The annual physical has been a staple of modern medicine for a long time. Yet, today some are questioning this practice. What are their arguments?

Alex Janin, writing in The Wall Street Journal, says a growing number of physicians say the value of a yearly physical depends in part on your age and health history, and that some young, healthy patients can afford to skip it. Some studies have suggested that the annual visits aren’t doing much to improve our long-term health, and a growing shortage of primary-care doctors can drag out appointment wait times.

Plenty of doctors still recommend an annual checkup, but more are changing what they do in that appointment, focusing on habits such as sleep, exercise, and diet with less poking and prodding in a physical exam.  An increased focus on lifestyle reflects the recognition that standard once-a-year physicals haven’t managed to stop the rise in chronic diseases such as obesity and Type 2 diabetes, which now affect roughly 42% and 10% of American adults respectively, according to Centers for Disease Control and Prevention data.

Other than managing blood pressure, assessing body mass index and screening for cervical cancer in women, regular physical exams in asymptomatic patients haven’t been shown to improve health, says the latest recommendation from the Society of General Internal Medicine, a professional group. A review in the medical journal JAMA found that overall, checkups weren’t linked to lower mortality rates or improvements in cardiovascular problems, although they were linked to better catching and treating of chronic disease.

Another analysis found that annual physical exams were associated with lower mortality risk among healthy adults compared with those who didn’t attend annual physicals.

If you’re at high risk of chronic disease, worried about your health or rarely see your doctor, you’re likely to benefit from annual checkups, according to the SGIM. Most doctors still recommend patients come in for a yearly visit—which often includes a thorough physical exam—especially as they move into midlife and beyond. Doctors recommend that you follow guidelines for preventive screenings regardless of whether you get annual physical exams. Even young, healthy patients aren’t immune to health risks, such as rising rates of some cancers.

In 2022, roughly 78% of adults reported seeing the doctor in the past year for a wellness visit, according to the CDC, including 68% of adults under 45. Traditionally, the annual physical involves a head-to-toe assessment that often includes listening to a patient’s lungs and heart; recording their weight, height and blood pressure; and checking reflexes and blood tests.

One Medical, a membership-based primary-care practice with offices around the country, redesigned its annual checkup in 2020 to emphasize patients’ personal health goals and lifestyle counseling rather than strictly a physical assessment. It starts with patients filling out a questionnaire in advance that covers topics such as sleep and exercise habits, alongside family history of illness.

Other approaches lean on technology and previsit screening. BellSant, a health technology company, is hoping to sell doctors on a new preventive care approach. Rather than patients scheduling an annual physical, they would fill out health assessments on an app and get a blood test. Their doctors would use that information, plus data from users’ wearable devices, to give priority to patients with more urgent health needs.

Supporters of the traditional approach say conducting a consistent, by-the-book physical exam with every patient allows them to catch issues they might not otherwise, establishes a health baseline and reduces the chance of error. A thorough examination also helps put many patients at ease, says Dr. Eve M. Glazier, a general internist and president of the multispecialty provider group UCLA Health Faculty Practice Group.

The traditional annual physical becomes more useful as patients age and are more likely to develop chronic conditions and take multiple medications, says Dr. Mirza Rahman, physician and president of the American College of Preventive Medicine.

Spending less time on physicals for young, healthy people could ease a strain on primary-care doctors, some say. The Association of American Medical Colleges estimates there will be as many as 48,000 too few primary-care physicians practicing in the U.S. by 2034.

My opinion is the annual physical is an important part of maintaining good health, especially for those adults over the age of forty. Just because you might have to wait longer to get an appointment is no reason to put off your annual physical. Your life may depend on it!

What’s the value of a tooth? In the 1950s, when I was losing my first tooth, the going rate for the tooth fairy was 25 cents. My wife confirms she had the same experience, even though she grew up in Florida, while I grew up in Pennsylvania. Alas, inflation seems to have impacted everyone, including the tooth fairy. Serena Ng, writing for The Wall Street Journal, tells us what the tooth fairy is paying today.

“When her daughter was about to lose her first baby tooth, Kokoa Lawson went to work researching ideas. She wanted to make the tooth fairy experience magical and extra special for her only child. She gave her daughter a $100 bill decorated with glitter and tiny removable rhinestones. “She kind of lost her mind when she found it,” says Lawson, who lives in Temecula, Calif.”

But some cousins were jealous about the tooth-fairy haul and Lawson says she “did get a little pushback from friends.” “I simply said, ‘This is just what our tooth fairy does,’ and suggested they make it special in their own way for their kiddos,” says Lawson, 40, who works as a model and actress. Her outlay dropped to $20 for subsequent teeth.

The tooth fairy is getting more generous and creative worldwide—and parents are learning how tricky that can be. Parents already were going big for birthday parties and college acceptances, but now they are increasingly making a splash for smaller milestones, too. Pinterest, the online platform for sharing ideas, calls the phenomenon “inchstones” and has declared it a top predicted trend for 2024.

Global Pinterest searches were up for “potty-training rewards ideas” (100%), “end-of-year school party ideas” (90%), and “my first tooth party” (40%) between September 2021 and August 2023.

A poll last year by Delta Dental, a large U.S. provider of benefits, pegged the average payout per lost tooth at a record $6.23, from $5.36 in 2022. It isn’t just inflation delivering a bite. The same poll found 20% of children now receive both money and something else—often a gift—for each lost tooth.

 “Cash, a videogame, sometimes an iPhone,” says Mark Burhenne, a former practicing dentist who runs AsktheDentist.com. “It’s the parents competing” to improve the gifts, adds Burhenne, 64, who lives in Napa Valley, Calif. (His 35-year-old daughter Catharine Burhenne, who co-founded the website, says she is bucking the “generous gifting” tooth-fairy trend. She recently enlisted ChatGPT late one night to write a note from the tooth fairy.)

In the U.K. Chidera Nig, 32, says the tooth fairy gave her daughter 60 British pounds, equivalent to $76.50, a letter and a silver fairy necklace, along with a Louis Vuitton bracelet. Nig says her husband purchased the bracelet on the day their daughter was born, and it felt like the right time to give it to her. “That was her first baby tooth that she lost, and the process was uncomfortable for her, so we decided to give her the extra tooth fairy experience,” says Nig, a content creator. The money went into a piggy bank. “Childhood goes by so fast and we believe in cherishing every moment, celebrating milestones and creating long-lasting memories.”

Anuradha Singh, 51, a lawyer, asked her husband to take over her tooth fairy duties while she was traveling from their home, then in Hong Kong. Lacking change and not knowing the going rate for baby teeth, he left the equivalent of $64 under their child’s pillow, Singh says, adding: “It was an utter failure by the deputy tooth fairy.” She says she tried to claw the money back, but her daughter, then seven, resisted.

One problem—kids talk and compare.

In Cheshire, England, before five-year-old Rae lost her first tooth last autumn, she wrote to the tooth fairy, requesting a gift for herself, and something for her little sister. On the big night, she received three British pound coins, and two chocolate coins to share with her sister. On the way to school the next morning, Rae ecstatically told everyone she met what the tooth fairy had brought.

“I didn’t think about how that would unfold,” says Natasha Evans, Rae’s mother. “The others were like, hang on—the tooth fairy didn’t bring us chocolate coins!” Some children said they received only one pound, and one said they got a five-pound note. The other parents looked uncomfortable. Evans, who is 35 and manages a post-sales team at a software company, had to explain to each child and parent how the tooth fairy delivered chocolate because Rae had asked for something for her sister. “I said the tooth fairy normally doesn’t do that, and the next time she won’t do that,” says Evans, adding that she plans to stick to just money going forward.

To put this all in perspective, I did a little research. One dollar in 1950 is worth $13 today. That means the 25 cents I received from the toothy fairy in the 50s is worth $3.25 today. Inflation is affecting everyone, but it seems the tooth fairy has gone way beyond the real inflation rate. I’ve said it before and I’ll say it again – some people just have too much money and too much time on their hands!

In Part I of this series, we discussed options for healthcare insurance coverage for those who choose to retire before age 65 when people qualify for Medicare coverage. We discussed the first two of four options mentioned in an article by Gail Marks Jarvis published in The Wall Street Journal.

The first two options were Employer coverage and ACA (ObamaCare) coverage. Today we’ll discuss two more options; Private coverage and Last Resort options.

Private Coverage

Early retirees who don’t qualify for a subsidy can still buy private insurance through the ACA marketplace, and it is smart to do so even though it will cost full price and is likely more expensive than non-ACA private insurance, says St. Petersburg, Fla., insurance agent Peter Motzenbecker.

That is because there are few private plans available anymore outside the ACA system, and those that remain often don’t have the pre-existing condition coverage provisions that ACA plans do. In other words: ACA plans don’t screen people for their health before insuring them. And whenever people are insured through the ACA marketplace, they will be covered even if an illness stems from a past condition. Private plans frequently deny coverage if they determine a person’s malady stemmed from a condition that existed before they bought insurance.

The denial-of-care risk also applies to private plans that last for only a few months, says Christine Simone, chief executive of Caribou, a firm that helps financial planners compare health plans. Such plans are called “short-term” or “skinny” policies, and people sometimes buy them when they lose a job and need insurance for just a few months before taking a new job or going on Medicare.

Short-term plans are far less expensive than Cobra coverage as a stopgap for someone who leaves the workforce unexpectedly, Simone says, but she calls them “a gamble.” Although you have to pass a health screening to qualify for a short-term plan, a provider could refuse coverage for a condition by deeming it pre-existing.

Depending on the short-term plan, there can also be caps on coverage, such as $1,000 for a hospital stay. That can leave an individual short of what will be needed if, for example, he or she has a heart attack and has to be hospitalized at a cost that can easily be in the tens of thousands of dollars.

“It’s a misconception that private insurance outside the [ACA] exchange is better,” says Chumbley Hogue, the Dallas health-insurance agent.

Last Resorts

Another route to reduce coverage costs for those who have lost their job for health reasons could be through a Social Security disability designation. Such a designation would allow a person to get Medicare coverage before age 65, but Chumbley Hogue warns that the process can take months and Medicare often doesn’t start until 24 months after a person is deemed disabled.

One other alternative advisers suggest is to find work at a business that provides health insurance to part-time workers. Such companies include Starbucks and Trader Joe’s, according to career website Indeed.com. Given employers’ typical contributions to health insurance, an individual working part time for a large company might have to pay about $119 a month for health insurance, according to Kaiser Family Foundation Vice President Cynthia Cox.

All of this information should make you think twice before retiring before age 65. Your health is critical to the enjoyment of your retirement, so don’t take it for granted. Make sure you know in advance where you’re going to get your healthcare insurance and what it will cost. That’s a crucial part of your retirement plan.

All of this information should make you think twice before retiring before age 65. Your health is critical to the enjoyment of your retirement, so don’t take it for granted. Make sure you know in advance where you’re going to get your healthcare insurance and what it will cost. That’s a crucial part of your retirement plan.