In August, the Alabama State Employees’ Insurance Board approved a plan that will charge workers an additional $25 to cover their insurance premiums, if they don’t take advantage of free health screenings available to all state employees. The program, to begin in January, will require state workers to receive medical screenings for body mass index and health problems such as high blood pressure, high cholesterol and obesity.

Punishment or Opportunity? It is an important step toward better preventive care at a time when health costs are soaring and Americans are in increasing denial about their ever-ballooning weight. State employees are being asked to go to a free health screening, and if necessary, a free doctor’s consultation. If those screenings show that a person is predisposed to illness due to their weight or other conditions, they will be offered help to begin to address their health issues. Only if workers fail to take advantage of the free screening will they be charged the additional $25.

Varying reports place Alabama with the second or third highest rate of obesity in the country. Not the only thing the state is doing to reduce obesity. They will pay for 1/2 of the cost to enroll in Weight Watchers so that employees can learn to change their eating habits and feel better. Now is not the time to resist efforts to make us healthier.

Managing that money is more profitable than offering health insurance.

As if they weren’t screwing us enough already… WellPoint Inc., the nation’s largest health insurance company, ran into a snag last year while pursuing an important new business initiative.  Federal banking regulators insisted on classifying WellPoint as a healthcare company. And that was interfering with its efforts to open a bank. The Federal Reserve Board eventually agreed that the company’s core insurance business could be considered financial services. WellPoint finally convinced the Fed that its mail-order pharmacy and its program for managing chronic diseases were merely “complementary” to its main business — financial services. It pledged to limit them to less than 5% of total revenue.

Insurers are moving away from their traditional role of pooling health risks and are reinventing themselves as money managers — providers of financial vehicles through which consumers pay for their own healthcare. Like home and auto insurance, traditional health coverage is based on shared risks within broad populations of customers: a small proportion with big medical expenses and a large majority with few or none. Premiums paid by the latter help pay the costs incurred by the others and provide a margin of profit. In theory, this system serves everyone’s interests, because people generally can’t know in advance which group they’ll fall into.

Insurance companies began remaking themselves as administrators, providing employers with expert help in processing claims and negotiating rates with doctor groups and hospitals. Profit margins on these services are high because the companies can charge fees without assuming the cost of underwriting customers’ medical needs.

Among the signs of the change is the growth in health savings accounts, which allow individuals and families to pay out-of-pocket medical expenses from tax-exempt savings. As with individual retirement accounts and 401(k) plans, the money in HSAs tends to sit for long periods and can be invested in mutual funds and securities.

“There’s fees for managing the account, transaction fees, fees for investing the funds,” says John Casillas, director of the Medical Banking Project. “You’re going to see many billions of dollars moving from premium payments to professionally managed investment funds under HSA rules. Some people think that banks are going to threaten health plans by replacing them in the marketplace.”

Hence the rush by medical insurers to open their own banks. To help foster this change, the insurance industry developed a new form of health plan carrying a low premium and a deductible (the amount a customer must pay out of pocket each year before the insurance kicks in) of $5,000 or more.

Under the rules, contributions to HSAs are tax-exempt, as are their investment gains. Withdrawals are also tax-exempt if they are used for qualified medical expenses. Over time, HSA balances could grow to hundreds of thousands of dollars.

As waistlines continue to expand in Japan, the country’s lawmakers are taking the unusual step of fining companies that employ overweight workers, an approach that diet experts say would likely meet with failure in the United States. Companies would be sued left and right for “discrimination.”

Weight-loss groups in Japan exercise together, singing inspirational weight-loss songs with lyrics such as “Goodbye, metabolic. Let’s get our checkups together. Go! Go! Go!” Meanwhile, posters in Japan feature rotund cartoon figures with buttons popping off their pants urging people to overcome “metabo.” The goal measurements for Japanese men’s and women’s waist circumferences are 33.5 inches and 35.4 inches, respectively — guidelines straight from the International Diabetes Federation in Belgium. People who exceed these measurements will be targeted for health education initiatives. If they fail to lose the extra inches, their employers could be fined.

As a country with more than one-third of its population classified as obese, the U.S. might benefit from a stringent program like Japan’s. According to the Centers for Disease Control and Prevention, 78 million Americans are obese.

Japan has a system of universal health coverage divided into a national system, and employees health insurance in which membership is mandatory. The question would then imply that a US system of univeral health coverage exist. Which it does not.

A Proof of Virginity Presented To Families Before A Wedding

The surgery in the private clinic off the Champs-Élysées involved one semicircular cut, 10 self-dissolving stitches and a discounted fee of $2,900.

Like an increasing number of other Muslim women in Europe, a 23-year-old French student of Moroccan descent had a “hymenoplasty,” a restoration of her hymen, the thin vaginal membrane that normally breaks during the first act of intercourse. “In my culture, not to be a virgin is to be dirt,” said the student, perched on a hospital bed as she awaited surgery Thursday. “Right now, virginity is more important to me than life.”

Gynecologists report that in the past few years, more Muslim women are asking for certificates of virginity before marriage.

That trend in turn has created a demand among cosmetic surgeons for hymen replacements, which, if done properly, they say, will not be detected and will produce tell-tale vaginal bleeding on the wedding night. The service is widely advertised on the Internet; there are medical tourism packages to countries like Tunisia where the procedure is less expensive.

Jim Jubak’s Theory of Why Wal-Mart Is The Healthcare Answer  

Wal-Mart has done more to expand coverage and lower costs in the past year than any government program to come out of Washington in the past 10 years. About 47 million Americans now lack health insurance. Health care costs are rising far faster than general inflation. And health care is on track to consume 25% of U.S. gross domestic product by 2025. That would be up from 16% today and 5% in 1960.

Of the 44 million elderly and disabled covered by Medicare, 80% have their health bills paid by the traditional fee-for-service program. The other 20% get their Medicare benefits through private health plans that receive payments from Medicare. These plans, now called Medicare Advantage plans, have been around for decades. And they’ve recently formed the backbone of many plans to fix U.S. health care by expanding coverage and cutting costs. Because the competition that was supposed to unleash so many benefits and reduce costs has never really materialized. These programs, like many government programs in other areas, were written in consultation with or in some cases actually by the drug and insurance industries. That “consultation” made sure any competition introduced wasn’t too onerous.

Letting Wal-Mart run the health care system would fix many of those problems. It’s a company that understands how low prices can build market share and thus increase profits. Furthermore, it’s a company with a culture of cutting costs that has shown no compunction in pushing suppliers to the wall over price. Wal-Mart has decided it can make money by applying its always-low-prices strategy to drugs and medical services. For example, in 2006, the company first rolled out a program to sell a long list of about 300 generic drugs for $4 a prescription. It added 24 more drugs to the list in 2007. The addition of over-the-counter generics is aimed at another trend: the increasing practice of drug-benefit plans to refuse to pay for such medications.

To see the rest of the article, click here.

Workers in certain industries can have more comfort in knowing that, even if they are fired, there is so much demand they should be able to find another job very quickly.

Talk of a recession and creeping unemployment rates are enough to make you wonder: Where can you find stability in unstable times? Kiplinger consulted career experts and combed through job trend data to come up with five industries that should provide safer havens to workers, no matter what the economy is doing. No matter what field you work in, you have the possibility of losing your job. But there are things you can do to protect yourself and increase your odds of getting another job, just in case.

Healthcare  
Many of the nation’s fastest-growing careers are in the health care industry, according to the Bureau of Labor Statistics. An increasingly aging population fuels demand in this field. Some specific jobs with stable prospects include doctor, nurse, pharmacist, physical therapist and physician assistant.

Education
Teachers for any grade level who specialize in high-demand fields such as math, science or bilingual education should have an easier time finding and keeping a job. And the outlook for college instructors looks stable, too. College enrollment is rising as the number of 18- to 24-year-olds increases. Some areas of the country are more stable than others for teachers because education jobs follow population trends. So teachers in fast-growing states in the South and West, such as Nevada, Arizona, Texas and Georgia, will have more opportunity than in slower-growth areas in the Midwest and Northeast.

Security
Crime doesn’t stop in a recession. That makes security jobs, such as police officers, detectives, private security guards and international security experts, a good bet. Layoffs in this industry are rare. In the off-chance law enforcement officers lose their jobs to budget cuts, they have little difficulty finding jobs with other agencies because demand is so high.

Environmental Sciences
The current “green” movement reaches far beyond changing your light bulbs to fluorescents. It’s also translating into a solid career choice. The BLS expects environmental careers, including ecologists, hydrologists, environmental chemists and others, to grow 25% over the next decade.

Government
Some of the most stable jobs around are within the federal government, where firings and lay-offs happen at just one-quarter the rate in the private sector. One reason: Even in hard economic times when big businesses are forced to downsize, the government must carry on. And only one in every 5,000 non-defense workers is ever fired for poor performance each year. Crazy odds! Due to an increasingly aging workforce, the government is doing a lot of hiring lately, especially among the 20-something crowd.

What perks would drive a normal person to consider the graveyard shift? 

Money money money! Yet money isn’t the only benefit. There are other intangibles, like greater autonomy, fewer meetings (all the higher-ups are sleeping!) and the likelihood of getting promoted sooner since there are less people to compete against.

1. Registered Nurse (RN)
Day Shift: $54,500 annually
Night Shift: $55,700 annually

2. Licensed Practical Nurse (LPN)
Day Shift: $36,300
Night Shift: $38,400

3. Certified Nurse Assistant (CNA)
Day Shift: $22,200
Night Shift: $22,600

4. Truck Driver
Day Shift: $31,300
Night Shift: $36,000

5. Bartender
Day Shift: $24,600
Night Shift: $31,200

6. Waiter/Waitress
Day Shift: $16,500
Night Shift: $22,500

7. Verizon telephone operator
Day shift: $890 weekly
Night shift: $979 weekly

8. Television writer/ news writer
Writers on the night shift get a 15% differential hourly rate.

9. Nanny
Night nannies generally start their shift at 2 p.m. and work until 10 p.m. They receive about 20% more than daytime nannies

10. Pharmacist
Median Total Cash Compensation: $97,700
Night Shift: differential varies significantly, from 2% to 10%

Have you ever flipped through a Men’s Health magazine?  

The book, “Eat This, Not That!” by Men’s Health editor-in-chief David Zinczenko writes about food choices at favorite restaurants, supermarkets and holiday items. The book includes a clever ranking of the country’s 20 worst foods in various categories. Here are some of them: 

Can Growth In Education and Health Save The Day?

640,000 new jobs from education and healthcare were created last year. Propelled by aging baby boomers and rising student enrollments, hospitals and schools are still hiring while almost everyone else is cutting back.

Could adding more nurses, teachers, and hospital orderlies really hold off a recession? The answer is yes. What people don’t realize is that health and education combined make up the single largest source of jobs in the U.S., employing 28 million people, or about 20% of the total workforce. What’s more, government funds support many of these jobs, either directly or indirectly, making them less subject to the business cycle. The hidden danger now is that fading tax revenues may cause state and local governments to cut back on their funding for schools and medical care.
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When Is It Time For Financial Intervention, Mom and Dad?

When does it make sense to search for a planner for your parents? In Jennifer Openshaw’s opinion, right now. It doesn’t matter what age or stage they’re at. Problem is, the majority of Americans wait until a crisis or retirement hovers over them to take action.

You can always use a triggering event to broach the topic, such as:

• A divorce

• An illness, even a short-term one. “What if this had been more serious?”

• Loss of income, even if minor. “What if [the primary breadwinner] lost his job?”

• A refinancing or a new loan. “Why did you need to refinance? Are you having some financial pressures?”

• Unpaid credit cards, other bills - a sign of trouble

Openshaw believes the keys to success in making this happen are:

1.) Remove yourself from the process. Don’t assume that just because you’ve been down the financial-planning road or invested your money yourself that you’re the one to handle it for your parents.

2.) Bring in an independent, fee-only adviser. Most advisers will only talk to you if you have $500,000 or $1 million in assets. That is, unless they sell commission-based products. Opt for an adviser geographically close to your parents, and one who is truly objective - meaning, they’ll charge by the hour, as high as $400 depending on where you live.

As part of her search, Openshaw developed a mini-RFP (request for proposal) that outlined my requirements (location, experience, references) and her needs. Those needs might include any of the following:

• Cash-flow (budgeting)

• Retirement planning

• Investments

• Insurance (life, but maybe long-term, too)

• Taxes

3.) Give them a say in the decision. Don’t forget to allow your parents the opportunity to meet and give the “go-ahead” with your planner.

Each of the following mistakes can cost you $100,000.

1.) Investing too conservatively during retirement. If you follow conventional wisdom and, as you approach retirement, shift money out of stocks into more stable investments you could miss many opportunities. Instead of parking too much of your assets in bonds, invest in an asset mix that leaves enough room for Standard & Poor’s 500 stock index.

2.) Launching a divorce war. A full courtroom showdown can easily cost $250,000. Try to soften the financial impact by using a lower-cost mediation option. Or try to work on saving your marriage.

3.) Underinsuring your home. If you’ve lived in the same house for at least 10 years, it’s probably worth 50% to 100% more than you paid for it. But if you haven’t updated your homeowners insurance, you could lose those gains if disaster strikes. Ask your insurer to reassess your home’s replacement cost and adjust coverage accordingly.

4.) Overpaying for your mortgage. The annual percentage rates on mortgages in a given area can vary by close to a percentage point. Over a typical 30-year term, this can cost you $27,000 on a $299,000 home. Shop for the best mortgage rate by checking local banks, your credit union, big-lender Web sites and mortgage-related sites.

5.) Maintaining an unhealthy lifestyle. Bad health habits not only catch up with you as you age but they can also hit you in the pocketbook in the form of higher life-insurance premiums. Before you apply for life insurance, consult your doctor about the best way to get your health status in line with the “preferred plus” underwriting requirements.

6.) Paying needless fund fees. If you buy mutual funds from a broker, you could pay a commission, or “load,” of up to 5.75%. Annual expenses can also vary among funds, from 1.5% or more a year to as little as 0.1%. Fix: Choose no-load mutual funds with low expense ratios. You can buy them directly from investment companies such as Fidelity, T. Rowe Price, and Vanguard.

 How Well Are You Dealing With Stress?

One-third of Americans are living with extreme stress and nearly half of Americans (48%) believe that their stress has increased over the past five years. Stress is taking a toll on people — contributing to health problems, poor relationships and lost productivity at work, according to a new national survey released today by the American Psychological Association (APA).

Money and work continue as the leading causes of stress for three quarters of Americans. Nearly half of all Americans report that stress has a negative impact on both their personal and professional lives. Stress causes more than half of Americans (54%) to fight with people close to them. One in four people report that they have been alienated from a friend or family member because of stress, with 8% connecting stress to divorce or separation.

Stress in America continues to escalate and is affecting every aspect of people’s lives — from work to personal relationships to sleep patterns and eating habits, as well as their health. Physical symptoms of stress include: fatigue); headache; upset stomach; muscle tension; change in appetite; teeth grinding; change in sex drive and feeling dizzy.  Psychological symptoms of stress include: experiencing irritability or anger,  feeling nervous, lack of energy and feeling as though you could cry.  In addition, almost half (48%) of Americans report lying awake at night due to stress.

While many Americans recognize that stress has a negative impact on their health, they may lack the motivation to make lifestyle and behavior changes. Only 35% report that they would modify their behavior following the diagnosis of a chronic condition. Encouragement from a spouse or partner would motivate 38% to make behavioral changes.

I have to agree that there is a lot of pressure to specialize.

1. “They should put me on the endangered-species list.”   A good primary-care doctor (someone to coordinate your health care, help choose your specialists and be the first to diagnose just about any problem) is the key to good medical treatment. But they’re getting harder to come by. Why? Fewer med students are going into primary care: Interest is so low that the number of primary-care internal medicine residency positions dropped by more than 50% in the past decade.

2. “I’m the pauper of my profession.” One big reason fewer medical students are specializing in primary care is pure and simple economics. In 2006 primary-care doctors earned an average of $171,519. That might sound like a lot to most working people, but it’s less than half of what dermatologists made that same year. And the call of more-lucrative specialities is only likely to get louder for today’s residents: According to one study, the income of primary-care doctors, adjusted for inflation, actually fell by 10% between 1995 and 2003.

3. “Sorry, your 12 minutes are up.” Some doctors are able to see 40 patients a day. That’s one every 12 minutes. And it doesn’t show signs of slowing: According to one survey the average number of patients doctors saw grew by 7.5% from 2004 to 2005. While this system isn’t inherently bad, it can be abused. Assistants may have a different philosophy from the doctor, leading them to treat problems differently as well. Communication can break down, causing confusion about medications, and a misdiagnosis by an assistant is always possible.

4. “I hawk for Big Pharma in my spare time.” Your physician relies on his best judgment when deciding what drugs to prescribe. And influencing that judgment is big business. Market-research firm IMS has found that the pharmaceutical industry spends $7.2 billion a year targeting doctors with ads and sales representatives.  Drug companies know doctors are more likely to take their cues from other doctors, so they sponsor weekend seminars at expensive resorts featuring presentations by physicians.

5. “Sore throat? You might be better off going to the mall.”  Walk-in clinics are springing up across the country. They’re run by nurse practitioners, who diagnose simple maladies, like strep throat or flu, and provide prescriptions, medical advice or referrals if the problem is beyond their scope. These clinics have caught on in part because they’re fast and don’t require an appointment. They’re also cheap — $40 to $60 a visit, versus $150 for a doctor or $300 for an ER visit — and many take insurance. Today there are about 460 such clinics, but analysts expect the number to jump to 4,000 by 2009.

6. “I hate technology.” Primary-care physicians have been slow to adopt the technology: A recent study found that only 28% use these systems. Why? They can cost up to $70,000, and cash-strapped GPs see little payoff. For most patients the benefits of the technology are huge. It eliminates prescription errors due to illegible handwriting. It ensures that patients get the right dosage. Records won’t get lost. It reminds doctors when they need to monitor their patients. And specialists and others can easily forward electronic records to your GP.

7. “Your insurance company is calling the shots.” These days doctors have more freedom to send you to a specialist or order expensive tests than they once did under managed care. But that doesn’t mean the system is fixed. With increased deductibles, it’s often the patient who foots the bill for a referral or an expensive test. Insurers also still wield the power when it comes to hospital stays.

8. “My legal history is none of your business.” Today’s insurance plans give patients a wider range of doctors to choose from, but patients don’t have any more information to help them decide. The best information about doctors is off-limits to patients. It’s the National Practitioner Data Bank, which state medical boards and hospitals use to do background checks, and it includes information on disciplinary actions and malpractice payments. The best publicly available information is tracked by state medical boards, many of which publish this information on their Web pages. If yours doesn’t, you can pay $9.95 for a report from DocInfo.org, a site run by the Federation of State Medical Boards.

9. “If you’re over 65, don’t bother me…” Doctors who specialize in geriatrics are increasingly rare. Right now there is just one geriatrician in the U.S. for every 5,000 seniors, about half of what we should have, according to the American Geriatrics Society. Treating older patients who have multiple, often complex problems is about the worst way a doctor can make a living. Medicare doesn’t compensate much more for a 45-minute appointment with a patient with dementia, hearing loss and a half-dozen other maladies than it does for seeing someone for a simple checkup.

10. “…unless, of course, you’re willing to pay extra.” Unfortunately, the shortage of geriatricians is worsening. The American Geriatrics Society estimates that by 2030, there will be a shortage of about 36,000 geriatricians in the U.S., up from 7,000 today. Though the situation seems dire, there are ways to guarantee qualified care. One approach is to see a good primary-care doctor who is also a geriatrician long before you need one. Other approaches can be costly. In Sarasota, Fla., many doctors provide “concierge” service: Patients pay an annual retainer of about $4,000 in exchange for their doctor’s cell number and upgraded access. These pricey options aren’t what most people have in mind when they think of health care reform, but they may be the only way to maintain ready access to a good doctor.

Many parents say they will do anything for their children. But that doesn’t mean you have to go out on a financial precipice. Median Price Per Child: $338,000  

Children born in the U.S. today will cost their parents more than $338,000, on average, by the time they graduate from a public college. Send your precious offspring to a private university, and you can expect to shell out an additional $70,300 for tuition. Think education is your only big tab? Think again. Just keeping a roof over junior’s head will cost nearly $105,000 through age 18. Food will eat up $41,400, and health care will set you back $17,400 over 18 years.

Experts say the best way to plan for many of the biggest expenditures, be it college, vacations, child care, summer camp, or a Bar Mitzvah, is to set aside individual reserves of cash for each goal.  Most people don’t do that. Instead, they just throw it on a credit card and worry about it later. A good plan is an automatic investment program that transfers money out of your bank account on a recurring basis. Businessweek asked financial planners and advisers for additional strategies and tips on planning and saving for some of the biggest costs of child rearing.

College: Since this is your biggest potential expenditure, start saving as soon as possible, ideally within the first year of your child’s birth. Your best bet is probably a what’s known as a 529 college savings plan because the money accrues tax-deferred—and some states let you put away as much as $300,000. Here’s a good calculator to give you an idea why you should start saving now.

Housing: Aside from college, one of the biggest costs associated with raising children is providing shelter, which amounts to more than $100,000 per child over an 18-year span. The bulk of those costs go toward a mortgage, property taxes, maintenance, repairs, utilities, and furnishings. You can save money by handling some home maintenance yourself—but only tasks you’re capable of doing well.

Food: It certainly helps to shop in bulk at stores like Costco and Sam’s Club, but make sure you bring a list and stick to it. Another smart way to keep food costs in line is to learn to cook.

Activities: Extracurricular activities can get very expensive, with an average cost of $35,000 over an 18-year period. While your son or daughter might play ice hockey for just five months out of the year, your best bet is to set money aside year-round to finance things like the cost of team membership, additional ice time, travel, and equipment. Though parents may want to expose kids to many different experiences, one way to limit expenses is to focus your children on a few activities they are passionate about.

Child and Health Care: Costs for child care and health care are significant, though they vary wildly around the country. Find out whether your employer offers a child-care or health-care flexible spending account. If you are in the 28% federal tax bracket and live in a state with a 5% tax rate, a $5,000 annual contribution saves you $1,650 in taxes.

California among worst in providing health insurance through jobs

The percentage of Californians who get health insurance through their jobs is among the lowest in the country. Nationwide, about 63% of Americans have health policies offered by their employers. But in California, only 55.7% of workers were covered through their jobs last year, making it the state with the fifth-lowest level of employer-sponsored coverage according to the study by the Economic Policy Institute in Washington.  The number of employers offering health insurance has fallen nationally in recent years due to rising premiums and the diminishing bargaining power of the average worker. Companies have responded to the pressure by requiring employees to pick up a larger portion of the tab, through higher co-payments and monthly contributions, and reducing benefits and coverage for spouses and children.

While low-wage workers had the lowest level of coverage, middle-wage employees in California saw the steepest decline in those offered insurance during the past five years. And more than 600,000 fewer children in California were covered by their parents’ insurance last year than in 2000.

In California, the problem is worse due to the sheer size of the population and the fact a large number of residents work in jobs that typically do not offer health insurance, such as agriculture, hospitality and the service industry. California, which has more than 6.5 million uninsured residents, is considered a leader among states proposing health reform. Everything that’s going on in the nation is going on in California in a big way - immigration, economic inequities, large employers, small employers. You have highly profitable companies and a lot who are just scrambling to get by,” states Jared Bernstein, senior economist with the Economic Policy Institute.