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  1. //write Dr. Novack’s commercials//
    Well I’m looking for a job…
    *checks soul to see if it’s for sale yet…*

  2. gadfly, you should write Dr. Novack’s commercials attracting Northern clients in the future for the PHCS PPO Network, which is Nationwide.
    How about: “If you need a break from the snow and are having knee surgery soon, and locally, your PHCS PPO Network surgeon is charging $5,000, many times I can do knee surgery for THREE. You can fly in, stay at the Hilton, take limos, sun bathe, drink frothy cocktails, and paint, and still save over $500 left over, for free.”
    Plus, medical travel expenses are a Qualified Medical Expense (QME) with your tax free HSA, it’s sweet. Power to the consumer.
    As I see it Matthew can either support HSAs or try and argue against them. Flip or fly. I know it’s a lot easier to support HSAs than try to argue against them, that’s darn hard, ask Senator John Kerry (MA-D).
    Besides it will not be long until there are more tax free HSAs in America than union workers. There are only 10 million of them. We will have that many HSAs before the 2008 election, mark my words.
    Pundents, consultants and politicians should support the Tax Free HSA and it’s important contribution to the Ownership Society or be on the wrong side of history. It’s a statement of fact and it won’t take long.
    Our new advertising campaign that starts after Labor Day will express this concept in Detroit on WJR, the boomer, during Rush, everyday. We do have a lull during Thanksgiving but not through Romadon, we are hard at it. I think day, after day, after day, with the message, is the only way to go.
    Got the Blues, feeling Bad, paying too much for health insurance?
    Lesson One: Join the Ownership Society; reform has begun, at Save101.com
    As always, medical underwriting is required.
    President Bush said, “Become empowered with a tax free HSA.” Governor Jeb Bush said, “Citizens will be wise with their tax free HSA balances.” I say, “Tax Free HSAs are the doorway to the 21st Century finacial services sector.”
    Come on Matthew stop that stin’ thinkin’ and start thinkin’ proper. It’s a whole lot easier, trust me. Let’s work on getting a podcast where you are interviewing CEO Jim Keys of 7-Eleven and he is discribing 7-Eleven’s HSA program that was started the first month in January 1997. Like Jim Keys says, “You are either moving forward or you rust.”
    Don’t be on the wrong side of history, that could hurt.

  3. //no free lunch in Bali for Gadfly//
    Dang, I was planning to sun bathe, drink frothy cocktails, and Paint. 🙁

  4. Kids — we pay the taxes and take the deductions that the government actually gives us, and not the ones that we think they ought to charge or give us. Otherwise, according to RDG I support Bush’s adventure in the desert because I’m paying for it.
    Sadly, there’s no free lunch in Bali for Gadfly….even if the selfish elite will be there.

  5. Matthew,
    You did nothing to clear up the confusion. It seems to me that by your participation in HSAs that you do in fact support them, despite your rhetoric to the contrary.
    If the IRS audits you, you are on your own.

  6. //This is brilliant! You just saved me a fortune.//
    Since you will be swimming in tax-free windfall under the new RDG dispensation, Matt, will you take me on a nice escape to Bali before the pinkertons come and get you?

  7. Matthew,
    If you don’t claim your HSA deposit and take your deduction by April 15th of the following year, you will lose your deduction forever, exactly like an IRA. So you have some time to weigh your alternatives and if you even want to use your tax dodge HSA, that you would prefer no one else have the pleasure of duplicating and saving on their burdensome taxes that they work until May to pay for instead of buying food for their hungry children, darn Democrats.
    rdg wants to know why you yourself use a tax free HSA to save on your income taxes yet you don’t want anybody else to have what you already have. It just sounds kinda selfish and elitist.
    But that’s what I love about you Matthew.

  8. RDG
    Sorry for the confusion but I love your idea. From now on instead of obeying the law and paying taxes/taking deductions as the law suggests, I’m going to not take theones I dissaprove of (like HSAs) but not pay the taxes for things I also don’t support.
    Invading Iraq? Not for me, so I’ll not pay a chunk for that wasted 150bn. The Drug War. I dont approve, so none for that wasted $70bn. Interest on the debt–all run up by bonehead Republicans, so I’m not paying for that. Medicare and Medicaid are both too expensive, so I’ll only pay for half of those.
    This is brilliant! You just saved me a fortune. err…will you come to my IRS hearing?

  9. Matthew you wrote, “And if there are 10 million Medicare recipients with Federally funded HSAs there will be no more Medicare. You still have never answered me about the basic mathematical problem behind that. Do you care to do it now?”
    Matthew, that is the 2008 election. This is the last Presidential election before the Baby Boomers start swelling the Medicare rolls. You probably already understand that Medicare Savings Accounts (MSA) were passed in the Balanced Budget Aggreement in 1997 but restricted Medicare’s MSAs to 390,000 seniors. Then in the historic Medicare Rx bill of 2003, when HSAs were passed for all Americans, the cap of 390,000 seniors was removed. So it’s already the law of the land. Granted, not one senior has got the first dollar deposited by the Feds yet, but it’s coming.
    The magic word here is “Defined Contribution.” If the Medicare program is paying $1,000 a month here in Tampa for seniors to the Medicare HMO, this money is redirected to the seniors’ MSA, tax free, at the senior’s option. The seniors can pick and choose, in the free and open market, which insurance company they desire with a higher deductible that costs less than the zero deductible of the HMO. I have a 64 year old female client with HSA insurance that pays 100% including Rx and her cost is under $200 a month. But let’s just say Medicare Qualifying MSA insurance would cost $700 a month for this example of math. This would mean the extra $300 a month, or $3,600 a year, would remain in the MSA which may be spent or saved with tax free interest. I submit that $3,600 a year, growing tax free, could become a large financial estate in 20 year when the Medicare senior is 85 years old, all Federally funded.
    Of course the CEO’s of the HMO’s hate the MSA option because they say, “It’s like paying a senior $300 a month, tax free, not to join an HMO, that’s not fair.” But really, who cares what HMO execs say. These guys are about as popular as NAZIs.
    My question is, how many tax free HSAs in the underage market do we need before you will quit saying the HSA is minor player?

  10. Mathew,
    You have said previously that high deductible plans are bad public policy. Yet you yourself have one. Is this a contradiction? I think it is. Why is what is good for you not what is good for everybody? Shouldn’t policy be based on the understanding that people will act in their own best interests?

  11. Matthew,
    I think you got me confused with Ron. I agree that HSA plans don’t do anything to get quicker payment to the service provider. (sorry for the double post earlier, there seemed to have been some kind of hiccup when I tried to post)
    But in one sense why should health care be different from other services? It finally dawned on me how absurd the current situation was when I got a dental bill one day. I had dental insurance at the time. My wife went in for a root canal. The bill was 900 dollars. I waited to see how much the insurance would pay. Meanwhile my wife had an 800 dollar cap put on her tooth that just had the root canal. Time passes and I get an EOB explaining that we’ve reached the plan max of 1000 this year because of earlier fillings. Now over 30 days have gone by and I owe the dentist 1700. Why shouldn’t he expect prompt payment instead of me delaying paying the bill? He basically floated me a 0 interest loan while I take my time paying the bill.

  12. Ron
    I agree that the third party payment system is very strange, but there is nothing in the HSA that means that high-deductible plans will be any different to how they operate now. I have one. I paid my providers AFTER i got the EOBs from the insurer and AFTER I had got the insurer to get them corrected and I paid EXACTLY the discounted rate that the insurer would have paid had I not had a high-deductible plan. How exactly did that improve life for the physician. It didn’t — in fact it made it worse because then they have to chase down individuals rather than insurance companies.
    Unless health plans are going to sell high-deductible plans without access to their networks or discounts, please tell me why this is different for physicians.
    And the doctors who’ve been talking to me about this are all the ones who’ve mentioned it in focus groups, at talks and meetings, not to mention the AMA since I heard about it in 1993. They all wanted this to get away from the insurance companies, and they are not going to get what they want.
    And if there are 10 million Medicare recipients with Federally funded HSAs there will be no more Medicare. You still have never answered me about the basic mathematical problem behind that. Do you care to do it now?

  13. Isn’t it disturbing that doctors cannot expect payment at the time of service? I’m talking about an office visit with some lab tests. What prevents the doctor from getting paid immediately? Oh wait. I know. Its the third party payor system. And its the fact that people get charged different prices for the same service depending on their insurance status. The current situation is very strange indeed.

  14. Gadfly,
    Yes. HSA funds can be put in a brokerage account.
    I think this question comes from the fact that there are two components to the HSA concept. The first is that people must be covered under a qualifying high deductible major medical insurance policy. The law describes what is necessary for a policy to qualify.
    Once a person has a policy in force, they can put money in an HSA account. The account is separate from the insurance and does not have to be administered by the insurance company. The account trustee can be pretty much any financial institution that could be an IRA trustee. Banks with MSA experience were the first in the market to offer the accounts. But other providers are available.
    I don’t think anyone will go crazy trying to game their liability as the deduction is pretty straightforward. If you contribute X dollars to an HSA you deduct X dollars from your AGI even if you don’t itemize your deductions. The upper limit of X is specified in the law.

  15. Matthew,
    You wrote, “The reason that doctors were so keen on this was that they thought that they could put up a price list and get paid right then and there full freight by the patients. That’s delusional”
    That could happen, it’s not delusional. Of course the doc would have to be organized enough to know how much their cost would be at the time of the service. Tax free HSA people will pay the dentist right on the spot for services with their tax free HSA VISA card. Same with Rx down at Wal-Mart. It’s not like anybody said docs are the only ones who can’t be paid on the spot with HSA funds. I have tons of docs as HSA clients and that has never came up even one time, trust me.
    Who told you that doctors only think of the HSA as a way to get payment on the spot, was it Eric?
    Do we have to wait till there are 10 million people on Medicare with Federally funded HSAs before you can see this is the wave of the future? Or would just 10 million in the underage population going tax free with an HSA work? Because if it’s the latter, I can almost tell you the month, this isn’t rocket science you know.

  16. Ron my friend. This was for the doctors not the consumers. There’s basically no difference from the physician end between an HSA and a non-HSA hihg deductible PPO. The reason that doctors were so keen on this was that they thought that they could put up a price list and get paid right then and there full freight by the patients. That’s delusional
    And HSAs are a) minor…less than 1 million out of 300 million, and b) a very minor part of the consumerization movement in health care

  17. Out of curiosity, can people put their HSA money into brokerage instead of an interest-bearing bank account? I ask because IRAs can go into brokerage, and that’s served to tie more people’s fortunes to the stockmarket.
    Also from my experience with IRAs: once a new financial product is out on the market, “expert” financial advisors will figure out how to play the system and give their clients that advice. What the financial advisors have to say eventually trickle down to articles that normal people read, and next thing you know there are infomercials telling people how to get Free Money. People went crazy throwing their money back and forth between IRAs trying to game their tax liability. I’m wondering if there’s a potential for something like that to happen with HSA once it’s conceived as a financial product.

  18. In Reality Matthew,
    I tell new HSA people, that have gone tax free, not to even mention the fact they have an HSA at the doctor’s office, it would just confuse them. Just hand them your insurance card and they know what to do. They will make a photo copy of the card and put it in your file. Everything is exactly the same for them. It makes no diffence if you have an HSA or not. That’s all they need to know. Anything else will just confuse them. If you are paying with a beautiful green tax free HSA VISA, don’t even tell them it’s a HSA VISA. It’s a waiste of time. Imagine trying to explain the best American tax dodge of all time to some clerk in a doctor’s office, why would ya?
    You know Matthew, these PPO dicounted rates for providers are being posted to online HSAs, like ours. Soon we will have HSA account holders telling the doctor’s office how much they charge for their procedures. Now that’s what I call informed consumers.
    Next time you could say, “Tax free HSAs are the first account with tax free deposits, growth and withdrawals. Plus, tax free HSAs reduce premiums, save taxes, help people build wealth and basically empower the consumers.”

  19. Maybe he meant that HSAs have little backing among people who both know what they’re talking about and aren’t out to screw people.

  20. Matthew,
    The guy said, “What are you trying to say, is it going to be like air travel and online pricing?” I will tell you Matthew in 8 years of MSA and HSA enrollments, nobody has ever said that to me. You explain HSAs differently than I do, that’s for sure.
    When you explain HSAs the guy said, “So doctors will have to chase down patients to get paid.”
    I was waiting for ONE good quote on HSAs and I didn’t hear it. Not even ONE concept. The guy ended with, “You sure know alot about Consumer Driven Healthcare.” Maybe I’m wrong and people will say that they learned alot from this podcast, but I doubt it.
    Our Outline of Coverage used to say that we are the 43 largest company in the world. What did you mean when you said, “HSAs have little backing?” Maybe you were talking about the President of the United States.
    I’m sure you will do better next time Matthew.
    If anybody learned something and wants to correct me; I’m all ears.

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