This thread has been really insightful. I turn 37 this year.

My MIL made a lot of money in her O&G career but spent frivolously her entire life and probably thought that she would just work forever (she loved her job). The industry quit her in 2014 and she hasn't made it back. She's having to accept the fact that she will live a very minimal lifestyle for her retirement and will always struggle with money.

Her example reinforced my strong desire to save/invest....but I assumed that I could probably make it working until my mid-60s like she did. Now I've realized that I need to do game plan my 50s if I'm not on some type of leadership track.

5 or 6 years before my wife and I were planning to both retire early (goal was to retire between 50-55) I built a large spreadsheet that tracked all our assets, income, and expenses and then built it out to forecast till we were 80.
The exercise shows what you are spending your money on and allows you to forecast future expenditures and changes to test against future income. Built it to include the ability to change inflation factors and return on investment rates. Then built different scenarios to test when we could retire and what lifestyle we could live. At one point I thought I had everything in it (college costs, increasing medical expenses, car replacements etc) and I proudly showed my wife and she quickly said "where are the girl's wedding costs?"…so back to another iteration.
After several years of tracking, planning, and adjusting, we were finally able to be confident enough to both retire at 52.
That was 11 years ago, and we now are better off than what we planned. Much of that has been a better stock market than I forecasted (plan conservative and you will be happy), but the key is the old adage "it takes money to make money'. We both had worked 30 years each for the same company and saved a lot during our younger years.

I also manage both our 93 yr old mother's assets and the other obvious lesson is you CANNOT live in your old age just on social security and a corporate pension (which don't even exist any more). For example my mother has my dad's survivor's USMC 20 yr enlisted man's pension, his 20 yr post military pension, and his higher social security benefit. All that currently only adds up to ~$30,000/yr after all the adjustments after he died at 92. BUT, what they did do was saved constantly, in their case; savings bonds, CDs and a few mutual funds. Without that savings she wouldn't be able to afford the assisted living place she's currently in.

So my suggestion, regardless of how much to make, or your lifestyle, start planning now and understand what it will really take to retire the way you want to. Without good planning you will be in for a rude awakening..

I agree that we have great specialists, if one can afford them. It's everything else about the system that is completely messed up.

PCP's are the biggest influence over the general health of a population, and we have set up the system so that the best and brightest in the field avoid it like the plague. Their salaries are a joke when you factor in how long they train and spend on schooling.

Many specialties are becoming severely underserved and it will get much worse as the baby boomers retire, and there aren't enough people to backfill these roles because there aren't enough kids in medical school, because there aren't enough residency spots for them to train in after med school. This is all by design because the AMA wants to keep physicians scarce. The where do practices and hospitals have to go to recruit? India/Asia and the Middle East.

AgsMyDude said:

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YouBet said:

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Diggity said:

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By what metric do we have the best healthcare?

We have some great specialists because they make a **** ton of money but other than that, the ROI is pretty damn low.

This thread is a good example of why the system is broken.

And you can't disconnect healthcare from insurance. Blaming lifestyle is a cop out in my opinion.

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The fact that I can call an elite practice literally yesterday and see a world class shoulder expert on Monday...three business days later.

Let me know if someone on the rest of the planet can do that.

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Calling as a new patient? Just curious as I've never been able see any sort of specialist as a new patient without at least a month wait, most closer to 3.

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Yes.

Noble07 said:

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This thread has been really insightful. I turn 37 this year.

My MIL made a lot of money in her O&G career but spent frivolously her entire life and probably thought that she would just work forever (she loved her job). The industry quit her in 2014 and she hasn't made it back. She's having to accept the fact that she will live a very minimal lifestyle for her retirement and will always struggle with money.

Her example reinforced my strong desire to save/invest....but I assumed that I could probably make it working until my mid-60s like she did. Now I've realized that I need to do game plan my 50s if I'm not on some type of leadership track.

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also start to plan for the fact it is unlikely you will receive social security payments by the time you get to 65...
or they will be minimal.

one MEEN Ag said:

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Best ways to reduce your health care costs if you retire early are:
-Open a business, hire someone outside your family and go get a business rate. Business could suck, who cares. It just needs to show a profit enough years to keep you from being designated a hobby by the IRS.
-Take college courses and get healthcare through the college.
-Go on a medishare program through a church.
-take advantage of extended cobra benefits if you just left a job.

-Other option is to take care of yourself and anticipate paying cash for things.

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you left out having a second passport and getting health coverage through that country

YouBet said:

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Diggity said:

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By what metric do we have the best healthcare?

We have some great specialists because they make a **** ton of money but other than that, the ROI is pretty damn low.

This thread is a good example of why the system is broken.

And you can't disconnect healthcare from insurance. Blaming lifestyle is a cop out in my opinion.

---

The fact that I can call an elite practice literally yesterday and see a world class shoulder expert on Monday...three business days later.

Let me know if someone on the rest of the planet can do that.

---

short story, on our honeymoon we were in london, drinking with some locals at a pub. Health care came up, and the british guy was bragging about how their health care was so good and it was free.

A few hours later, he tells a story of how is dad died, he was on a list to receive a liver transplant but after 6 months or whatever of waiting, he died.


yeh.. sounds great!

YouBet said:

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AgsMyDude said:

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YouBet said:

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Diggity said:

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By what metric do we have the best healthcare?

We have some great specialists because they make a **** ton of money but other than that, the ROI is pretty damn low.

This thread is a good example of why the system is broken.

And you can't disconnect healthcare from insurance. Blaming lifestyle is a cop out in my opinion.

---

The fact that I can call an elite practice literally yesterday and see a world class shoulder expert on Monday...three business days later.

Let me know if someone on the rest of the planet can do that.

---

Calling as a new patient? Just curious as I've never been able see any sort of specialist as a new patient without at least a month wait, most closer to 3.

---

Yes.

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Either not a very good doctor or you had some sort of "in".

AgsMyDude said:

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YouBet said:

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AgsMyDude said:

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YouBet said:

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Diggity said:

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By what metric do we have the best healthcare?

We have some great specialists because they make a **** ton of money but other than that, the ROI is pretty damn low.

This thread is a good example of why the system is broken.

And you can't disconnect healthcare from insurance. Blaming lifestyle is a cop out in my opinion.

---

The fact that I can call an elite practice literally yesterday and see a world class shoulder expert on Monday...three business days later.

Let me know if someone on the rest of the planet can do that.

---

Calling as a new patient? Just curious as I've never been able see any sort of specialist as a new patient without at least a month wait, most closer to 3.

---

Yes.

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Either not a very good doctor or you had some sort of "in".

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Carrel Clinic here in Dallas. Pretty well known so i hope they are good. I'm kind of desperate to diagnose what's going on with me.

I have zero in.

so you think the US spending 20% of our GDP on healthcare costs is sustainable?

Attempting to tie the ability of a European to retire back to healthcare spending makes no sense when our country spends twice as much as other developed countries, while again achieving worse outcomes on average.

Diggity said:

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so you think the US spending 20% of our GDP on healthcare costs is sustainable?

Attempting to tie the ability of a European to retire back to healthcare spending makes no sense when our country spends twice as much as other developed countries, while again achieving worse outcomes on average.

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You are ignoring culture though. It's not so much the healthcare system as it is we are morbidly obese in the USA and now we are even celebrating that as healthy in 2022. When, as a culture, we incentivize people to slowly kill themselves like that then the healthcare system can only do so much to offset it.

YouBet said:

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Diggity said:

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I agree that we have great specialists, if one can afford them. It's everything else about the system that is completely messed up.

PCP's are the biggest influence over the general health of a population, and we have set up the system so that the best and brightest in the field avoid it like the plague. Their salaries are a joke when you factor in how long they train and spend on schooling.

Many specialties are becoming severely underserved and it will get much worse as the baby boomers retire, and there aren't enough people to backfill these roles because there aren't enough kids in medical school, because there aren't enough residency spots for them to train in after med school. This is all by design because the AMA wants to keep physicians scarce. The where do practices and hospitals have to go to recruit? India/Asia and the Middle East.

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Do you know why that is?

Because PCPs have been automated. All they do is draw blood and tell you if something might need a further look. That's literally all mine does.

So everyone else wants this idealistic world where everything is handled in this preventative medicine fantasy where you catch everything up front and it gets handled.

Real world doesnt happen that way. My internals are all great but my skeletal system is trash. Nothing my PCP does is relevant for any of that. I'm completely dependent on access to specialists for that.

In a socialist system that dumb m'fers the world over advocate for, I would be screwed because I would be waiting months to see someone.

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The main reason PCPs are paid less is that Medicare (who is the de facto price setter) pays a whole lot less in the "fee for service" world for E&M's (visits) than they do procedures. Doctors are smart people, and they flock to the specialties that reimburse the best (cash is even better!).

Your particular case notwithstanding, nearly every research study tells us that patients fare much better in the long term if they have regular visits to their PCP's. This results in less ER visits, early detection of major issues, identification of "lifestyle" issues, etc.

On a macro level, it's a much better use of money to spend more up front on a good system of primary care then to wait for patients to get severely sick. We don't do that.

We spend so little on reimbursement for primary care that physicians have no choice but to book 30 patents a day. At that point, they are limited on how much screening and care they can provide, because there's only so much time in the day.

Diggity said:

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YouBet said:

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Diggity said:

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I agree that we have great specialists, if one can afford them. It's everything else about the system that is completely messed up.

PCP's are the biggest influence over the general health of a population, and we have set up the system so that the best and brightest in the field avoid it like the plague. Their salaries are a joke when you factor in how long they train and spend on schooling.

Many specialties are becoming severely underserved and it will get much worse as the baby boomers retire, and there aren't enough people to backfill these roles because there aren't enough kids in medical school, because there aren't enough residency spots for them to train in after med school. This is all by design because the AMA wants to keep physicians scarce. The where do practices and hospitals have to go to recruit? India/Asia and the Middle East.

---

Do you know why that is?

Because PCPs have been automated. All they do is draw blood and tell you if something might need a further look. That's literally all mine does.

So everyone else wants this idealistic world where everything is handled in this preventative medicine fantasy where you catch everything up front and it gets handled.

Real world doesnt happen that way. My internals are all great but my skeletal system is trash. Nothing my PCP does is relevant for any of that. I'm completely dependent on access to specialists for that.

In a socialist system that dumb m'fers the world over advocate for, I would be screwed because I would be waiting months to see someone.

---

The main reason PCPs are paid less is that Medicare (who is the de facto price setter) pays a whole lot less in the "fee for service" world for E&M's (visits) than they do procedures. Doctors are smart people, and they flock to the specialties that reimburse the best (cash is even better!).

Your particular case notwithstanding, nearly every research study tells us that patients fare much better in the long term if they have regular visits to their PCP's. This results in less ER visits, early detection of major issues, identification of "lifestyle" issues, etc.

On a macro level, it's a much better use of money to spend more up front on a good system of primary care then to wait for patients to get severely sick. We don't do that.

We spend so little on reimbursement for primary care that physicians have no choice but to book 30 patents a day. At that point, they are limited on how much screening and care they can provide, because there's only so much time in the day.

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I'm not disputing that at all and agree. My point was more that in those socialistic settings they almost ignore speciality care because as one meen ag put it, it's a cost first mentality over there. If you actually get to the point of needing a doctor for speciality care there is no better place on the planet than the USA.

There are certainly things to improve over here but this drumbeat by the left to move to UHC as a panacea is throwing the baby out with the bath water.

YouBet said:

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Diggity said:

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so you think the US spending 20% of our GDP on healthcare costs is sustainable?

Attempting to tie the ability of a European to retire back to healthcare spending makes no sense when our country spends twice as much as other developed countries, while again achieving worse outcomes on average.

---

You are ignoring culture though. It's not so much the healthcare system as it is we are morbidly obese in the USA and now we are even celebrating that as healthy in 2022. When, as a culture, we incentivize people to slowly kill themselves like that then the healthcare system can only do so much to offset it.

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obesity is a huge problem obviously, but I don't think you can totally absolve the healthcare system of all "lifestyle issues". These are clearly health related issues, and we've done a terrible job getting it under control. We have done a great job of getting smoking rates down compared to other countries, getting parents to use car seats, and wearing seat belts in general, but for some reason obesity isn't emphasized. Hell, we put obese women on the cover of SI.

Whether or not you agree this is all related to our healthcare system, it clearly costs us a huge amount of money as taxpayers and is a big reason why insurance premiums keep going up.

Medicare sucks. It's a glimpse of government care. My parents have it, and it won't pay for any of the latest and greatest innovative medical treatments. If we had government care, there would be no more innovation. It would not only be worse for individuals, but it would be worse for humanity because it's American innovation that eventually gets proliferated world wide. That goes away when America gets rid of private health care.

So you think if America went to a centralized health insurance system that all innovation and research would just stop?

Not arguing that isn't a perk of America's current system. I mean diabetes is a pretty good example. In other countries insulin is more readily available and way more affordable. But those other countries don't have some of the more advanced monitoring systems we have, it's a trade off.

That said, I highly doubt that innovation would just stop. We'd still be leading the way, just differently.

YouBet said:

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AgsMyDude said:

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YouBet said:

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AgsMyDude said:

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YouBet said:

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Diggity said:

---

By what metric do we have the best healthcare?

We have some great specialists because they make a **** ton of money but other than that, the ROI is pretty damn low.

This thread is a good example of why the system is broken.

And you can't disconnect healthcare from insurance. Blaming lifestyle is a cop out in my opinion.

---

The fact that I can call an elite practice literally yesterday and see a world class shoulder expert on Monday...three business days later.

Let me know if someone on the rest of the planet can do that.

---

Calling as a new patient? Just curious as I've never been able see any sort of specialist as a new patient without at least a month wait, most closer to 3.

---

Yes.

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Either not a very good doctor or you had some sort of "in".

---

Carrel Clinic here in Dallas. Pretty well known so i hope they are good. I'm kind of desperate to diagnose what's going on with me.

I have zero in.

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Mostly just busting your chops. Good luck and hope it goes well!

LMCane said:

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one MEEN Ag said:

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Best ways to reduce your health care costs if you retire early are:
-Open a business, hire someone outside your family and go get a business rate. Business could suck, who cares. It just needs to show a profit enough years to keep you from being designated a hobby by the IRS.
-Take college courses and get healthcare through the college.
-Go on a medishare program through a church.
-take advantage of extended cobra benefits if you just left a job.

-Other option is to take care of yourself and anticipate paying cash for things.

---

you left out having a second passport and getting health coverage through that country

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Very true, Barnes.

We've looked into Portugal's golden visa via the RE option. You investment is tied up until citizenship, but then you can withdraw. Depending on the duration you need to gap between retire to Medicare, and your health outlook it might make sense. But it's another option out there.

We ought to nationalize the O&G industry while we're at it. I'm tired of paying so much for gas. Come to think of it, there's a whole lot of industries that should be nationalized so the government can "optimize" them like only the government can… Then we could all retire early. This makes the most sense.

Just saying I don't think that's a very good analogy.