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Advantages of using a brokerage account to hold an HSA
Use a Brokerage Company to Hold your HSA

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Health Savings Accounts (HSAs) have gained popularity in the United States as a tax-advantaged way for individuals and families to save and pay for healthcare expenses. These accounts come with several advantages and disadvantages, which are important to consider when evaluating their suitability for your financial situation and healthcare needs.

If you have even a modest amount of money that you can set aside for the future, consider using the HSA. While it may seem like a modest amount of money to set aside, incrementally it can be substantial by the time you reach retirement. It costs very little in administrative fees to use most brokerage firms. The advantage is that any unused contributions roll over to the next year, and the years that follow, growing with time. Insurance companies generally take any unused funds at the end of the year, and keep them.

Advantages of HSAs:

  1. Tax Benefits: One of the primary advantages of HSAs is the tax benefits they offer. Contributions made to an HSA are tax-deductible, and any interest or investment gains within the account are tax-free.

  2. Triple Tax Advantage: HSAs offer a triple tax advantage, as contributions are tax-deductible, earnings are tax-free, and withdrawals for qualified medical expenses are tax-free. This makes HSAs a powerful tax-advantaged savings tool.

  3. Flexible Use: Funds in an HSA can be used for a wide range of qualified medical expenses, including doctor's visits, prescription medications, dental care, and even some over-the-counter items. The flexibility in spending is a significant advantage.

  4. Portability: HSAs are portable, meaning you can take the account with you if you change jobs or insurance plans. This allows you to continue using the funds for healthcare expenses in different situations.

  5. Roll-over: Unlike Flexible Spending Accounts (FSAs), HSA funds roll over from year to year, so there's no "use it or lose it" requirement. This provides long-term savings potential.

Disadvantages of HSAs:

  1. High Deductible Requirement: To be eligible for an HSA, you must be enrolled in a High Deductible Health Plan (HDHP). These plans come with higher deductibles, which can be a disadvantage if you have significant healthcare expenses.

  2. Limited Contribution Amounts: There are annual contribution limits for HSAs. While they have increased over the years, they may not be sufficient to cover all medical expenses, especially for those with chronic conditions.

  3. Not for Everyone: HSAs may not be suitable for individuals with high healthcare needs or low income, as they may struggle to fund the account adequately or face financial strain from the high deductible.

  4. Penalties for Non-Qualified Expenses: If you withdraw funds from your HSA for non-qualified expenses before age 65, you'll face a 20% penalty, in addition to paying income tax on the withdrawal. This can deter misuse but may also limit access to your savings.

  5. Investment Risk: While HSAs can be invested in stocks, bonds, or mutual funds for potential growth, there's also the risk of losing money due to market fluctuations. Some individuals may prefer more stable savings options.

  6. Complex Rules: HSAs come with rules and regulations that can be confusing for some people. It's essential to understand the eligibility criteria, contribution limits, and qualified expenses to make the most of the account.

  7. If you enroll in Social Security you will be automatically enrolled in Medicare Part A, which will disqualify you from contributing to an HSA.

Using a brokerage firm for your Health Savings Account (HSA) has certain advantages over going through an insurance company. Here are some of the key benefits:

  1. Investment Options: Brokerage HSAs typically offer a wider range of investment options compared to HSAs provided by insurance companies. With a brokerage HSA, you can invest in a variety of assets such as stocks, bonds, mutual funds, and exchange-traded funds (ETFs). This can potentially lead to higher returns on your HSA funds compared to a traditional savings account offered by an insurance company.

  2. Greater Control: When you use a brokerage HSA, you have more control over how your HSA funds are invested. You can tailor your investment strategy to your risk tolerance and financial goals, which can be beneficial if you have a longer investment horizon and want to maximize the growth of your HSA.

  3. Lower Fees: Brokerage HSA accounts often have lower fees compared to HSAs offered by insurance companies. These lower fees can result in more of your contributions being invested and growing over time, rather than being used to cover administrative costs.

  4. Flexibility: Brokerage HSAs offer flexibility in terms of investment choices, and you can manage your investments to suit your financial objectives. This can be particularly advantageous for individuals who are comfortable making investment decisions and want to grow their HSA funds over the long term.

  5. Diversification: With a brokerage HSA, you can diversify your investments across different asset classes, reducing risk and potentially improving the performance of your HSA. Diversification can be challenging to achieve in a traditional HSA savings account provided by an insurance company.

  6. Potential for Higher Returns: By investing your HSA funds in a brokerage account, you have the potential to earn higher returns over time, which can help your HSA grow faster and cover more of your healthcare expenses in the future.

While brokerage HSAs have their advantages, it's important to consider a few potential disadvantages as well:

  1. Risk: Investing in a brokerage HSA carries investment risk, which means that your HSA funds can fluctuate in value. If the market experiences downturns, you may lose money, which can be a disadvantage for individuals who prefer a more conservative, low-risk approach.

  2. Expertise Required: Managing investments in a brokerage HSA requires some level of investment knowledge and experience. If you are not comfortable with investment decisions or don't have the time to manage your investments, you may prefer the simplicity of an insurance company HSA.

  3. Fees and Costs: While brokerage HSA fees can be lower than insurance company fees, they still exist. You should be aware of these fees and how they can impact your overall returns.

  4. Administrative Complexity: Brokerage HSAs can be more administratively complex than traditional HSA savings accounts. You'll need to monitor your investments, make asset allocation decisions, and potentially deal with tax reporting requirements.

NOTE: With many insurance company sponsored HSA's, it is a 'use it or lose it' proposition. Any money you do not spend by being frugal goes back to the insurance company.

With a bank or broker, any unused funds remains in the account and hopefully grows over the years. It remains with you, to be used for health related problems, or it becomes part of your estate.


In summary, HSAs offer significant tax advantages and flexibility for those who can manage the high deductible requirement and are willing to invest time in understanding the rules. However, they may not be suitable for everyone, particularly those with high healthcare expenses or limited income. Evaluating your financial situation and healthcare needs is crucial in determining whether an HSA is the right choice for you.

David S. Klein, MD, FACA, FACPM

1917 Boothe Circle

Longwood, Florida 32750

Tel: 407-679-3337

Fax: 407-678-7246

Bronchitis is a common respiratory condition characterized by inflammation of the bronchial tubes, which are the air passages that connect the windpipe (trachea) to the lungs. It can be caused by viral or bacterial infections, as well as exposure to irritants like cigarette smoke, air pollution, or dust. My case followed a severe infection caused by a bacterium, Mycoplasma Pneumoniae. The inflammation in the bronchial tubes results in increased mucus production, leading to symptoms such as a persistent cough, chest discomfort, and difficulty breathing.

There are two main types of bronchitis: acute bronchitis and chronic bronchitis. Acute bronchitis is often short-lived and typically caused by viral infections, like the common cold or the flu. It can resolve on its own or with supportive care. On the other hand, chronic bronchitis is a more long-term condition usually associated with smoking or prolonged exposure to irritants, or following pulmonary infections, bacterial, viral and/or fungal.

Treatment for bronchitis depends on the underlying cause. In cases of acute bronchitis, treatment typically focuses on managing symptoms and includes rest, hydration, and over-the-counter medications to alleviate cough and fever. For chronic bronchitis, the primary approach is to quit smoking if applicable, and healthcare providers may prescribe medications to open the airways and reduce inflammation. In either case, it's essential to consult a healthcare professional for a proper diagnosis and guidance on managing the condition effectively. Antibiotics may be indicated, selection is guided by sputum culture, but more precisely with Respiratory PCR testing.

What is sputum?

Sputum is a term used to describe the mucus or phlegm that is coughed up from the respiratory tract, including the bronchial tubes, and expelled from the mouth. In the context of bronchitis, sputum plays a significant role as it is one of the hallmark symptoms of the condition. When a person develops bronchitis, the bronchial tubes become inflamed, and the body responds by producing excess mucus as a protective mechanism. This mucus can be clear, white, yellow, green, or even blood-tinged, depending on the severity and the underlying cause of the bronchitis.

The color and consistency of sputum can provide valuable information to healthcare providers when diagnosing bronchitis. For example, yellow or green sputum is often associated with bacterial infections, while clear or white sputum may indicate a viral cause. Blood-tinged sputum could be a sign of more severe irritation or inflammation in the airways. Monitoring changes in sputum can help healthcare professionals determine the progression of the condition and guide treatment decisions. Sputum analysis, along with other clinical assessments, aids in tailoring the most appropriate treatment plan, whether it involves antibiotics for bacterial bronchitis, antiviral medications for viral bronchitis, or bronchodilators and anti-inflammatory drugs to relieve symptoms and reduce inflammation.

Clearing that pesky mucus from the lungs. First things first, get the junk out!

The Flutter Valve for Mucous Clearance

What is an asthmatic without the obligatory 'inhaler.' Used by physicians for many decades, these portable devices have delivered life-saving medications at the moment that the medication is needed. Sprayed directly into the mouth, timed precisely with inspiration, and after significant practice, the asthmatic might get it right.

The Incentive Spirometer for Increasing Depth of Breathing

There is a simple device, remarkably inexpensive, that takes much of the worry out of timing the 'squeeze.' Teaching a child to do it right is very difficult, expensive if you consider the waste of medicine that is involved in 'practicing.'

The Philips Respironics Optichamber makes it very easy to administer the bronchodilator and increases the amount of medication delivered to the lungs by around 60%. I have patients that are able to get by with one puff instead of two on their Ventolin, saving more than a few dollars by reducing the frequency of inhaler refill.Sel

The 'Spacer' for an Inhaler to Increase Efficiency of Asthmatic Inhalers

I found that you can get these with a detachable mask, something that might be worth having around, but it works very well if you place the mouthpiece directly in your mouth.

The Inhaler, mine is Ventolin (albuterol, Ventolin is the better of the generics)

attaches on the opposite side of the chamber.

  1. Attach your inhaler mouthpiece to the opening in the spacer.

  2. Shake the inhaler, before each use.

  3. Exhale and just as you begin to inhale slowly, you actuate the inhaler into the chamber.

  4. Precise timing is not essential as it is without the Spacer. This device is equipped with a high volume whistle that fires if you inhale 'too fast.' Perfect feedback, actually.

The need for self help became obvious after my first hospitalization for pneumonia: My First Impression

I was admitted in January 2023 with asthmatic respiratory failure after a two week long bout of pneumonia (Mycoplasma Pneumoniae.) I had been doing well, I thought, working full time in the clinic. One Thursday afternoon, however, I was escorted out of the office and ended up in the hospital.

Antibiotics, oral steroids and 3 days later, I had a discussion with the respiratory therapist who was giving me my nebulizer treatments. He looked at my inhalers and asked: "Hey, Doc, where are your spacers?" Well, it is not my field of expertise, but I know better now. The spacer makes the inhaler work like a champ.

The Test

Being a bit skeptical, I needed to be convinced. The RT suggested that I try two puffs without the spacer, and see how well I'm breathing. He was withholding the nebulizer, I might add.

Then, he told me to take one 'hit' on with the spacer. I did as I was told, and moments later, the effect was unlike any I had previously experienced with the albuterol. I did not take a second inhalation, as it was entirely unnecessary.

The principal advantage to the spacer is efficiency. The principal disadvantage is bulk. It does not fit neatly in my trouser pocket. It is the Essential Accessory for the Asthmatic.

The spacer increases the efficiency of the inhaler by 40 to 60%

The device is probably a reasonable device to carry in a purse, folio or whatever the garment that men are seen carrying through the airports.

I bought three of them, leaving one at the office, one in my bathroom and one in my car.

I have been a physician for 42 years, and I rarely pick up pearls of wisdom as I did from that Respiratory Therapist.

It is now a frequently used piece of armamentarium in the treatment of my patients with asthma and chronic bronchitis.

I provided a link to an Amazon page where you can see the instructions for use.

I chose not to use the spacer-facemask, for my own situation.

Functional Medicine Physician

David S. Klein, MD, FACA, FACPM

Stages of Life Medical Institute

1917 Boothe Circle

Longwood, Florida 32750

COVID is back. Get ready, prepared and do not get caught by surprise.

We have had 3 Covid patients in the past week that 'got it' on an airline, coming back from Italy. Products you must have on hand!

As of the present date, the COVID-19 pandemic remains a global health crisis of immense significance. While substantial progress has been made in understanding the virus, developing vaccines, and implementing preventive measures, the situation remains dynamic and complex.

One of the primary concerns in the current COVID-19 situation is the ongoing threat posed by the emergence of new variants of the virus. These variants can potentially impact the virus's transmissibility, severity, and vaccine effectiveness. Vigilance in monitoring and responding to these variants is crucial to stay ahead of the virus and adapt vaccination strategies and public health guidelines accordingly.

Covid-19 Vaccination: is it right for me?

Vaccination efforts have been a cornerstone of the global response to COVID-19. While numerous countries have made significant progress in vaccinating their populations, vaccine distribution disparities and hesitancy continue to be challenges.

Further, it is becoming obvious that the COVID vaccines have limited durations of effectiveness. Through research done at the Stages of Life Medical Institute, looking directly at COVID-19 antibody levels, it was clear in 2021 that the vaccine would provide protection for as little as 90 days to a maximum of 150 days. Additionally, protection did not mean that an individual would not get sick, it simply meant that the severity of the illness would be reduced.

In a word, you can run, but you cannot hide. The riskiest places to be are airports, airliners, movie theaters and other tightly enclosed spaces.


Supplies to have on hand, if and when you get COVID-19

  1. Hand washing will be the most effective way to protect yourself. The virus is largely fecal-orally transmitted, as is the nature of other COVID viruses. Yes, there are other COVID viruses, well known to the medical community, but particularly well known in the Veterinary community.

  2. Masks may or may not provide any protection at all. This is a matter of personal preference, but wearing one may remind you to wash your hands frequently and not take any unnecessary chances.

  3. Eating at restaurants should be done with caution. The virus does not survive well on hot foods, but can last a good while on cold foods. Wipe off your eating utensils, drink hot beverages and eat hot foods, preferentially.

  4. You can catch COVID just as easily from a sick child as from an adult.

  5. Do not share plates, portions of food or drink from the same glass.

Other than that, get re-inoculated if it has been 6 months or longer. If you are adverse to getting the shot, this is a free country, at least for the time being. Booster or not, we are all at risk.


Recommendations for those who get sick (Keep these on hand, just in case)

Over-the counter (Available with us at


Guaifenesin 400 mg by mouth (1 capsule, four times daily)

Licorice Root Extract (1 capsule twice daily

Lactoferrin Containing Colostrum (2 capsules four times daily)

Lactoferrins for COVID treatment and prevention
Lactoferrin Colostrum for COVID (take 2 capsules 4 times daily)

Prescriptions, if your physician so agrees:

  1. Plaquenil, hydroxychloroquine (200 mg, Take 2 tablets twice a day for the first day, then 1 tablet twice daily, for two weeks.)

  2. Benzonatate (100 mg by mouth twice daily, as necessary, for excessive cough.)

  3. Naprosyn (500 mg by mouth twice daily)

  4. Paxlovid (I'm not real impressed with this one)


Our practice remained open, every day, during the COVID pandemic. We saw our patients in the office, in the most traditional manner. The only person that got sick during this period was me, and I got it while on vacation, not paying attention to the recommendations, above.

The hydroxychloroquine is an anti-inflammatory, works well within the first 20 minutes or so of ingestion. The Naprosyn works with it through a separate mechanism.

The over-the counter medications are incredibly effective, particularly if taken early in the disease. Have them handy, ready for use. I think we're winding up for a busy season.

David S. Klein, MD, FACA, FACPM

1917 Boothe Circle

Longwood, Florida 32750

Tel: 407-679-3337

Fax: 407-678-7246

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