Health Archives - GUJRAT INDIA

The Effects Of Tobacco On Women And Smoking Health Issues

While we consider female lack of desire and women’s health news on carcinogens in cigarettes position a risk to everyone, our world’s women are over twice as likely as males to get aggressive kinds of lung cancer and more likely to establish it at an earlier age.

– And women, it turns out, have an even harder time stopping than guys.

– Stopping cigarette smoking is much easier said than done.

– Females are likewise more likely to die of lung cancer than breast cancer.

– Stronger withdrawal signs may be credited to hormonal agents or the larger nicotine dosage absorbed by smaller female bodies.

No matter female’s age, the dangers of cigarette smoking add to female lack of desire and women’s health news everywhere today tells us infertility, osteoporosis, blindness, and stress and anxiety, surely may result.

The expecting mothers who smoke threat not just their health, but their children’.

Passing smoke impacts the children and other individuals around moms who smoke.

Smoking cigarettes and smoking health issues is a vice that almost always starts during adolescence.

They probably never will when teens finish from high school without ever smoking routinely.

Smoking problems while kids turn into women’s smoking problems and the latter get the worse health problems.

Youths may exhibit symptoms of addiction within a couple of weeks or days right after they began smoking cigarettes.

While cigarette smoking was unusual in women through the history books, but during the late 1800’s, and in to the 1910’s, the tobacco industry recognized the potential of women as a gold mine for the expansion of the cigarette market.

In truth, tobacco business released the campaign slogan, “Instead of a sweets like ice cream and candy, grab a smoke,” which quickly encouraged women to smoke so as not to gain weight.

This was followed by, “You’ve come a long, terribly long way, young lady,” as a tribute to the burgeoning women for equal rights parade.

These marketing projects not just portrayed female’s cigarette smokers as stunning, enjoyable and independent, but also sent out subliminal messages that cigarette smoking assists women to manage their weight.

Cigarette ads are banned in kids and teenager’s magazines.

In a previous discussion I explored the many things in the way for women and a life of self-confidence and success.

But still in much of the world billions of dollars are spent on other ways to advertises like alongside the highway, billboards, and adult publications which can quickly be accessed by the youth.

Because since the late 1980’s lung cancer has actually exceeded breast cancer as the leading cause of cancer deaths among females in the United States.

Cigarette smoking causes heart illness, which is the number one killer of the western world’s female population.

Women who smoke likewise damage their beauty they once held, and they do recognize this in the mirror.

Smoking speeds up the aging procedure and produces more facial wrinkles, gum illness, oral decay, raspy voice, and bad breath, and female lack of desire and women’s health news on this is everywhere.

I mean mental health is likewise affected due to anxiety and stress anxiety conditions.

Ladies are more likely to be depressed and be a woman with lack of libido, than non-smokers, which young and older women with anxiety disorders are more likely to smoke.

Some females, nevertheless, are finding innovative methods to break the practice for the rest of their lives.

Participating in activities where smoking cigarettes would not fit, such as exercising, biking, mountain-climbing, as well as turning to a non-smoking lifestyle that consists of going to smoke-free places with your kids.

The dangers of smoking for women has increased attention and awareness for young women’s health and from female entrepreneurs and companies, resulting in a number of jobs that focus on supporting tobacco cessation efforts particularly for our lovely women of the world.

The Course in Miracles states, “The body can not know. And while you limit your awareness to its tiny senses, you will not see the grandeur that surrounds you.”

Regardless of age, the threats of smoking contribute to all kinds of women’s health issues and lead to female lack of desire and women’s health news has shown us of the infertility, anxiety and stress, osteoporosis, and loss of sight.

While cigarette smoking was unusual in ladies during the start of their coming out time for equality ages ago, the tobacco market recognized the potential of ladies as a market for the growth of the cigarette industry.

We have grown as Spirit and our awakening to a better life, and that’s why we have discovered things like, “Smoking cigarettes triggers heart disease,” which is the number one killer of women.

Females are more likely today, and as we move forward in generations, to no longer have as much concern over female lack of desire and women’s health news about other women’s issues holding our fine women of the world back.

( Always be sure to search the net for helpful material on being a confident woman today and moving forward in life.)

To “a long way baby” for success and love for life!

The Lost Costs With Administrative-Related Tasks With Group Health Plans

Health coverage is expensive- both for individuals and for companies that provide it.

The costs affect much of the medical field, including drug prices, cost of coverage,

costs of care and visits, and a myriad of other areas of the health industry. Part of

those costs is resulting from the administrative handling of health insurance logistics,

and those costs affect the rest of the field, too.

According to studies in the field, noted by the CAQH Index, in 2019 they noted that

“SPENDING ON HEALTHCARE ADMINISTRATION COSTS AN ESTIMATED

$350 BILLION ANNUALLY IN THE UNITED STATES DUE TO IT’S

COMPLEXITY.”

Data from the 2019 CAQH Index indicates that $40.6 billion or 12 percent of the

$350 billion spent on administrative complexity, is associated with conducting

administrative transactions tracked by the CAQH Index. Of the $40.6 billion spent on

these transactions, $13.3 billion or 33 percent of existing annual spending on

administrative transactions could be saved by completing the transition from manual

and partially electronic processing to fully electronic processing. The progress that

the industry has already made to automate these administrative transactions has

saved the industry over $102 billion annually.”

Administration is, of course, an important aspect of any industry, especially one as

complex as medical and related fields. The difficulty with modern health insurance

means extensive administrative hours as they tend to a myriad of issues on multiple

fronts. This means, as noted earlier, a great deal of expense that filters throughout

the medical field.

Unfortunately, small business owners tend to bear the brunt of these costs, at least

when it comes to businesses rather than people. As noted here,

“NOT SURPRISINGLY, THE COST OF PROVIDING HEALTH COVERAGE TO

EMPLOYEES LOOMS LARGER THE SMALLER THE BUSINESS,

BUT THIS ISSUE PLAGES BUSINESSES REGARDLESS OF SIZE”

The price tag on health insurance is a significant pain point for small employers. The

problem extends to recruiting and retaining talent, as well. To compete with larger

employers, small employers are hard-pressed to offer benefits like health insurance,

even as the benefit takes up a larger share of the bottom line. Two-thirds of

businesses (69%) said the problem has been getting worse. They reported that costs

have increased over the last four years; one-third of this group reported annual

increases of 10 percent or more. Businesses with fewer employees cited bigger

increases than larger businesses. Employers cited prescription drugs and lack of

choice of health care plans as pain points.

There are ways to curb this expense without impacting the medical field or health

insurance. One method is the increased use of digital materials. According to the

previously cited Index, “Although partially electronic transactions often cost less and

are less time consuming than manual transactions, there are savings opportunities

associated with moving from partially electronic web portals to fully electronic

transactions. For the medical industry, $2.7 billion of the $9.9 billion total savings

opportunity could be achieved by switching from partially electronic transactions to

fully electronic transactions. The greatest per transaction savings opportunity for

medical providers is a prior authorization. Medical providers could save $2.11 per prior authorization transaction by using the federally mandated electronic standard rather than a web portal. Understanding the impact of portal use in more detail is important as the industry focuses on opportunities to decrease administrative costs and burden.”

The medical field is one area where increased use of digital technology has lagged in

comparison to other fields. Concerns over confidentiality and security, combined with

outdated legislation, mean much in the medical field is handled with pen and paper.

That said, the COVID-19 pandemic has resulted in rapid inroads in digitization. Still,

administrative costs remain high, with subsequent effects throughout healthcare.

Along with the use of digital technology, another way to reduce costs is through increased automation. As noted by the previous study, “The 2019 CAQH Index estimates that the medical industry has avoided over $96 billion in annual administrative costs through efforts to automate administrative transactions. By comparison, the dental industry has avoided over $6 billion annually. For both industries, the largest annual savings has been achieved for eligibility and benefit verification at $68.8 billion for the medical industry and $3 billion for the dental industry. However, although the industry has already avoided significant administrative costs through automation, 33 percent of existing spending could be saved through further automation.

To continue to drive progress, harmonization is needed across all stakeholders to

reduce administrative costs and burdens. Aligning on a common understanding of the

barriers to electronic adoption and the business needs of the future is imperative for

plans, providers, vendors, standards development organizations, operating rule

authoring entities and government to maintain and improve upon industry

achievements to date.”

There are other ways to mitigate costs as well, without subsequent suffering in quality. One way is to reduce what one article sites as administrative waste. As noted by said

article,

“ADMINISTRATIVE WASTE AS ANY ADMINISTRATIVE SPENDING THAT

EXCEEDS THAT NECESSARY TO ACHIEVE THE OVERALL

GOALS OF THE ORGANIZATION OR THE SYSTEM AS A WHOLE.”

The National Academy of Medicine’s seminal 2010 work, The Healthcare Imperative:

Lowering Costs and Improving Outcomes, identified unnecessary administrative costs

as one of six key areas that need to be addressed to bring greater value and lower

costs to healthcare consumers.

ADMINISTRATIVE COSTS HAVE BEEN ESTIMATED TO REPRESENT 25-31%

OF TOTAL HEALTHCARE EXPENDITURES IN THE UNITED STATES,

a proportion twice that found in Canada and significantly greater than in all other

Organization for Economic Cooperation and Development member nations for which

such costs have been studied. Moreover, the rate of growth in administrative costs in

the U.S. has outpaced that of overall healthcare expenditures and is projected to

continue to increase without reforms to reduce administrative complexity.

It is thus important to differentiate administrative waste from necessary

administrative spending. As noted by the previously cited article, “A key segment of

wasteful administrative spending is found in the significant amount of paperwork

needed in our multi-payer healthcare financing system. Having myriad payers, each

with different payment and certification rules increases the complexity and

duplication of tasks related to billing and reimbursement activities. Hence,

“THE TOTAL BIR COMPONENT OF ADMINISTRATIVE SPENDING-

REPRESENTING ABOUT 18 PERCENT OF TOTAL HEALTHCARE

EXPENDITURES-IS OFTEN SINGLED OUT AS WASTEFUL AND A

POTENTIAL SOURCE OF SAVINGS. AN OFTEN-CITED STATISTIC IS THAT

HOSPITALS GENERALLY HAVE MORE BILLING SPECIALISTS THAN BEDS.”

A problem with separating administrative waste from proper administrative costs is

insufficient data. While healthcare provides, creates, and utilizes fast amounts of

data, that information is geared to specific fields and areas. As a result,

administrative data tends to be neglected and understudied. As this article notes,

“Our current understanding of administrative spending relies on a patchwork of

mostly aging analyses, leaving policymakers very much in the dark when it comes to

addressing this growing category of healthcare spending.

MOREOVER, PATIENT ADMINISTRATIVE BURDENS HAVE NEVER BEEN

TALLIED, REPRESENTING THE GREATEST GAP IN OUR UNDERSTANDING

OF ADMINISTRATIVE BURDEN. PATIENTS INCUR ADMINISTRATIVE COSTS

WHEN THEY ENROLL IN COVERAGE, RECEIVE CARE, AND GET

REIMBURSED FOR EXPENSES. PATIENTS WITH PARTICULARLY COMPLEX

NEEDS MAY EVEN RESORT TO HIRING A PATIENT- OR MEDICAL-BILLING

ADVOCATE OR AN ATTORNEY.

Other data gaps include research to identify potential administrative waste associated

with provider credentialing, pre-authorization or grievances and appeals.”

Though more data may be needed in regards to understanding administrative waste,

there are still methods to handle it and ensure expenditures on administration in

healthcare are spent properly. This will help reduce overall healthcare costs,

including health insurance. One of the costliest areas of administrative costs is

billing. This issue has been known for some time. As noted here, “In 2010, the ACA

tried to rein in administrative waste. In recognition of the high cost of billing and

payments, section 1104 of the ACA required the US Department of Health and human services to promulgate rules to standardize many aspects of billing and payments. Specifically, the ACA called for a national system to determine benefits eligibility, coverage information, patient cost-sharing to improve collections at the time of care, real-time claim status updates, auto adjudication standards, and real-time and

automated approval for referrals and prior authorizations. These actions were

supposed to be implemented in 3 waves in 2013, 2014, and 2016. However, only the

first 2 waves were implemented in 2013 and 2014. These regulations standardized

eligibility required real-time claims status, and created electronic fund transfer

standards.

THE MOST COST-SAVING ACTIONS, AUTO ADJUDICATION OF CLAIMS

AND PRIOR AUTHORIZATIONS, WERE SUPPOSED TO BE

IMPLEMENTED IN 2016 BUT WERE NEVER ENACTED.”

The matter is complicated by how to diffuse healthcare is within the United States.

There are federal administrations, state administrations, regional groups, corporate

groups, church groups, local clinics, and clinics operated by chains, such as CVS

Minute Clinics. The previously cited article makes note of this, stating that

“BECAUSE THE US HEALTHCARE SYSTEM IS SO FRAGMENTED, THERE

IS NOT A CLEARLY DOMINANT ENTITY TO SET ADMINISTRATIVE

STANDARDS AND FORCE ADOPTION.

The federal government is the largest payer, but its market power is not concentrated

because its payments flow through hundreds of different programs, including 50

unique Medicaid programs, Medicare, hundreds of Medicare Advantage plans, ACA

insurance exchanges, federal employee health benefits, the military health system,

Veterans Affairs, and the Indian Health Service.Each of these programs has governance over its administrative rules. Some programs, such as Covered California, use their local market power to force standardization of administrative elements, such as benefit design. The private sector alternatives lack either geographic reach or local market scale. The largest private sector entities are

the payers United Healthcare and Anthem. However, neither of these companies are

positioned to be administrative standard setters. United Healthcare lacks a local

market scale because it usually only accounts for 10% to 20% of patients for

clinicians. Anthem lacks geographic scale because it only operates in 23 states. Only

the Medicare system operates in all states and is accepted by nearly all health care

organizations, which means changes to Medicare’s administrative rules are adopted

nearly universally. Medicare is also a large payer, through the Medicare Advantage

program, to the largest commercial payers, which could enhance Medicare’s ability to

serve as an administrative standard setter. This makes Medicare the only participant

with the market power to set administrative standards.” As Medicare for All seems an unlikely, though useful solution,

OTHER AVENUES TO CURTAIL ADMINISTRATIVE WASTE NEED TO BE

CONSIDERED. ONE SUCH METHOD WOULD BE INCREASED USE OF

BILLING SPECIALISTS TO REDUCE THE NEED FOR ADMINISTRATIVE STAFF,

AND, AS A RESULT, THE AMOUNT OF ADMINISTRATIVE SPENDING.

Billing specialists are a good example because of the decentralized nature of the

United States healthcare systems. Centralized billing, even by a third party, would

help to reduce costs. As noted here, “Germany and Japan both have multiple payers

but centralized claims processing. Despite having more than 3,000 health plans,

Japan’s administrative expenditures were a stunningly low 1.6 percent of overall

health care costs in 2015, one of the lowest among OECD [Organization for Economic Co-operation and Development] member nations. In their analysis of three universal health care options for Vermont, including single-payer, researchers William C. Hsiao, Steven Kappel, and Jonathan Gruber estimated substantial savings from administrative simplicity from each option. The two single-payer options they examined would result in even greater administrative savings of between 7.3 percent and 7.8 percent, depending on the rate-setting mechanism. The group estimated that a third scenario, which would establish a centralized claims clearinghouse while allowing multiple payers, could generate savings equal to 3.6 percent of total expenditures. This suggests that about half of the total administrative savings from a single-payer system could be obtained within a regulated multipayer system.”

THUS, BILLING SPECIALISTS, ESPECIALLY OUTSOURCED SPECIALISTS,

CAN HEP REDUCE OVERALL HEALTHCARE COSTS.

As this article notes, “This process is more straightforward than in-house billing for

medical practice staff. They can scan and email superbills and other related

documents to the medical billing service provider.

Most medical billing service providers charge a specific percentage of the collected

claim amount, with the industry average being approximately 7 percent for

processing claims.

The convenience factor is a major reason that medical practices choose to outsource

their billing. A provider handles all the data entries and claim submissions on behalf

of the medical practice. They also follow up on rejected claims and even send invoices directly to patients.

If a medical practice is using electronic health records (EHR) software, then this

process becomes even easier. Practices can store information from a patient’s

superbill in the EHR and securely transfer data to the billing service provider using

the interoperability feature. This eliminates the need to manually scan and send

documents.”

There are benefits to in-house billing as well. The previously mentioned article

mentions that “The in-house billing procedure for processing insurance claims

involves many steps that are universal to every practice.

First, the medical staff enters information into the medical billing software from a

superbill that’s prepared during a patient’s visit. The superbill contains specific

diagnosis and treatment codes, along with additional patient information that the

insurance company needs to verify claims.

Using the software, the practice submits the claim to a medical billing clearinghouse,

which verifies the claim and sends it to the payer. The clearinghouse scrubs the claim

to check for and rectify errors (for a fee) before sending it to the payer. By not

submitting claims directly to a payer, the practice saves time and money and lowers

its claim rejection rate.”

BILLING SPECIALISTS, EITHER IN-HOUSE OR OUTSOURCED, ARE AN

EXCELLENT WAY TO REDUCE OVERALL HEALTHCARE COSTS.

By reducing administrative waste, costs, in general, can be reduced. This also means

those savings will, at least in theory, be transferred to clients. This is especially

important for small businesses, who are often the hardest hit when it comes to paying

for health insurance. As demonstrated, a major issue for health costs and their

increase is related to all the administrative costs.

Several studies have shown this to be true. As referenced in this article, “A new study

from Stanford University finds that

THE TIME EMPLOYEES SPEND WITH INSURANCE ADMINISTRATORS

CLEARING UP QUESTIONS AND ISSUES-CALLED “SLUDGE” BY

RESEARCHERS-HAS COSTS IN THE TENS OF BILLIONS ANNUALLY.

The study, led by Jeffrey Pfeffer, a researcher, and author found

THAT THE DIRECT SOTS OF TIME SPENT BY EMPLOYEES ON HEALTH

INSURANCE ADMINISTRATION WAS APPROXIMATELY $21.57 BILLION

ANNUALLY.

with more than half (53%, or $11.4 billion) of those hours spent at work.

The study noted that excessive time spent on managing benefits can have several

negative outcomes. “Red tape can exert significant compliance burdens on people’s

accessing rights and benefits, thereby imposing time costs and depriving people of

resources or services to which they are ostensibly entitled.”

Various measures can be implemented to help reduce the costs of healthcare.

Eliminating administrative waste through the use of billing specialists is one of these

methods. Not only can such specialists curb waste, they can also provide a cohesive,

centralizing force to a heavily decentralized system.

Senior Health Care Insurance

Health Insurance For Seniors On The Net

When a good friend of mine inquired where he could obtain information about medical insurance for his out-of-state, elderly mother, I told him to try the Internet.

He reported back to me about a week later, in desperation: “I am giving up, I am too confused.” He had taken on an overwhelming project with his widowed mother, living in another state. As the only child, and following the sudden death of his father, it was his responsibility to care for his mother.

In this world of technology, the family unit is often living in different geographical areas and the family members are usually quite involved with their own lives, careers, and families. In addition, when both parents are alive, often one or both parents are quite independent and do not require a lot of assistance. As time goes on things, of course, change, and sometimes change very suddenly. There can be a crisis, with regard to the health care needs of one or both aging parents.

With our baby boomers facing this problem in ever increasing numbers, and with the information highway in full bloom, there is a definite need for planning.

Protecting your parent’s assets and health is a huge and daunting undertaking, which requires a tremendous amount of education and practical application. Our seniors face many diverse responsibilities upon reaching age 65. To name just a few: Estate planning, taxation, Medicare, social security, wills, insurance, and various other legal and financial matters. All of these different areas require expertise from accountants, lawyers, estate planners, insurance agents, home brokers, financial advisors, and others.

The Internet is a good starting point for most people to find resources for questions and solutions for your problems. There is, however, no replacement for good solid intelligent advice from an expert.

Twenty years ago, insurance for elders was sold by “senior insurance specialists”, with just a handful of companies in each state. The programs were most often Medi-gap or Medicare supplemental policies, which covered the expenses not covered by Medicare, including hospital and doctor deductibles, durable medical devices, and non-approved Medicare costs. Ironically these specialists did not sell a lot of nursing care policies, even though Medicare paid a national average of less than 2% of these expenses. With the advent of “financial and estate planning” and more insurance companies entering this market, a more broad and diversified product line became available to agents, brokers, planners, and seniors.

Part of this new diversification was the “home health care plan”, sold by itself, and in conjunction with senior health insurance products. The appeal of the “home health care policy” was that a senior could stay at home and still receive medical and custodial benefits, allowing a person to recuperate in the comfort of their own home.

This was the answer to a huge problem. The last place an older person wanted to go was a “retirement home”, or “rest home”, or, God forbid, the “nursing home.” It appeared that seniors could now rely on this new innovation without worry of having to move out of their home environment in the event of a health problem.

As with most things,” if it is too good to be true”…. The home health care policy is no exception. The problem is, there is not enough coverage for a lengthy illness or recuperation time. The fact is, the new trend is toward an “all in one” type facility, allowing for a variety of levels of care all in one location. In other words a senior could start off with little or no health care concerns in an independent, less expensive area, and then go to an assisted living, or nursing care facility, all within the same compound.

A “nursing home” requires a nurse on the premises 24 hours per day, assisted living is just eight hours. The advantages to this are financial. The patient or senior is only charged according to the care level required during the time he or she is admitted to that facility. Another benefit is it alleviates a lot of planning because the care is delivered, as it is needed. The medical attention is available to all residents regardless of their current health.

Some people are offered a lifetime package, which covers their care for the rest of their life, regardless of their current age. It also allows for social outlets to an otherwise somewhat isolated group. On-line shopping services have become a huge business. It is definitely here to stay and many insurance policies are purchased from Internet quotes and on-line applications.

There are literally hundreds of thousands of insurance agents and brokers advertising on the Internet. Most of them will provide instant on-line quotes and even applications for the potential insured. I highly discourage a layperson to purchase insurance in this fashion. A little knowledge can be dangerous.

The federal government has mandated to all states through legislation, the standardized senior health insurance policy guidelines, which are governed and regulated by each state insurance department.

There are plans for almost every level of health. Some are designed and priced for a less than healthy individual. Others are for a person with minimal health concerns. . The whole concept of insurance is to provide protection for “unanticipated” sickness or injury, especially catastrophic expenses, which would devastate a person’s net worth. The more small expenses a person is willing or able to pay (self-insure), the lower the rate. I recommend this strategy when evaluating your insurance options.

Another consideration when reviewing various insurance plans is to look at the company itself. How long has the company been selling this type of insurance? Do they have a lot of complaints filed with the local department of insurance? Are the rates stable? Does it pay claims on time? Service? Most agents talk about the rating. These ratings are as follows: A+, A, A-, B+, B, B-, C+, C, C-, or “not rated”.

Do not be fooled by rating alone. It is good to have a high rating, but it is far better to have a company that has longevity, stability, innovation, service, and expertise. The problem is that some companies enter into a market and quickly leave without explanation. This does not give security to the policyholder.

The most important consideration should be a review of the profit/loss ratio for that product. This will establish stability, and longevity in the market. An insurance company with a moderate profit in a particular line of business will remain in that market. On the other hand, a company with losses will make changes and possibly even withdraw. This is information not normally available to Internet users.

Before entering into an insurance contract, the senior person, the family, and other advisors must be realistic, and a careful evaluation of the entire picture must be examined. The age, the health of the senior, the financial resources, the personality and attitude of the senior, and most importantly the desires of the senior, should all be considered.

Early planning is important, as qualification becomes increasingly more difficult as the applicant’s health declines. The senior health care market is complex. I will offer some words of advice to attempt to alleviate potential pitfalls.

*Choose a well-informed, seasoned, and service oriented agent or broker to assist your decision making process. The professional can offer invaluable information, but do not be afraid to ask a lot of questions and even get a second opinion.

*Do not wait until your parent or loved one is sick, or injured. Plan ahead and take the time needed to cover all the options.

*Choose an experienced insurance company. A Company that has been in the marketplace for a significant time and has maintained a balance of rates and benefits and sound risk selection with moderate rate increases over time is your best bet.

*The plan should be flexible, with a broad range of options and benefit selections to the insured. There should be no tricks, or complicated language for the coverage. An incredibly low rate is a red flag for trouble in the future.

*Do not rush or be rushed by an over aggressive sales person.

This policy will not be inexpensive and will need to be read and reviewed for a clear understanding of the contents. This is one advantage to the Internet. You are allowed to read indefinitely before you act.

A long-term care program, with or without insurance coverage, will only work if the senior has input into the care selection process. If there are any questions about the accreditation of a facility please call the “Continuing Care Accreditation Commission at 202-783-7286.

Navigating Through Tough American Economic and National Health Care, Health Insurance Reform Issues

For Practicing Agency Brokers, Trusted Insurance Advisers, And Financial Planning Consultants….

From time to time, there is a need for guidance in Financial Services Practice; now is definitely one of those times. There are two distinct issues working in tandem which determine modifications in the future conduct of our business: The Economy and the Reforms. Here are ideas on how to navigate our way through the maze. This can most certainly be done. With care, thoughtful performance, and innovation, Financial Services Professionals can serve the general public and make the experience satisfying and profitable. Let’s begin with some commentary on the general economic circumstances first. Following that, we’ll take up the Reform issues, how to move through them, and how the way we advise members of the general public on savings, insurance, investment, and retirement concerns.

1.To begin the economic discussion, we need to address the full and true extent of just what we as a nation and we as practitioners are up against. As of this writing, in the winter of 2009, unemployment, including the employed, self-employed, and business owners, has passed 10%, about 15 to 16 million people. Add another 6 to 7 percent to that, which includes the part-timers, disabled, retired, and those of working age who have stopped looking. We are looking at about 22 million Americans not drawing active paychecks. The closing of businesses, branch locations, shops, stores, retail, wholesale, and service sectors, adds to the severity of the overall problems. It is conceded that there are many who are drawing from savings, taking early pensions/Social Security income, receiving extended unemployment compensation, and retirees on full pensions. That said, the loss of productivity is simply staggering. All this decreases the taxes available from which cities, counties, states, and the federal government must fund budgets. Naturally, all this leads to ever worsening annual deficits and unfunded liabilities. Finally, federal government for the past 30+ years has pursued deficit-spending policies which add to all of this. A look at USDEBTCLOCK.ORG tells the whole story in real time. Take a look and notice a few things.

The national debt stands at some $12+ trillion, while the federal budget shows in the neighborhood of $3+ trillion. Take a closer look and it can be seen that $1.7 trillion is taxes, while the difference is annual debt – sale of treasuries, printing of currency. The unfunded liabilities of Medicare/Medicaid, Prescriptions, Social Security top $106 trillion! To get an idea of what these liabilities mean, consider that this funding is what must be contractually paid out in entitlements over the lifetime of those presently enrolled in these programs, say, from now and over the next 20 to 30 years. And that will become progressively larger as the Baby Boomers begin checking into the systems. This is merely the highlighted treatment of the issues and doesn’t take in figures on the levels below the federal programs and subsidies: state, and related deep concerns over inflation, tax increases, brain drain, not to mention the TARP, STIMULUS, industry handouts/loans, and funds to individuals and non-governmental organizations under Acts in force, such as new mortgages and existing mortgage relief.

We read, see, and hear the word “unsustainable” a lot. Another phrase is ” the debasing of our currency.” Still another is “breaking the buck.” Are these figures actually important to us? Well, yes. One example will suffice: the interest alone on just the national debt is about $340 billion/year, or about 12% of the national budget. And that is going to get much higher. Relate that to a family making, say, $75,000/year. With this level of household debt, that family will pay some $9,000/yr. merely to pay interest, not even to reduce its debt obligations! Just recently on CNBC, a professor of finance designated the U.S. Dollar as fiat currency, which it is. Watch just about any television station and note all the advertisements about gold. Yet, many Americans just roll on as if everything is going to be just fine. Let’s hope for that miracle. The American People have been through some very difficult times over the past 250+ years and have managed to rebound. That could happen again. This time, however, things are quite different and difficult.

Does all this mean that Americans should just roll over, play dead, and let the federal government take care of everything? As a nation, will we file for default and a kind of national bankruptcy? This may be a legitimate senario; and it could be solved through establishment of a new currency sometime in the future, after everything gets paid off in near worthless U.S. currency. But, nations and the people in them, get hurt—badly. Russia, Panama, Argentina, Germany, Cuba (and there are more examples out there), all went through this, and the people there know just how bad this is: a national nightmare from which one cannot awaken. Special note on Argentina: The collapse of that country’s currency, the Peso, not long ago, lead to black markets, swap meets, trading for needed goods with hard assets, such as gold, bartering and trading in kind, not to mention increases in violence and crime. When new prices and wages readjust to some new currency, the resultant pricing of goods and services is extremely unfavorable to individuals and businesses. One can hope and pray that this does not happen or at least is some years away. Some experts suggest anything from 2 to 20 years—-read: nobody knows for sure! That said, this leads to strategies that we in the financial services industry can and should probably look into and maybe adopt. If all this sounds like gloom and doom and just too ridiculous, let me assure readers that this writer has done his research, can back it all up, and is most assuredly not making it all up as he goes along! Independent corraboration and documentation on all of this is readily available on the internet, libraries, university papers/archives, and other public records.

2. Here are some practical suggestions for Financial Services Professionals. While nobody can predict the future, this portion of the narrative is best described within two arbitrary time frames: A. 2010 to 2014-2015. B. Beyond that to, say, 2020-2025. This time division is established for specific reasons. At the time of this writing, the U.S. Government is poised to pass and place into effect a national healthcare/health insurance reform act. It doesn’t much matter whether or not one is in favor of this particular piece of legislation or some others, reform is necessary and will come very soon regardless of what the final act turns out to be.

Care rationing is a matter of fact, already in place for some years, and will get more pronounced for everyone. There really is no other sustainable way to do any kind of reform in attempts to control steeply increasing costs of insuring seniors and those below age 65 yr. who can either not afford to be insured, can’t qualify, or act as though they don’t want to protect themselves(checking into their local hospital ER so we can all pay for that; and hospitals, in order to remain in business are already tightening up on the emergency provisions of the law). The projected costs of the one that looks like it will become the law of the land, warts and all, is estimated at between $1 and $2 trillion over the next 10 years. It will no doubt end up by 2019 considerably more. If it doesn’t, it will stand alone among all the U.S. entitlement programs in the history of the Republic to come in at or below the CBO cost estimates. Look for increasing income taxes, fewer paychecks to tax, very slow employment recovery, very fragile equities markets, more federal currency creation, more inflation, weakening U.S.Dollar.That’s the context in which we find ourselves and determines what we do as financial services advisors and implementers. Good luck. That said, let’s discuss Part A – the next 3 years.

Part A. During the next three years, things will proceed at more or less normal conduct of business in an atmosphere of continuing inflation and increasing taxes. As practitioners, we can expect to market the same or similar coverages as we do now. Adverse Selection(taking into account pre-existing conditions) will still be there to control premiums on life, individual, family, group healthcare, disability coverage, long term care insurance, retirement plans(more on this later), to mention the prominent ones. We still will be doing our due-care, due-diligence, financial planning, fact finding, observing compliance, and doing what is best for the client. There are going to be less people and businesses with which to work, and they will have less money with which to do things. Remember, the client always comes first. Words to live by.

Certainly, we owe it to those who favor us with their business to let them know what is coming as soon as we know what is in store for them and for ourselves. For the most part, we will try to continue as before – for about the next several years. After that, things begin to get very different. Let us progress to Part B, Beyond that.

Part B. After 2014-2015, health insurers drop Adverse Selection and pre-existing conditions no longer play a part in the health underwriting process, at least for much of the individual, family, small group medical insurance, and Medicare Supplementary coverages. We’ll all most likely be undergoing training, certification testing, and more state/federal regulation. There’s an upside to all of this. As long as the health insurance industry remains in play, we should be able to make as much or even more money. Nobody knows what the effect of some U.S. Health Insurance Company, Co-op, or Exchange might have on the viability of the health insurers. The CBO states that some very small percentage of the public will enroll in the Public Option plans. That remains to be seen. Many people will be subject to non-enrollment penalties and fees.

What we do know about public plans and elimination of pre-existing conditions is the example we have in Texas. This public option is called the Texas Health Insurance Risk Pool, under the jurisdiction of the State of Texas. In Pool plans, there are no pre-existing conditions to stop one from procuring a pretty good major medical insurance coverage; in fact, one actually has to have significant medical condition or conditions to be eligible. Approximately 29,000 Texans are presently enrolled, out of the millions who have commercial coverage of individual, family, or group coverage. Even with State and Federal subsidy grants each year, the premiums on these plans run 2.5 to 4 times what a similar commercial plan might cost and the coverage is not as good. In a word, it is really expensive. It may be that, since the great majority of Americans probably generally qualify by providing medical evidence of insurability anyway, the impact of accepting all applicants by the commercial insurance companies may not send the overall individual/group premiums skyrocketing(an outcome with which this author does not agree). Those who can’t afford health insurance may get federal subsidies. The fact is that nobody really has a clue. We won’t discuss the MA and OR state-run health care/insurance plans. Not working out very well. Adverse Selection Elimination is a main culprit, leading into healthcare rationing and increasing premiums.

For insurance professionals, the marketing opportunities may just turn out to be positive. Bringing into the insuring public millions of previously uninsured and underinsured younger people may be a good thing. Supplementing health insurance for seniors will be there. We need to work hard at staying in the game and not getting squeezed out by federal competition. All people out there will certainly still need competent financial services professionals, maybe even more than at present. There are those in professional positions of economics, demographics, medicine, actuarial science, and other disciplines who think that any public option may not drive out the insurers, especially knowing that private enterprise, ingenuity, innovation, increased efficiency, would allow the private sector even to drive out the public option. Look at how the Post Office, Medicare, Medicaid, VA hospitals, Social Security, and other entitlements have worked out. Remember that $106 trillion(and climbing) of unfunded liabilities and where that has put the nation and the American People. As these liabilities keep coming due, they increase the federal budget! Doesn’t sound like some great efficiency to this writer.

Finally, there is this prediction regarding earned and renewal compensation. Don’t look for some sudden drop off just because of Reform. This author has found from experience that most people are quite cautious and suspicious of new programs and will tend to retain what they have for just as long as they can, until they gain confidence in such programs, or are forced into them. Even then, many, if not most, will still retain current health insurance coverage in some form to pick up what Reform does not. That was this writer’s great surprise with Harris County here in Texas, when in 1970, the County government replaced an outdated and woefully inadequate set of fringe benefits with full comprehensive coverage. Most all the supplemental coverages that were marketed to large numbers of employees from 1965 to 1970 remained on the books for many years. That is likely to happen in our national future. So take heart.

Earlier, the topic of currency debasement, creation of trillions of dollars by the Fed out of thin air, and inflation(about 2.5% annually, by the way) was touched upon, especially as related to obtaining goods, services, and accumulation/distribution of retirement funding. This leads into the arena of retirement capital, funds formation, equities markets, cash value life insurance, annuities, precious metals, commodities, bank deposits, money markets, treasury instruments, and the like. This also includes non-tax qualified and tax-qualified retirement vehicles, such as IRAs and 401(k)s, as examples. One suggestion is the recommendation that some portion of a client’s capital or retirement portfolio of funds be placed in hard assets. Gold and silver come to mind. We would defer to a precious metals specialist for that. Hedging and potential gains are two objectives that come to mind.

Everything is open to new ideas based upon the changing circumstances. Your practice is obviously going to change; caution and creativity are the guides. Whether we operate in single needs, multiple needs, or comprehensive planning modes and implementations, all of our recommendations are going to be different as compared to past years. It is a bit like attempting to walk in quicksand. And this applies to all product implementation, not just the health insurance arena. So be careful out there.

The way we operate in ethical conduct of business will change. The suggestion is put forth that in the future, starting in 2010 and beyond, we in financial services when advising businesses and individuals, will need to either form alliances with other financial professionals who are licensed in areas where we are not, or refer people to other trusted advisors in order to fully inform the people we serve of the risks and rewards to allow them to make proper, informed decisions that work for them and provide them the opportunity to form strategies and thus to protect themselves. We are definitely in for quite a ride; so fasten your seatbelts. A tip from one who is an investor, not a sales agent: dollars are currency;gold is money. Get to know the difference. Know all the new rules, regulations, and compliance requirements. Study. Engage with other professionals. There is a big job ahead for all of us, starting now.

This is by no means an exhaustive analysis of what’s ahead, but it is a beginning. Still, taken to heart, it gives us inspiration to continue to provide the most excellent advice and coverage implementation to our clients and would-be clients. We who are true professionals are in the unique position to guide, advise, offer direction, clarify, and eliminate confusion. No government bureaucrat can come close to what we do. Imagine that!