Healthy Tips

According to an annual survey by the National Coalition on Health Care, the cost of healthcare will continue to increase at a rate of least twice the rate of inflation. Experts project that Medicare funds will be extinguished by 2019, requiring the U.S. government to foot the bill for all U.S. citizen healthcare expenses. The result would overwhelm the industry, leading to decreased private sector affordability and healthcare accessibility.

However, thanks to tax-incentivized Health Savings Accounts (HSA), U.S. citizens can start setting aside money now that will help cover their future healthcare expenses. According to some experts, the only way to get reliable and speedy healthcare in the future may require that citizens pay for it out of pocket – especially if healthcare becomes nationalized. Having tax-deferred healthcare funds set aside an HSA may help citizens gain access to medical resources that are quickly becoming scarce.

Before you decide whether an HSA is right for you, consider the facts:

The High Cost of Healthcare

- The current national deficit has surpassed $500 billion with no signs of reversal in the coming years.

- The U.S. spends 4.3 times the national defense budget on healthcare.

- 2008 healthcare expenditures were expected to increase by a rate of twice the rate of inflation.

- Total healthcare spending in 2007 totaled $2.4 trillion. That’s $7,900 per person.

- U.S. healthcare spending amounts to 17 percent of the U.S. gross domestic product (GDP).

- By 2017, healthcare is expected to cost $4.3 trillion per year – 20 percent of the GDP.

- There is an imbalance in money going into and coming out of the Social Security, Medicare, and Medicaid funds. These funds are quickly shrinking and Baby Boomers aren’t even accessing them yet. (They’ll start accessing their awaiting funds in just two years, which will cause the funds to be used up even faster.)

- Experts predict that the Medicare hospital insurance trust fund will be non-existent by 2019 at current spending rate.

Healthcare Burden on Families Leads to Problems for U.S. Government

As health care costs rise, many individuals become unable to pay for health insurance. If they cannot pay for health insurance, but require medical attention, they run the risk of having to file for bankruptcy, have assets repossessed, or foreclosing on their homes. As a result, the federal government will be forced to take on the additional financial burden of their unpaid healthcare expenses.

- About 46 million Americans are uninsured, causing those uninsured individuals to rely on the government help to pay for their healthcare expenses.

- 50% of individuals that file for bankruptcy file, in part, because of large medical expenses. Only 68 percent of those individuals had health insurance, according to a study by Harvard University.

- Approximately 1.5 million families foreclose on their homes each year citing unaffordable medical expenses.

- According to the national average, experts believe that retiring elderly couples will need to have saved $300,000 just to pay for medical expenses.

As healthcare becomes more and more unaffordable for businesses and U.S. citizens, the government is continues to lean towards a nationalized healthcare plan, such as the healthcare plans implemented by many socialize Western European nations. However, free healthcare for all will not guarantee access to healthcare services. Instead, a system of free healthcare has proven to actually decrease access to healthcare because of an increase in healthcare-related requests for service. Simply put: evidence indicates that when people have access to something for free, they will use it more than they need.

In a nationalized healthcare system, the only solution for the government to control costs is to limit access. This precedent of limiting of access is normal in countries that have socialized medicine. As a result, these country’s citizens often do not receive adequate healthcare coverage.

The Trouble with Socialized Healthcare

- In Britain, nearly 1 million people are on waiting lists for public healthcare services.

- Canadians often seek healthcare in the U.S. for urgent or specialized issues.

- Many individuals in countries with socialized healthcare die while waiting to be treated because of limited access to public programs.

- Per capital, one-third fewer people are able to get bone marrow transplants in Britain through the nationalized healthcare program.

- Seventy-five percent fewer British citizens had access to nationalized bypass surgery services.

- Also in Britain, 20 percent of colon cancer patients died because of treatment delays. These cases are thought to have been curable with earlier treatment.

- Already in the U.S. in places where healthcare is required by the government, citizens are encountering decreased access to medical resources (such as in Massachusetts where there is a government requirement for health insurance).

In Britain, where healthcare is largely inaccessible because of the nationalized system, one out of every five operations is paid for out-of-pocket. Even while projected public healthcare services in the U.S. threaten to decrease access to healthcare, many individuals will still have the option to access private healthcare resources in order to get immediate and individualized attention.

One way of ensuring that individuals have the financial means to pay for these necessary private services is to maintain an HSA, which will grow in value as individuals age.

Using an HSA to Afford Healthcare Services

An HSA is a safe solution to help individuals pay for expensive medical costs. Furthermore, having an HSA can help you to protect yourself against decreased healthcare access that will correspond to the future nationalization of healthcare.

An HSA works like any savings account, in which you deposit money for safekeeping. Through your HSA, you can invest that money into high-interest stocks, mutual funds, CDs, or other growth opportunities. You will get an immediate tax break for investing in an HSA. Additionally, your money will grow tax-deferred and will be tax-free when you withdraw it to pay for medical expenses.

If you had a HSA qualified health insurance plan in place by December 1, 2008, you can make a financial contribution to your HSA through April 15, 2009. As of January 1, 2009, you can make contributions to your plan for the 2009 year.

Remember: though the federal government is available to offer a financial safety net in times of great need, each individual is responsible for his or her own healthcare costs, living expenses, and lifestyle costs.

Take action now to protect the health of your family by contributing to an HSA. Anticipating future healthcare needs will help to secure lifelong health and well-being.

It’s no wonder – every year the average American spends thousands of dollars on healthcare related expenses. These expenses include the cost of monthly insurance premiums as well as any out-of-pocket bills not covered by insurance.

In particular, the recent introduction of Health Savings Accounts to the public, and their enthusiastic promotion by the Bush administration, has spawned an interesting debate between supporters and critics of HSAs. A contentious new topic of discussion, the hullabaloo surrounding Health Savings Accounts shows that Americans do have strong opinions when it comes to their health.

It seems many people are interested in learning more about what a Health Savings Account can do for them. Is it a good option for you? Should the everyday American be concerned about access to healthcare if HSAs grow in popularity?

Many detractors of this new healthcare option warn that only young, healthy, financially stable people with good jobs benefit from HSAs because they are the only ones who can afford it. Health Savings Accounts must be opened in conjunction with a high deductible insurance plan, either through your employer or through the insurance company of your choice. The argument is that the average person can’t afford to deposit the minimum annual amount required for a Health Savings Account and pay a higher deductible.

But in reality, the amount you invest in a Health Savings Account can be deducted from your annual income tax calculations. In addition, once you deposit that money into a Health Savings Account it is left to grow tax free, safe from the taxman even when you make a withdrawal. This perk is not a tax haven created solely for the rich but can benefit anyone for whom lower taxes mean more money in the bank. And the annual deposit you make into the account can be as high as your insurance deductible – you are free to use the amount deposited for that year’s deductible payment as well, after which point the insurance kicks in and covers any added expenses you may accumulate for the rest of the year.

Although being made to purchase high deductible insurance coverage may seem more expensive at first, you will save thousands of dollars over time due to the low monthly premiums that inevitably come with this type of insurance plan. The money you invest in a Health Savings Account is not static either – interest is calculated on the deposit, stretching your money and making it work for you. You are also free to invest the money to make it grow, but of course, this option does involve some risk.

On top of all this, you are allowed to use the money in your HSA for a wide range of medical expenses. Normally insurance policies only cover certain medical bills and health items, but HSAs allow you the flexibility to pay for preventive care, such as dental checkups and other medical appointments, as well as prescriptions, contact lenses and other such necessities that are usually funded out-of-pocket. If you don’t use all the money in your account throughout the year the amount rolls over to the next calendar year and will continue to earn you interest.

While Health Savings Accounts may not be suitable for everyone, many Americans can save a lot of money on healthcare by switching to such a plan, and should regard the advent of this new choice with interest rather than apprehension.

Health Savings Accounts and the Future of Healthcare

Some warn that the growing use of Health Savings Accounts could potentially lead to the loss of employer-sponsored health insurance altogether. The worry is that everyone will be left to fend for themselves in order to cover healthcare expenses and most people won’t be able to foot the bill. But this is not likely to occur. As of now HSAs must be used along with an insurance plan, and most people deciding to switch have been offered the choice by their employers. As insurance rates continue to rise, more companies are drawn to HSAs because they save money through this type of coverage as well. But company-sponsored health insurance is not in danger of disappearing. Even with Health Savings Accounts becoming more popular, the easiest and most efficient way to administer even this kind of insurance package is through the employer.

Overall, hopes are high that Health Savings Accounts will make the healthcare system as a whole more accessible and affordable. As the individual takes on greater responsibility for the cost of healthcare, prices should remain low rather than rise at an exponential rate. From the most optimistic viewpoint, patients paying medical bills and seeing the real price of their medical care will fuel healthy competition amongst doctors and hospitals and ensure that quality healthcare is provided for a reasonable price. And as Health Savings Account holders reach the age of retirement, the unused savings accumulated over the years can be withdrawn and used for anything they need, whether or not it is a healthcare expense. In the future, more and more self-employed people will most likely flock toward this type of savings account in order to reap the benefits that come with consistent access to healthcare coverage. More flexibility and choice are also factors that will likely contribute to HSAs growing in popularity.

Of course, HSAs are not a panacea for all the problems that plague the current healthcare system, but their continued usage has the potential to foster greater accountability within the medical field. Healthcare issues are complex and cannot be governed solely by the institution of a single healthcare scheme, but even the smallest change for the better can make a big difference in the lives of individual Americans and their families.

Health Savings Accounts are an excellent way to build a second retirement account. These tax-favored accounts, which have only been available since January of 2004, can be opened by anyone with a qualifying high-deductible health insurance plan. Once you open an HSA account, you can place tax-deductible contributions into it, which grow tax-deferred like an IRA. You may withdraw money tax-free to pay for medical expenses at any time.

The biggest reason more people don’t retire before age 65 is lack of health insurance, and many Americans reach age 65 woefully unprepared for the medical expenses they’ll face once they do retire. One of the most important long-term reasons for establishing an HSA is to build up some money for medical expenses incurred during retirement.

Fidelity Investments reports that the average couple retiring in 2006 will need $190,000 to cover medical expenses during retirement. This assumes life expectancies of 15 years for the husband and 20 years for the wife.

HSAs are, without exception, the best way to build up money to pay for medical expenses during retirement. You should not contribute any money to your traditional IRA, 401 (k), or any other savings account until you have maximized your contribution to your HSA. This is because only health savings accounts allow you to make withdrawals tax-free to pay for medical expenses. You can take these distributions anytime before or after age 65.

Your HSA contributions won’t affect your IRA limits — $3,000 per year or $3,600 for those over 55. It’s just another tax-deferred way to save for retirement, with the added advantage being that you can withdraw funds tax-free if they are used to pay for medical expenses.

For early retirees who are healthy, a health-savings account can also be a smart option to help lower their health insurance costs while they wait for their Medicare coverage. The older someone is, the more they can save with an HSA plan. For many people in their 50’s and 60’s who are not yet eligible for Medicare, HSAs are by far the most affordable option.

Any money you deposit in your health savings account is 100% tax-deductible, and the money in the account grows tax-deferred like an IRA. For 2006, the maximum contribution for a single person is the lesser amount of your deductible or $2,700. In other words, if your deductible is $3,000, you can contribute a maximum of $2,700; if your deductible is $2,000, then that is the maximum. For families, maximum is the lesser of $5,450 or the deductible.

If you’re 55 and older, you can put in an extra $700 catch-up contribution in 2006, $800 in 2007, $900 in 2008, and an additional $1,000 from 2009 onward. The contribution limit is indexed to the Consumer Price Index (CPI), so it will increase at the rate of inflation each year.

How much you accumulate in your HSA will depend on how much you contribute each year, the number of years you contribute, the investment return you get, and how long you go before withdrawing money from the account. If you regularly fund your HSA, and are fortunate enough to be healthy and not use a lot of medical care, a substantial amount of wealth can build up in your account.

Health savings accounts are self-directed, meaning that you have almost total control over where you invest your funds. There are numerous banks that can act as your HSA administrator. Some offer only savings accounts, while others offer mutual funds or access to a full-service brokerage where you may place your money in stocks, bonds, mutual funds, or any number of investment vehicles.

One of the biggest advantages of retirement accounts like HSAs are that the funds are allowed to grow without being taxed each year. This can dramatically increase your return. For example, if you are in the 33% tax bracket, you would need a 15% return on a taxable investment to match a tax-deferred yield of only 10%.

As another example, if you are in a 33% tax bracket and were to invest $5,450 each year in a taxable investment that yielded a 15% return, you would have $312,149 after 20 years. If you put that same money in a tax-deferred investment vehicle like an HSA, you would have $558,317 – over $240,000 more.

Because catch-up contributions are allowed only for people age 55 and older, if one or both of you are under age 55 you should establish your HSA in the older spouse’s name. This will allow you to capitalize on the expanded HSA contribution limits for people in this age range and maximize your HSA contributions. Once that person turns 65 and is no longer eligible to contribute to their HSA, you can open another health savings account in the younger spouse’s name.

Strategies to Maximize your HSA Account Growth

If your objective is to maximize the growth of your HSA in order to build up additional funds for your retirement, there are three important strategies you should implement.

Strategy #1: place your money in mutual funds or other investments that have growth potential. Though this is riskier than placing your money in an FDIC-insured savings account, it is the only way to really take advantage of the tax-deferred growth opportunity that an HSA provides.

Strategy #2: delay withdrawals from your account as long as possible. Though you may withdraw money from your HSA tax-free at any time to pay for qualified medical expenses, you do have the option of leaving the money in the HSA so that it continues to grow tax-free. As long as you save your receipts, you can make medical withdrawals from your account tax-free at any future date to reimburse yourself for medical expenses incurred today.

As an example, let’s say a 45 year old couple places $5,450 per year in their HSA over a period of 20 years, they have $2,000 per year in qualified medical expenses, and they get a 12% return on their investments. If they withdraw the $2,000 from their HSA each year, they’ll have a net contribution of $3,450 per year into their account, and they’ll have $248,581 in their account when they begin their retirement years.

If on the other hand they delay withdrawing that money, they will have $392,686 in their account at age 65. If they choose they can withdraw the $40,000 to reimburse themselves tax-free for the medical expenses incurred during that 20 year period, and still have $352,686 in their account – over $100,000 more than if they had withdrawn the money each year.

Strategy #3: make the maximum allowable deposit to your HSA at the beginning of each year. Even though you are allowed until April 15 of the following year to make deposits to your HSA, you should take advantage of the tax-free growth in your account by funding it as soon as possible. The extra interest you can earn by contributing to your account on January 1 of each year rather than the next April 15 can amount to over $40,000 in a 20 year period, and over $100,000 in 30 years.

Using Your HSA to Pay for Medical Expenses during Retirement

When you enroll in Medicare, you can use your account to pay Medicare premiums, deductibles, copays, and coinsurance under any part of Medicare. If you have retiree health benefits through your former employer, you can also use your account to pay for your share of retiree medical insurance premiums. The one expense you cannot use your account for is to purchase a Medicare supplemental insurance or “Medigap” policy.

Though Medicare will pay for the majority of health expenses during retirement, there many be expenses that Medicare will not cover. Nursing home expenses, un-conventional treatments for terminal illnesses, and proactive health screenings are all examples of medical expenses that will not be paid for by Medicare, but that you can pay for from your HSA.

Long-term care is assistance with the activities of daily living, such as dressing, bathing, or feeding yourself. It can be provided in your home, a retirement community, or a nursing home. Long-term care expenses can be paid for using funds from your HSA, and long-term care insurance can even be paid for from the HSA up to the following maximum annual amounts:

Age 40 or under: $260

Age 41 to 50: $490

Age 51 to 60: $980

Age 61 to 70: $2,600

Age 71 or over: $3,250

To establish a health savings account, you must first own an HSA-qualified high deductible health insurance plan. Compare HSA plans side by side to determine the best value to meet your needs. Once you have your high deductible health insurance plan in place, you can open your Health Savings Account with the financial institution of your choice.

The healthcare industry in the United States is dominated by the culture of conventional Western medicine. And health insurance caters to those who control the industry: medical doctors and hospitals. There is a long history of prejudice against chiropractic by medical doctors, which is one reason that chiropractic care is not often covered by health insurance.

Many research studies have shown that chiropractic care is beneficial and that it is more cost effective in the treatment of low back pain and other common musculoskeletal conditions than traditional Western medicine is. Chiropractic also lowers health care costs by focusing on prevention, was well as on treatment.

It is surprising that health insurers choose not to cover treatment that is as beneficial and cost effective as chiropractic care is. Studies have continually shown that individuals who seek the care of a chiropractor on a regular basis are healthier and, generally, spend less on health care than those who do not.

Chiropractic Care and Consumers

What is not surprising is that consumers are wise enough to see the advantages of chiropractic care. Many people prefer to see a chiropractor simply because they see tangible benefits from the care they receive. Many others are disillusioned with traditional Western medicine and the healthcare system, and they look for alternatives such as chiropractic care.

It is clear, both from patient testimonies and from clinical research that consumers benefit from chiropractic care. Unfortunately, they may have difficulty affording chiropractic care because it’s often excluded from healthcare insurance policies.

Health Savings Accounts can help consumers afford chiropractic care, even when it is excluded from their health insurance policy. They can pay for chiropractic care and other alternative medicine with pre-tax dollars by using a Health Savings Account.

Many chiropractors keep their costs as low as possible in order to make chiropractic care more available to consumers. They can, however, only absorb so much of the cost of providing that care. Another way chiropractors can help clients gain access to chiropractic care is to encourage the use of Health Savings Accounts.

Health Savings Accounts and Consumer Choice

The combination of a Health Savings Account and a High Deductible Health Plan (HDHP) is supposed to encourage individuals to become thoughtful, wise consumers of health care. The individual is spending more of his or her own dollars on healthcare, so she will be more concerned about how those dollars are spent.

Health Savings Accounts give consumers more choice in how their healthcare dollars are spent. Money in the HSA must be spent on approved medical expenses, but there are really very few restrictions on what kind of healthcare you choose. More and more chiropractic patients are discovering that having an HSA is saving them money on their medical expenses.

Traditional health insurance has gatekeepers and controls. Even when chiropractic care is covered (not typical on individual plans), the individual requesting chiropractic care may be required to go see their family physician (or gatekeeper) and get a referral. Not all medical doctors will refer to chiropractors. If chiropractic care is covered on the health insurance plan, and if you can get a referral (which amounts to permission to see the chiropractor), there may be limits to the number and types of treatments you can receive.

Using a Health Savings Account to pay for chiropractic care gives you, the consumer, more choice. You can choose what type of medical treatment to get, where you will get that treatment, and how many treatments you will get. You can spend HSA dollars on preventive care as well, and actually have the government give you a tax deduction for keeping your family well.

Since Health Savings Accounts (HSAs) were created by the Medicare bill signed into law in 2003 they are being considered by more and more Texans as a health insurance option. Here is a quick overview on a complicated subject.

What’s a Health Savings Account (HSA)?

They have two parts. The first part is a qualified high-deductible health insurance policy that covers large medical bills. The second part of the Health Savings Account is an investment account or retirement account from which you can withdraw money tax-free for medical care. If you don’t withdraw the money for medical expenses, the money accumulates with tax-free interest until the age of 65, when you can withdraw it for any purpose and pay normal income taxes.

Who’s eligible for an HSA?

Anyone under age 65 who buys a qualified high-deductible health insurance policy can open an HSA. If you’re covered by another health insurance policy that isn’t a qualified high-deductible plan (either as an individual or a dependent), you’re not eligible for an HSA. If, however, you are eligible, you can still carry other accident, disability, dental, vision and long-term care insurance policies.

How much can I contribute annually to an HSA?

For 2007, you can contribute up to $2,850 for individual coverage or $5,650 for families. If you’re 55 and older, you can make a catch-up contribution of $800. Legislation approved at the end of last year allows you to contribute up to these limits, even if your insurance deductible is less.

Can any high-deductible health insurance policy qualify for an HSA?

Any high-deductible health insurance policy can qualify, as long as it meets the IRS requirements. The deductible must be at least $1,050 for individuals or $2,100 for families, and the annual out-of-pocket expenses cannot exceed $5,250 for an individual or $10,500 for a family. This includes deductibles and co-payments, but not premiums. So you can buy an individual high-deductible healthcare policy, or purchase one through your employer.

To qualify as an HSA-eligible policy in 2007, your health insurance plan must have a deductible of at least $1,100 for individual coverage or $2,200 for families. You can then make a contribution to your HSA up to the amount of the deductible each year. If you’re buying an individual plan, be sure to ask your health insurance company if it is an “HSA qualified” high deductible plan. Not all high deductible plans are eligible, or “qualified”.

Where can I get an HSA-Eligible Plan?

First you need a qualified high deductible plan. Finding a plan depends on whether you get it through your employer or purchase individual insurance.

Employer Insurance -If you get health insurance through your employer, ask about the HSA-eligible option during the group policy’s open-enrollment period, which is generally in the fall. Or talk to your benefits manager to see if HSAs will be on your health insurance menu. Choosing an HSA could significantly reduce your share of premiums, and some employers may opt to fund all or part of the HSA, much like a 401(k)-style match.

Your individual insurance company or employer will then almost certainly direct you to their preferred vendor for the administration of your HSA account. Using the preferred vendor is usually to your advantage as data is more easily transferred between the insurance company and the HSA administrator and you get a break on the administration fees. You are, however, free to chose another HSA administrator if you prefer.

“Consumer driven healthcare” is the name that has been given to the change that is currently happening in the medical marketplace. As millions of people get Health Savings Accounts, medical providers are having to adapt to the new reality of people spending their own money when purchasing healthcare. As more companies compete for your business, the opportunities to save money will continue to grow.

Since the advent of employer-sponsored health insurance during World War II, the pricing and quality of medical services has been shrouded in mystery. As the real price for computers, organic food, big-screen TV’s, and just about everything else has continued to drop (including health services where there is not a third party payer, such as laser eye surgery, contact lenses, over the counter medication), the price of healthcare has continued to rise. But that is finally beginning to change. And you, fellow HSA-owners, are the reason.

To gain a competitive advantage, healthcare providers have traditionally attempted to grow local market share in an attempt to extract higher payments from insurance companies. But since Health Savings Account owners have the ability to accumulate unspent funds and invest them tax-free, those of us with a Health Savings Account have a strong incentive to avoid unnecessary care, and to be more cost conscious when we seek treatment.

There are now billions of dollars in Health Savings Accounts, and healthcare providers want access to that money. And since you control it (instead of the insurance company), the only way for the provider or retailer to get that money is to offer you high quality care at a price you are willing to pay. And dozens of companies are doing just that.

The Market Responds

One obvious response to the consumer-driven healthcare movement is the proliferation of quick-service medical clinics. These clinics, which require no appointment and typically charge less than $50, offer a low-cost way to diagnose and treat strep throat, bronchitis, pink eye, and other common ailments. MinuteClinic operates dozens of locations in Target, Cub Foods, and CVS Pharmacy stores. Wal-mart, which currently has 75 in-store clinics in 12 states, is forecasting more than 6,600 in-store medical clinics will be open in retail stores within 5 years.

Diagnostic labs, which have traditionally sold their services to physician’s offices, are now offering tests directly to the public at prices often 70% less than you would pay at a doctor’s office. With most you can order the test online, go give blood, and get your results in a couple days.

Companies are even providing self-testing services and devices which can enable you to avoid going to the doctor when minor medical events occur. One of the most common reasons kids see a doctor is because of a possible ear infection. For about $50 you can buy an EarCheck Middle Ear Monitor. This uses sonar to test for fluid behind the eardrum, which may indicate an infection. “The QuickVue Strep Test” which costs less than $4 per test in a pack of 25, can quickly help you determine if your child has a strep infection, which would require a doctor’s visit, from a common viral infection, which would not.

Demand Price Transparency

Health Savings Accounts reward personal responsibility in three ways: 1) they reward you with tax-breaks for putting money aside to cover future medical expenses; 2) they reward you for taking care of your health by enabling you to grow your account; and 3) they reward you for being a cost-conscious and discerning consumer.

So be a discerning consumer, and spend your money wisely. Remember that the doctors and healthcare providers you see work for you. If you don’t get the quality of service or a fair price, take your business elsewhere. Here are some common sense suggestions to make sure you do get a good price:

1. Ask how much it will cost, before you buy. There is nothing else that you buy without knowing the price up front, so don’t feel intimidated to ask your doctor the same.

2. Review your bill before paying it. You might be shocked how often extra charges are “accidentally” tacked on to hospital bills.

3. Ask for a cash discount. To avoid the hassles of filing for insurance and trying to collect past-due charges, most physicians will gladly offer a cash discount if you ask.

4. Explain that you will be paying out of your own pocket. When a doctor is prescribing tests or writing prescriptions, he or she is rarely taking cost into consideration. The American Journal of Preventive Medicine recently reported that up to $63 billion in medically unnecessary tests are ordered every year.

5. Vow never to pay list fees. Doctors and hospitals routinely discount their services to insurance companies and PPO organizations. As a cash-paying customer, you should get the best price available.

For many years, a small group of health economists and other policy-makers pushed for a more market-based approach to healthcare. They correctly argued that healthcare was like any other market and that if you put a true price on health care services and let the market function, costs could be controlled. We are now beginning to see this happen.

Our healthcare system is the best in the world. It is a dynamic and complex work in progress, which can only get better as the consumer gets involved. So be savvy about how you spend your healthcare dollar. And watch those unspent funds in your Health Savings Account continue to grow.

The Medicare Trust Fund will soon be out of money, and there will be no practical way for the government to continue to provide the level of benefits that current Medicare recipients receive. The result will be serious rations, waiting periods, and a reduction in benefits. If you wish to maintain your medical freedom, and have access to a high level of medical service, you must be prepared to pay for it yourself. The best strategy is to take good care of your health, and to build up your medical retirement fund as large as possible by using a Health Savings Account.