One reason why this is a problem is because Health Insurance is not only about dollars and cents, it’s mostly about risk and human behavior.  Too many people, of all walks of life, have unfortunately over the last 70 years or so treated Health Insurance not like insurance at all, but like a managed care program.

This has resulted in a lot of problems that everyone is familiar with, mostly manifested in very high Health costs, thus very high Health Insurance costs.

The truth is that the policy decisions surrounding this right now are almost irrelevant.  What IS relevant is what you and your business or family can do to minimize how much you have to spend on health care in a particular year.

Luckily, without any real change in the “system”, most of us can start right now focusing on the right decisions first.  Once we do that, when it comes to those other decisions that your broker can help you with, they can help you with a foundational understanding of what your principle drivers of Health Insurance costs should be.

First, though, let’s get one fundamental rule out of the way that should support and defend the answers to all three questions.  And that is this simple and inescapable fact:

There are only two numbers that actually matter in Health Insurance–Minimum Cost and Maximum Cost.  And what we mean by that is that if you start with the idea that your goal is to minimize the maximum dollar amount you would have to spend in any given calendar year for medical expenses, while at the same time keeping your minimum costs (your premium) affordable, it makes it a lot easier to come to the right decisions every step of the way.

Next time, we’ll discuss the first question.  Keep in mind that the questions don’t necessarily have to be answered in order, they really have to be addressed comprehensively, but we’ll start with this question nonetheless:

Are we a business or a family?

Butch Porter, MBA is a health insurance advisor and Principal of Goose Creek Financial. He can be reached at wdporter@gcfin.com or www.GCFin.com

(this article can also be found at: investorfinances.com)

[Elder's Note:  Mr. Bertaut and I are fellow commenters on StandFirm.  He is a senior healthcare intelligence analyst for Blue Cross and Blue Shield of Louisiana, and has been offering fascinating insights of late, on Obamacare.  Though not directly related to the demise of DSO, I thought the subject to be tangentially important as it relates to families, and also because Bp. Breidenthal did sign this document.  Accordingly, I have asked Mr. Bertaut to write a bit on this for The Oysters and he has agreed.

I hope that Mr. Bertaut's analysis will be helpful to the readers of this blog, and I offer to him my profound thanks for taking the time to write this thoughtful article. ]

The United States Center for Medicare and Medicaid Services (CMS) estimates the Health Insurance Coverage status of 305 million people living in America as the following (as of December 2008):

During the period when the Patient Protection and Affordable Care Act (PPACA) was being considered, arguments were made by both supporters and detractors that the Private Health Insurance Markets would be changed drastically by Reform.  Those on the left indicated that the Bill was unfair, because it passed a mandate that forced Americans to purchase health insurance and left private coverage as the only option, thus putting American’s at the mercy of “Greedy, villainous Health Insurance Executives (Nancy Pelosi, August 2009 House Testimony).  In addition, the Progressive Coalition in the House of Representatives, 71 members strong, signed a statement that said that without a “public option” (a private insurance entity run by the federal government as an alternative to for-profit or private not-for-profit coverage) the Senate Bill was a boon for insurance companies, offering up 46 million new customers with federal subsidies to boot.

On the right, and in alliance with the Health Insurance Companies, detractors said the bill would impose so many new government regulations on Health Insurance Companies that insurance pools would be destabilized and runaway premium costs would result.  Thus in the end, the federal government would be ordered to step in anyway, thus creating a Single Payer, or Federally Controlled Health Insurance plan that would interpose itself between patient and doctor and eventually ration the care Americans received through that entity.

Both arguments are compelling and both outcomes undesirable.  In this article I would like to examine the realities from a “boots on the ground” perspective as a Chief Forecaster and Senior Healthcare Policy/Intelligence Analyst in the health insurance business.  To be clear, I am not an attorney, accountant, or actuary.  I am not qualified to comment on regulatory issues as to their specific effects on employer groups.  What I am called upon daily to do, is to coordinate the projections for all the moving parts of the PPACA Bill and its changes and to forecast its effects on the Plan that employs me (The not-for-profit Blue Cross and Blue Shield of Louisiana) and communicate these changes and potential effects in a meaningful way to a whole bunch of smart, experienced stakeholders in the healthcare industry so they can incorporate my projections and background fact and data into their decision making going forward.

Let’s examine the arguments one at a time.  First, let’s examine the changes the Health Insurance Industry must absorb by 2014 and see how conducive they are to growth.

The PPACA contains some important changes that all insurance companies must build into their product and ratings by 2014 (some sooner) at the latest.  All health insurance sold in the U.S. by 2014 must share the following federally ordered characteristics:

1.  Must accept all comers. Insurance must be sold on a guaranteed issue basis.

2.  Must not medically underwrite (this is called Community Rating).  Neither individual nor group insurance will be allowed to be priced based on the health or claims experience of the group or individual.

3.  Must not “rider out” conditions for any length of time at all. Health status will probably not even be collected by Health Insurance companies following the enactment of the bill, as the typical medical questions we ask are strictly for pricing and medical management purposes.

4.  Must not vary pricing in a big way based on age. Today insurance pricing for a 60 year old in an individual policy may be priced as much as 10x higher than the price for the typical 19 year old.  This bill changes that maximum range to a federally specified 3x.

5.  Must not vary pricing based on gender. Actuarial studies confirm that between ages 21 and 64 women typically have almost double the medical expenses that men do.  This is largely due to the expenses of childbirth.  Insurance plans have spread the risk by charging women more for their health insurance over the years (although it is never 2x, typically 15 to 20% more is seen) but this is now illegal.  In effect, all men now will be paying for “pregnancy coverage”.

6.  Insurance companies may not make “excessive” profits. In reality, there are a trio of codicils in this bill that will more than likely make “for-profit” health insurance a thing of the past.  These are worth visiting now:

a.   Insurance companies must spend 80% of all premiums on qualified health care expense, and may not have more than 20% overhead (including profits) on all individual and small group business.  15% overhead is the maximum allowed on all Large Group Business.  Violations will inspire federally mandated rebates to all policy holders in the pools affected.

b.  Insurance companies may not claim as a taxable expense, any compensation for any employee from CEO on down in excess of $500,000.  Imagine trying to compete for NBA talent if your team is the only one with a $1M a year salary cap per player, and you get the idea of how this may affect the industry.

c.  Health Insurance as an industry will be required to pay massive, fixed, licensing fees to the Federal Government.  The first payment of $8B is due in 2014.  The amounts grow quickly to over $14B by 2017.  These are fixed amounts due, to be paid by health insurance carriers based on their market share of premiums, and do not change regardless of the financial performance of the health insurance carrier.  The entire industry on over $700B in premiums in 2008 only reported $6.8B in profits.

7.  Insurance companies may not have “Excessive Rate Increases”. As of this date, no one knows what “excessive” is, but clearly the profitability and solvency of health insurance carriers will be a matter of politics, not economics going forward.  Witness the reaction of the Administration to the Anthem HealthCare rate increases in their Individual Insurance Pool this year.  Having been privy to the Actuarial Data that was used to compute the “Greedy 39% Increase” (actually a 24% average rate increase) I can say with authority that any insurance carrier subject to the same circumstances Anthem was faced with in their California Individual Market (100,000 people leaving an insurance pool but only taking 5% of the claims with them, in other words, the sickest, most expensive people stayed) would have either had to raise rates in a similar fashion, or face biting questions from their state insurance commission about why they were going to let a pool that covered 700,000 people lapse into insolvency, which is what may happen now.

8.  Insurance Companies must adhere to the Federally Qualified Health Benefit Plan standard. Many people do not realize that the actual definition of what constitutes a valid Health Insurance Plan is, for most Groups that do not Self-Insure, controlled by the states.  That means we actually have in the U.S. about 52 different definitions of health insurance (including Puerto Rico and D.C.).  The PPACA strives to create a single, overriding standard definition of what constitutes a Health Insurance Plan (called the FQHBP Standard) and apply that to all Insurance Carriers going forward.  The FQHBP standard is a comprehensive standard that shall be defined by the U.S. Department of Health and Human Services sometime in the next 180 days, but we do know a few things about it.

a.  It is based on the insurance offered to Federal Employees (FEBHP) with some enhancements
b.  It is a rich standard with no lifetime or annual limits on coverage.
c.  It will require first-dollar coverage with no co-pays or deductibles of over 30 different tests designed to screen for a variety of conditions.
d.  It will require either 20 or 25 percent of all Americans (depending on which Actuarial Society you believe) to buy more expansive coverage than they have today.

9.  Insurance Companies must pay all healthcare providers who treat their customers in the emergency room enough money to hold the patient harmless, regardless of the network status of that healthcare provider.  In other words, insurance carriers must pay anyone who provides healthcare in an emergency situation (as defined by a reasonable person) the total amount they bill the patient, no matter how high it is, no matter whether that provider (doc, hospital, or lab) has an agreement or contract with the carrier.  If you have ever seen doctor, lab, or x-ray “billed charges” compared to insurance company “network rates” you know that this order is going to drive up costs very quickly and enrich a lot of healthcare providers in the process.

10.  Insurance Companies must sell through government controlled Exchange Marketplaces. One of the ways Health Insurance Carriers save an enormous amount of money and keep premiums down is that they sell health insurance through vast networks of private Individual and Group brokers.  The commissions these brokers earn pale before the expense of duplicating this sales and support machinery internally, which is why the system is so popular nationwide.  Carriers would have to add tens of thousands of highly-compensated employees nationwide with benefit packages and expenses that far outstrip the investment in broker commissions.  The Exchanges, however, make no allowances in their current form for the engagement of these skilled, regulated, highly trained entrepreneurs who bring so much value and expertise to the purchase of health insurance for everyone from Individual Seniors to Exxon-Mobil.  The onus for the brokerage function in the Exchanges will fall squarely back on the Insurance Carriers, meaning we will have to add many employees and RAISE our costs at the exact time that our profitability and risk management is being reduced and federally controlled.

Now, if a reasonable person, understanding how health insurance works today, can figure out how to squeeze a future for the health insurance business from these new regulatory limits and changes to the fundamental way that carriers do business today, then I will desist and stop writing about all this.

But Mike, what about the 46 million new customers?  The Fed is going to order all the uninsured Americans to buy health insurance from the Private Insurance Companies, right?  So what about all that extra money you are going to take in?

Great question (even if I did ask it myself!).  Let’s examine that in some detail.  First, the makeup of the uninsured needs to be analyzed to see what kind of customers they will make.

According to the U.S. Census Bureau Conference Call update on the Uninsured (September 2009), as of December 2008 there were 46.3 million people living in the United States of America who did not carry health insurance.  Presumably, these people are the new “customers” that the insurance companies will gain through the reform process.  Unfortunately, a close examination of both the Census Data and the Individual Mandate as proposed in the PPACA will quickly reveal that this is not the case.

Census says that of the 46.3 million people in their survey:

9.4 million are illegal immigrants.
12.3 million are ALREADY ELIGIBLE FOR MEDICAID but have not signed up.
11.4 million have the money and health status to purchase insurance at a whim.
13.2 million make too much money for Medicaid, but are too poor or too sick to buy their own coverage.

So, where are the new customers in this pool?  The 9.4 million illegal immigrants have been forcefully removed from this conversation by the PPACA, which states on almost the first page that they have no part, no regulation, and no benefit from the bill.  This population is clearly out for insurance companies to sell to.

The 12.3 million folks already eligible for government insurance through the Medicaid program are not likely to purchase private insurance coverage for several reasons.  First, the pool is predominately children under 18.  Second, they are all very low income or completely disabled.  Third, they are already refusing coverage either through ignorance of the program or lack of need of medical care, the idea that they would spend out of pocket to buy insurance because of a mandate seems even less likely.  Fourth, the Individual Mandate specifically exempts those who don’t make enough money to file a tax return, into which class these folks specifically fall.  I think it reasonable to assume they are out as well.

The PPACA and its assumptions as assembled by the Congressional Budget Office place a large stock in the belief that the 11.4 million Americans who have the money to purchase health insurance and are ostensibly healthy (else they would buy coverage) will be forced to become health insurance company customers.  In reality, it is unlikely that a majority of them will purchase coverage for a simple reason: Economically, it makes much more sense for them to forego coverage.  The fines for not purchasing health insurance are either $750 per year (up to 3x in a family setting) or 2.5% of modified adjusted gross income.  Thus the upper income person who has never purchased health insurance coverage will be faced with the prospect of obeying a federal law (and paying in the neighborhood of $5500 a year for basic FQHBP coverage in 2014) or paying a fine that does not approach this level of spend until his MAGI reaches the $200,000 mark.  Frankly, the American Society of Actuaries, based on their experience with the Massachusetts mandated coverage (now in its fourth year) expects about 2.5 million of the 11.4m to get into the pool.  The Congressional Budget Office was directed by the PPACA authors to set that number closer to 9 million.  Only time will tell if these assumptions will bear out.  There is another consideration, however.

Because the insurance companies may no longer control pool membership or premiums paid based on health status, or pre-existing conditions, and because all health insurance sold going forward must be on a “guaranteed issue” basis, folks can choose to pay the fines ($750 a year or 2.5% of MAGI) instead of purchasing coverage (at about $5,500 annually) because THEY CAN BUY COVERAGE AFTER THEY GET SICK. The Blues Plans in Massachusetts are already observing this phenomenon in droves.  Because of the well-meaning insurance regulations that allow everyone in the pool and a very weak individual mandate to buy (albeit stronger than the Federal one being proposed), literally thousands of people purchase health insurance after their doctor diagnoses them with a condition, and then if it is corrected via medication or surgery, they immediately drop that coverage again.  In 2009, this behavior drove so much premium dollars out of the insured pools, that the AVERAGE rate increase for small employer groups across all health insurance companies doing business in Massachusetts in 2009 was 21%, and the projections for 2010 are more like 25%.  People are catching on, and it is strongly in their economic self-interest to delay buying coverage until they absolutely need it.

Imagine how much insurance will cost if this behavior is spread to the rest of the U.S.?  There is a very good chance that it will be.  But let’s get back to the topic at hand.

Let’s assume for a minute that all 11.4 million folks who can afford coverage go ahead and buy it and their average price the aforementioned $5,500 per year per person.  That would indicate a total new income to the health insurance industry of $62B.  Now, under the new federally-mandated medical loss ratio rules (think profits as mentioned in item #6 above), the maximum amount of overhead the carriers may charge on this $62B is 20%, or $12.4B, meaning $50B of it would have to be spent on care, or rebated back to the insured customers.  This means insurance companies can have, at maximum, $12.4B to cover overhead and distribute to the bottom line of all the carriers involved.  But the Fed requires the payment in 2014 of $8B from the industry immediately, so now the “take” is $4.4B.  By 2017 the licensing fee is $14.3B and it is indexed to inflation going forward.

Still not bad, you say?  Except almost all that coverage had to be sold through the Healthcare Exchange, where the carriers will have to pay for all the typical brokerage functions at a much higher rate by internalizing all those processes and all the customer service the brokers now provide at their own expense.  This represents a huge shift of work away from private contractors and into carriers.  If it was cheaper for carriers to do it themselves, we can assume market forces would have driven the brokers out long ago.  Instead, just the opposite has happened and their range of products and services to customers has GROWN freeing insurance companies from having to acquire and maintain all these new capabilities, typically at great savings to the carrier.

Well, what if CBO is correct and $9M of them get into the pool?  Now the payment is $49.5B and the amount available for overhead $9.9B.  Very close to the $8B payment required in 2014, and actually well below the 2015 and beyond payments ($11.3B in 2015, $14.3B in 2017).

What if the American Society of Actuaries is correct?  They are, after all, the only body in American with real-world experience of mandates and penalties and their affect on the insured marketplace.  If only 2.5 million of these “monied opting outs” gets into the pool, that will generate premiums of $13.75B, leaving only $2.75B available for overhead in a year when the industry will have to pay the Fed, just for the privilege of existing, $8B.  Remember, the PPACA financing DEPENDS on a health insurance industry contribution of $14.3B in 2017.  The only place this money could possibly come from is from raising premiums on every American with private health insurance coverage.  This “stealth tax” seems to be specifically designed to allow President Obama to continue to declare that he has not broken his promise of no tax increases on those making less than $200k per year, even though the vast majority of Americans who will suffer from these “licensing fees” will be Americans who make less money than that.

I don’t want to forget the other section of the uninsured, that group of “in-betweeners” numbering somewhere north of 13 million people who make too much money to qualify for Medicaid in their states, but not enough money to purchase their own coverage.  The PPACA will simply expand eligibility for Medicaid to any person whose household income is less than 133% of the Federal Poverty Level.  It will also severely limit “means testing” as a way to keep folks with substantial holdings out of the Medicaid Pool.  This expansion means the average family of 4 making $30k per year will get free health insurance, and this will cover almost everyone in the “in-betweener” pool, men, women, and children with federal government sponsored free health insurance.  Again, it will not be necessary for them to purchase private coverage.

I do not think a reasonable person could digest all the realities that I’ve espoused above and come out with some sort of favorable outlook for the health insurance industry.  Industry profits, which average in the 1.5-4% range over the last 10 years, are not likely to grow, neither are for-profit company stocks liable to attract any vast new sources of investment.  The PPACA is specifically designed to lessen control, lessen influence, and lessen solvency of all health carriers in the U.S. by those with the power and wherewithal to do so.  The question we must ask now is, Why?

I leave that to you, gentle reader, to ruminate upon in your own time.

Michael Bertaut,
Senior Healthcare Intelligence Analyst
Blue Cross and Blue Shield of Louisiana
Sunday, March 28, 2010
9:54 AM CDT

So there you have it.  The Government has taken an EXTREMELY flawed system, doubled down on all the things that make it flawed, and then taken it over.

By the way…are any of you Tricare?

Gone.  Vamoose.  Congratulations; you’re on Medicare.  Thank you for your service.

How Long Can Your Human Asset Keep Paying Dividends?
When Time magazine’s cover declares “Jobs are the new assets,” you know there’s been a re-awakening to the value of human capital. A brief overview of why human capital is so important in individual financial programs, and what you can do to enhance and protect what is arguably your most important asset.

The Logic of a Longevity Annuity
Who would buy a financial product that won’t pay penny for 25 years and if the account holders don’t live that long, they lose their entire investment? Sounds like a very bad investment. But it’s also a very interesting insurance idea that allows individuals to spend down their wealth in retirement – and not go broke. (Oh, and there might even be a better way to accomplish the same thing.)

Non-Cancelable and Guaranteed Renewable: Contract Language You Need
When you consider disability insurance, several clauses in the contract determine who really has control over the long-term value of the coverage. Find out why “non-can” can make all the difference.

FINANCIAL LITERACY QUESTION:How much is a TRILLION?
(You’ve got to see it to believe it!)

Complete PDF HERE.

A look at how psychological biases sometimes get in the way of preparing for change, and how changes 30 years in the making may shape your financial future. (Comes complete with recommended principles of action!)

The IRA: A Case Study in Present-Event Bias

An example of what happens when economic changes cause a rethinking of government regulations.

Long-Term Care Insurance Continues to Change – 

Is Now the Time to Buy?

As long-term care insurance goes through several changes, what should consumers do about meeting this financial challenge? Some news and views for right now.

FINANCIAL LITERACY QUESTION: How many Americans get to retire on their own terms?2009-mar1

On the front page of its Business section, the Washington Post (1/25, F1, Haynes) reported, “A growing number of workers in 2009 will pay more for health benefits — and in some cases receive less coverage — as their employers grapple with the financial fallout of rising medical expenses and diminished revenue and profits, recent surveys of human resource officials show.” According to the Corporate Executive Board, “30 percent of the employers” surveyed “said they expected to raise deductibles an average of 14 percent in 2009,” while “Mercer, a global benefits consulting firm,” discovered that of the “nearly 2,000 large corporations” surveyed, “44 percent planned to increase employee-paid portion of premiums in 2009.” Additionally, in order to “cut costs, employers increasingly are introducing high-deductible health savings accounts (HSA) and focusing on wellness programs,” the Post noted. The article went on to discuss specific examples of employers that are increasing employee premiums or adding the option of HSAs in 2009.

As your friendly neighborhood Health Insurance Professional, I’ll offer my sage advice on this: Raise the deductible first. It makes a lot more sense to shift RISK to the employee (within reason) than it does to shift PREMIUM to the employee, and if the employees are properly educated on their options, then they will prefer to MAYBE spend an extra few hundred or couple of thousand dollars a year, then to DEFINITELY have that much or more additionally taken out of their paycheck.

The Post article, as is common with press regarding the Private Health Care System in the U.S., displays an utterly unrealistic view of that system (I know…really shocking). This, for instance:

Carter, a technical editor for a District consulting firm and mother of twin boys and a girl, is facing steep increases in out-of-pocket expenses for health coverage this year. What she shells out for premiums and co-pays more than offsets any fuel savings. Her employer picks up 50 percent of the coverage for her family, up from 33 percent a few years ago. But because insurance costs have soared, she says she’s actually paying $200 a month more in premiums.

Her co-pays also have risen to $30 from $20. That extra $10 adds up, Carter of Bowie says, with “accident prone” teenagers in and out of the emergency room: Her 19-year-old track star son suffered a lacerated liver, broken rib and concussion when he slipped and fell on wet pavement. Her 16-year-old cheerleader daughter who is asthmatic is in physical therapy three days a week for a dislocated knee. Carter and her other son contribute to the costs with visits to the doctor for serious flare-ups of asthma.

So the companies are paying a higher percentage of the premiums than they were (very rare) but its a “sucker-punch” to expect policy-holders to pay an extra $10/doctor visit.  The truth is, the company is likely not raising copays ENOUGH, which is one of the reasons why costs keep going up.  If Ms. Carter actually had an in-network DEDUCTIBLE (which from this it doesn’t look like she does) the company AND her would fork out a LOT less money monthly for her coverage.

Here Locally in Loudoun County, the School Board has the option (and it looks like it’ll happen) to increase copays on prescriptions from a 5/20/40 to a 5/25/45 tiered system.  How much is that going to save Loudoun Taxpayers (to say nothing about how much it’ll save out of School employees’ checks every month)?  Over $1,000,000.

An extra $5 per prescription MAYBE saves roughly $10/employee/month DEFINITELY.

If your employees (or your employer) are NOT educated on these phenomena, then feel free to shoot me a note at wdporter@gcfin.com, and I’ll be happy to help.

_______
Butch Porter
Goose Creek Financial
Loudoun Health Insurance Professional

And since I’m not qualified to make recommendations on health or mental health, please take this post as an informational piece and not a position piece.  That being said, I’m hoping my medical professional colleagues have some opinions on the issue, so here goes.

This article comes via a friend of mine who is a post-doc in NeuroScience at Baylor University.  The abstract of the article is as follows:

What is attention-deficit hyperactivity disorder (ADHD)? Why are so many children being diagnosed with ADHD and prescribed medication? Are stimulant drugs an effective and safe treatment strategy? This article explores the current state of scientific research into ADHD and the key social and ethical concerns that are emerging from the sharp rise in the number of diagnoses and the use of stimulant drug treatments in children. collaborations among scientists, social scientists and ethicists are likely to be the most promising route to understanding what ADHD is and what stimulant drugs do.

The article goes on to explore such issues as: the validity of diagnoses, alternative treatments, ethics of medicating children, etc.  A couple of excerpts I found interesting:

Diagnoses of psychiatric disorders are controversialbecause they are based on clinical assessment of behavioural symptoms: there are no laboratory tests to determine no unequivocally whether a subject has the disorder. In the case of ADHD, this problem is exacerbated by the fact that ADHD symptoms are difficult to distinguish from normal childhood behaviours. As long as there is no clear and indisputable scientific rationale for the growing rates of ADHD diagnosis and treatment in children4, the validity of ADHD diagnosis will continue to come under social and ethical scrutiny.

and:

In the future, better diagnoses and more comprehensive understanding of ADHD aetiology are likely to have a positive impact on treatments for ADHD. At this time, however, the state of scientific understanding is not sufficient to overcome the problem of over-diagnosis of ADHD and overuse of stimulant drug treatments. In this context, it is necessary to evaluate the ethics of medicating children for ADHD.

Safety is a paramount ethical issue in psychotropic drug treatments for children with ADHD. children are not small adults; nevertheless, most of the psychotropic drugs that are prescribed to children have only been tested on adults. Although stimulants have been used to treat childhood behavioural problems since the 1930s, there have been few systematic longitudinal scientific studies of the long-term effects of stimulant drug use in children. Moreover, an increasing number of children are taking not just a single psychotropic drug, but a combination of these drugs. The fact that there are no safety data available for drug cocktails does not dissuade parents and clinicians from using these drugs off-label in children, in increasing quantities and in ever younger populations of children. The FDA has attempted to resolve this problem by providing 6-month patent extensions to drug companies that conduct follow-up studies in children. However, the pharmaceutical industry selectively reveals psychotropic drug trial results and has concealed unfavourable safety data. These are compelling reasons why careful, systematic follow-up of children taking psychotropic drugs is essential.

The main reason I post this is, of course, that a fairly sizable number of my clients and/or their children are taking or have taken medications for ADHD and it’s important that we all have as much information as conceivable.  Plus, since I have a kid of my own, I’m always thinking of what it’s going to be like a few years down the road when I get that note from the principal:  “Your kid is fricking crazy, put him in an institution for Pete’s sake!”

_________

Butch Porter
Goose Creek Financial
Loudoun County’s best source for Health Insurance Expertise
703-651-3705

It is easy to understand why, this time of year, many are struck with a case of the winter blues. We leave for work before the sun comes up and head home in the dark barely glimpsing daylight. As the days get shorter and colder many find themselves dealing with sadness, increased appetite and excessive sleeping. What they may be experiencing is more than a case of the winter blues, but rather seasonal affected disorder, or SAD. Many of my clients suffer from this disorder and often they just expect it is a part of the season that will pass, but there are treatments that can alleviate or lessen the symptoms.

SAD is a mood disorder associated with depression and related to seasonal variations of light. SAD has been linked to melatonin, a sleep-related hormone secreted by the brain’s pineal gland. This hormone, which can cause symptoms of depression, is produced at increased levels in the dark. So, as the days become shorter, these effects are felt by an estimated 6% of Americans. Eighty percent of those who suffer from SAD are estimated to be women, though the reasons for increased depression in women are not yet understood.

According to the National Institute for Mental Health, SAD symptoms include: Regularly occurring symptoms of depression (e.g., excessive eating and sleeping and weight gain) during the fall or winter months; full remission from depression occur in the spring and summer months as well as a craving for sugary and/or starchy foods. Just as sunlight affects the seasonal activities of animals, such as reproductive cycles and hibernation, SAD may be an effect of seasonal light variations in humans. As seasons change, there is a shift in our “internal clocks” or circadian rhythm, due partly to these changes in sunlight patterns. This can cause our biological clocks to be out of “step” with our daily schedules. The most difficult months for SAD sufferers are January and February.

Phototherapy or bright light therapy has been shown to suppress the brain’s secretion of melatonin. Although, there have been no research findings to definitively link this therapy with an antidepressant effect, many people respond to the treatment. The device most often used today is a bank of white fluorescent lights on a metal reflector and a shield with a plastic screen. For mild symptoms, spending time outdoors or arranging homes and workplaces during the day to receive more sunlight may be helpful. One study found that an hour’s walk in winter sunlight was as effective as two and a half hours under bright light. If phototherapy doesn’t work, an antidepressant medication may prove effective in reducing or eliminating SAD symptoms, but there may be unwanted side effects to consider with medication.

If you or someone you know struggles with depression this time of year, you should contact your physician or a mental health professional to accurately determine A diagnosis and treatment. Keeping an accurate log of your mood, energy, eating and sleeping habits over time will be helpful for determining whether any changes are in fact seasonal. Although you may be tempted to boost your exposure to light around the home, consultation with a medical professional will be important because the intensity, frequency, and duration of light treatments may vary from individual to individual. Additionally, a professional may recommend other forms of treatment in addition to light therapy.

Remember that small things like a walk on a sunny winter day can be a boost both physical and mentally. And spring is only a few months away!

Data indicate cost disparities among women, men for individual insurance policies.

The New York Times (10/30, A23, Pear) reports, “Striking new evidence has emerged of a widespread gap in the cost of health insurance, as women pay much more than men of the same age for individual insurance policies providing identical coverage, according to new data from insurance companies and online brokers.” Price quotes and rate tables indicate that “the disparities are evident in premiums charged by major insurers like Humana, UnitedHealth, Aetna, and Anthem.” And, although “in job-based coverage, civil rights laws prohibit sex discrimination,” the “individual insurance market is notoriously unstable.” While “some insurance executives expressed surprise at the size and prevalence of the disparities,” others, such as women’s advocacy groups, “have raised concerns about the differences, and members of Congress have begun to question the justification for them.” Still, citing more use of healthcare services among women, “especially in the childbearing years,” insurance companies “say they have a sound reason for charging different premiums.”

This, like a myriad of things that comes out of the New York Times, is INSANE.  What’s missing is three simple facts:

1) Women use the doctor more…period.  To not take that into account from an actuarial standpoint would be completely and utterly insane.  It’s not a civil rights issue that women use the doctor more.

2) Maternity is typically automatic with Group Health Insurance, it’s rarely an option.  The last I checked, men are not getting pregnant…at least as far as I know.

3)  Women pay less for Life, Long Term Disability, Long-Term Care insurance, Car Insurance…and Men special interest groups, the last time I checked, weren’t lobbying Congress to equalize that playing field.

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Butch Porter
Goose Creek Financial
Loudoun County’s best source for Health Insurance Expertise
703-651-3705

Researchers estimate that there are between 8-25 attempted suicides for each teen suicide death and that four out of five teens who attempt suicide have given clear warnings.  There are many behavioral indicators that can help parents or friends recognize the threat of suicide in a loved one. Since mental and substance-related disorders so frequently accompany suicidal behavior, many of the cues to be looked for are symptoms associated with such disorders as depression, bipolar disorder anxiety disorders, alcohol and drug use, disruptive behavior disorders, borderline personality disorder, and schizophrenia.

Some common symptoms of these disorders include:

• Extreme personality changes
• Loss of interest in activities that used to be enjoyable
• Significant loss or gain in appetite
• Difficulty falling asleep or wanting to sleep all day
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Withdrawal from family and friends
• Neglect of personal appearance or hygiene
• Sadness, irritability, or indifference
• Extreme anxiety or panic
• Self-destructive behavior (drinking alcohol, taking drugs, or cutting, for example)
• Poor school performance
• Difficulty concentrating

Tragically, many of these signs go unrecognized and while suffering from one of these symptoms certainly does not necessarily mean that one is suicidal, it’s always best to communicate openly with a loved one who has one or more of these behaviors, especially if they are unusual for that person.

There are also some more obvious signs of the potential for committing suicide. Putting one’s affairs in order, such as giving or throwing away favorite belongings, is a strong clue. And it can’t be stressed more strongly that any talk of death or suicide should be taken seriously and paid close attention to. It is a sad fact that while many of those who commit suicide talked about it beforehand, only 33 percent to 50 percent were identified by their doctors as having a mental illness at the time of their death and only 15 percent of suicide victims were in treatment at the time of their death, according to the National Institute for Mental Health.  Approximately one-third of teens who die by suicide have made a previous suicide attempt, so a history of suicide attempts is a cause for careful monitoring of behavior.

If you or is someone you know exhibits any of the warning signs of suicide, get help right away.  Talk to someone you trust as soon as you can, such as a parent, teacher, school counselor, or therapist.  If you are uncomfortable talking about your feelings with someone you know, call a suicide crisis line (such as 1-800-SUICIDE or 1-800-999-9999) or 911.  These toll-free lines are staffed 24 hours a day, 7 days a week by trained professionals who offer confidential support to help you work through tough situations.  Counselors and therapists can also provide emotional support and can help teens build their own coping skills for dealing with problems.  Ashburn Psychological Services has a highly trained team of psychiatrists and psychologists to assist you should you be concerned about your teen’s social, emotional or behavioral functioning.