The Personal Finance Podcast - Why Your Healthcare Costs Keep Rising with Dr. Jordan Grumet

Starting point is 00:00:00 Can you walk me through, say, like a normal ER visit? Let's say, you know, a $15 bag of saline turns into being a $1,500 bill. Why does that happen? So just walking in the door, you already have fallen into a trap of all these third parties that you don't even realize. Now, hospital is using that electronic medical record to up code. In other words, they're trying to gather as much information as they can to say that this is as complex a visit as possible so that they can charge the insurer more money. So they stopped fighting hospitals and hospital systems

Starting point is 00:00:33 and started paying more and more and more for care because 10% of a higher bill ends up being more money they can keep. And then your knee hurts so they order you with Tylenol. Here's the thing. Tylenol should cost a few pennies, maybe a dollar or two, but then you get your bill and it's like $50 or $100 for each Tylenol. Even if you discounted 50% and you're real happy because you went to the registrar and they said, fine, only pay us 50%.

Starting point is 00:00:57 you're still paying way too much. On this episode of the Personal Finance Podcast, why your health care costs keep rising with Doc G. What's up, everybody, and welcome to the Personal Finance Podcast. I'm your host, Andrew, founder of MasterMoney.com. And today on the Personal Finance Podcast, we're going to be talking about why your health care costs keep rising. with Doc G. If you guys have any questions, make sure you join the Master Money newsletter by

Starting point is 00:01:37 going to mastermoney.co slash newsletter. And don't forget to follow us on Apple Podcast, Spotify, YouTube, or whatever your favorite podcast player is. And if you want to help out the show, consider leaving a five-star rating and review on Apple Podcasts, Spotify, or your favorite podcast player. Cannot thank you guys enough for leaving those five-star ratings and reviews. They truly, truly mean the world to us. So what if I told you? one of the biggest threats to financial independence has nothing to do with the stock market. It has everything to do with the health care system. One unexpected diagnosis, and all of the sudden, your financial independence plan will drastically change.

Starting point is 00:02:17 And on this episode of the Personal Finance podcast, we're pulling back the curtain on why your health care costs keep climbing. And we're doing this with someone who has been a physician for decades now. And I could not think of a better person to help us walk through this. So Doc G, who has been on the show a number of different times, is a hospice position who has spent his career at the intersection of medicine, money, and meaning. And he has seen firsthand where the dollars disappear, who's really pocketing these dollars, and what truly matters when Bill stop and life comes into focus. His work is all about building a regret-free life,

Starting point is 00:02:54 and we're going to use that same lens on one of the most stressful money topics that is out there. We're going to break this down into three parts. First, I want to talk about why our costs keep rising from the $15 a bag of saline that turns into a $1,500 medical bill. Why does that happen? And why is this keep continuing to go on? Two, I want to talk about how to protect yourself today. And then finally, we're going to go somewhere most money shows never do. And we're going to talk about the end-of-life money lens as well.

Starting point is 00:03:21 So this is a very important conversation. I think most of you need to understand how this works, why health care costs are rising at this rapid 7% increase over the course the last couple of years. So I am really, really excited to dive deeper into this. So let's welcome Doc G back to the Personal Finance Podcast. So Doc G, welcome back to the personal finance podcast. I think this is the third time, if I'm not mistaken. It is, and I've enjoyed every single one of them. Well, I'm really excited to have you here.

Starting point is 00:03:49 For listeners who haven't heard you yet, I want you to kind of talk through kind of who you are, what you do up front here, and then we'll dive into, I think, a really important topic. So the thumbnail sketch is, I am a hospice, doctor who talks about finance and purpose. The longer story is, my father died when I was seven. He was a doctor. I decided to become a doctor like him. That was my sole version of purpose until I totally burnt out in the profession within the first few years, realized becoming a doctor didn't bring him back, started looking into finances, eventually found my way to financial independence, left medicine

Starting point is 00:04:25 and built a life doing things that I was much more passionate about, like podcasting about personal finance. Eventually, I wrote a book about purpose. What's interesting with this new book, The Health Care Heist, is actually, I talk a lot about burning out from medicine and how it didn't fit me and maybe I should have done something different with my life. But I never go into the detail of why being a doctor was so frustrating. What systemically is wrong with the profession in our health care system. So with this book and this story I've been telling, I've really been trying to go back and say, well, we kind of glossed over that before. But let me tell you some of the reasons I burnt out and walked away from actually what is a fantastic profession doing something

Starting point is 00:05:03 that was really meaningful and yet I felt like I couldn't continue. And I think that is one of the most important conversations that we have to have today because the cost of health care is rising at such a rapid rate that honestly, even over the course of the last couple of years, I've seen stats that we were talking about even of last year. And your book is full of stats, which I think is really important. But I've seen stats even over the course of the last couple of years that we're seeing like an inflation rate of like 7% on just health care costs per year, which is just just some of the wildest things we could, you know, ever even be talking about. So we have a whole, a whole system here that I think is backwards.

Starting point is 00:05:36 I know you think the same thing. And so I want to walk through some of this stuff so people understand why this is happening. I want to kind of talk through, you know, some of the things we could consider doing. And then how we can kind of think about this when it comes to our own dollars as well as we go through this episode. So can you walk me through, say, like a normal ER visit? And let's say, you know, a $15 bag of saline turns into being a $1,500 bill. Why does that happen? So first and foremost, let's think about all the systems that are happening in the background that you don't even realize, right?

Starting point is 00:06:05 So the ER is not the best place to get care. In fact, back in the old world, you'd call your primary care doctor. They'd even do things like stitches and all sorts of things in their office. But over the years, physicians have become more specialized, and a lot of practices have now become owned by venture capital and private equity. They're running businesses, and they find that certain care is, really good for them and makes lots of money and certain types of care doesn't. Doctors no longer owning their practice are much less likely to fit you in for an extra visit. They're much less likely to do something more complicated in the office that they used to do.

Starting point is 00:06:40 And so just by the fact that you're going to the emergency room already, they're these systems, there's these third parties that have changed our health care system and they're already leading to more expensive care. Because an emergency room is more expensive than going to a primary care doctor. There's more waiting. There's more problems in general. So just walking in the door, you already have fallen into a trap of all these third parties that you don't even realize. Next thing you go in and what do you do the first thing you go into emergency room? You sit down and someone's in front of a computer and they're taking all sorts of information.

Starting point is 00:07:11 And they're asking you about your ethnicity. They're asking you about all sorts of information. Well, they're putting it into an electronic medical record and the hospital is using that electronic medical record to up code. In other words, they're trying to gather as much information as they can. to say that this is as complex a visit as possible so that they can charge the insurer more money. But wait, I have an insurer, and that insurer doesn't want to pay out that much money, right? Because they want to make as much money as possible. So the insurer is going to, of course, negotiate with the hospital systems so that all this upcoding doesn't create a huge bill.

Starting point is 00:07:46 Well, that's where you'd be wrong. Because since Obamacare, health insurers get to keep only 10% of the premiums they collect. So they stopped fighting hospitals and hospital systems and started paying more and more and more for care because 10% of a higher bill ends up being more money they can keep. And then on the backside, they started basically charging people more for premiums because actuarially they could say, well, we're now paying out $2 billion a year instead of $1 billion. So we need to charge you more premium. So they're taking the extra premiums. And then they got to keep 10% of the $2 billion they were paying out a year as opposed to the $1 billion they used to be able to keep. 10% of that. So already, just even by the time you get behind the door and are walking towards

Starting point is 00:08:30 your little room in the ER, a number of companies have made more money on you. Physician comes to see you. Physician just got sued because almost every ER doctor has been sued at some point. So the physician examines you and looks at your leg and says, I can move that knee. You know, you fell and you hit your knee. I'm 100% sure you don't have a fracture. But they order an X-ray. anyway. Why do they order an x-ray? Because if they're wrong and they send you out, they can get sued. And a malpractice attorney can make a lot of money on that. And so that's defensive medicine. And so now your doctor is ordering tests. They would have never dreamed of ordering 10 or 15 years ago. But so many doctors have been sued that now they're practicing defensive medicine, all of this is costing you more money. And then your knee hurts. So they order you with Tylenol. Here's the thing. Tylenol should cost a few pennies, maybe a dollar or two, but then you get your bill and it's like $50 or $100 for each Tylenol. Well, why does that happen? Well, why that happens is each hospital system and doctor actually makes contracts with the insurance companies, and some insurance companies pay more or less than others.

Starting point is 00:09:44 But the problem is if you charge $10 and one insurance company would have paid you $50, but you only charge $10, they'll only pay $10. So what the hospitals do, what the doctors do, is they try to figure out the highest amount they possibly could charge to make sure that they get everyone under that umbrella. Because you can't go charging different insurance companies different things. You charge one thing, but then you make a contract for each insurance company to pay what they will. And those are all separate contracts. But the problem with that is so then the hospital says, well, let's call that Thailand all $100, even though the insurance is going to pay too. But what happens if you don't have insurance? then you get that bill as someone who is self-insured for the whole hundred hours.

Starting point is 00:10:25 And then you've got to go and try to negotiate. Even if you negotiate 50% down so that ER visit was $10,000 because you got the normal saline because you got the Tylenol, because you got the X-ray. And each of those, each line item is double, triple or quadruple what it really should be because they want to make sure they get and capture all the other insurances and make sure they get as much money as possible out of it. And so even if you discounted 50%, and you're real happy because you went to the registrar and they said, fine, only pay us 50%.

Starting point is 00:10:56 You're still paying way too much. And these are just some of the inefficiencies. And you haven't gotten any better care. And possibly you've gotten worse care because you've gotten maybe some blood tests and some x-rays you didn't even need because some doctor was covering themselves in case there's malpractice. And so when you put this all together, and this is just, you know, you going for one ER visit, imagine this happening hundreds of thousands of times a month across the United States. If you've been listening to this show for a while, you know it's not just me anymore.

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Starting point is 00:13:58 There's incentives all over the place that are misaligned in terms of the way that people are operating, the way that people are acting. Is this why, you know, in the book you call insurance a massive wealth transfer and you kind of talk through, you know, why that is, and talking through adding insurance into the middle of this equation kind of causes care to cost more instead of less for a lot of folks. Is it because of those incentives or is this because of even deeper things? I think we have to go back to how health care is practiced in America. So if you go back to colonial days, there were no doctors and there were no hospitals, your neighbor was having a baby, you or your wife or someone would go over there

Starting point is 00:14:37 and help them, right? And so the idea was healthcare was from the people for the people. And even as we go through American history, it kind of stays that way for a while. Like, why did we end up having hospitals? Why did we end up having antiseptic technique? Why did we end up having pharmaceutical companies? Most of it was actually to pay for wartime injuries, right? We would go to war. There'd be wars within the United States or elsewhere, and we would need to create these methods of taking care of the wounded and getting them the right pain medicines and dealing with their issues. It was only once we go into like the, you know, the 20th century where all of a sudden you have these businesses that are popping up that aren't just providing a public good, but are trying to profit. And that's where things really turn.

Starting point is 00:15:27 And so in the United States, we've really turned health care into a capitalistic money-making field. And the problem was when you do that, I guess the real easy way. way to say it is this. When a doctor sees a patient, they're bound by certain obligations. There is the Hippocratic oath and the oath of Geneva. Basically, they're ethical codes for doctors and how they treat patients. There's also the standard of care, which is a legal bar that we have to reach to make sure that we're doing what a reasonable physician would do in the same position. But here's the problem. When you have corporations that are making major health care decisions and acting as if they're doctors, they don't have the Hippocratic Oath. They don't have the

Starting point is 00:16:13 oath of Geneva. You know what they have? You know what if corporations have? They have a fiduciary responsibility to their shareholders. You see, corporations, they don't really have a responsibility to patients. They have a responsibility to their shareholders. And so corporations tend to make decisions that improve the bottom line. But you and I both know that what improves the bottom the line doesn't necessarily improve medical outcomes. And so we have this natural tension here. And over the last bunch of decades, we've really taken the power out of the health care providers' hands and put it into these third parties. So if you go back to before about 2019, over 50% of the medical practices out there in the world were owned by the actual health care

Starting point is 00:17:00 providers. But somewhere around 2019, it's switched. And now over 50% are owned by private equity, venture capital or hospital systems. And they've got bottom lines and fiduciary responsibilities. And the kind of health care and the cost of health care we're getting is directly a result of this. And that is the thing that I have seen time and time again where I used to, so my first entry level job, I was a financial analyst at a very large in-home health care company. And at that company, part of my job was to go and look at struggling other locations that were, you know, potentially either within our business and or other locations that we wanted to acquire. And I would go into those locations, kind of analyze their financials and figure out, do we want to buy this business or not? And we would do this over and over and over again.

Starting point is 00:17:48 And you could see, like, even for me, locally now, you could see my local urgent care just got bought out by private equity. It used to be owned by the specific hospital system. All of a sudden, private equity bought it out. The prices doubled. just from that one acquisition alone. And so I think this is what a lot of people are seeing currently is health care is becoming, you know, private equity. It's becoming privatized.

Starting point is 00:18:08 And I know how much those companies are making because I lived it. I was in there kind of seeing some of the background and how much profitability is truly there. It is unbelievable. I have another friend who does stuff like this. He actually acquires struggling healthcare companies and he turns them around. And he'll buy some of them for, you know, a few million bucks and turn them around and sell them for 50. I mean, private equity is paying huge multiples, which means our prices are going to be rising. And here's the funny thing about it is there's a whole playbook.

Starting point is 00:18:36 They don't even have to turn around a lot of these companies. What they usually do, and it's been well documented, they usually come in and the first thing they do is sell the facilities out from the business. And so most facilities, I used to see this in nursing homes all the time. What would happen is private equity or venture capital would come in and buy a group of nursing homes. And the nursing homes owned the building, they would sell. the building and then rent it out. And the reason they sold all of the buildings is it gave them a huge hit of cash and they could pay back their investors really quickly. And so they sell the building.

Starting point is 00:19:11 They sell all the equipment. They basically start implementing efficiencies to have less providers, less overhead and more care. They basically try to increase their high value tests, their high value services. none of that actually improves health care. And what happens is they quickly pay off their investors, they quickly get off their profits. And a lot of these systems eventually end up in Chapter 11. A lot of them go bankrupt.

Starting point is 00:19:40 But by that time, these private equity and venture capital have paid everyone back. They've taken their profits and they disappear or they sell at a loss. And that is exactly why it's just so frustrating. And I think a lot of this is just one of those areas where you can see this, something has to change. I don't, we're going to talk about some of that stuff too, but I think it's just really, really interesting how we are seeing these prices just shift.

Starting point is 00:20:03 And around the time that you said, 2019 is when we saw healthcare begin to start inflate, really. We started to see those numbers. If you go back and look at the stats, you can see it start to rise in terms of every single year it's inflating at a higher percentage. And I think that's one of those things that we need to be aware of as consumers and folks who are looking at, you know, these different medical bills and understanding how this actually works.

Starting point is 00:20:25 Now, you talk about in the book, too, that doctors are spending a lot of their times on the computer now. Like, they're spending a lot of time, you know, typing into the computer and doing a bunch of different things. How does software end up inflating people's bills? Well, there are a few different problems with the electronic medical records industry. First and foremost, realized that A, there was the VA system in America that's been using electronic medical records since the 1970s. They used a government system called Vist A. it was exceedingly cheap, exceedingly easy, and it functioned really well. But in the early 2000s, the government really started pushing for making everything electronic,

Starting point is 00:21:07 but instead of using this day or doing it through the government, they allowed third-party businesses to create these medical records systems. So first and foremost, they're exceedingly expensive, right? So it's increasing the overhead of hospitals' medical practices, which eventually trickles down into some version of providing more services or charging more for services, billing more to insurance companies, which causes premiums to go up. But basically, it's all eventually trickling down to you and I. So first and foremost, it was just expensive to initiate.

Starting point is 00:21:39 The next thing is these systems are actually built, and one of the ways that these private companies get buy in is they build them so that you can upcode. So the idea is this system is going to allow you to add all sorts of extra information. And when you're coding as a doctor or hospital system, how much you can bill all depends on how complex the cases. And the complexity of the case is 100% based on what you put in the medical record. And so these systems prompt you to say the things that allow you to upcode. So immediately electronic medical records actually increased the cost of our health care system. Health insurance was paying out more.

Starting point is 00:22:17 Medicare, Medicaid also paying out more. And I think that, yeah, it's, you can see that time and time again where it's kind of one of those things that, you know, the increase in costs surrounding every area of healthcare. And a lot of these companies, these software companies know, hey, I can charge a lot more for this because there's a lot more being billed here. And there's just this huge cycle that just, it seems like the cycle just kind of keeps causing this to rise more and more and more, which is the, the frustrating thing for us, again, that we need to kind of continue to think through. And look at the fact that, so let's take Epic. is a medical records company. That company has made billions. Billions.

Starting point is 00:22:56 So we had doctors, patients, and our baseline cost of medical care. A third party, medical records system person comes in, Epic, it costs the system billions over the next few decades. It would all be worth it

Starting point is 00:23:12 if we got better care. Like if care was more efficient, if there were less mistakes, if survival, any of this. But most of the studies show that after all this implementation and after all everything that's gone on, medical care is no better. We make less of some mistakes, but more of others. The cost of care hasn't gone down at all. Basically, this has just been a big boondoggle for these companies. They've made a huge amount of money. They've put their hand in the cookie jar,

Starting point is 00:23:42 grabbed billions of dollars out of the system, but they haven't improved the system at all. In fact, I'd say in a lot of ways they've worsened the system. You know, doctors now, instead of having eye contact with their patients, spend most of their time with their head buried into a medical system, it just isn't good for patient care. It erodes patient doctor trust. None of it's good. And so much of this money is going to people, like you said,

Starting point is 00:24:06 who are never even touching the patient, they're never even reaching the patient, they're not the professionals that are kind of helping the patient within their situation. Do you think that administrative bloat is the main reason why costs are rising? Is this one of those things that is just causing this to become just the behemate that it is becoming? I think administrative bloat is the tool to create these huge profits that third parties benefit from. And I think administrative bloat also really puts a divide between doctor and patient. And it's kind of divide and conquer.

Starting point is 00:24:38 Like if you are a third party and you're making billions and you're paying billions or millions to lobby Congress the big thing for you is you just don't want anything to change. And so a lot of these dollars in the administrative bloat divides doctors from patients, and therefore they're much less likely to come together and push for change. And so we see this over and over again, make the medical system difficult, make the providers unhappy and make the patients unhappy, but keep them separated and nothing will ever change. And we as this third party will continue making more and more money.

Starting point is 00:25:21 And that's exactly what's happening. If you stripped out everyone, you know, who is not giving care from profiting, how much cheaper could this actually be? And would this downgrade the care or would this just be one of those things where if you cut out all the excess, this would actually be cheaper for the consumer? Well, you know, it's kind of clear because most countries in the world have universal health care that's somewhat government-run or at least minimally privatized. And most systems around the world pay $6,000 to $7,000 a year per patient,

Starting point is 00:25:55 whereas in the U.S. we're somewhere closer to $13,000 or $14,000 a year. So my suspicion is about 50% of it comes from all of this blow in these third parties. And the truth of the matter is, mostly health care across the world in a lot of these universal health care systems is fairly similar to the U.S. Canada is fairly similar to the U.S. The U.K. is fairly similar to U.S. They both have their problems. And don't get me wrong, sometimes you have to wait longer for services.

Starting point is 00:26:23 But generally you do about the same. Now, I will tell you, there is a caveat. People do come to the U.S. People with lots of money, right? The billionaires, the princes, the leaders of state. A lot of those do come to the U.S. for care. And the reason is we have very fantastic high-level services, high-level cancer service, high-level transplant service.

Starting point is 00:26:44 If you have a lot of money and can pay for it, you can get the best of the best still in the U.S. I don't know if that'll be forever, right, with our drain on, you know, with our doing much less research and are bringing in less immigrants who are experts in their field who then come migrate to the U.S. That may not be forever. But as of today, you could still get some of the best care in the world in the U.S., but that's really reserved for the wealthiest of people who are willing to pay out of pocket and have the connections. If you talk about the care of your average citizen here,

Starting point is 00:27:13 compared to the care of your average citizen in the UK or Canada, they're fairly similar, but just for a lot less. I think a lot of people believe that, hey, some of the universal health care systems, maybe the care is not as good or it's not as the same as the U.S., but you're saying it's basically pretty similar in terms of some of the stuff. They obviously have their issues in place, but it's pretty similar in terms of thinking through that. Well, if we're dealing with these massive bills that are rising, and if we're dealing with a lot of shifts in the health care system. This is something we, A, have to plan for when it comes to retirement, especially as

Starting point is 00:27:42 we're starting to approach retirement. We've got to start thinking about this and how we're going to handle health care, especially for everyone who wants to become financially independent or retire early. If you want to retire early, you really have to think through health care before you get to Medicare age. Otherwise, you are going to have this huge cost that you did not anticipate. And this is the number one reason why we've seen a lot of people go back to work when they, you know, retire early is because they didn't realize how much

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Starting point is 00:31:00 Next thing is if you're paying out of pocket, a lot of times you can negotiate. You can call the doctor's office. You can call the hospital. You have nothing to lose. You can make payment plans. You can do all sorts of things. If it's an insurance company, you could still try to negotiate with the insurance company for co-pays, premiums, those kind of things.

Starting point is 00:31:18 You're going to be a little bit less successful there. But at least make sure you got the care that you were supposed to get. Make sure that your deductibles and everything after your deductible. they're covering what they're supposed to. A lot of times what you'll find is that they either denied care or say you didn't get a pre-authorization and therefore don't pay for something, which means that the doctor's office is eventually going to come after you. So you want to make sure you see those and you want to make sure that if they denied

Starting point is 00:31:43 care for something your doctor said you needed, you should fight it. You should appeal it. You should at least go through the basic appeals and see if you can get it overturned. A lot of people don't. And that gives the insurance companies the ability to just keep on denying care. A great example of this is I had somebody who just wrote into us via email that said, hey, I heard your episode on negotiating your medical bills and we went and looked. They just recently had a baby.

Starting point is 00:32:07 And when they went and looked, there was a couple of charges on their bill that ended up being care that they did not receive. And they had negotiated $6,000 off of their bill of care that they'd never received. It was just a mistake on the coding and the billing. And I think for many people out there, you'll be surprised at how many mistakes are out there when it comes to coding. There's almost always a mistake. Almost always.

Starting point is 00:32:29 It's unbelievable. And so like it's one of those things that I think most people need to at least be very aware. Don't just grab your bill and pay it. You know, go through the process of understanding what you're paying for. And then if there are things that are mistakes on there, go back and negotiate. Go back. And if it's a huge bill, you can work on payment plans. I've had people go back and negotiate ways where they said, hey, I only have X amount

Starting point is 00:32:49 of dollars. This is what I can pay. Will you accept that? And they've had people accept it before. And so again, it's one of those areas where if you are, If you did not receive service, you need a fight for that because I think it's really, really important to make sure that you are thinking through this. Now, another thing you talk about in the book is something that I absolutely love, which

Starting point is 00:33:06 is the HSA. So I call the HSA, the super retirement account. It's got those triple tax advantages, which I think is really, really important. But why do you think an HSA is one of the most underutilized or underrated accounts when it comes to personal finance? I mean, first and foremost, most people just don't know they have access to an HSA, right? So if you have a high deductible plan, you can do HSA, but if you don't, you can't. So a lot of people start in a normal plan, but eventually life changes and they end up in a high deductible plan don't even realize it's accessible.

Starting point is 00:33:35 That's number one. Number two, a lot of people think the HSA works is like an FSA where you lose your money at the end of the year. HSA, you never lose the money. Thirdly, most people don't realize once your money goes into the HSA, you can actually invest it. So it's not just cash sitting in account. It's cash that can go into the stock market and grow. Lastly, for most people, this idea of not using it immediately, letting it grow, keeping receipts, and then taking it out as needed, just they don't understand the whole process, right?

Starting point is 00:34:08 This idea that, hey, I can pay out of pocket for all sorts of things, keep those receipts. Meanwhile, my money is growing in the HSA and 10 years later, when I want to access that money in the HSA, I can grab those receipts out and start pulling the money out. And as you said, the magic is it goes in before taxes. It grows tax-free. And if you use it for the right types of things for health care expenses, you take it out without taxes. So it's incredibly powerful. I wouldn't say you want to put your whole retirement in it.

Starting point is 00:34:38 But there are very few vehicles any of us have that are triply tax-free, almost nothing. So it's a wonderful way to beat the system. And God knows you are going to need. to pay for healthcare. People think you turn 65. You get on Medicare and all of a sudden you don't have any health care costs. Nothing could be further from the truth. You still are means tested and have to pay a monthly fee to Medicare. There are secondaries. There are all sorts of things that you still have to pay for. Healthcare is never free, not even after you're 65. So having that HSA available can be exceedingly helpful. And the beautiful thing about it is once you turn age 65, if you overfunded it for some reason,

Starting point is 00:35:18 and it basically turns into similar rules as like a traditional IRA or a 401K where you can pull that money out and pay the taxes on those dollars. But in addition, I think most people don't realize how many qualified medical expenses there really are. Tons. It's unbelievable. You can buy a Peloton now with an HSA. So there's just so many, an aura ring I just saw the other day that you could buy. And even Amazon has a whole section on Amazon's website that is all HSA eligible items. And so what I like to do with my HSAs is I will save the risk.

Starting point is 00:35:48 receipts into like a Google Drive file and then I just have a little spreadsheet and now in the age of AI if you can remove your personal information, there are ways that you can kind of come up and get that going where you can, you know, have it added to a spreadsheet pretty quickly or you could just kind of recite the amounts and have those amounts kind of stuck into a spreadsheet pretty quickly. But again, your personal information needs to be off that if you're going to utilize AI in any way, shape, or form for something like that. But in reality, I have a spreadsheet that I just kind of keep and it's an ongoing spreadsheet that keeps going on how much I have in receipts, just so I have the number so I can kind of track it as time goes on. And you may realize,

Starting point is 00:36:21 oh, I purchased some other items that I never realized were actually HSA eligible. And if you have those receipts somewhere, you would definitely keep and hang on to those. I think it's such a powerful way to even bridge your account. I mean, even just thinking if you retire in your 50s, for example, and you have $100,000 HSA and you have $50,000 worth of medical receipts, you can utilize those in a way that, you know, helps, you know, fund your retirement until you get to traditional. Yeah, or insurance premiums or Medicare premiums. People don't realize.

Starting point is 00:36:48 Like, we talk about the fear of Irma, right? Irma is if you have a certain amount of income, you actually have to pay more for Medicare, which a lot of people don't realize. And people, sometimes you just can't get your income low enough to avoid Irma. But if you have an HSA, you've got that money sitting there ready to pay those increased Irma premiums. And that can be really beneficial. If someone's trying to decide between, you know, going high deductible health plan or

Starting point is 00:37:14 a cheaper deductible health plan. Can this backfire on them in any way, shape, or form? And how do they kind of think about that? Because I know that's one of the questions that I get from a lot of people is, hey, should I go with a high deductible health plan so I can get an HSA? And it's going to depend, I think, on the situation. But how can that backfire and when would it make a little more sense for people? So I'm by no means an expert in this, but it really depends on what your spending is going to be.

Starting point is 00:37:38 I mean, if you know that you have a chronic disease, chronic illness, and you're going to be meeting your deductible every single time, you know, a low deductible might be very reasonable. Whereas if you rarely use the system, a high deductible with a HSA can be very beneficial. And don't forget, you can negotiate, right, up to the deductible, right? So when you haven't met your deductible, a lot of times you pay directly to the provider. And that's when you can call the provider and say, hey, how about a 10% discount? How about a 20% discount? So these are all your options to really, really kind of cut down on costs. And one of the things that I like to do is, you know, if you're healthy and you're kind of looking at some of this stuff, is I will kind of shift depending on the years on what kind of health plan I have.

Starting point is 00:38:24 So some years, for example, when I knew my wife and I were going to have a baby, I would shift the health plan over from a high deductible health plan to just a standard health plan and have that in place where I knew there's going to be a lot more medical costs in that given year. And so I mapped it out and kind of figured out, okay, this makes a lot more. sense to shift at that year. Then I go back to the high duckball health plan when it's time again. And I know there's going to be possibly less medical costs. I mean, fingers crossed always. But that's just one of those areas where one of the ways that I think through it in the way that I kind of operate when it comes to some of that stuff. So a lot of our listeners are interested in retiring early. And when they start to plan for health care and financial independence, I think this is something that is very, very important for anybody who retires early. I think this is just always

Starting point is 00:39:07 forgotten for a lot of people when they don't plan this out. So if they're going to lose coverage, but they don't have Medicare available to them yet. So let's say maybe they retire in their 40s or they retire in our 50s, which you and I know many people who have done so. We know people who retire in their 30s. And so if they are going to decide to do something like that, how should they start to think through this process? I mean, how much should they budget for health care? Is there some sort of budget that you are kind of thinking through or ways that you think about that? You know, all those different types of things. How do you think about health care with early retirees.

Starting point is 00:39:39 So there are a number of different options and you really have to game it out, right? And so people who know that they're going to have a low income. So let's say you live off of $30,000 or $40,000 a year. You are an early retiree. Maybe the way you're paying for your lifestyle is through some mix of cash you had available. Maybe you're converting, you know, you're traditional to a Roth and doing a Roth ladder and pulling some out of that, you're going to have an exceedingly low income. So the good news there is you will qualify for subsidies and health care probably just won't

Starting point is 00:40:14 be that expensive for you. So if you are in a low income state, healthcare.gov uses subsidies. It's very good insurance. That's number one. Number two is to do what I and my wife did. We have a very high income, even though we don't make much money anymore because we are, you know, selling off equities to pay for our lifestyle and we're more of the high-steads. spending bracket. So we're never going to qualify for subsidies. So what I did is I kind of looked at

Starting point is 00:40:43 our budget and I assumed, which for a family of four that in where we live in Illinois, it's going to be $3,000 a month. So that was actually part of my, you know, quote unquote fire budget. I looked at how much do I need? Now, one thing you have to remember is it's a short term problem. If you retire at 55, you're really talking about 10 years. When we look at fire budgets, financial independence retire early budgets, we're usually looking at 30 years or more. This is a little different because you're only talking about maybe 10 years, maybe 20 years, only if you retire. If you retire at 35, you're finally looking at a 30 year, you know, problem. So one way is just to say, I'm going to include this in my expenses. You make a rough estimate. Of course, you can't see the future. So you don't know what it's

Starting point is 00:41:26 going to be. But for me, it was $3,000 and I just added it into my budget. Other people do other things. There are some easier, cheaper ways to get insurance if you are willing. So alternate versions of insurance, there are health savings ministries. So that's usually a religious organization. You have to follow certain ethical, moral, or religious dictates. But if you do, you can sign up with them. Everyone puts their money in. And then there's an administrator that disperses it to people who need it.

Starting point is 00:41:58 It is technically not health insurance. So it doesn't have the protections from the government. that, for instance, Blue Cross Blue Shield has. But a lot of people I know have been very happy with it, and it's usually a third or a fourth the premium costs. There's also something called farm insurance. If you are lucky enough to live in a city that has a farm bureau occasionally, no, we're not talking about everywhere in the U.S.,

Starting point is 00:42:21 but in a few different places you can join the Farm Bureau, and they actually give out really cheap insurance. And then if you're adventurous, there's stuff like expat insurance. So there's some ways to play the game. If you live outside of the U.S. more than six months a year, there's some versions of expat insurance you can use. Those are difficult, but if you really want to game the system, there's some hacks you can use. Unfortunately, it's a lot harder than it should be. Like, think about it.

Starting point is 00:42:48 If you're from Canada, this is not even a consideration. If you're from the U.K., this is not a consideration. If you're from most of South and Central America and from most of Europe, this is not a consideration. This is mostly a U.S. problem. So whenever I talk about this and I give advice and talk about the different ways of dealing with it, I want to be clear and saying it's a broken system that has led us here. So yes, we can piecemeal an answer. But what I really want to push with this book is let's fix this system so we don't need to piecemeal an answer. Like you pay enough taxes as an American citizen that you probably should get universal health care anyway.

Starting point is 00:43:23 Exactly. I think that's the, and that's the key component. Like you're in a location where you're saying, hey, I've got this income coming in and I'm paying, you know, $3,000. thousand dollars per month. I'm doing the same. I'm about about 2,500 bucks every single month. And I think it just is surprising to people if they don't realize, hey, your location does matter and some of that as well. And your income is going to matter. But in the long run, this can get very expensive depending on where you currently stand. And if you don't budget for that, it can be a bigger deal. My relationship with money has changed a lot over the years. Early on, I thought building

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Starting point is 00:46:39 And so I don't have to really worry as much about long-term care anymore. Or do you recommend that people kind of plan that out? So just like we're talking about paying for health care before 65, long-term care also is something you have to gamify and try to figure it out, again, because our system is broken. should pay for it, it doesn't. So let's talk about some things to think about. First and foremost, we used to talk about this idea of a retirement smile, right? So at the beginning of the smile, you retire, you're spending a lot because you're in your go-go years, you're traveling, you're doing all sorts of things. As you go to your slow-go years, right, you're getting 70s and

Starting point is 00:47:15 80s. You don't want to travel as much. You're not doing as much. You start spending less. And then the idea was the smile, you start spending more again towards the end when you have to pay for long-term care. Interestingly enough, a lot of the newer studies are showing that that smile is probably not as advanced of a smile as we think. We're actually not paying nearly as much in long-term care as most people fear. Like, 70- and 80% of people will pay a very small amount for long-term care or nothing, and only about 20% are going to pay a number that would be onerous. So first and foremost, most people aren't going to deal with this issue.

Starting point is 00:47:50 But because we are people who like safety and because we are early planners, we want to figure out a way to manage this long-term care. so it doesn't bankrupt us. So first of all, let me tell you what I do. I am in a position where I had a high income, and when I was really in the midst of my accumulation years, we started looking at long-term care policies when I turned 40. So we were really ahead of the game.

Starting point is 00:48:11 And remember, when you're young, it's cheapest. So when I turned 40, we looked at the premiums. It was extremely expensive to pay monthly for a premium. And so we started looking at insurance policies that had long-term care riders. And so I never advocate whole life insurance. I almost always advocate term insurance. But both my wife and I plunked a bunch of money down and bought basically long-term care wrapped in a whole-life insurance policy.

Starting point is 00:48:39 And so for us, I'll give you the actual numbers. I think it was 80,000 each for us. But that gave us a huge amount of long-term care coverage, and we never had to pay another premium again. So instead of paying monthly premiums, what happens when you become disabled and need long-term care? Well, you tend to forget things like the bills. And if you've been paying your long-term care premium forever and then forget a month or two, you might lose it.

Starting point is 00:48:59 And once you lose it, it's gone. And so that is one way. It's probably more for the wealthy, but it is something you can do. Another way is exactly what you said is you could say, well, long-term care insurance is too expensive, but we can backtrack and say, well, your average person at the end of life spend somewhere around $150,000 to $250,000 of care in those last few years. So if that's in 30 years, how much money do I need to start investing and putting away in a separate account to cover that today? And what you realize is it's just not nearly as much as you think. So, you know, you put $10,000, $20,000 today and you're thinking about 30 years down the road and you put it in aggressive equities, et cetera.

Starting point is 00:49:41 At some point, it's going to get towards that 150, 250. And so you can plan in advance and you can basically do what we do in Coastify, right? in coast-fi, you basically figure out how much you need invested to eventually become enough for retirement. Well, it's the same thing for long-term care. You figure out how much you need to put in today so that it will coast to being long-term care. You can do the traditional, which is get insurance and pay your monthly premiums. It tends to be exceedingly expensive, so most people don't. And believe it or not, there's some other interesting ways around long-term care, which most people don't know of. So if you have ever worked as a social worker or dealt with people at the end of

Starting point is 00:50:19 life, you know there's something called continuity of care facilities. So a continuity of care facility is usually when you get older, you can move into a community where you live independently. Some places you actually have to buy an apartment, so let's say you put $250,000 or $500,000 down for apartment, you sell your house, you buy the apartment, other places you just pay rent and you live there independently. But once you're there independently, let's say you get sick and need assisted living. They actually have an attached assisted living, and a lot of them have an attached skilled or nursing home. And once you're in the system, you maybe pay an extra $100 a month to move up in levels of care. So continuity of care is something that even non-wealthy people can do,

Starting point is 00:51:02 and it's like a long-term care insurance policy, but instead you move into a continuity of care facility. That's actually what my parents did, because they didn't have long-term care insurance. Lastly, the other thing is you can just move into a community of older people and agree that we're all going to help take care of each other. And you see this in some places where people live in a building and they all know their neighbors. And when so-and-so breaks their hip, one of the neighbors will come in and they'll provide some care and they'll cook meals for them and et cetera. So all of those are possibilities. None of them is perfect. It's a solvable problem. We shouldn't have to work so hard to solve it. But unfortunately, the way our system is today is that you do have to work to solve

Starting point is 00:51:40 the problem. But there are solutions. You know, throughout this conversation, we're seeing problems left and right with the health care system in the way that we're even kind of, you know, thinking about some of this stuff. If someone's listening right now, they're like, hey, how can we help fix this? Or what are some of the things that we can do in order to try to make a difference? Is there anything that you think people should be doing or considering right now to try to help make a change? Or is this something that really just has to happen when it comes to policies across, you know, politics in Washington, D.C. and some of those things there. So here's the problem.

Starting point is 00:52:11 There are things we can do as individuals and there's things we have to do as a community. Let me start with the hard ones. What we have to do as a community. And then we'll talk about some things each individual can do. As a community, I believe the only way we get change is never going to be through basic legislation because these third parties are so entrenched.

Starting point is 00:52:28 They pay so much money in lobbying that things just aren't going to change, right? That's why we have gridlock in Congress for all these years. Even Obamacare with everything they tried to do, it didn't really fix the grand majority of problems. So I feel like we need revolution. Now, I'm not talking about revolution like bayonets or guns or those kind of things or pitchforks. What I'm talking about is what a revolution is when the main stakeholders come together and speak as one voice to push for change and they convince the political parties

Starting point is 00:53:00 and they convince the governing structure that they have to change. And we've seen this throughout the United States. A great example is civil rights, right? civil rights basically in the 1960s we finally had such a large push by so many stakeholders that the Civil Rights Act had to happen because there was enough people, enough citizens pushing for change that it caused a revolution. We need the same thing in health care. Unfortunately, right now you have patients and physicians and health care providers are all fairly divided, right? The system is pushing us apart. It's blaming each other.

Starting point is 00:53:35 the main stakeholders, those who need care and those who provide care, are not speaking as one voice. So from a pie in the sky level, we need to come together as one voice and push for grassroots change. I argue in the book that way we get there is storytelling. How do people become allies? How do the doctors and the patients become allies? How do we become intimate with each other in a way that we trust each other? It's when each side tells stories. Now, patients have been telling their stories forever.

Starting point is 00:54:03 They come in the exam room, they bear their souls, and then they bear their bodies to the health care practitioners. But it's unilateral intimacy. Healthcare providers don't tell people their stories, which mostly makes sense, because when you come to the emergency room of chest pain, you know, why your doctor to sit your side and say, well, I hear what your problem is, but listen to my day. But outside of the exam room, we do a great job of telling people what we know, how to avoid health, you know, heart disease and how to get your cholesterol better and how to exercise. But we do a horrible job of telling people who we are. In other words, explaining the systems that don't work for us either and what it feels like to be a doctor. So I think the answer is we need to become better allies through shared storytelling.

Starting point is 00:54:41 If you go back to civil rights, the story of Rosa Parks was the perfect example of how stakeholders can gather around a story and push for change. I think the same thing has to happen in the U.S. So that's like the big story. The other question is how we as individuals can change things. Well, as individuals, the best thing we can do is not put our dollars in the pockets of these third parties. how do you do that? Well, first and foremost, if your insurance denies you something, fight it. Go to the mat and fight it. Every health care company has appeals. Go appeal it. If you go to your doctor's office and you need a new blood pressure med, blood pressure is something we've been

Starting point is 00:55:21 treating for centuries. You don't need the newest patented medication unless you have very severe blood pressure. Most likely you can get a generic that costs pennies and doesn't go into the hands of these big pharmaceutical companies. Find doctors who aren't owned by private equity and venture capital. I know it's hard, but there still are some doctors out there who own their own private practices or who do concierge medicine or direct primary care. Both of those are complicated systems, but basically they elect to not be part of the health insurance system.

Starting point is 00:55:54 So there are some things you can do above and beyond this bigger idea of coming together stakeholders, you can do some really basic things. Fight your bills, negotiate your bills. All of this takes money out of these big systems and puts it back into your pocket, which means the money is staying either in the hands of the patients or it's staying in the hands of the actual health care providers who are doing the work. That's what we want. If you had sitting here like a crystal ball and you were, you know, looking ahead and trying to predict what would happen in the future, do you see change happening here or do you think this is something that's going to have to Yes. Oh, the system is so broken. Revolution sometimes have to happen, and they will. That might look like universal health care. It might look like some common sense regulations. We're already starting to see it in our political system, right? So when you look at the different political parties, and I don't want to get too overtly political here, but when you look at the left, the left is pushing towards things like democratic socialists. And a lot of that will affect what happens with our health.

Starting point is 00:57:00 health care policy in the future. Like, we tend to react as a community, and we swing left or swing right, depending on what atrocities are happening in our world right now. And it is atrocity that health care premiums are going up. I mean, if you look at health care premiums from like 2000 to now, they just keep on going up double digits. The cost of meds is going up double digits. Everything is costing more.

Starting point is 00:57:24 There's a reason why people are saying that the economy is such a problem. health care is a big piece of this. I feel confident one way or another, we will push as a community for change and we will eventually get it. It might be hard. It might be difficult. I even think Obamacare was the beginning.

Starting point is 00:57:41 But just like anything in the U.S., there's lots of ups and downs. You push the limits. There's a little pullback. Then you push the limits more. There's a little pullback. But eventually we get to where we need to go. So I feel like there is definite optimism there.

Starting point is 00:57:58 And this is why I think for most people out there, we need to make sure that you're building wealth and you need to make sure that you're doing the right things for your financial future because having this in place is going to be one of those things. If we see this rising cost over the course of the next couple of years and the change doesn't happen rapidly enough, it is really important to focus on those things that you can control. But what are the things that you can control? You can control what your savings rate is. You can control how much income you were earning. You can try to negotiate your salary, increase that income to put those dollars towards wealth building for your financial future. So you can plan this. stuff out so that you can use money as a tool so you don't have to stress and worry as much about some of these different areas. And so that's why we talk about what we talk about here. We talk about this so that you can also make a change in your life, do the things that you need to be doing in order to help with this change. And I think this is really, really important. Jordan, thank you so much for coming on here. Where can people find more about the book, you and everything else? Thank you so much for having me. And I just want to remind people you do have

Starting point is 00:58:53 some control, even in a broken system. You do have some control. If you want to learn about the book, go to Jordan Grummet.com. That's J-O-R-D-A-N-G-R-U-M-E-T.com. There you can learn about all three of my books, taking stock, the purpose code, and the health care heist, as well as the different places where I create content,

Starting point is 00:59:10 the Earned and Invest podcast, as well as the purpose code substack. Check me out, Jordan Grummet.com. Awesome, and we will link all of that down below in the show notes. Thank you so much for coming on here. This has been great. Thank you so much for having me.

Starting point is 00:59:23 If you want a $3,000 a month payday for life, what would you feel free to do? Maybe take a long weekend, every weekend, or try a bunch of new hobbies. Would you feel free to upgrade and listen ad-free? Don't worry, we get it. Every $20 ticket could win you $3,000 a month for life and supports life-saving cancer research at the Princess Margaret. Feel free to buy your payday-for-life ticket today.

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The Personal Finance Podcast - Why Your Healthcare Costs Keep Rising with Dr. Jordan Grumet

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