We all owe our individual and collective health not just to ourselves but to any army of Samaritans — our friends, families, colleagues, caregivers, and the many medical professionals who practice at the highest levels of skill and compassion.

It’s tempting, especially when immersed in the ways that health care in this nation falls short, to turn from healthy skepticism to corrosive cynicism. But for this holiday in particular, let’s all give special thanks for those who practice the healing arts. Many of them will leave loved ones and work long hours over Thanksgiving, and not just because of a fee or a charge but to improve the lives of the sick and needy.

With all the adverse, if not hostile reaction Americans are showing in recent days to people beyond our shores, it’s also worth reminding ourselves that the call to help humanity truly is deep and universal. We can learn and be humbled by what others accomplish, including in health and medicine, with resources so much more spare than we can marshal, spending as we do, and, as the Organization for Economic Cooperation and Development notes, at the pinnacle for healthcare and not always seeing equivalent, positive outcomes.

But what if the money just wasn’t there? In Nepal, as New York Times columnist Nicholas Kristof has reported recently, an eye doctor improvises and ends up with a cheap, fast way to restore the sight to tens of thousands of blind people. Western practitioners derided Dr. Sanduk Ruit until his cataract microsurgery was subjected to a randomized trial whose results were published and showed his outcomes, with a 98 percent success rate, were the equal or better of Western counterparts. Further, his procedure costs $25 or so, while published data on cataract surgeries, without costly machines, run more than $3,400 per eye. Ruit has expanded his pioneering technique into a broad practice and it treats more than 30,000 poor across the region, people who otherwise would be doomed to darkness and even greater economic depredation; he charges a small fee to half the patients but treats the others for free.

Meantime, Dr. Devi Shetti also merits mention: He’s an Indian cardiologist who has built a large-scale heart care system that seeks to provide services to those in most dire need but least able to pay with what National Public Radio terms “cardiac care Henry Ford style.” He left a $350,000-a-year practice in Miami to return to his native land, where he tussles with vendors, especially those from the industrial west, about every cost, knowing his patients may be selling their homes or sole source of sustenance (a cow) to cover a loved one’s care. He has shown that prices can be driven substantially lower. He and his five dozen colleagues perform more than 14,000 procedures annually and at a fraction of the cost. Their break even number now, the doctor says, is $1,200 per patient, though he thinks it can go lower; compare that with the United States, where, for example, a bypass procedure in 2013 in the Midwest cost more than $100,000. Those who can pay do but more than half his patients receive cost-free care. Recognizing a huge inequity in a land he clearly loves, the doctor never even discusses payment for girls who are his patients; he knows their parents might otherwise neglect such children solely because of their gender.

Here’s hoping that practitioners like Ruit and Shetti advance their work in helping the needy and poor even more and that their Western counterparts, our caregivers, find due inspiration in their accomplishment.

I’m grateful for the time and consideration my family, friends, colleagues, and clients give to me, my practice and our collective health. Thank you to all on this special holiday.

The epidemic of overtreatment is hardly new, and it often stems from physicians’ tendency to order excessive tests. But now Uncle Sam is getting ready to step in even more, prompted in part by disturbing data that detailed serious inaccuracies and flawed results with 20 case studies involving diagnostic tests for cancer, heart disease, autism, and Lyme disease.

As the New York Times described it, “one blood test to help detect ovarian cancer was never shown to be effective … but was used anyway. False-positive tests may have led to ‘unnecessary surgery to remove healthy ovaries.’ Pregnant women have considered or had abortions because other tests inaccurately indicated abnormalities in the fetus. Several tests now on the market detect a genetic variant that was once thought to increase the risk of heart disease, a link that has not been confirmed. Yet more than 150,000 people have been given these tests … and ‘many were likely over- or under-treated with statins,’ cholesterol-lowering drugs, at a cost estimated at more than $2.4 billion.”

More oversight of testing labs

To slash excess cost and to try to make health care more affordable, the Obama Administration, the Times reported, is seeking to step up regulation of diagnostic tests run out of a single laboratory. These tests have gotten complex and have not had as much oversight by the Food and Drug Administration, which, instead, traditionally has regulated testing run by multiple labs offering” commercial test kits.” Federal regulators required operators of the multiple lab tests to report recalls or incidences which their products contributed to patients’ harm or deaths.

Any moves to step up federal regulation of diagnostic testing, however, may run into a partisan divide, with the newspaper saying that Republicans, though split, will oppose it and Democrats will favor it.

Ask these four tough questions

So where does that leave patients? Perhaps, as I have stressed, with a big need for caveat emptor when the folks in white coats run at you, wanting to run the gamut of medical possibilities absent best practice and common sense.

The cardiology crowd, for example, has been struggling for a year or so with the results of research by Harvard, RAND, and USC, that found that the highest-risk cardiac patients had the best 30-day outcomes at some of the nation’s best hospitals when the top heart docs happened to be out of the house at medical conferences.

Ezekiel Emmanuel, an oncologist writing in the Times, not only runs down reasons why, including elite physicians’ reliance on aggressive testing and treatment regimens, he also offers four, tough, and likely uncomfortable questions that patients can insist their doctors answer about their care:

“First, what difference will it make? Will the test results change our approach to treatment? Second, how much improvement in terms of prolongation of life, reduction in risk of a heart attack or other problem is the treatment actually going to make? Third, how likely and severe are the side effects? And fourth, is the hospital a teaching hospital? [Studies have] found that mortality was higher overall at non-teaching hospitals.”

PSA test curbs working

When medical groups, physicians, and patients think through better care, by the way, the results can be significant: New research, for example, has found that a guidance is succeeding in getting MDs to curb excessive prostate cancer screening. After studying data about the protein specific antigen or PSA prostate cancer test, the U.S. Preventive Services Task Force, urged physicians, starting in 2011 and finalizing its recommendation in 2012, to reduce the wide, routine administration of the screening.

The testing rate declined 16% in 2012 versus the year before, the new American Cancer Society study finds.

Just to be clear: If men have a cancer history, individual or familial, or if they have other risk factors, the PSA test may be called for still. But the research has raised questions about the effectiveness of the PSA test and whether it detects cancers that will grow so slowly and not harm patients as much as aggressive treatments might.

The guidance remains controversial, with some specialists worrying that men, already reluctant patients, and now with their physicians’ support, may forego a test that could be valuable.

Just a reminder to the health conscious: Make moderation your motto during the holiday eating season. And, if you’re heeding the Food and Drug Administration, it’s worth considering capping the amount of sugar you take in as part of your daily diet in the days ahead. That means, just for starters, no sugary soft drinks.

The agency for the first time, as the New York Times has reported, set a goal “for Americans to limit added sugar to no more than 10 percent of daily calories … For someone older than 3, that means eating no more than 12.5 teaspoons, or 50 grams, of it a day. That’s about the same amount of sugar found in a can of Coke, but for most people, giving up sugary soft drinks will not be enough to meet the recommendations. Caloric sweeteners like sugar, honey and high-fructose corn syrup are found in obvious places like sodas, cookies and candy — but they are also lurking in foods with health appeal, like low-fat yogurt, granola and wholegrain breads, as well as in ketchup, pasta sauce, canned fruit and prepared soups, salad dressings and marinades.”

FDA officials, to the furor of the sugar industry, previously had called for more detailed labeling on packaged foods, disclosing the amounts of added sugars they contain as a percentage of the daily caloric intake.

If you haven’t had your head stuck in a honey pot and missed the medical research that increasingly shows the health harms from Americans’ excess consumption of sugar, and especially the damage that the giant national sweet tooth inflicts on youngsters, here’s just one of many studies, this one on sugar’s role in increasing cardiovascular risk.

Americans craving for and consumption of sugary calories, of course, also has been implicated in the nation’s obesity nightmare. Obesity rates, despite extensive campaigning otherwise, are creeping up still, and the problems are worsening for women.

For a nation that’s 238 years old, America can be remarkably immature in certain ways — take, for example, in its thinking about sex. Maybe if we weren’t so adolescent about this life-giving topic, we wouldn’t have been subjected to some of the recent, tawdry, and distressing reports from yes, both celebrities and scientists.

HIV-AIDS persists as one of the nation’s major public health challenges, as the U.S. Office for Disease Prevention and Health Promotion points out, noting: An estimated 1.1 million Americans are living with HIV, and 1 out of 5 people with HIV do not know they have it.HIV continues to spread, leading to about 56,000 new HIV infections each year.” Retrovirals have allowed millions to live and live better with HIV as a serious, chronic disease.

But surely the public discourse on HIV should not be dominated by the sad hijinks of the likes of television star Charlie Sheen, who took to the airwaves, along with tut-tut commentaries that followed, to disclose his HIV-positive status and the wealth-soaked lifestyle that contributed to it. His ostensible reason for his broadcast appearance, he said, was to encourage others’ greater HIV awareness and to urge the sexually active to get tested regularly for the disease. Of course he also said that his new-found candor will allow him to cut off the millions of dollars he has paid to keep his status secret.

(One detail that was both timely and ultra-creepy was the disclosure that Sheen made guests at his house sign an arbitration agreement upon arrival, no doubt to ensure swift “justice” should any controversies arise. See the recent New York Times series about how “forced arbitration” has privatized lawsuits and in the process wreaked havoc on usual standards of fair play in American civil justice.)

The ignoble  celebrity might possibly be ignored were it not for some ignorance piling on — witness the jaw-dropping public interview given by the chief executive of Tinder, an app used by the young to facilitate sexual encounters or hook-ups. Sean Rad, 29, said he was addicted to Tinder and hook-ups, further disclosing that he doesn’t understand the difference between sodomy and sapiosexuality (a trendy term for preferring partners with brains). Well, alrighty then. What made his comments attention-grabbing was that they were made at all — Tinder is part of a larger company, Match, which is about to go public, with a valuation estimated at $4.2 billion. The company is in the midst of what is known as the quiet period when investors deliberate and regulators see corporate silence as a virtue in the consideration process.

The temptation might be to tell Charlie and Sean and their ilk to just grow up, man. But maybe that’s what Americans collectively need to do about sex, including talking openly about it in more mature ways, including condom use and other ways to safer sex. And the Centers for Disease Control and Prevention has provided a stark reason why: The agency has reported that, for the first time since 2006, three sexually transmitted diseases — chlamydia, syphilis, and gonorhhea — have increased and at “an alarming rate.”

Let’s all get a clue: The CDC ties young people, especially a small segment of the population ages 15 to 24, to the sharp rises in chlamydia and gonorhhea. Chlamydia can be cured and needs to be treated to avert major harm to women’s fertility. Gonorhhea often is spread without detection, is showing increasing resistance to treatment, and can cause serious health harms.

As for primary and secondary syphilis infections, the agency says these are increasing steeply among gay and bisexual men. The CDC has called for heightened research on why, noting that half these infections involved men who also were HIV positive. Although treatable in its early phases, syphilis often goes undetected and if allowed to progress, it can lead to paralysis, blindness, dementia, and great harm to fertility. The CDC noted that societal attitudes, including homophobia, may contribute to risky, detrimental health behaviors among gay and bisexual men, fueling their STD woes.

It’s, frankly speaking, more than a bit mind-boggling that dated taboos about private behavior still contribute to the spread and damage of ancient sexual diseases. It’s past time for us to talk with our children, families, friends, and fellow Americans about how we can have healthy sex and to be open about the best ways to do so, safely.

Cigarette+butts+in+ash+trayAs I’ve just written in my monthly Better Health Care newsletter, smoking is a pernicious addiction with startling persistence. But at least, as the Centers for Disease Control and Prevention has reported, this nasty habit has fallen to its lowest rate in generations, with the agency, sadly, pinpointing the populations still puffing away and suffering for it.

As the Washington Post summarized the latest agency data: “Among the 17 percent of adults who still smoke … People in the Midwest …[do so] more on average than Americans elsewhere in the country. People on Medicaid are more than twice as likely to smoke as those on Medicare. Adults with a GED certificate smoke at eight times the rate of those with graduate degrees. Asians smoke less than other ethnic groups. Men smoke more than women, but not by much.”

Because we know that smoking is the No. 1 cause of preventable cancers (not to mention heart attack and other killers), and cancer is a costly and difficult disease, the information that poor, sick, disabled, and less educated Americans still are heavy tobacco users is disheartening and frustrating. The very week that the CDC released its latest smoking information, USA Today posted its report on how dismally the rural poor fare with cancer and in getting needed care for a disease that has become, for many others, a chronic and not a fatal condition.

The Obama Administration, meantime, has just announced an anti-smoking “stick” targeted at getting the poor to quit but infuriating many of them in the process. The administration, through the Department of Housing and Urban Development, has proposed a ban on smoking in public housing nationwide. The ban would hit projects in big cities hard, will be a challenge to enforce, and, residents are complaining about Big Brother interference in their lives in the private confines of what they call home.

But the Times cites a CDC study estimating that “a nationwide smoke-free public housing policy would result in annual cost savings of about $153 million, including $94 million in health care, $43 million in reduced costs for painting and cleaning smoke-damaged units, and $16 million in averted fire losses.” Not to mention, if the smoking ban prods some residents to quit, lives saved.

As I discussed in the newsletter, lifestyle changes, especially like quitting smoking, can be significant in preventing cancer.

The Los Angeles Times, in detailing a decades-long effort to maintain an invaluable cancer registry cataloging 1.7 million cases in Southern California, offers further insight into this issue and the difficulty public health officials confront in tackling this disease. The paper, for example, says that registry data revealed the need for women of Japanese descent to reconsider diet and exercise in preventing cancer. When Japanese women first immigrate to the United States, they had eaten low-fat, plant-based diets, had babies earlier in their lives, and got lots of exercise, mostly through farming. But soon they were assimilated, eating Western diets, delaying childbirth, and more sedentary than their before. Their breast cancer rates soared to the highs experienced by longtime white female U.S. residents.

Let’s give credit where it’s due: Transplant surgery, in popular lore, has become one of modern medicine’s most miraculous practices, not only saving individual lives but also blazing new frontiers about the functions of organs in the body and providing insights of large significance into the workings of the human immune system. This progress hasn’t come without considerable cost to health care as a whole — and recent developments should prompt some deep thinking on how transplants work now.

First, let’s look at the disturbing study that suggests that wealth gives patients needing a transplant an edge when it comes to getting an organ. As the Associated Press notes in describing the research just presented to the American Heart Association, “You can’t buy hearts, kidneys or other organs but money can still help you get one. Wealthy people are more likely to get on multiple waiting lists and score a transplant, and less likely to die while waiting for one …[This work] confirms what many have long suspected — the rich have advantages even in a system designed to steer organs to the sickest patients and those who have waited longest. Wealthier people can better afford the tests and travel to get on more than one transplant center’s waiting list, and the new study shows how much this pays off.”

Who is to blame for this seeming inequity or gaming of the system? The United Network for Organ Sharing, or UNOS, has a government contract to run the system that decides who among 100,000 Americans waiting for various organs will get one suitable for transplant. The independent body “considers medical urgency, tissue type, distance from the donor, time spent on the waiting list and other factors.” Despite criticism of its practices, such as occurred when Apple tycoon and California resident Steve Jobs got on the liver transplant list in Tennessee, UNOS allows patients to traverse the country seeking the optimal situation for themselves and possible procedures. To even get on the lists, however, the patients–each time–must fork over, depending on the organ the need, anywhere from $23,000 to $51,000 for various suitability tests. Ouch.

Popular accounts about transplantation — feature stories with winsome kids or huggable grandmas — often also don’t describe the monetary toll of the procedures. In 2014, for example, almost 2,000 patients had heart transplants, procedures with an estimated, billed cost of $1.2 million each; 29 patients had complex heart-lung transplants, with a price tag of $2.3 million each.  Further, patients typically need to spend time before and after their transplant in serious, hospital care; they then face a lifetime of health challenges, including extensive medication regimens. They spend their own money (for example, to get to and from care) but insurance and government programs often must pick up a big portion of these hefty tabs. In other words, all of us bear a share.

It’s also only rarely discussed but, as current practice holds, the transplant approval process tries to minimize judgments as to how individuals arrived at their need for an organ; those who abuse alcohol or drugs and damage their livers, for example, must demonstrate sobriety for a period while under consideration for transplant — but they are not denied access to the life-saving receipt of an organ.

So are cost-conscious and ethical considerations already weighty enough in this field? Just wait. As the New York Times has reported, surgeons at the Cleveland Clinic hope to pioneer uterine transplants to address infertility in select patients who can meet some hefty prerequisites, including the ability to pay, at least, for their travel and stay in the Midwest for the preparation, five-hour surgery, and recovery. Doctors who considered whether to pursue the challenging process of making uterine transplant a more standard procedure recognized, they say, that it will not be life saving. But they said this type of surgery “has broadened to include improving quality of life, with for example, face and hand transplants.”

The physician who has driven the effort to try uterine transplants, which have been performed elsewhere but rarely and with mixed success in terms of patients bearing healthy children, is quoted in the Times as saying: “There are women who won’t adopt or have surrogates, for reasons that are personal, cultural or religious. These women know exactly what this is about. They’re informed of the risks and benefits. They have a lot of time to think about it, and think about it again.”

Good thing. It’s something all of us who are part of and pay for the healthcare system need to join.

Magical thinking moves all too many Americans to pursue strange ways to improve their health, even if the risks are hugely apparent and the rewards wildly open to question. Just consider:

  • Would you immerse yourself for supposed health reasons in a sub-zero controlled climate “colder than the coldest naturally occurring temperature recorded on Earth” or allow an object so frigid that it burns to be applied to parts of your body?
  • Would you lash together an everyday 9-volt battery with wires and electrodes purchased at any old electronics shop, and zap yourself in the head, hoping to improve your cognition?
  • Would you simmer beef or pork bones and vegetables in ordinary tap water in a pan on your home stove, then believe that the resultant broth would “detoxify your liver, lubricate your stiff joints, patch up the holes in your gut, and erase your wrinkles,” as well as help to heal a ruptured Achilles’ tendon?
  • Would you guzzle a supposedly healthier, tea-like fermented brew called kombucha that many Asians gag at and that “tastes a lot like vinegar and can sport tendrils of live cultures that resemble jellyfish?” (Oh, and by the way, this concoction has surprisingly high amounts of alcohol in it.)

Oh, my. If you’re a dedicated consumer of health and healthcare information, you’d see reports like these and wonder if the Holy See hadn’t already long ago apologized to Galileo and the world hadn’t journeyed far into an age of science, and more particularly, a time of greater education, widespread skepticism, and know-how about evidence-based medicine.

Well, check that. As the Wall Street Journal reports, cardiologists, it seems, have started to regain their perspective on a familiar, all-too-common remedy: heart stents. As the Journal notes:  “Unnecessary use of … stents to clear blockages in diseased coronary arteries fell by about 50 percent between 2010 and 2014. The drop came after new practice guidelines were issued in 2009 as a quality improvement strategy designed to discourage stent use in patients with stable disease and minimal symptoms of chest pain.”

It seems that doctors saw great results when they implanted stents to open blocked heart paths when patients were in the midst of heart attacks and thought, without due proof, that the devices would be more generally beneficial to cardiac patients. Hundreds of thousands of patients have been stented before further research showed that many didn’t benefit. This magical thinking led to costly, wasteful, and inappropriate procedures, a new study finds. Though surgeons appear to have curtailed the procedure, the researchers also noted that it may be that doctors and hospitals are using different billing codings to make this seem so.

As I’ve said before, modern medicine, indeed, offers myriad miracles. But careful, thoughtful, and skeptical consideration needs to be given to all healthcare practices.

Skull_X-ray_-_lateral_viewAmericans may be thick-headed about many things. But slowly, it seems, our collective consciousness is rising about the risks our favorite pastimes pose to our health. A spate of indicators suggest that, finally, even die-hard fans and resistant organizations are recognizing the brutal havoc that sports like football and even soccer can wreak on the brain, especially in young players.

The U.S. Soccer Federation, for example, has announced that it will recommend that players age 10 and younger be banned from headers and that those ages 11 to 13 be limited in how they make contact between their heads and the soccer ball, the Associated Press has reported. The soccer governing body also has said that medical professionals — who must be present in the group’s development academy matches — and not coaches should make the call as to whether players suspected of suffering a concussion during a game may return to play.

These and other positive steps to better protect young competitors, it should be noted, occurred only because parents and players in San Francisco filed a federal lawsuit against a bevy of soccer organizations. Settling that suit with more protections for aspiring athletes is yet another rebuke to those who denigrate the real and effective role that the civil justice system can play in getting big, all too often intransigent institutions to improve the safeguards of public health and wellness.

Attention has grown steadily to the harm of head trauma in all sports, especially for youngsters whose brains and nervous systems are in the midst of critical growth and development. Girls are at risk when they play soccer, studies have found, and for boys, it’s not just headers but collisions that pose perils.

Americans’ favorite sport — football — has only haltingly come to grips with its epidemic onslaught of head injury-related issues. It took a class-action suit before the NFL responded with a settlement that will cost the league more than $1 billion but also allows it to keep from the public detailed information as to what pro football knew and when about the horrors of head injuries among its legions of now high-paid stars. It’s also unclear how much care the harmed players will require over their lives and whether, even with the sizable sums pledged by the league, the concussion class action suit will be a fair, good deal for them.

Meantime, public sentiment is shifting visibly away from relentless, unquestioning cheering for the sport that tens of millions of us watch and play: A New York Times columnist has asked the tough question whether our affection will fade for football and its bone-jarring violence, as it did with the bare-knuckle and once hugely popular sport of boxing. Hollywood also soon will launch its own surprising salvo at the game with the holiday debut of the movie Concussion.

As for parents, a sensible approach to kids’ safety in sports needn’t take the joy and spirit out of sports. A number of organizations, including the Centers for Disease Control and Prevention and the American academies of pediatrics and neurology, have launched initiatives and provide resources focused on protecting young athletes’ brain health and, even in football, as the Wall Street Journal points out, fun alternatives are rising, such as increasingly popular flag football leagues.

Just in time for Friday the 13th: Tired of the office jocks chin-wagging all day long about the Skins, Nats, Caps, and whatever? Weary of hearing other colleagues chatter about Kardashians, haute coture, or activities in trendy clubs with names that can’t be mentioned in family settings? Here’s a bizarre health-related topic that’s guaranteed to cause some jaws to drop around the water cooler. Don’t talk about this at the lunch or dinner table. But, curiously, there are two, bona fide recent reports on the skin-crawling topic of tapeworms and the harms they can cause. Ick, we know.

The first news item comes from no less than the Centers for Disease Control and Prevention and the New England Journal of Medicine about a curious case out of Colombia where an HIV-immune compromised patient presented with unusual tumors in his lungs and lymph nodes. Rounds of tests finally revealed that his cancer-like growths were tied to the 41-year-old man’s infection with Hymenolepis nana, the dwarf tapeworm. The tiny bug, which infects as many as 75 million globally (but rarely in the U.S.), had its own cancer and appears to have given it to its host, who, by the way, died of HIV complications — restricting further study on this odd case. Researchers, for example, don’t know if they had detected the worm-cancer linkage if killing the parasites would have helped.

Enough? Well, how about this report from the Los Angeles Times about a Napa, Calif., student who was suffering debilitating skull pain and was hours from death when surgeons discovered the cause of his affliction: a tiny cyst in a ventricle in his brain, encapsulating a still live scolex — the sucker portion a tapeworm uses to attach itself to its human host. How that varmint tissue survived and traveled deep into the young man’s brain isn’t known, the paper says, but the patient had complained for weeks of increasingly worsening symptoms, including dizziness, blackouts, and crushing headaches so severe they made him vomit.

Caveat emptor about these creepy yarns: There are many varieties of tapeworms, and their infections are rare in the U.S., with fewer than 1,000 cases reported annually, the CDC says. Most incidents involve individuals who eat raw or undercook pork or beef or who paddle around in murky, infected waters. The parasites are sadly prevalent still in undeveloped parts of Latin America, Asia, and Africa, of course, and with our interconnected planet these days, well, who knows. Maybe by discussing extreme cases we can get friends and family to listen to more ordinary but valuable health counsel?

November has become more than the month devoted to families and feasting: It’s now the start of the season when Americans try like heck to avoid becoming health insurance turkeys. Open enrollment periods are under way — for those who get their health insurance under the Affordable Care Act, aka Obamacare, and for millions covered by Medicare, as well as for the myriad U.S. workers insured under company health policies.

This is a daunting time when Americans are asked to decide on the kinds and levels of health care and coverages they want, and an array of options gets rolled out. Captive consumers are supposed to comprehend them all on the fly. As the New York Times points out, insurance, especially health plans, almost inevitably confuse, and most of us make a lot of bad choices.

It doesn’t have to be this way. The federal government web site, healthcare.gov, offers lots of information for those seeking Obamacare coverages; various organizations have put up online briefings on what you need to know about health insurance. The Henry J. Kaiser Family Foundation has even created online cartoons, breaking health insurance information down to its basics.

Because coverages vary and needs are highly individualized, it’s tough to advise exactly what consumers should to about their 2016 health insurance: Take the time, though, to shop carefully. For families, a lot of money’s at stake. Be sure you’re not paying for too much or too little prospective care and that the care-givers you want and the care you hope for is covered. Equally important, insurance coverage plays a critical role in maintaining health — whether providing preventive care or protecting individuals and families from big financial shocks if they must deal with catastrophic circumstance. So, struggle through, get the needed tasks done early — and reward yourself with a little extra pie in a less stressful holiday ahead.

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