For being medical professionals, many of us have hardcore health cost fears in retirement. We worry that we may not have enough money to deal with those healthcare costs or that our health insurance premiums will be obscenely unaffordable.
One of the reasons for this is that, much like the average person, we don’t fully understand how the US healthcare system works. We don’t know how to game the system, how to make cash work for us, and how to get around all the shitty insurance red tape.
This post is going to address all the common health cost fears in retirement. If you don’t want your health to dominate your spending in retirement, you have that ability to make choices to prevent that.
Cost of healthcare
Is it healthcare or health care? Supposedly, health care is the actual clinical intervention and healthcare is the mega billion dollar industry which has done such a great job of making Americans healthier.
Drug companies run medicine in the US, in case you were asleep. They research diseases and thrive on the US population being unhealthy. We have a disease-driven healthcare model which the insurance companies have lobbied for and medical professionals have backed.
Fortunately, immediately ready to pick up any slack left behind by the pharmaceutical industry, there is the supplement industry which is an escape from western medicine, guided by lofty notions, mass marketed in popular media.
The most expensive part of healthcare should be our monthly insurance premiums, but consumers somehow manage to rack up a ton more bills outside of this. A lot of this is out of fear – we pay for what we don’t know, in hopes that we can prevent something far worse.
On top of the monthly health insurance premiums, there are ER visits, telemedicine visits, surgeries, time wasted searching for a symptom online, multiple doctor visits for a misdiagnosed condition, lab tests, supplements, prescription medications, chiropractic care, acupuncture, medical device purchases, gimmicky devices, and diet products.
Cost of health
Most of us are born with health and like any tool, you need to figure out your body’s operation manual and maintain it. And the older you get, the more maintenance you’ll need to do. But maintaining health isn’t hard, the recipe has been out there for centuries.
In most healthcare systems the focus is on treatment of symptoms of poor lifestyles which eventually lead to chronic diseases. It isn’t about keeping you healthy – it’s about keeping you productive in society and about masking your symptoms.
To maintain your health you need to eat well, curb your stress, get enough sleep, hydrate adequately, exercise, and you need good genes. These aren’t things you’ll get from a doctor. In fact, I’m a great doctor and I know very little about this stuff – very little.
But, if you’re fat, I can give you weight loss meds. If you’re stressed, I can give you a benzo. If you have insomnia, I can give you a hypnotic. If your bones are brittle from inactivity, I can give you Fosamax.
The shockingly obvious fact about health is that it’s cheaper to maintain your own health than going to the doctor to treat your disease. Whole foods are cheaper than processed foods. Exercise is free and can be done at home, on the streets, and even in a prison cell.
Health in retirement
The average retiree in the US will have worked far too much for far too long and thereby neglected their health. You cannot stress for a 12-hour shift or look at path slides for 8 and then go home to doing your bills and expect to be healthy.
However, the western medical system has managed to keep even the most sedentary individuals alive with tons of surgeries, injections, medications, and supplements. I’ve had patients who started with type 2 DM at age 35, obesity, depression, heart attack, stroked, eventual dialysis, and lived to age 70 with the help of western medicine. That’s one way to live, but not my preferred mode.
When we’re young it doesn’t matter much what you eat, don’t eat, do, stress about, or snort. As we get older, say 40, our bodies can probably handle about 20 hours of work per week. For most of us, the rest need to be dedicated to exercise, activity, cooking, meditation, etc.
Since these habits aren’t learned, they are damn near impossible to adopt when we get older. Just look at how many doctors sport beer guts. We become a product of our society. We behave in the same way, live the same way, and often eat the same shit our patients eat.
You really can’t take a plaqued coronary artery or an insulin depleted pancreas at age 65 and make lemonade out of it. That needs to start a lot sooner. All’s not lost even if you are the ticking time-bomb of health. But it takes so much more effort, it can be debilitating.
Definition of health
Your definition of health will be very different from mine. My friend N.’s definition of health is being able to do the things she wants to do in life. My definition of health is not suffering from disease or side effects of treatments.
Quite a few of us medical professionals will start on anti-depressants, blood pressure meds, cholesterol meds, birth control pills, supplements, vitamins, protein shakes, move on to surgeries, injections, and, if cancer pops up, more surgery, more meds, chemo, radiation, often followed by an uncomfortable death.
I’m learning a lot as I’m working on my current AI project. Predicting who has or will get chronic diseases is actually not that difficult. The difference is that our AI project needs to determine chronic disease in a state where it can be diagnosed so medical institutions can bill for it. But nobody told your body that there is a lab test to diagnose disease.
For anyone, let alone a doctor, to think that diabetes is only diagnosed with an A1C of 6.5 is end-stage ignorance. Diabetes started long, long, long ago in your body. We use lab values to bill our disease-based health system and to monitor the ineffective management of medications.
I’m not against medications but I’m certain that the best treatment for a chronic disease isn’t surgery or a chronic medication. Maybe if we had healthier medication options, maybe if the FDA actually gave a fuck and wasn’t so biased, there might be better medication options available.
Chronic diseases are often the result of an unhealthy lifestyle. Sure, you could just have poor genetic luck but those are rare cases among the many.
- high cholesterol
- many cancers
- liver disease
Be your own doctor
When I owned a car I tried to be my own mechanic. When I remodeled my first condo, I was my own contractor. When I started my blog, I became my own graphic designer and web designer. When I became a physician and a patient, I still became my own doctor.
Most of the physicians in the US, or clinicians or whatever, are pulled into too many directions to make the patient their main focus. Even when I’m treating a physician in my practice, I’m less worried about their outcome and more worried about all the different steps it takes to move that patient through my clinic.
Nobody will give me a medal for doing something amazing for a patient, for maintaining their health, or curing them of an acute complaint. But there are lots of entities which will strip my naked, tar and feather me for the smallest mistake. That’s where my focus as a physician lands – not the patient.
The best material on becoming healthy and maintaining health is published by medical professionals in books and private websites. The best information I came across in regards to managing migraines wasn’t from my medical textbooks but a book published by a neurologist specializing in migraines.
Mainstream research studies are now overrun by pharmaceutical companies and biased researchers showing that the P of <0.05 indicates that a statin should be started as primary prevention of an MI. Even if the real chance of lowering an individual’s heart attack risk is less than 10% – it’s all about that P.
Health insurance premiums
Physicians and other medical professionals think that Medicare and Medicaid are bad. That you get shitty health care if you have one of these insurances – which is all they are, insurances. Plenty of clinicians take Medicare and Medicaid – good physicians and shitty ones alike participate in CMS.
Most individuals will put less research into their doctor than choosing their next AirBnb. It’s not Medicare you have to worry about, it’s the surgeon or hospital you’re going to stay at. It’s the physician who will see you and not the insurance you have.
When it comes to health insurance premiums, it likely will be one of your biggest health expenses if you don’t have Medicare. Most medical professionals won’t qualify for Medicaid – let’s not focus on that. With Medicare, you can pretty much stop worrying about your health cost unless you are planning on having a ton of interventions and planning on seeing very specific doctors and healthcare systems.
The cost of health insurance will only go up. I’m 40 now, by the time I’m 65, private health insurance will likely cost me several thousand dollars per month. And I expect that my monthly premium will not only be tied to my income but also my net worth.
Once health insurance premiums jump into the thousands, it’s also likely for some innovation space to open up. Many of us will possibly get the opportunity to self-insure against certain poor medical outcomes. In order to determine what you’ll pay for, you’ll need to decide what interventions you are okay with.
But before we jump into individual health care decisions, international healthcare or medical tourism, requires some attention.
A few of us already take advantage of medical tourism. Many medical professionals in the US are immigrants and are comfortable with or prefer going back to their country of origin for their health care. Not only is it cheaper but outcomes aren’t as bad and the intervention isn’t as aggressive.
Dental care, plastic surgery, childbirth, joint replacement, and even cancer therapy are common medical interventions which are far cheaper and have very good outcomes overseas. The main reason for the better outcome is purely out of competition; these foreign healthcare systems have to prove to the European and US citizens that they can offer them a better value and outcomes than their own medical system.
Individual health decisions
Back in the day when you only had the option of going to a surgeon and having an infected organ removed and when there were no medication options neither for pain nor for chronic disease management, your decision tree was rather bare.
Now, with so many fucking options, it’s even more important that we had an in-depth health conversation with ourselves.
- what will I do if I get breast cancer?
- what surgeries will I accept?
- which surgeries will I refuse?
- will I accept chemotherapy?
- do I want to have radiation of any part of my body?
- how long do I want to live?
- what am I willing to have done to me to live longer?
- which medications am I okay with and which will I refuse?
- will I manage living with pain on my own or take opioids and use a pain pump?
- would I have a liver transplant if needed?
These are tough decisions but fortunately most of us get many years of dealing with the US healthcare system as a way of practice before having to make these bigger decisions. Start with whether you’ll go to the doctor for a cold or flu. Then, will you take your child to the doctor for a cold or flu.
Will you use contact lenses or are you okay with glasses? How about LASIK surgery versus glasses? These are good ones to warm up with before having to decide on cataract surgery or trabeculoplasty.
Next, decide if you’ll take antibiotics for a possible strep throat or a UTI. And whether you’ll take cholesterol or blood pressure medications or if you’ll manage that yourself.
Every procedure or medication offered in the US has a cash value. It’s just that this cash value isn’t transparent because the model is driven by insurance reimbursement.
With today’s ridiculous high deductible plans – nearing $7k a year – it’s possible that most of us would never have to have insurance. We’d be able to negotiate cash payments and save the deductible, not to mention the insurance premiums. Is it a risk? Sure. But there is always a risk, even if you don’t realize that risk.
There are companies who will do the cash haggling for you. This is especially ideal when dealing with larger medical groups which have zero transparency and, in fact, will lie to you when asked for a cash price.
There are also private groups which would love to deal with cash rather than an insurance company. Such private groups will list their cash price or easily disclose them to you.
There are aggregation websites which will list the cash costs of a particular surgery. Some don’t like this model, they believe it’s unfair and that it creates unnecessary competition among surgeons. That would be true if the consumer is a dumbass and only looks at cost. But the cash-paying consumer is a savvy snake, who will take into account numerous factors when selecting their surgeon – and not just the cost.
Did you know that you could order 1,000 pills of losartan for less than $100? I have a friend who takes this medication along with a few others. He’s a doctor, a very smart doctor. But he hasn’t bothered calling up the same company which supplies his pharmacy to get the medication at a wholesale price.
What about lab tests? I don’t need another physician ordering lab work for me. I can order it for myself and pay only the lab fee. Is it illegal to order my own medication for myself and order my own lab tests for myself? Nope. Is it frowned down on by the medical board? Of course! But the burden of proof is with them to show that you are rubbing losartan dust on your gums for a high.
Your physician network
In my network of great friends and colleagues, I have the following medical professionals:
- sports orthopedic surgeon
- dental anesthesiologist
- family medicine doctor
- sports medicine doctor
These are the people whom I can depend on to help me or offer me advice on my health should I need the help in the future.
It’s no joke, healthcare has become obscenely expensive. If you don’t want to take your health into your own hands then your financial costs could get out of control if disaster strikes. But that’s not an excuse. It’s like the physician in SF complaining of a high cost of living. There are tons of other cities we can choose to live. It’s about making the most sustainable decision for ourselves.
All that said… all this bullshit that I just wrote… statistically, most of us will get to a ripe old age with saggy tits and balls dragging the floor, likely without any major disease. A few of us will deal with rather mild conditions. And a very tiny percentage of us will get cancer or have a major disease which requires an intervention. The risks are low but the the upside of planning will offer a massive peace of mind.