FSA, TSA, HSA - two of these can help a bit with medical bills

Except for some government employees, generous health insurance is rare. As the cost of insurance has skyrocketed, employers are shifting more of the cost to their employees, often through higher and higher copays and deductibles.

Either a Flexible Spending Account (FSA) or a Health Savings Account (HSA) can lessen the blow.

Note that in general you will be offered one or the other, but rarely will both be possible.

FSAs allow you (and also your spouse if they are employed) to put up to $3200 pre-tax income each year into an account that can be used to pay for eligible health and medical expenses. This saves you paying income taxes on the amount you put into the FSA. Your employer may, but is not required, to put money into your account as well, up to the amount you put in through payroll deduction.

Note that you can only contribute to an FSA if you have employer-sponsored health insurance.

It is very important to remember that these plans are “use it or lose it.” You may be able to roll over any balance at the end of the year, but if you do not spend these funds on eligible expenses, the money goes back to your employer. Also, if you change employers, your FSA does not travel with you.

Before deciding to contribute to an FSA, look carefully at your out-of-pocket medical expenses for the last year or two – and take into account any expected expenses such as dental work or elective surgery.

If it is offered, an HSA is an even better deal, particularly if you can afford to put in significant sums. An HSA can be set up by your employer or, depending on the type of health insurance you have, yourself. The contributions lower your taxable income, just as with an FSA, but there is no deadline for spending the money. You can let it accumulate, tax-free, and, as long as you use the money for health expenses, pay no tax on withdrawals. An HSA is yours – if you change jobs, it goes with you.

The maximum contribution limit of an HSA is higher than to an FSA. Individuals can contribute up to $4,150 to their HSA accounts for 2024, and families can contribute up to $8,300. People 55 and older are allowed an additional $1,000. As with FSAs, employers may but are not required to contribute.

On what can you spend the money in these accounts? Copays and deductibles are eligible, as are dental bills, medical equipment, eyeglasses and most over-the-counter medications. You can even use the money to pay for needed home renovations if they are medically-justified.

Neither of these types of accounts will remove all the sting of exorbitant medical costs, but if Uncle Sam is willing to help, you should let him do so.


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Are you taking too many pills?

Americans take a lot of pills! About 20% of adults between 49 and 75 are taking 5 or more prescription medications daily. This gets commoner as we get older. Surveys found that 13% of young adults (30-49) take 4 or more prescription drugs daily, while 54% of those over 65 do so.

While many of these medications are beneficial or even life-saving, there is a lot that can go wrong. Many medications interact with each other in harmful ways. Many more are of only minimal benefit while carrying serious side effects.

The problems with over-medication are much worse in older adults. As we age, we accumulate more chronic illnesses, and these often lead to more drugs prescribed. With age, the kidneys and liver are less able to eliminate drugs and levels may pile up to dangerous levels. Older adults are more susceptible to many drug side-effects, including confusion and excessively low blood pressure.

Another potential issue is that as medicine has become overly specialty-oriented, multiple doctors may be prescribing medications that seem fine from their perspective without realizing that other doctors are prescribing medications that may be conflicting with the new one.

How can you protect yourself?

First, be sure your primary care doctor knows what you are taking. I would have my patients make a yearly “brown bag visit,” bringing in ALL of the medications they were taking, including over-the-counter pills. A common finding was that people were taking the same medication twice – one bottle had the brand name and the other the generic, and the pills looked nothing alike – so they were unaware of this double dosing. We also often found medications that I was sure they had stopped but which their pharmacy “auto-refilled” and they kept taking.

Whenever your doctor suggests a new pill, always ask if there are life-style changes you could try instead. It may be that you need the medicine now, but could come off it in the future if you do make those changes.

Ask if the symptom being treated (ankle swelling, dry mouth, high blood pressure, etc.) could be a side-effect of a medicine you are currently taking. Perhaps that symptom would be better treated by changing the culprit pill rather than adding a new one.

Be particularly cautious when adding a drug on the Beers list, a list of drugs felt by the American Geriatrics Society to have a poor benefit to harm ratio. It is easily found on-line. You may still benefit from the medication, but have a frank conversation with your doctor.

Almost any time a new medication is added, a good rule is “start low and go slow.” Begin with a low dose and raise the dose only after giving the initial dose a trial.

Modern medications can be life- and health-saving, but they can harm. Caution and common sense should prevail.


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I am Woman - hear me - Please!

Pediatricians are fond of saying that children are not just small adults – that their physiology and response to diseases are different. In the same way, women are not just men with different sex organs. Every cell in women is different than the corresponding cell in men, due to the difference in chromosomes.

Thus, women, as we have learned, often describe different symptoms when they are having a heart attack – and as a result, the diagnosis is often missed or delayed. Women have many more “auto-immune” diseases such as lupus and thyroiditis. Women obviously have unique diseases related to the menstrual cycle, such as endometriosis or polycystic ovary syndrome.

Women’s health issues are severely under-studied. Even though women make up 55% of patients hospitalized with acute coronary disease, they make up only 25% of participants in clinical trials of coronary disease.

Because women are considered at lower risk for coronary disease (even though as noted, they are over half the patients admitted with acute coronary symptoms), they are less likely to be prescribed statins, a proven life-saving therapy for patients with coronary disease.

Even though 70% of women take at least one prescription drug during pregnancy, only 5% of these drugs have been tested and shown safe during pregnancy.

Why this disparity? Throughout history, medical research and practices have primarily focused on men. This stems from outdated beliefs that women's health issues were either insignificant or simply variations of men's conditions. Many clinical trials specifically do not enroll women of child-bearing age, even those these same women may be given the treatments after the drugs are approved.

Women often complain of being “gas-lighted:” having their complains ignored. Unconscious biases among healthcare providers can influence the quality of care provided to women. These biases may lead to symptoms being dismissed, pain being downplayed, or concerns being trivialized, all of which can result in delayed or inadequate treatment. For the same painful conditions, women are less likely than men to be prescribed pain medication.

Certain health issues specific to women, such as menstrual disorders or menopause-related symptoms, are dismissed as "normal." This can lead to healthcare providers dismissing or minimizing these concerns, further perpetuating the cycle of inadequate care for women.

Addressing these issues requires a multi-faceted approach that includes raising awareness, advocating for gender-inclusive research and healthcare policies, providing education and training on gender-sensitive care for healthcare providers, and ensuring equitable access to healthcare services for all. By recognizing and actively working to dismantle these barriers, we can strive towards a healthcare system that provides equitable and compassionate care for everyone, regardless of gender.


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Protein - panacea or problem?

Protein is everywhere on the grocery and pharmacy shelves these days. There are protein shakes, protein bars, high protein cereals – you name it.

One reason for this emphasis on protein is that in the 1980s and 90s we were taught to fear fat, and in the 2000s we were told carbohydrates were bad – so that only leaves protein!

We do indeed need protein for health. There are a number of essential nutrients (specific amino acids) that the body does not manufacture and which come from dietary protein.

How much protein do we really need, and is too much bad for us?

The recommended amount of protein an average adult should eat is 0.8 grams per kilogram of body weight. Almost every adult in western countries gets this much or more. For an adult weighing 165 pounds, this translates to 60 Gm protein/day. If you are trying to maintain or gain muscle mass, or if pregnant or nursing, you should increase this by 25%. This would include most older adults, who often lose muscle with aging.

Protein is available from a variety of foods, with fish, fowl and meat the most obvious but far from the only or even the best source. Dairy products, eggs, beans and lentils and nuts provide quality protein, as does soy. What should you avoid? Fatty cuts of meat and most processed meats (cold cuts, sausages, bacon, hot dogs) are bad for your heart and best minimized. If you are choosing hamburger, go for the 90+% lean packages.

Since all of the foods providing protein also provide different additional nutrients that we need, balance is key. Fish provides omega-3 fatty acids; meat provides iron; dairy products provide calcium and vitamins; legumes provide fiber and minerals.

Can you eat too much protein? Clearly yes, for a few reasons. Protein is our only source of nitrogen and tends to make the body acidic; the kidneys eliminate these toxins. If you have any degree of kidney impairment, excess protein can over-tax the body’s ability to cleanse the blood. Excess animal protein can lead to kidney stones. If you increase your protein intake without increasing exercise you will probably take in too many calories and put on weight.

Most experts agree that the maximum an average adult should eat is 2 grams/Kg body weight. For our average 165 lb adult, this is 150 Gm/day. Take a look at your intake, and if you are way over this, probably wise to cut back.

And be sure to get your nutrition from a variety of sources. Protein, carbohydrates and healthy fats are all necessary for good health.


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