantage that you can use it for any kind of bad luck; auto repair or earthquake. The most expensive bad luck is often bad health so it’s best to hold back a little unless you also have a tax advantaged HSA.

Until you have saved a lot you also need catastrophic insurance. But the more you have saved, the higher your deductable can be, and the more you save.

If everyone saved the amount the average person spends on healthcare, half the population would die with a surplus in their accounts. An inheritance tax on that could cover the costs of those with greater than average needs, and no one would need catastrophic insurance any longer. If everyone saved the amount they now spend on health insurance premiums that point would be reached much sooner.

To promote HSAs you don’t need to get involved in politics. You can ignore the politicians and insurance companies. Just talk to you patients and friends. If everyone wanted one, the politicians would provide them. Henry Ford didn’t become a politician, He just built cars. Then the politicians build roads for him.

Another nice thing, you may be swimming with the tide. The use of HSAs continues to rise since the 2008 law. If insurance premiums continue to increase, as some predict, HSAs may soon become the only viable alternative. And you can say, “I told you so.”

If “Obamacare” will cause insurance premiums to rise, as some say it will, then its repeal would be the worst thing that could happen.

Here is my HSA Video # 2.

http://www.youtube.com/watch?v=2DswEeP96P8

Here is my first HSA video:

http://www.youtube.com/watch?v=PHd7kp38nls

It leaves out a lot about how HSAs can work. Now it’s enough to raise awareness. Probably, the end result will be an amalgam of many peoples ideas, so it’s premature to mention my idea of the best plan. Maybe someone will have a better idea.

As a practical matter, if you start an HSA now, either tax advantaged or on your own, you need catastrophic insurance too. If you give up regular insurance with too little in your account or too high a catastrophic deductable, you take a risk. But at least you have some idea how big your risk is. With regular insurance you have no idea of whether or not it will cover your needs until after it happens.

Some people seem to think that you are only allowed to save money if it is tax deferred. I once ask my wife, “Did we put enough in our retirement plan this year?” She said, “All we are allowed.” I said, “Don’t you think we should put in a little more?” She said, “We put in all we are allowed. (I spent the rest.”) Parentheses are my interpretation.

We might do better with professional videos, but that would cost money. Maybe we could get our kids to help.

Remember, send the video link to your friends, and talk to them.

Script:

H S Bapaso Presents:

His Herd. Now they are getting old and don’t know who is going to pay for their healthcare.

Give us healthcare,

Give us healthcare,

Give us . . .  Healthcare Savings Accounts.

One for each of us.

Relax, Comet. I have money in the bank for your healthcare. I’m the one who should worry, with all that’s been going on. These days, health insurance prices are so high it makes sense to start a healthcare savings account even without government help.

Start your Healthcare Savings Account today,    for a little security    in a changing world.

Hey, what’s this? Are we at war? Some of us seem to think so. But really it’s just politics as usual. Politics is a game, nothing to get upset about. But games have winners and losers, so victory is an appropriate goal.

It’s a game we can’t avoid because politics is woven into the fabric of society. Society, and its infrastructures, are always changing. You can sit on the bench and do nothing, like the poor buggy whip makers who can’t find work anymore, or you can get ahead of the game, like Henry Ford, and become a winner. Or, you can try to get ahead of the game, and fail in the end. Or, you can try to reverse change, and fail from the beginning. Henry Ford directed the course of change toward his advantage.

Unlike in transportation, there has been very little recent change in the foundation of medical practice: the doctor-patient relationship. As this foundation is eroded, so is the quality of care. So, to be winners we don’t have to invent something new, like Henry, we have to preserve something old, because it is still valuable, and still works better than anything that has been suggested to replace it.

So, how do you win in today’s world? Well, obviously, make videos. Isn’t that what everyone is doing? How many hours of video are uploaded to YouTube every minute? How will your videos be noticed amongst all of those? Well, obviously, you make a video that goes viral.

What makes a video go viral? Ah, now that’s a good question. Nobody knows the answer, but there are some clues. Watch videos that have gone viral. Watch TV commercials. What do you see? Sex, pets, free money. Add a surprise twist and you’ve got a good start. Include unique, quality images.

If each one of us makes a video, there is a fair chance one or two of us will be clever and lucky enough to go viral. So, what should be the subject of our video? What is the one thing that would restore the doctor-patient relationship better than any other single thing? Obviously, healthcare savings accounts. Tell people how they would save money with HSAs and how they would be good for the country. HSAs would get third parties out from between them and their doctor. Don’t bother talking about how HSAs would be good for doctors, only doctors care about that, and we want everyone to care about HSAs. And if only your patients and friends watch your video, but each of us makes one, think how many people that will reach.

We want our message to sink into the unconscious mind. The unconscious never forgets. But the unconscious doesn’t understand negative statements. The unconscious understands positive statements, only. Notice the difference? Say, “Smile,” instead of saying, “Don’t be sad.”

Remember, the expression of all emotions tends to provoke that same emotion in the viewer. You want your viewers to follow you happily, rather than stalk off angry.

Come on now, give it a try. It’s easy. For practice, I’ve already made six videos. I opened my (free) YouTube account in the name of my horse, HSBapaso, in an effort to avoid embarrassment. I’m working on my HSA video right now.

Will you commit to making a video?

Will you at least talk up healthcare savings accounts?

Do you have a better idea?

I just finished a story about Cicero, Conspirata, by Robert Harris, © 2010, 334 pages, Simon & Schuster, NY. It calls itself a novel, but I can’t quite see that. Rather than the colorful, dramatic style of a novel which explores the personalities of the characters, it is told in the stilted passive voice of Tiro, Cicero’s slave and secretary, who recorded much of the history and invented shorthand, including the symbol: &. Perhaps it is an effort to capture the way a man who was brought up Greek and worked in Latin would sound in English. But it contains a lot of accurate history and its rhythm is hypnotic and soothing. The many dramatic events somewhat make up for the style. It follows, Imperium, © 2006, 403 pages, Hutchinson, London, that covers Cicero’s early career which includes much hard work and less drama. Imperium is not a made up word, but a Latin term for the life and death authority of a general or ruler.

My background in ancient history is a little sketchy, because I had always thought of Cicero as a philosopher first and politician second, but I had it backwards. This second of three planned volumes, leaves Cicero on the road south out of Rome into exile in the company of only a few slaves, as Caesar starts north with his army to Gaul. I am anxious to discover whether the third volume will follow his career all the way, until his severed head and hands are nailed on a platform outside the Senate, after Mark Anthony has him declared an enemy of the state. The hands were included because they wrote words spoken against Mark Anthony. His wife poked hatpins through the tongue of the severed head in revenge for the speaking of them.

But, think about politicians who know of from recent history; Nixon, LBJ, even Churchill. Would you want to live the life of one of them—or your own?

The last post, Horses, was also posted on Sermo, a forum for physicians and was well received. But those who commented mainly responded to their relationship with animals, so I am wondering how many noticed my final point, which was my main reason for posting it. This post expands on what I was trying to point out.

How to Rehabilitate the System

1. Don’t get mad.
2. Don’t complain.
3. Don’t try to predict the future. (It is impossible.)
4. Don’t try to become a politician. (It isn’t in you.)
5. Choose the one thing (goal) that would improve the system more than anything else: Healthcare Savings Accounts.
6. Talk to your patients. Talk to everyone you meet. Tell them how HSAs will help them: Save money. Have full access to care without having to get approval from an insurance company. They can keep their money if they don’t get sick. Tell them how they can start one, even without a government subsidy. When everyone wants one, politicians will want to give them subsidies to get votes.
7. Don’t talk about how this change will help doctors. It will actually not help some doctors who have large capital investments in equipment for procedures that are largely paid for by insurance companies. We have to face that.
8. When everyone wants a HSA—choose the one thing (goal) that would improve the system more than anything else: Rational Management of Medical Errors.
9. Talk to your patients. Talk to everyone you meet. Tell them how Rational Management of Medical Errors will help them: Receive prompt, adequate compensation if they are injured by an accident during the process of their health care. Improve transparency so that the causes of errors can be investigated quickly and adequately, so that the causes can be eliminated and errors reduced, to the point that health care becomes as safe as travel on an airline. Today we must acknowledge that it is no safer than riding in your car, or maybe a motorcycle.
10. 10. Don’t talk about how it will lower doctors’ liability insurance premiums, end malpractice suits, or that it will eliminate windfall awards that motive frivolous suits. It is OK to say it will lower the total cost of health care.
11. 11. When everyone wants Rational Management of Medical Errors—choose the one thing (goal) that would improve the system more than anything else: You choose the next One Thing. We have enough to work on for a while, but when we actually get to step 11, go back and repeat steps 1 thorough 8, over and over and over until the system is prefect. Don’t ask politicians for help and don’t try to beat them at their own game. They will ask us, to let them help us, when we have used the one talent that we have, which they do not have: to retain the confidence of our patients and to communicate with them.

As I came from feeding our three horses this morning I began contemplating my place in Heaven in view of the difficulty of caring for our two mares with laminitis/founder, and one of Heaven’s most significant (to me) revelations, “As ye do it to the least of these, My creatures, ye do it unto Me.” That recalled my life’s, probably, most significant accomplishment: The care of Lady Jane, a grey mare, in the semblance of a normal horse environment from the age of five when we bought her, until the age of thirty when she died. That morning, I found her on the ground, breathing heavily, unable to get up, and unaware of her surroundings. My wife called the vet, to facilitate the process, and the handyman to direct the backhoe. With the handyman I left her double twisted wire snaffle bit, copper wire chewed flat over the years, and two quarters, one of the current year and one of the year of her birth, to place in the grave near her head. Then I left to make rounds at the hospital.

A normal horse environment requires room to run, something to chew on all the time, and a herd with a leader. A horse doesn’t care who the leader is. If none is present any horse will accept the responsibility until another demonstrates more talent for the job. Horses know that they must act together to survive. Lady Jane was lead mare until she was very old and sank to bottom position in the herd. But she always had a place.

When a herd is stalked by a pack of wolves, the leader does not lead the herd in a charge against the pack. The leader leads the herd at a full gallop in the opposite direction. They may go miles or tens of miles. That is their talent. Lady Jane once carried me fifty miles in only five and a half hours, and she was not first to finish.

Horses do not go back and try to reclaim their territory. They find a new valley, with fresher and greener grass, and mountains and forests between them and the predators. There they live happily with no thought of the next challenge, after all, it may never come. Could such a valley also be inhabited by people, every one of whom maintained a health care savings account?

Lady Jane after fifty miles in five and a half hours.

Probably the second most helpful change to our system of health care delivery would be a rational approach to medical errors. We have it in the airline industry. Every crash is fully investigated and the cause published. If a defect is found in a plane’s design the fleet is grounded until it’s fixed. If the fault was with the pilot, he is dead.

Why don’t we do that in health care? Well, first, crashes are not so easy to identify. It’s hard to tell a natural death from one due to an error, and hard to tell a normal headache from one that is the side effect of a medicine.

We should work to identify, explain, and correct all errors. But even if we do this perfectly there is still no way to compensate those injured by the errors, automatically. They have to sue. With airlines and medical care both. Whoever is charged with responsibility automatically defends themselves. If they succeed no compensation is available. If not, the legal process consumes much of it, and the injured party may remain inadequately compensated. Or, the injured party may receive a windfall far beyond the size of his loss. The hope of this motivates frivolous suits. The difficulty of the process discourages many who suffer real loss from seeking restitution.

A “no fault” system to automatically compensate all victims of medical errors in an amount reasonably related to their injury would have major benefits. It would end impediments to prompt, full investigation of errors. This would allow timely feedback of results to decrease future errors. The risk of health care would be reduced, as it has been with airline flight, so the cost of compensation would fall. And legal costs resulting from errors would eliminated. Will trial lawyers to vote for that?

When I was about four, or it could have been six or seven, my mother told me it was very important to have a good reputation. She said it was especially important not to have a police record. She seemed very fearful that I might get one, so I took this advice seriously. My father was more of the type, “I’ll do what I think is right, and if anybody doesn’t like it, that’s their problem.” So, I have at times been insensitive to other people’s feelings, to my regret.

Since I joined the medical professional I’ve been disappointed in the direction in which health care has evolved. Though recent legislation may have corrected some problems it probably created others and it left the two biggest problems unsolved: a practical mechanism to control the costs of care and medical liability.

No one really knows how the legislation will change the system until it is implemented. It is unlikely a literal interpretation will be achieved. No one can predict the future, so those who make predictions today may look foolish tomorrow, if their predictions are remembered.

As a profession we must find a way to achieve a massive correction in course, or politicians and bureaucrats will continue to guide our ship. But how shall we do it? Put on our war paint and join those who cry, “Repeal and Replace?” Or, follow in the footsteps of Marcus Welby?

What? Marcus Welby never said a political word in all his episodes. Exactly! But Marcus Welby is what people, voters, want doctors to be. If we want voters to support our mission we should maintain that image. We don’t have to go back to wearing stethoscopes on our necks instead of over our shoulders, but we do need to communicate to people that their welfare is our primary concern, not your own.

We want health care savings accounts so patient will have easy access to the means to obtain the care they need without paying extra to support insurance companies and without the hassle of dealing with them; not because that will make it easier for doctors to get paid without the hassle of insurance companies. We want liability reform so patients will be promptly and adequately compensated for injuries due to medical errors and so we will have the transparency needed to identify the errors and eliminate them as soon as possible; not so doctors won’t get sued and won’t have such high liability premiums.

If our proposals benefit doctors too, that’s an accident. Leave your war face at home. Speak softly, but to everyone you meet. Encourage them to start an HSA. Spread the gospel. Don’t get discouraged, you know, it eventually caught on.