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.

About the only things I know about Massachusetts have to do with beans (Blazing Saddles), a bunch of whiteys dressed up as Indians (wonder if they were wearing wigs?), and burning witches at the stake (now that's hot).

 Being from the Deep South, my purview of the rest of the country is somewhat narrow, and I suppose for every one of us, there is enough history, news, and politics in our own states to keep up narrowly focused and narrowly minded for a lifetime.  Thank God, I never had to spell Massachusetts in a spelling bee growing up, because that would have for sure thrown me out of the saddle.

Being interested in healthcare, I have been hearing for a couple of years about this movement by the state of Massachusetts to mandate health insurance for all of its citizens.  Besides finding the idea of it generally suspicious, I've really not paid much attention to it.

I stumbled across an article online in The MetroWest Daily News, written by guest columnist Jon Kingsdale.   Being from the South, I had no clue what market this paper served, so I checked the obituaries for the paper and saw such locals as Sudsbury, Falmouth, Framingham, and Rockland, Westborough, and Westchester.  While I didn't know the people or places, I figured out pretty quickly they weren't  from around here.  This was confirmed when I saw many seemed to have died in various branches of the U Mass Hospital system.

I suppose if I were some policy wonk, I'd also recognize the name of Jon Kingsdale, but I didn't and had to look him up too.  But not in the obituaries.  Turns out he is the CEO of the Massachusetts Health Connector.  Didn't know what that was either so I had to look it up too....

Honestly, I don't know how you folks in Massachusetts keep up with all this stuff, but the Health Connector is the state run agency that is in the middle of making sure all the good citizens of that state get health insurance or get fined.  Don't you just love Government?

Anyway, the short story on Massachusetts health policy is that pretty much all adults in the state have to have health insurance in 2009 or face fines.  I'm not sure about kids, but presume they have to have coverage too, but I'm guessing it would be difficult to collect fines from them.  And the fines are not small.  They could exceed $900 per year.

Citizens of Massachusetts can't just have any old insurance coverage, they actually have to have policies that provide them with certain standards of coverage.  As an aside, it is sad that there are policies out there that purport to provide coverage, but that in fact are crap and will do nothing but make an individual health crisis worse in the event it ever had to be used.

So where is the The Gradock Bulletin going with all of this?  We can read policy geniuses comment on this all day long, but our attention spans are too short.  We want your input.

We want to hear some normal people's perspective on this state mandate. Either individuals or employers trying to provide benefits to their employees.

Is it working?  What is it doing to healthcare costs?  Is it being administered efficiently?  Is it better than what was in place before?  Who is getting rich off of it?  Things like that.  

We have put up a discussion forum on the subject at HSAeducator.com in their Forum section and invite real people to share their experiences.  To tell the rest of the world, the real story.

And for all of us outside the great state of Massachuttes, to ask questions about the program.   Why?  Because it or some version of it could be "coming to a theater or drive-in near you."

To give those outside the state an idea of what those in Massachusetts must have in their insurance plans to avoid penalties, below is the list:     

• A comprehensive set of services (e.g., doctors visits, hospital admissions, diagnostic surgery, mental health and prescription drug coverage).
• Doctor visits for preventive care that are not subject to a deductible.
•  A cap on annual deductibles of $2,000 for an individual and $4,000 for a family.
• For plans with up-front deductibles or co-insurance on core services, an annual maximum on out-of-pocket spending of no more than $5,000 for an individual and $10,000 for a family.
• No caps on total benefits for a particular illness or for a single year.
•  No policy that covers only a fixed dollar amount per day or stay in the hospital, with the patient responsible for all other charges.
•  For policies that have a separate prescription drug deductible, it cannot exceed $250 for an individual or $500 for a family.

Folks, we want to know The Good, The Bad, and The Buttugly of healthcare in Massachusetts today.  Click Here to get to the Forum   -  You will have to register when you get there if you are not already.

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. 

If you are one of those folks who dreads the open enrollment period for your health benefits, who puts their heads inside of their shell and basically runs and hides, I'm sorry to say, you are the hunted.  If you simply sign up for whatever you had last year (but likely at a higher price, and possibly with reduced benefits) without doing your homework, you are the hunted.  If you haven't figured out things like HSAs, HRAs, or FSAs, then you are the hunted.  If you simply do what your office "best friend" does, then unless they are a hunter and your family situation mirrors theirs exactly, then you are the hunted.

• On the other hand, if you read the insurance materials from cover-to-cover;
• If you know which doctors come with which insurance plan;
• If you understand the difference between the various premiums as well as the deductibles;
• If you understand the difference between HSAs, HRAs, and FSAs and fully utilize them within your plan;
• If you understand the differences between the drug coverage offered;
• If you know what you spent on health care in the current year for yourself and family including premiums, medications, OTC costs, and doctors visits;
• If you spent every nickle out of your FSA or made the maximum contribution to your HSA;
• If you understand the tax benefits of an HSA (if you have one or are considering one); then you are definitely the Hunter.

If you are the Hunted, it may not be too late and you still have a chance.

Hunters, to the extent you can "kick ass" when it comes to making healthcare decisions, you do it!!  

 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.

I came across an article in Wednesday's (10/29) edition of Workforce Management Magazine which was extracted from a presentation made by Maureen E. Sullivan, SVP Blue Cross Blue Shield Association at the National Consumer Driven Health Summit on October 20.  The name of the presentation was called Health Plan Initiatives, Trends and Research in Consumer Driven Care.   If you want the full download please click on either of the links above for loads of relevant statistics related to Consumer Driven Health Plans.

If you are in a hurry and trust me, the answer to the question in the headline is, YES!  Well, statistically speaking that is ,when HSA eligible enrollees are compared with non-CDHP enrollees.

If you've read this far, and need a little CDHP or HSA education click on either link and learn a little.

If you want to know the characteristics of a 2008 HSA eligible enrollee keep reading.  If you are wondering what the definition of an "HSA eligible enrollee" is; the research sample was derived from Blue Cross Blue Shield HDHP plan members who either had opened an HSA or were eligible to open one.

So, and HSA eligible enrollee:

• is more likely to be offered an incentive to open their HSA
• wants more control over their healthcare costs
• is more cost conscious and cost driven
• is more engaged in tracking their healthcare expenses
• is more engaged in understanding their healthcare costs prior to treatment
• is more engaged in healthcare screening, exercise, nutrition, and health coaching
• uses more preventative services but no less necessary care services than non-CDHP enrollees (they are no more inclined to skimp on things like inpatient/outpatient procedures, diagnostic imaging, ER visits)

So, to say it again, if you are part of the HSA nation, there's a pretty good chance you are indeed an HSA savvy shopper.  But you knew that already didn't you?

"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.

.......it's actually harder.

Remember a few years ago when this outfit called the X Prize Foundation paid $10 million for the first privately funded manned space flight?  Quite a contest.  Quite a feat.

Well yesterday, WellPoint and the X Prize Foundation announced a new competition offering $10 million for solutions that can impact positive change in health care cost and quality.

Nice prize.  Tall order.  But just damned cool.

Now if you are itching to sign up and want to know the details (read the rules-no doubt some lawyer is having fun with those), you'll have to wait until early 2009.

Just think for a moment.  Imagine if you will.  Here is a contest that embodies CDH not GDH.  Consumer Directed Health as opposed to Government Directed Health.  It recognizes that we are smart enough, creative enough, and have the ingenuity to tackle and solve some of the largest issues that confront us today.  We don't have to sit back and pray to Government for the answers.  I like that.

My family has had our High Deductible Health Plan (HDHP) for just under one year, and last month we discovered that what we believed to be an embedded deductible was nothing of the sort.  Huh?  What's an embedded deductible you say?

When shopping for health insurance you'll often see an individual deductible and a family deductible quoted side by side.  In our case the individual deductible was $5,200 and the family deductible was $10,400.  From our reading of the insurance policy, if an individual within my family hit the $5,200, their coverage from that point forward for that person would be at 100%. Warning Will Robinson, WRONG, WRONG, WRONG!!!

There are policies with embedded deductibles that do what I thought mine did, but you've got to be very careful that if that is a need you have, that your policy will actually provide that benefit.  In fact, you really should talk to your insurance agent, and if you don't have one, get one.  They are free and if they are any good, they can steer you clear from this fly trap.

The last thing you want is to hit what you thought was your deductible and find you still have a ways to go before your insurance starts paying.