Wellness Program Returns

One of the gaping holes in our national struggles with reducing the costs of health care is the limited emphasis upon wellness. Plus, Congressional insider trading, researching charities before donating and the U.S. fiscal union as "an engine of subsidy."

— When 60 Minutes outed Congress' lack of insider trading restrictions upon themselves last year, the hue and cry from those of us who do (reasonably) have that legal proscription, led to belated, and hurried, legislation closing the loop hole.

Studies had shown that members of the House of Representatives outperformed the market by a comfy average of 9% per year while Senators managed an impressive 12%. It will be very interesting to see what subsequent analysis shows of their results going forward now that the law is in place. It is highly likely that their future results will not be so stellar and their righteous protestations will have been punctured.

— Lest we overreact to the apparent unfairness of economically stronger northern European countries being asked to bail out some of the weaker southern ones, I was surprised to see a study from The Economist that shows we do much the same thing here in the U.S. Only here it is done very much out of public scrutiny.

For instance, over the last 20 years, some states — Minnesota and Delaware for instance — have annually paid in to the U.S. Treasury more than 110% of what they received back. Conversely, over the last 20 years, Mississippi, West Virginia and New Mexico have received annual subsidies of 12% of the state's entire GDP.

“Greece's entire 2011 deficit, for example, was 9.1% of GDP,” Austan Goolsbee, professor of economics at the University of Chicago’s Booth School of Business and chairman of President Obama’s Council of Economic Advisors from 2010 to 2011, wrote in The Wall Street Journal in May. “The U.S. fiscal union has worked, in no small part, by enabling subsidies to the Mississippis without requiring the approval of the Minnesotas. It creates an important form of insurance.”

— One of the gaping holes in our national struggles with reducing the costs of health care is the limited emphasis upon wellness. I have often touted to whomever would listen the rough stats that about half of what makes us sick and kills us is our own doing and we could get a disproportionate bang for our health care dollar buck by drawing national attention and effort to the goal of simply living in a healthier way.

Now I have come across a Harvard study that showed that every dollar a company spends on wellness programs saves about $3.27. We obviously need to do more with this — a lot more.

— Have you ever noticed that when a lecturer asks for questions, the questioners really do not actually want to ask a question?

They either 1) want to express an opinion, either agreeing or scolding, 2) seek to show off (what they think) is their superior knowledge, or 3) wander off into wordy obscurity. People, even docs at professional conferences, appear not to know how to ask questions, so it might help any of us speaking at a dais to request that questions start with one of our interrogatory friends: who, what, why, where or when. Real questions. Journalism 101.

— We sometimes forget, at our peril, that "Murphy's Law" (if something can go wrong, it will) has never been repealed. It calls to mind the sergeant on the old NYPD Blue series who ended every morning meeting with "Be careful out there." In money, in medicine, in life.

— Last week's winning Powerball Lotto windfalls brings up some sage advice for all of you putative future winners. Because taxes are going to go up, take your winnings as a lump sum to minimize the hit. Also, the way the some of the alternative annuity pay-outs are structured, an early death could lead to an even worse estate tax thumping.

Incidentally, I once quoted a mathematician who calculated that the odds of winning these mega-lottos are so high against you that the chance of winning is about the same "whether or not you buy a ticket!"

— As we look forward to enduring the annual talk about New Year's Resolutions, keep in mind that, in one survey of docs, only 64% had an advance directive in place, albeit better than the 20% of the general public.

Also, a surprising number of otherwise sober-minded docs still do not have a will or a thoughtful financial plan. Maybe this is the January to get those things done and get some small, additional peace of mind to start the New Year.

— The reason folks donate assets to a charity instead of cash, such as stocks that have risen in value, is that you get to deduct the current full market price, no matter how little it may have originally cost. You get to avoid paying any (capital gains) tax and the not-for-profit recipient pays no tax either.

Tax relief from charitable giving is usually a worthy, small addition to the deficit. I say “usually,” because there are something over 1.5 million not-for-profits in the U.S., according to the Foundation Center. Some of these nonprofits either have no real charitable purpose or are really bad (inefficient, wasteful) at it. Do your homework next time before giving and look at the charity's financials (often online) to see how much of the average dollar donated actually goes to medical research, starving children etc.