PHILADELPHIA REFLECTIONS
Musings of a Philadelphia Physician who has served the community for six decades

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N-HSA: The New Health Savings Accounts
Some new ideas are ready to be debated. Here are the ones I favor for 2016.

Rexamining the Role of Children

In a way, health insurance suits family plans better than individual ones, because often there is only one responsible working person to foot the bill for everyone. But equally often it is the other way, every ship on its own bottom. Politicians know a no-win situation when they see it, so the matter seldom gets an enduring if arbitrary solution.

So it should be no surprise that responsibility for obstetrical costs has no solution, only expedients in a changing world. It's probably one of the hidden pressures for letting the government pay for it, so we can all forget the issue. Another feature is that it's expensive. The statistic seems high, but 3% of health costs are supposedly derived from the first year of life, and that means $10,000, which really seems quite high. And the report of the first 21 years developing 8% of health costs, also seems high. But something costs that much, and its costs must be paid by someone. As I thought about it, childhood is the reverse of all other health costs, where most people can save the money and then spend it. It's impossible to pre-fund newborn costs unless they are paid by some other generation, on the baby's behalf. If that's the case, what would be so bad about grandparents pre-paying a baby's cost?

Furthermore, grandparents have only recently rejoined the family. In my own case, I had four grandparents like everyone else. But I never met them. I have two great-grandchildren who are almost as tall as I am, and numerous grandchildren who are taller. For decades I have had them to my house for Christmas. All of this seems to relate to my own longevity, and is the destiny of almost everyone else, too.

So this observation is the underlying basis for suggesting we examine generation-skipping for the first year of life. It has the additional advantage of lengthening the period for compound interest to work, especially if the grandparents can save some surplus from Medicare to start the process. If you add that desirable feature to Medicare, you have just about solved a problem where no one else has a clue.

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