A few days ago I was fascinated by an article in the Wall Street Journal that talked about how working on laptops wreaks havoc on ones back shoulders and neck due to the horrible posture it promotes.  As best I can tell, with a laptop, it is very difficult to get the keyboard and the monitor in the proper position to support proper posture and good back/neck/shoulder health.  The result is back aches.   

Until a few weeks ago, I suffered laptop back aches too.  For the last two years I have been working out of my home office and use my laptop exclusively.  I generally work at my desk but doing so for long periods of time really causes my back to ache. 

This all changed however with the arrival of our Christmas tree this year. As luck would have it, the spot in our den where the tree was to go, was occupied by our La-Z-Boy.  Simple solution to that was to put it into my office. 

Being as how my back was aching all the time, I took it upon myself to park my skinny butt in the La-Z-Boy with my laptop and plough right back into my work.  After a couple of days my back was feeling pretty good, and we all know how good a well housebroken La-Z-Boy feels.

According to the WSJ article the keyboard should be at elbow height with arms and elbow at a 90 degree angle and the monitor should be at eye level for maximum ergonomic bliss.  In my La-Z-Boy, I find that in a certain level of recline, I am close to that posture.

So I wondered to myself, if I got a note from the Doctor that said for my medical well being I needed to work exclusively from my La-Z-Boy, could I then pay for a new one from my Health Savings Account?  The answer to that question from my doctor is probably, "what have you been smokin' son?" 

Don't got trying to pay for your next La-Z-Boy from your HSA.  It won't work.  But if you've been suffering a little laptop back pain, try the La-Z-Boy.

In the meantime, I'm trying to figure out if we can keep the tree up through the end of January. 

 For starters, she speaks our language.  And that is the language of Consumer Driven Healthcare.  A brief expose' of her positions are outlined in the December 22 edition of Business Week and worth a read.   If time is tight, keep reading below for a summary and maybe even a few thoughts of our own (maybe).

Regina Herzlinger is a professor of Business Administration at Harvard Business School and she advocates neither government nor employer based healthcare.  Branded a heretic by some, she advocates a free and open healthcare market that is totally focused on you and me.  Also known as the patient and the consumer.

Her position is that there should be total transparency in the healthcare space.  In otherwords if doctors, hospitals, and insurance companies all had to compete openly in the marketplace for yours and my healthcare dollars (that we controlled) we would have economic environment not unlike the retail sector.  Those that provide us with health related services would compete like crazy, drive prices down, and we could make our own and hopefully better decisions about our healthcare.

In her model, the government's role is really four-fold:  mandated (a word that frightens me generally) coverage for every American, strict oversight to ensure fairness in terms of price/coverage, a national database of pricing and quality, and lastly tax breaks and subsidies depending on income.

She agrees with the folks at the Gradock Bulletin, that HSAs are not the silver bullet to healthcare reform, but rather part of the solution.  We believe an important part.

Sounds good, no?  Here's the rub.  Those who disagree with Ms. Herzlinger do so because they think we are too stupid to fend for ourselves.  That there is no way we could possibly sift through all the choices and make informed healthcare decisions.  To that I respond, ptuey.   We go to the grocery store, there are tens of thousands of items, all with different prices, different sizes and with different nutritional values.  It is a virtually transparent marketplace and because it is, we are able to make informed decisions.  We are neither chimps, nor chumps.  Education, information, transparency can lead us to meaningful reform.

 Now there's a seemingly dry topic for an article on HSAs but guess what?  It is one of the top keyword searches driving individuals to this site.

And since we are all about HSA education, it seems only fitting that if you blasted through cyberspace and somehow landed on this page reading this article, and this sentence specifically, it seems only fair that we get you to a place that can get your question answered.  If you will click right here you will be shot through cyberspace just a little bit further into this site and where your question will be answered.

It's all pretty much laid out on one page to keep from putting you to sleep, but as you read it, should you want to learn more about high deductible health plans or anything else related to HSAs just click to the next page and read ‘til you feel like an HSA expert.

Oh, and one more thing, there is a pretty good starter page of frequently asked questions about HSAs if you have a question.  If you can't find the answer, just post your question on the HSAeducator forum (you will have to register) and one of our experts will try to answer it for you.

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.

So if you are reading this article there's a decent chance you are actually interested in learning about Health Savings Accounts or maybe taking control of your healthcare, or maybe taking control of your health.  Or then again, maybe you are looking for some information on the Haiku Society of America or perhaps the Handicap Scuba Association.  If the latter two, sorry, but you are hopelessly lost.

If you are an HSA wonk or someone just wanting to learn more, there is all kinds of good information on this site, HSAeducator.com, but if you want even more, the folks at HSAeducator.com have added a new link on their site that will pull up the latest and greatest news, videos and blogs related to Health Savings Accounts, High Deductible Health Plans, and CDH.  It actually is pretty cool, although, at the moment a little challenging to find.  If you look up to the right of the first article on this page, up under the "search hsaeducator.com" box, you will see the words, "  Health Care In The News" .  If you are looking for the latest in HSAs just click on that link and it will bring up a window and you can see what others are saying about HSAs out there.     Check it out and let us know what you think.

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. 

....NOT! 

I saw a humorous YouTube video which led me down an interesting path of reflection and reinforced the extremes in thinking some people have on healthcare in America.   Healthcare is a complicated social issue, and to the best of my knowledge there is only one only perfect solution.  And that's  perfect health.

I've included the video here as it is humorous, but I present it with a large caveat.  Health insurance in America is indeed less than perfect.  It is kind of like owning a used car.  Most of the time it works and gets us where we need to go.  It might have a few accessories like power locks and windows that provide us with some creature comforts, but overall it's just not that pretty.  Sometimes it breaks down and unexpectedly costs us more than we have on hand expect to make it work which can be frustrating but not devastating.  And on rare occasion something major happens and the clunker leaves us high and dry, in the middle of some barren desert, without a chance of survival.

This video, if viewed in a vacuum suggests that health insurance companies are the cause of the problem, spawn of the Devil, the root of all evil (and healthcare problems).  The creators of the video would like us to buy into this premise and then blindly accept their healthcare dogma.

....But the video is funny.  Just take it with block of salt.

After watching the video I followed the link and landed on the Health Care for America Now website.  I felt compelled to read their story, which at an ideal level has some merit (qualitiy, affordable healthcare for all Americans), but at a practical level takes the incredibly arrogant, and naïve position that they are right and anyone who disagrees with them is wrong.  Their truth is a manipulated and contradictory truth at best.

Remember the video?  The one above that makes insurance companies to be the spawn of the Devil, if not the Devil himself?  Health Care For America disdains insurance companies, yet they basically suggest that if you are satisfied with your insurance you can keep it.  That suggests to me that they have either overstated their cause "insurance is not affordable for families...etc." or their true agenda is something else.

This organization states:

"Our government's responsibility is to guarantee quality affordable health care for everyone in America and it must play a central role in regulating, financing, and providing health coverage by establishing:...."

Aha, their agenda....

The thing that really annoys me about this organization is not their desire to improve healthcare for all Americans, but their suggestion that this is a problem for which the bulk of the responsibility for fixing it falls to the Government.  I love it that they are trying to expose social injustice and health issues, but it really frosts my gonads that they fail to suggest that Americans themselves are part of the problem.  That State and The Federal Government are part of the problem.  That healthcare practitioners are part of the problem.  That attorneys are part of the problem.  That big business is part of the problem.  The list goes on, and we nibbled around the edges of this a few days back in our article "The Unscientific Top Ten..."  Yet the face they put on it is one of insurance company greed; part of the problem for sure, but a small part of the problem.

 Government owned, run, and mandated insurance is a slippery slope.  In the end, if the Government is true to form, like that old used care, it will leave us broke and disheartened. 

What frightens me about Health Care For America Now is their proposal rings of the entitlement bell shrouded in the guise of a right.  Unfortunately, rights are entitlements the minds of many.  If healthcare is a right, then it needs to come with an enormous amount of personal responsibility, accountability and some level of sacrifice.  We need to take care of each other.  If we believe  the Government cares a rats about us, I believe we are sorely misguided.

We should treat healthcare must be treated as a privilege for there are people in this world far less fortunate than us who drink dirty water and live in homes with dirt floors and minimal shelter.  Our focus should be on health first and then on healthcare.  For more thoughts on this please read, "Mountains Part Deux."

I think the solutions to our healthcare challenges need to be more collaborative.  I believe organizations like the Healthiest Nation Alliance are healthier at their roots than say Health Care For America. We've shown this video before, but it is worth another look. 

If you have read this far, then you are thinking.  That's good.  Now think a little more about how you can change the world.  Too big?  Then think about how you can change your world or maybe your child's world.  Start with your own health and you will be on your way to better, more affordable healthcare. 

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.