Dan Crowell represents the changing face of health and healthcare in America.  Dan is the street superintendent for the city of Lafayette, Indiana.  Now I don't know Dan but I read about him JConline.com, the online edition of the Journal Courier Newspapers of Lafayette and West Lafayette Indiana.

Both cities, faced with ever rising healthcare costs have joined together to save money on health insurance and to promote healthier employees.  One of the keys to their strategy is through employee engagement.  This goes beyond the health risk assessments that most city employees participated in this year, and  includes the formation of a joint city committee comprised of city employees to analyze the data from the risk assessments and then collaboratively determine which health issues to focus on through to promote more healthy lifestyles.

The city managers are looking at other ways to reduce costs and improve overall employee health, and have added HDHPs with HSAs as an insurance option for their employees in 2009.

This brings us back to Dan Crowell.  You see, Dan Crowell, Lafayette's Street Superintendent, is one step ahead of the game and is the city poster boy for what can be.  Dan, over the past couple of years dropped 100 pounds through regular exercise (and I would guess a more healthy diet, but the article didn't say) which he maintains to this day. 

Some folks can get motivated on their own, and others need a little help.  But in order for us to drive our healthcare costs down and our health up, it will take collaborative efforts between employees and employers, between insurance companies and individuals, between the Government and all of us.  Dan and the cities of Lafayette and West Lafayette, get it and are doing their part to become part of the healthcare solution.  A tip of the hat to them.

Ron Klar, a guy way smarter than me when it comes to healthcare, the healthcare debate and fixing the problems related to our Nation's ills, wrote a terrific article just before the election entitled, AmericarePlans: A McCain-Obama Hybrid Proposal posted on Health Affairs, The Policy Journal of the Health Sphere.  Being the last guy on the grape vine, it took awhile for me to intersect with his article. 

I'm not going to regurgitate the article here as it is much better chewed, swallowed and ingested in its original form.

Klar points out, that one of the greatest challenges in any health plan, be it driven McCainanites or Obamians, is coverage for high risk individuals or those with pre-existing conditions.  He then goes on to outline a solution that, as the title of his article suggests is a Hybrid of both the Republican and Democrat healthcare platforms.

The thing I really like about Klar's plan is that he points out (without pointing it out) that we need to be aware that while we have been presented for months with but two options, we should not be bound by either the right or the left, but we should be unbound by our creativity.  We should be unbound by solutions.  We should be unbound from the box which politics so often seems to want to put us into.

It's a thoughtful and hopefully thought provoking read.  Check it out if you can. And if you want to learn more about Health Savings Accounts and High Deductible Health Plans, it's all right here at HSAeducator.com. 

 When I was a kid, up until the age of about eleven, my Grandmother used to conduct Doctor Jekyl-like experiments on my hair with her handy scissors.  I was a total toe head and when she was done they could have slapped me on the side of a paint can and called me the Little Dutch Boy.

I revolted at eleven and began a 30 plus year quest to find the perfect barber.  Recently though, in my quest to save more money into my health savings account I decided to give Betty, my barber, a little vacation and let my wife cut my hair.

The first haircut she gave me was disasterous and fully documented in an article on this site entitled "Hair Savings Account,"  and the second haircut, well that one was nearly apocalyptic and covered in "Health Savings Accounts and my Left Ear."

Because of the partial skinning I received last go round, it has taken longer for my hair to recover.  My wife, on the other hand still hasn't.

Still looking for ways to save, after considering allowing my teenaged daughter to have a run at it, or maybe that lady who I see walking around my house once a month reading the meter, I decided to take matters into my own hands.

I got out my Conair turbo pet grooming sheers, dropped a number 7 on them and let her rip.  It was absolutely exhilarating.  As a guy I felt like friggin' Rambo.  In control, self sufficient, even able to give himself his own haircut.  Now I did have to deal with hair pretty much everywhere. It was kind of like being in a New York tickertape parade.  Hair flying in my ears, all over my face, I was just covered up.  I was spitting out hair the whole time and I'm pretty sure it was multiplying as it fell toward the ground. 

Now, you may be thinking, big whip, he just shaved his head.  Hardly.  Cut and style baby, and if I say so myself it looks good.  Real good.  Well at least the parts I can see.

Are self haircuts a good idea?  Well, finding creative ways to save more money into one's Health Savings account is a good idea.  If I could figure out how to get my wife to do her own hair; now that would be big bucks but I don't see that happening.  With the right tools, a good vacuum cleaner, independence and creativity, you will be amazed at how you can save more into your HSA.

I have an HDHP.  When I go to the Doctor to have them look at the creatures crawling around in my throat, causing me to itch all over, or making my hair fall out in clumps, I am expected to pick up the full tab until I hit my deductible.   I even have a little stash of money, called an HSA to pay for it.  BUT, I don't pay a nickel when the Doctor is done with me.  Not immediately.

The Doctor has to put in a claim to my insurance company, the insurance company tells the Doctor how much they are going to pay, they then tell me how much I am supposed to pay, I then send the Doctor a check, the doctor tells the insurance company they received the check, and then insurance company tells me that the Doctor told them that they received the check.  If this laser-like process of precision breaks down in any way or God forbid, I don't send the check, honestly, I have no clue what happens.

For the past year, I have been writing for the Gradock Bulletin about health savings accounts, high deductible health plans, consumer driven health, healthcare and wellness and pretty much anything else that comes to mind that might be educational, worth a rant and/or is somewhat entertaining.

With that said, I have compiled Gradock's "Top Ten Reasons Why Healthcare Is So Friggin' Expensive!"  This is a very unscientific survey of one, but it points to a the gaggle of reasons that collectively (along with a few others I'm sure) that cause you and me to pay more when we go to the Doctor and put health insurance out of the reach of millions of Americans.

10.) We can't figure out how to spell "healthcare."

The fact that sometimes it is spelled as two words (health care) and sometimes as one scratches at the surface of inefficiency (it takes more keystrokes and kills more trees when spelled as two words)

9.) The right hand don't know what the left hand is doing:

See paragraph #2 above

8.) Americans are fat slobs:

Which makes us loveable and friendly, but contributes to chronic illness like heart disease, hypertension, and diabetes which cost us billions if not trillions of dollars a year in healthcare costs.

7.) State Mandates:

Did you know that your state may require insurance companies to cover certain illnesses no matter whether you are at risk of it or not, whether you are healthy or not, whether you care about the illness or not.  So for example, if you are a single male living in Arkansas or any of the other 20 states that require maternity coverage, you are paying, in your premium for someone else to have a kid.  Or if you live in Connecticut or any of 9 other states you get to pay for wigs.  Or if you are a non-smoker living in Maryland, you are paying for some lung burning smoker's, smoking cessation treatment when you pay your insurance premium.

6.) The uninsured and non-critically ill in hospital emergency rooms:

Emergency rooms, by their name and nature are set up to deal with emergencies, not the coughs of the illegals and uninsured, or the weekend colds of the insured.  This mindset may be compromising emergency rooms, and certainly is driving the cost of healthcare up for all of us.

5.) Regs on Meds:

My insurance company will not pay for, nor will they allow for money I spend on meds that come from Canada to count against my deductible.  Now some of this is to protect me from witch doctors, voo doo priestessesire and shady drug companies whipping up toxic drugs in oil drums on the streets of some third world country, and I understand that.  But part of this is driven by drug companies desire to tamp down competition.

4.) Three Card Monte Mindset:

Or in other words lack of transparency in healthcare.  Healthcare is set up so that we do not know what procedures, tests, and treatments cost, leaving us to guess where the most cost effective care is to be found.  And it is almost impossible to find the best doctors at the best prices in this environment.  There is some progress being made in this area with the establishment of minute clinics and services like outofpocket.com that are exposing the cost of healthcare which can help create more competition and ultimately drive costs down.

3.) "The Doctor's Handwriting" and malpractice law suits:

If the Pharmacist can't read the Doctor's hand writing and mis-dispenses meds or has to spend more time figuring out what the thing says, then we are talking time and money.  Or if the Nurse in the hospital gives the wrong dose or the wrong medicine to a patient, that can be a bad day.  Do you know that if a drunken, illegal alien with not a nickel to his name rolls into the hospital with his arm half cut off and doesn't like the way the attending surgeon sewed it back on, he can sue the surgeon?  Now I believe the guy has a right to sewing but not suing, unless there is horrific and obvious gross negligence.    

2.) Cleanliness is next to godliness:

Now I'm not a germaphobe but do realize how much stephastrepasyphacoctolis gets spread around because folks don't practice basic hygiene.  That lands folks in clinics all the time with preventable illness and, yes, drives the cost of healthcare up.

1.) What about executive compensation?

We can't let that one slide.  I'm all for people making money and if they make armored cars full of it that's fine it they are truly responsible for creating most of the value.  But I do have a tough time with guys who get paid huge sums of cash for what sometimes ends up to be short term value, or get paid huge sums of money when they screw up and get fired.  Hey, I could screw up any big publically traded company for way less than these guys get paid.  And what kind of money are they making?  Well I took a look at the AFLCIO database on executive comp and here are a few examples:  In 2007 the CEO of Abbot Labs was paid $33 million in total comp; the CEO of Aetna got $23 million total comp; the CEO of Merck got paid $20MM in total comp; the CEO of Humana got $10 million in total comp: the CEO of UHC got $13 million in total comp and the CEO of Cigna got $26 million in total comp.

These were the ten I was able to rattle off without too much difficulty and I know there are many more.  Feel free to comment on this article with additional reasons.  Maybe we can compile it and share it an another article or post it on this site's forum.

"A Thrifty Man Is A Free Man"  Advice from my fortune cookie March 1982

Good advice during these strange and troubling economic times.  Good advice anytime and way cheaper than a fortune teller (unless of course, the fortune teller is your crazy aunt Zelda).

The October 20^th edition of Business Week offered up a timely article entitled, "The New Age of Frugality" by Steve Hamm.  It discusses the tightening of spending by Americans with our contracting economy.  Many people are getting a crash course on saving right now.  Now this may suck if you are a spender, it's good for self-discipline, a good motivation for correcting bad habits, and can maybe heighten our appreciation for things we took and take for granted.   This article may help you out if you feel all alone in this new world or if you are looking for ways to save. 

I'm a guy who believes there's no end to a tube of toothpaste.  I think finding ways to save may be part of my DNA.  So for me, Health Savings Accounts make sense and I'll bet early adopters of HSAs share that same mentality. 

 "HSA" does have the word "Savings" in it, which is to a thrifty person as the strip is to a gambler in Vegas.

HSAs are not just about putting money aside for a rainy day.  There is far more to them than that.  They create tax advantages three different ways.  They're tied to high deductible health plans which involve lower premiums which means you get to keep more of your own money.  Because HSA account holders have greater financial responsibility for their own healthcare they can motivate them to be more motivated about their health both in terms of how they shop for healthcare and how they take care of themselves.

So, anyone who has taken the initiative to learn about HSAs already has a savings mindset, and anyone directed to an health savings account by their employer has a great opportunity and a tool to develop a savings mindset.   Adopt a savings mindset, with your healthcare and with your life and it will help pilot you through these challenging economic times.

You've just been enrolled in an HSA for the first time huh?  You might feel like you just hooked a big nasty line pulling pike.  That sucker is and bad and feels like he's pulling you all over the place.  How in the world are you going to deal with it?

If you have the right gear to reel it in, and maybe a cold Budweiser, you might just get him in the boat.  Except for the chilly beer, that's what HSAeducator.com is all about; having the right gear.

If you feel like your line was hit hard by this new HDHP/HSA insurance plan, or maybe you are the pike on the line and your employer just rammed turned you, HSAeducator.com can definitely help you out.

As an opinion maker of uno, I recommend you look at your new insurance and savings plan you have as a gift.  I believe high deductible health plans when combined with health savings accounts can be a major part of America's solution to healthcare.  While they turn a lot of the responsibility for our health and healthcare over to us, they give us control too, and control is power.  You may not know it yet but dude (and fisherdudesses) with your HSA you've got the power.   

But you are new to the HSA fishing tournament and, I'm getting ahead of myself.  Before you can harness the power of your new HDHP and HSA, you've got to learn the language. 

It all starts right here.  HSAeducator.com starts by answering the basic HSA questions.  Things like:

• Ÿ How much can I contribute to my HSA each year?
• Ÿ What can I spend money from my HSA for?
• Ÿ Can I buy fishing lures with money from my HSA or maybe a new boat?
• Ÿ What happens if I put too much money into my HSA?
• Ÿ Do I have to use the bank my company is pushing for my HSA?
• Ÿ If I change jobs what happens to the money in my HSA?
• Ÿ What if I don't spend all the money in my HSA each year?
• Ÿ Should I try to spend the money in my HSA every year or let it pile up for something major?
• Ÿ Can I pay my HDHP premiums from my HSA?
• Ÿ Can I take my HSA contributions off my taxes?
• Ÿ Can I spend my HSA dollars on a back snapper?
• Ÿ Is an HSA the same as my FSA?

Good questions and they're all answered on HSAeducator.com.  Plus, if you have really specialized questions you can check out the health savings accounts discussion forum , ask your question and they'll give you an answer or maybe or someone else with an HSA can give you some guidance 

One more thing that makes HSAeducator.com different from say, that slick brochure your employer gave you, is that it's written in English.  Not the Queen's English, but plain old every day conversational English, not something that looks like it was written by a the U.S. Congress or some lawyer.   So while it is no your favorite "fishin' magazine," it's a damned sight closer than the Harvard Law Review.

If you read "High Deductible Health Plan - Rejected" you know that my family got rejected for our new HDHP plan when we tried to switch insurance providers.  This is a brief update on where we stand presently.  If you have found yourself in a similar situation, might find this somewhat worthwhile reading.  The challenge with my current plan is that our provider seems to think that they need not provide us with any prescription coverage unless one of us is rolled into a hospital on a gurney, and then only as long as we remain strapped to it.

My insurance agent is working getting us some air coverage and specifically is researching what's called a critical illness plan.   He has not put anything in front of me to read about these policies, however, I understand that they kind of work like a term life insurance policy with some payout benefits in the event of a major medical situation.   The payouts would be as a lump sum, which, in theory would go a long way toward covering the presumed prescription gap in my HDHP. 

Remember, insurance really should be used for the big stuff.  Part of the reason the cost has gotten so out of hand is that most folks want to use their insurance for every wart and pimple they get.  As comparison, imagine what you would pay in auto insurance if you wanted to cover things like oil, wiper blades, tires and breaks.  It'd cost you a fortune.

My agent called last night and advised he is having some challenges finding a critical care option that will cover my kids as well as my wife and me.   But we'll deal with it and as I learn more, you can read about it here.

Here's something to think about.  When you start looking at high deductible health plans  if they don't you the coverage you need or want exactly, there may be ways to supplement them to get the coverage.  Once again I recommend finding a good insurance agent who knows HDHPs and let them do the heavy lifting for you.  And if they can't, fire 'em and find one who can.  That's one of the great things about consumer directed health.  It's about taking control.  Never forget, you're the boss!

About this time every year employers all over the nation unveil their latest, greatest insurance offerings for the coming year. They've worked over their brokers, agents, and consultants, dusted off a few old tricks and brought a couple new ones to the game.  They've frosted up this package with Betty Crocker's finest, served it up on their finest china, put it on a fork and are now playing the "airplane" game with you.

Now you're probably thinking, "what's this hillbilly talking about?"  Tell me, am I right?  You've got your enrollment package, your employer is patting him or herself on the back at what a great job they did at keeping your premium from rising, or at least rising too much and you're saying, yeh, but what about my co-pays, why do I have to pay more for drugs, what about my deductible?

Health Savings Accounts are still relatively new, having just come into law at the end of 2003.  And every year, more and more employers are beginning to offer them to their employees.  Sometimes as an option for employees and sometimes as the only option for employees.

For the past couple of years, at this very time of year my friends come to me with quizzical and dim looks on their faces and begin asking me about the high deductible health plans (HDHPs) and health savings accounts (HSAs).  My friends are fairly bright folks, but as you know, the subject of insurance is about as exciting as a flat keg of beer at a fraternity band party.

They don't mind asking me about it because

So there's all kind of buzz on the internet today regarding the Doug Holtz-Eakin's conference call on McCain's health plan over the weekend.  Basically, he wanted to set the record straight, or at least defend the McCain plan from the general assault that Mr. Barack Obama and Co. mounted against McCain's health care policy.  If you are like me, you're probably asking, "what is a Doug Holtz-Eakin and what does he know about anything?"

Holtz-Eakin is Sr. Policy Advisor to Mr. McCain, so I suppose that means he knows more about McCain's and Obama's health care initiatives than the average Joe.  On the call he suggested among other things that Obama's recent ad campaigns were "cynical and deceitful."  To read an entertaining overview of Holtz-Eakin's de-bunking of Obama's effort, please click here and enjoy.

Once you read the overview, you might be left wondering, how in the world is McCain going to pay for that tax credit he's proposing as part of his plan.  Good question and worth an answer.  The estimated price tag is somewhere north of a tr-tr-tr-trillion dollars (12 zeros if you are curious) over the next ten years and McCain, Holtz-Eakin and company believe it can be found in extracting efficiencies from Medicare and Medicaid.  They believe the plan can be cost neutral from savings elsewhere.

Now I commend McCain-Holtz-Eakin on creating efficiency.  Bravo I say, but we are all (well I assume we are all) a bit cynical about our Government's ability to create efficiency. 

One thing's for sure on this political issue.  Mr. McCain and Mr. Obama are, for the most part, on different ends of the spectrum on how they would address this big giant purple people eater called health care.  And suffice it to say, health care, regardless of which candidate is ultimately elected, is going to be a tough nut to crack.

It's really quite easy actually...

United Healthcare recently released the results of a survey they did on their HDHP policyholders.  They took a look at the demographics and behavior of depositors and found that 86% of those surveyed opened health savings accounts when their employer contributes on their behalf.  However, only 27% of consumers opened HSAs when their employer did not contribute.

Ok, so if you are new to health savings accounts (HSAs) and your employer offers to contribute to your HSA and you do not open one, I'm sorry, you are probably the biggest LOSER of all losers.  You are being offered FREE MONEY for goodness sakes.  It takes very little time to open an HSA, and many employers will steer you toward the bank of their choice (be careful though, you can put your HSA dollars in any bank that offers them and just because your employer recommends one probably means there is something in it for them as much as you).  This is not "Let's Make A Deal."  If you decline the money, you are not going to be asked if you would like to choose what's behind Door Number 2.  Read between the lines:  TAKE THE MONEY LAZY BONES!

Now, if you are in the 73% of consumers whose employer does not contribute to your HSA and you have, for whatever reason, not opened one, there is hope for you.  Also, we'll cut you a little more slack because you are not being offered FREE MONEY (but you kind of are, and maybe just don't realize it).  First off, you can avoid becoming a LOSER by opening an HSA.  According to the survey 68% of individuals with HSAs actually contribute to them on their own, so half the battle is simply opening the derned things. Once you open one, the law of averages and momentum say you will contribute to it.

I know, but you are saying, why should I?  Well, here's a few reasons that are far better than simply being insulted and called a Loser by a total stranger:  First, you can deduct 100% of the contributions from your federal income taxes up to the annual maximum contribution.  So for example you are single and make say $30,000 per year, your annual maximum contribution is $3,000 for 2009.  If you can squirrel the full $3,000 into your HSA, then your tax base is reduced from $30,000 to $27,000 and you pay federal tax on the lower amount.

But if you are still not sold, here is another reason.  The money sitting in the HSA grows tax free.  So say you put the $3,000 into an account and it earns 2% annual interest over the course of the year you make $60 off your money and the sixty bucks is not taxed when you spend it, provided you spend it on qualified medical expenses.  So if you are thinking $60 is hardly worth tying up $3,000 for I'd say Bully!  $60 would cover a big chunk of a visit to the Doctor if you had to go in for a visit.  Plus, it's FREE MONEY.

Still not sold?  OK here's another reason not to be a LOSER.  Say you wake up one day and want to tell your boss to take his crummy $30,000 a year job and stick it where the flowers can't grow.  If you have an HSA you get to keep it.  Unlike an FSA the HSA is your account, so even if your employer has been funding it, that money is yours to keep.  If your new employer offers high deductible health plans with HSAs, then you simply go on bout your business.  Or if you are an individual and you decide the only boss you want to work for is you, then you can purchase your own HDHP and still keep the HSA you're your original employer.

If you have read this far, hopefully you have learned something and get the picture.  If you have the opportunity to open an HSA and fail to do so, you are not taking advantage of a very important piece of your health care plan.  Go do a little research and then open an HSA.