You're still trying to get through that case of aspirin you bought last December, and you've never worn the prescription sunglasses you picked up about the same time. Instead of buying a bunch of stuff you don't really want at year-end to avoid losing the money in your flexible spending account, this is a friendly reminder as we pass the midpoint of the year to start spending NOW.

Procrastination may be understandable. But about a third of people leave an average of $168 unspent in their FSAs every year, according to Hewitt Associates. The funds go back to their employers—and that's just idiotic. The typical balance in an FSA is about $2,500, says J.D. Piro, principal and chair of the health law consulting practice at Hewitt. "As a percentage of the account, $168 is fairly low, but it's very high if it's your $168."

I was slicing cheese one Saturday morning when the knife slipped, and as I watched the blade bury itself in my finger, I thought, "I am so going to need stitches." Fortunately, I have an emergency room just three blocks away. But as I struggled to get into my clothes with my hand wrapped in a towel, it occurred to me that maybe my health plan wouldn't consider a cut finger suitably dire to justify a visit to the ER.

If my health plan were to deny the claim, I could be stuck with a big bill, I worried, since emergency room care is a lot more pricey than a visit to the urgent care clinic or my own doctor's office. This is not just idle speculation; I've talked to people to whom this has happened. So I sat down at my computer, logged into my health plan's website, and, pecking with one hand, tried to find some answers. Twenty minutes later, I was still looking (though the bleeding had mostly stopped). What I had found was the address of the nearest in-network urgent care center—an inconvenient hour away on the subway. But I bandaged up my hand, and off I went.

This week, the American Medical Association took the bold step of deciding not to decide whether to endorse using "secret shoppers" to evaluate their medical practices. Rather than adopt a tepidly positive report by the group's Council on Ethical and Judicial Affairs, which had offered its qualified support provided certain conditions were met, the AMA's House of Delegates voted to refer the issue back for further study after it had heard doctors' concerns. And so physicians have missed another opportunity to embrace customer feedback, just as they've taken a hard line against online physician rating sites, which I've discussed before in this space.

Secret shoppers are by now commonplace in retail and hotel settings and are considered a valuable tool to improve customer service. They're undercover reviewers who pose as, for example, medical patients in order to assess quality of service. Medical practices have been slow to adopt their use, and the medical sector accounts for only about 2 percent of secret shopping revenue, according to the report.

I talk to a lot of people about their experiences using our healthcare system, and many of the complaints I hear are from people who have health insurance but are still scrambling to cover their healthcare bills. Their share of the premiums alone costs more than a family vacation, and then they're faced with rising deductibles, copayments, and, increasingly, limits on coverage for various services on top of that. What good is having insurance, they wonder, if they're saddled with serious bills when they get sick?

A new study reports that the number of people who are "underinsured" has grown 60 percent in the past four years, to 25 million. Middle- and upper-income families make up the fastest-growing share of this group; rates for those with incomes of $40,000 or more nearly tripled, to 11 percent. Families with incomes under the poverty level (about $20,000), however, had the highest rate of underinsurance, 31 percent.

These days, there's one milestone birthday plenty of people look forward to: the one when they become eligible for Medicare and can leave all their healthcare worries behind. That's the hope, anyway. But the reality is that turning 65 takes care of only a little more than half of subsequent medical expenses. Now a new study from the Employee Benefit Research Institute shows that a couple without employer-sponsored retiree coverage can expect to need anywhere from $194,000 to $635,000 to cover healthcare premiums and out-of-pocket costs during retirement.

To arrive at their figures, researchers developed a model that took into account numerous mortality and investment risk scenarios, different sources of healthcare coverage, and different healthcare needs.

Is having some sort of health insurance—even spotty coverage—better than having no protection at all? That's the conventional wisdom behind initiatives like the bill signed last week by Florida Gov. Charlie Crist that allows insurers to sell inexpensive health insurance policies with limited benefits to uninsured Floridians. The new law is the latest example of a nationwide trend toward offering "limited benefit" or "bare bones" plans that often cover some everyday medical expenses like visits to the doctor and prescription medications but may come up seriously short if a policyholder gets seriously ill.

The governor acknowledges that the new Florida plans won't offer "Cadillac coverage." But for $150 a month or less, he says, they'll include some coverage for preventive services, drugs, surgery, screenings, and durable medical equipment, among other things. And how is that possible, you're wondering. Some plans won't provide catastrophic coverage that would pick up the tab for major medical expenses like cancer treatment or heart surgery, for example, nor will they necessarily cover all of the benefits available through comprehensive plans, like podiatry or certain transplants. There could be dollar limits or other restrictions as well.

Making sure kids have good healthcare is something everybody agrees is important, but a new report shows that some states do a much better job than others of making good on that intention. Aiming to cover more of the roughly 9 million children who lack insurance, both Democratic presidential candidates have called for universal coverage for children. Without a stronger commitment at the federal level, it's hard to imagine how we're ever going to address the inequities highlighted by the report so that kids can count on getting the care they need no matter where they live.

Organized as a score card, the Commonwealth Fund report examined how states perform on 13 different indicators in five categories: access to care, quality of care, cost, potential to lead healthy and productive lives, and equity in the quality of care provided regardless of race, income, or insurance status. It ranked states within each category and then assigned states a final overall ranking.