Why Your Healthcare Costs Keep Rising with Dr. Jordan Grumet

24:47Well, 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 six to seven thousand dollars a year per patient whereas in the u.s we're somewhere closer to 13 or 14 thousand dollars a year so my suspicion is about 50 percent of it comes from all of this bloat 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 the u.s the uk is fairly similar the u.s they both have their problems.

25:29And don't get me wrong, sometimes you have to wait longer for services, 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. 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 our bringing in less immigrants who are experts in their field who then come migrate to the U.S.

26:11That 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 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 US. But you're saying it's basically, you know, pretty similar in terms of some of the stuff.

26:39They 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 we're starting to approach retirement, we 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.

27:06Otherwise, 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 health care costs. For example, you know, when I run businesses, I don't have, you know, a company who is supplementing my health insurance. And it is a few thousand dollars per month for me to have health care coverage for my family of five. And so for many people out there not realizing what the cost is can be really, really important. But Jordan, if someone gets a medical bill and it lands on the kitchen table, what is the first thing they should do before they pay that medical bill?

27:40Should they look at it, scan it? What are some of the things that they should do in order to kind of save on costs here? Yeah, first and foremost, look at it, right? Because a lot of times you'll find things that weren't even done. And so first and foremost, it's tracking down what the charges are and why. 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 kinds of things.

28:13You'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 deny care or say you didn't get a preauthorization 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 care for something your doctor said you needed, you should fight it.

28:42You 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. 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.

29:14It 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. 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 of dollars.

29:44This 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 to fight for that. Because I think it's really, really important to make sure that you are thinking through this. Now, if you've ever felt like your bank is working against you instead of for you, you're not alone. Between overdraft fees, monthly fees, and just trying to access your own money, it all adds up fast. That's why Chime is changing the way people think. Chime offers fee-free banking built for you, not the bank.

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33:16Check responses set up required, compatibility and availability varies 18+. Another thing you talk about in the book is something that I absolutely love, which 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, A, 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.

33:51Don't even realize it's accessible. That's number one. Number two, a lot of people think the HSA works 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 an 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? This idea that, hey, I can pay out of pocket for all sorts of things, keep those receipts.

34:31Meanwhile, 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, 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 health care.

35:10People 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, 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.

35:43But in addition, I think most people don't realize how many qualified medical expenses there really are. Tons. With an HSA. It's unbelievable. You can buy a Peloton now with an HSA. So there's just so many. An Oura 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 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 have it added to a spreadsheet pretty quickly.

36:19Or 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 a number so I can kind of track it as time goes on. And you may realize, oh, I purchased some other items that I never realized were actually HSA eligible. And if you have those receipts somewhere, you would definitely, definitely keep and hang on to those.

36:48I 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. Yeah, or insurance premiums or Medicare premiums. People don't realize, 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.

37:19But 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 a, you know, 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?

37:52So I'm by no means an expert in this, but it really depends on what your spending is going to be. 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 an 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?

38:27How 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. 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 gonna be a lot more medical costs in that given year. And so I mapped it out and kind of figured out, OK, this makes a lot more sense to shift it that year.

38:58Then I go back to the high deductible 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 and 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 forgotten for a lot of people when they don't plan this out.

39:30So 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?

39:58So 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, your 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 be that expensive for you.

40:34So 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 spending bracket. So we're never going to qualify for subsidies. So what I did is I kind of looked at 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.

41:12I 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 going to be.

41:46But 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. It is technically not health insurance, so it doesn't have the protections from the government that, for instance, Blue Cross Blue Shield has.

42:24But 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., 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.

42:57Those 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. If you're from Canada, this is not even a consideration. If you're from the UK, 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 in saying it's a broken system that has led us here. So, yes, we can piecemeal an answer.

43:31But 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. Exactly. I think that's the key component. You're in a location where you're saying, hey, I've got this income coming in and I'm paying$3 ,000 per month. I'm doing the same, about$2 ,500 every single month. I think it's 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.

44:05And if you don't budget for that, it could be a bigger deal. One other thing, though, is like long term care. Do you look into long term care at all? Or is this just something that, hey, it's part of my portfolio? I built up this, you know, large portfolio. 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, our system should pay for it. It doesn't.

44:35So 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 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.

45:08We're actually not paying nearly as much in long-term care as most people fear. Like 70 % to 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. But because we are people who like safety and because we are early planners, we want to figure out a way to manage 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.

45:47So we were really ahead of the game. 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. 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.

46:26So 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. 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 spent somewhere around$150 ,000 to$250 ,000 of care in those last few years.

46:58So 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. At some point, it's going to get towards that$150 ,000,$250 ,000. And so you can plan in advance and you can basically do what we do in CoastFi, right? In CoastFi, you basically figure out how much you need invested to eventually become enough for retirement.

47:32Well, 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 are 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 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.

48:08Some 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. And it's like a long-term care insurance policy.

48:42But 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.

49:11We 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 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, 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 to try to help make a change?

49:39Or 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. There are things we could 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. They pay so much money in lobbying that things just aren't going to change, right?

50:10That'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, is when the main stakeholders come together and speak as one voice to push for change and they convince the political parties 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?

50:45Civil 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. 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.

51:25I argue in the book that the 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 its stories. Now, patients have been telling their stories forever. They come in the exam room, They bare their souls and then they bare their bodies to the health care practitioners. But it's unilateral intimacy. Health care providers don't tell people their stories, which mostly makes sense because when you come to the emergency room with chest pain, you don't want your doctor to sit you aside and say, well, I hear what your problem is, but listen to my day.

51:59But outside of the exam room, we do a great job of telling people what we know, how to avoid 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. 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.

52:29So 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. Well, 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 treating for centuries. You don't need the newest patented medication unless you have very severe blood pressure.

53:05Most 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. So there are some things you can do above and beyond this bigger idea of coming together as stakeholders. You can do some really basic things. Fight your bills.

53:43Negotiate 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 burn? Yes. The system is so broken. Revolutions sometimes have to happen and they will.

54:14That 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 healthcare 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 healthcare premiums are going up.

54:51I mean, if you look at healthcare 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. there's a reason why people are saying that the economy is such a problem. Healthcare 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. 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.

55:28But eventually we get to where we need to go. So I feel like there is definite optimism there. 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 gonna 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.

55:58You can control how much income you're 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.

56:24Where 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 some control, even in a broken system. You do have some control. If you want to learn about the book, go to jordangrummet.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 Healthcare Heist, as well as the different places where I create content, the Earn and Invest podcast, as well as the Purpose Code substack. Check me out, jordangrummet.com. Awesome. And we will link all of that down below in the show notes.

56:55Thank you so much for coming on here. This has been great. Thank you so much for having me.

57:27through September 16th. USNAC store online for details.