The Healthcare Heist: Who Profits? with Jordan Grumet (Doc G)

Speaker 0:21

Welcome to the Mindful Fire Podcast, a show about crafting a life you love and making work optional using the tools of mindfulness, envisioning, and financial independence. I'm your host, Adam Coelho, and I'm so glad you're here. Each episode of the Mindful Fire Podcast explores these three tools through teachings, guided meditations, and inspiring interviews with people actually living them to craft a life they love.. Let's jump into today's episode

Adam Coelho 1:04

Jordan, welcome back to the Mindful Fire Podcast. I'm so happy to have you back

Jordan Grumet 1:08

Adam, I'm happy to be here and looking forward to the conversation.

Adam Coelho 1:11

me too. I was so thrilled to have you reach back out to me and let me know you wrote yet another book. You are quite prolific. This is your third book. You started looking at, lessons about money from the dying, then you switched to focus on purpose that we're building in our lives, and now you've foc- you're focusing on healthcare. And so those are three sort of different topics. Healthcare I'd say would be the outlier of the two, of the three so far. What prompted you to write this book?

Jordan Grumet 1:38

here's the thing. I've been kind of holding back. So I've discussed for a long time how I discovered financial independence and realized that my sense of purpose was based on my father dying when I was young. He was a doctor, and I thought I could make up for that big tragedy by becoming a doctor, too. And so I've done a good job of describing why I left medicine, 'cause it didn't fulfill my sense of purpose, and how I used my finances to allow me to do that. But there's another side to the story that I don't talk very often about. I talk about getting burnt out from medicine because of issues with purpose, but the other side is I was getting burnt out from medicine because I felt like the doctors and patients, instead of being colleagues or allies, had become combatants, and I was spending more and more of my time fighting off the insurance industry, pharmaceutical companies, private equity and venture capital, believe it or not. They were all starting to impinge on my work life. And so I just felt like our healthcare system was changing in such a horrible way. And so I don't often talk about that piece of why I leave medicine. I often talk more about purpose and identity, but it was an equally important part of why I left medicine.

Adam Coelho 2:46

Interesting. So sounds like there was something pulling you, and then also something that you were leaving behind intentionally because it was a big stressor.

Jordan Grumet 2:54

Yeah, I was being pulled by a new sense of purpose, but I was being pushed by a healthcare industry that wasn't serving doctors, wasn't serving patients. The thing is, I found that it was really only serving these third-party corporate entities that were extracting all the money out of the system and weren't even really providing us any s- sense of better healthcare.

Adam Coelho 3:12

Yeah. That is the thing that is crazy, about the healthcare system in th- this country, in the United States, is that we spend way more than any other country and get worse outcomes than other countries. That, that's a bad combination.

Jordan Grumet 3:27

Yeah, it's actually ridiculous. If you look at most other countries outside of the US, they have universal healthcare. And it is true the people who live in those countries pay higher taxes, but when you look at the amount of money spent per patient, it's about $7,000 per patient around the world. In the US, it's about $13,000 per patient. And their healthcare is paid for by their government through taxes, so they pay a little bit of extra taxes and they get it for the rest of their life. Now look at the US. We get charged premiums from health insurance industries, and let me tell you, my wife is just coming off COBRA and we're looking at a $4,000 a month healthcare bill for four people. We are paying a heck of a lot more than that $13,000 per person. We're paying a heck of a lot more than the $7,000 per person. And we're not even counting here co-pays and deductibles and all those kind of things. It is most likely that healthcare for my family will cost us more than $50,000 next year. and we're not getting anything better. It is true, in the US at the higher levels, we do get nicer, in some ways higher quality care. But for your average person, what you get in the US is less wait times mostly, and you get nicer hospital facilities. But outcomes are all about the same regardless of what country you're in. So we're spending a heck of a lot more. We're spending as if we have universal healthcare, but we're not actually getting that universal healthcare.

Adam Coelho 4:50

Yeah. Yeah. Exactly. and often we're paying these premiums, and that's just money out the door. That's really for just catastrophic events, Like getting cancer or getting in a huge car accident. But y- that's not gonna help you stay healthy on the day-to-day because you still have to go and pay a huge deductible oftentimes.

Jordan Grumet 5:09

Yeah. it just taxes the system to such an extent. And again- If we were using these dollars for better healthcare and we were getting better outcomes, it would feel reasonable. But what's really happening is that the system has been optimized for corporate America and the medical malpractice system to basically extract all the money out. So we're basically- subsidizing business people mostly, and getting nothing in return, and that's where it gets really frustrating. It's one thing if you're spending a lot on healthcare, but you're getting so much in return, but we really aren't. We're just enriching all these third parties.

Adam Coelho 5:45

Yeah. Yeah, that's a really good point. And I know that, we're both fire podcasters and fire people, and the people listening to this are as well. And so one of the things, one of the biggest worries that people have about leaving their full-time careers and stepping into the new chapter of fi, of financial independence and retire early, this next chapter is healthcare. And so we're gonna explore that in a little bit. But first I wanna dive into this book that you wrote, and you, it's called The Healthcare Heist. heist is a pretty, strong word, and so who's being robbed and how are they being robbed?

Jordan Grumet 6:22

So we are being robbed, and then when I say we, I'm talking about all the healthcare providers, and I'm gonna use, I use the word doctors, but I'm really talking about doctors, nurses, chaplains, social workers, physical therapists, occupational therapists. there's a whole group of people providing healthcare. And then the rest of us is society who needs that healthcare. And so we're the ones who are really vested, we're the main stakeholders in the system. The problem is we have all these third parties who have basically inched in on this transaction of caregiver giving care to someone who needs it, and are adding all sorts of fees. They are putting their hands in the cookie jar, taking all the cookies out, and leaving us bereft. So who are these people? They are the health insurance companies. They are the pharmaceutical companies. They are the electronic medical records companies. They are venture capital and private equity that are buying up medical practices and hospital systems. And they are the medical malpractice system, which mostly includes lawyers and insurance companies. So those are the parties that are pa- basically extracting all the extra wealth out of the system. They're causing all of our premiums to go up. And again, we're not getting anything in return.

Adam Coelho 7:30

Yeah. and so walk me through a little bit more about, like, how all of that kind of comes to be. people have a felt sense of living that experience, having a claim denied or, whatever it might be, but, you've really looked deeply into this. maybe give an example of how these, these third parties are extracting money between me, who needs care, and a provider, a doctor who is providing that care.

Jordan Grumet 7:54

All right, let's talk about two of those third parties and discuss how this interaction goes. so let's first start with electronic medical records. Most people don't know that in the 1970s, the VA, that's our government-run healthcare system, started electronic medical records called Vist A. That was its system. It was incredibly cheap, incredibly easy to use. As a medical student and resident, when I went and did my VA rotations, I could learn how to use the system in a half an hour, and then I used it for the full month or two I was working there, then I left. That system actually communicates with every VA in the country, and they can share information and share charts. Costs almost nothing, very efficient, works great. What happens in 2000? in 2000 there's a government mandate that we have to really move to electronic medical records so that we can start basically reporting on all sorts of things like outcomes, et cetera, this is for public health, so we can clean up our medical records so that we can cut down on medical errors and so that hospital systems can communicate better. But the government didn't just say, "Hey, we're gonna use Vist A for everyone. We're gonna license it, and it's free for everybody. It's cheap, it's easy. Go ahead." What they did is they basically said that corporate America could develop these electronic medical records system, and as long as they followed a certain rules, they would suffice. So we have the rise- of electronic medical records systems and companies. They create medical records, but guess what? Who is their customer? their customer is the hospital system or the doctor. So they had to sell these to people for a reason, so they basically sold them on, We're gonna help you bill more." And so they created these really complex systems that don't make a lot of sense for a practitioner because they change the way we practice- medicine, they change our workflow. But they sold these on this idea that you can actually collect more money, you can be- Yeah government compliant easier. And so they charge huge amounts of money. some... I remember my practice when we, went up on electronic medical record, it was about 30 to $50,000 per physician. Okay. So it costs a lot of money You spend a lot of time using that medical record system to chart on and put information into the system that you would have never spent your time doing before, but now the doctor was putting in all sorts of information so they could report it to the government so that they could not have their Medicare fees cut, these kind of things. Doctors stopped paying attention to patients, right? Instead of looking at them in the eyes, you're now- looking at a computer screen, so there's this physical- barrier. let's fast-forward 25 years later. We've spent billions and billions of dollars on electronic medical records. Epic, one of the big ones, has made billions, has made its owner and its founder a billionaire multiple times over. Guess what? Most of the studies now show that electronic medical records didn't cut down on costs, and they didn't cut down on medical errors. They did somewhat, like there were certain errors that were avoided, but the medical records system itself caused more errors. And so didn't cut down on cost, didn't cut down on errors. Epic provides medical records, let's say, for two competing hospitals in one city. But because their customer is the hospital and the hospitals have requested that information can't be shared between hospital systems, you might have Epic in one hospital and Epic in another hospital, but they don't talk to each other. So if you're a patient, you go to one hospital, but then you get into a car accident that's close to the other hospital and they take you to the other hospital's ER, that ER can't actually access any of your medical records. So everything is siloed because one- Crazy system doesn't wanna share their information with another system 'cause they want you to return to their system. And so basically, this has been a huge corporate boondoggle, and no one wins. Patients have a less close connection to their doctors because the doctors are hidden behind a screen. The cost of healthcare has gone up. These corporate entities have made billionaires out of their founders, have riched their employees, have enriched the people who own their stocks, but they actually haven't contributed a single thing. So that's one example. Let's pivot to another example, the medical malpractice system People think about the medical malpractice system and it makes sense, right? If doctors make mistakes and patients are hurt, guess what? The patient should be compensated. This does make sense. Here's the problem. The problem is that when you actually look at medical malpractice, can you guess what percentage of medical malpractice cases that are filed are dropped before they reach court? Do you have any idea?

Adam Coelho 12:11

Probably, 70%.

Jordan Grumet 12:12

Yep, two-thirds. So 66%- Oh, pretty close percent of cases are dropped without a finding, right? So no doctor payout.

Adam Coelho 12:19

Yeah.

Jordan Grumet 12:20

After that, once a case reaches court, 85% of cases find for the doctor and not the plaintiff. Wow. What does this suggest to you? It actually suggests to you that there's just not that much medical malpractice. When you actually litigate it- you find that there's a lot less than you think. But there are downstream consequences. Unfortunately, there's not a huge amount of data, but I found some data from 2008 that showed that there's something like $55 billion worth of payouts for medical malpractice in that year. But the lawyers got about 45 to 50% of it, 'cause it's all contingency based. But there was about 45 to 50 billion of defensive medicine costs. So doctors, after being sued or the risk of being sued, guess what they do? They order extra tests, and because they order extra tests, it actually taxes their healthcare system. Mm. And guess who pays for that? When the doctor orders extra tests and the insurance company pays for it, they increase your premiums. Or if you have Medicare or Medicaid and the doctor- It's gonna go up. Yeah orders more tests and Medicare or Medicaid costs more, they eventually increase your taxes. So you and I are paying for this huge boondoggle when there actually isn't that much medical malpractice. The only ones who win are the actual lawyers. The patients and families themselves usually get a small percentage of what they sue the doctor for.

Adam Coelho 13:34

Yeah.

Jordan Grumet 13:35

And so we've created a system that's unsustainable. Now, those are just two examples. We can look at pharmaceutical companies, we can look at health insurers, we can look at venture capital and private equity, and find that the systems for those entities are exactly the same. They extract lots of wealth out of the system, but they don't actually help anyone.

Adam Coelho 13:53

Yeah. it's interesting. There's just, like, all these different ways that costs are being inflated and the money is just going to these third parties and just costing us all more, right? Yeah, it's crazy.

Jordan Grumet 14:06

And you have to realize, these entities make a lot of money. They hire lobbyists, the lobbyists go to Congress. They basically are buying off our Congress people. And because there's no such thing as campaign finance reform, these politicians are putting little bits and pieces into the legislation that benefit these companies. I'll give you a perfect example. In fact, this is actually criminal. If you remember back to Obamacare, and if you paid attention to Obamacare, there was this outcry about death panels. Do you ever remember this whole thing about death panels?

Adam Coelho 14:39

Yes. Yes. It was just- Okay yeah, I don't even know what it was, but it was like everyone was... They... It was just, a talking point. They were trying to scare people, right?

Jordan Grumet 14:46

So let's go into what that is and where it came from. So the idea was Obamacare and the legislators had realized that a lot of money is spent on futile care at the end of life. Basically, people who are dying get unnecessary care that will never benefit them, but get it anyway, costs lots of money, and people still die. And so the idea was, part of Obamacare is we should pay, for instance, primary care physicians to have a visit in which instead of examining the patient or do- ordering labs or doing those things, they should get paid to counsel the family about end of life, especially in these very sick patients in ICUs or people- who have end-stage cancers, et cetera Here's the thing. The politicians, especially a bunch of Republicans, said, "Well, that sounds a lot like death panels." And this idea was that you'd have these death panels of doctors who would come around and deny care to patients by telling them not to get it. where do you think the term death panels came from? Most people don't know. It came from a marketing firm. Where or who did the marketing firm work for? It worked for health insurance. It was a health insurance marketing company. The health insurance companies were petrified that Obamacare would eventually cut their premiums, and so they hired a marketing company to try to kill Obamacare. And what they came up with, part of it, was this term death panels, and basically those pharmaceutical companies then put a bunch of lobbying money into the pockets of these Congress people- and said, "Hey, here's the talking point we really want you to work on." Yeah. Death panels. And so this is a perfect example of how a third party, an insurance company, used its money to manipulate our healthcare system. Now, you and I both know that people benefit from counseling about end-of-life care. Sure. We also know that doctors shouldn't be doing that for free. this is our professional services. This is what we are trained to do. Yeah. So we should be able to bill insurance for a one-time visit to talk about end of life and quality of life and quality of care. There is no reason why any of this should've been killed other than these third parties who wanted to kill Obamacare in general because they thought it would hurt their bottom line. This kind of stuff is going on over and over again in medicine, and people have no clue it's happening.

Adam Coelho 17:12

Yeah. Yeah. again, it's like this is a, th- that would, if they really thought about it, that would be beneficial to insurance companies. They would have to pay less for that unnecessary care that's not gonna do anything if they just pa- it's like what Obamacare made, preventative care free. Yeah. That makes sense.

Jordan Grumet 17:31

But here's the thing. It would've been beneficial for health insurance companies, but actually Obamacare changed the equation. Obamacare inadvertently screwed things up, but they didn't know it when they were doing this legislation. They wanted to make sure health insurers were actually spending the money they got in premiums on healthcare. And so what they did is they made this rule, 85% of what you bring, or 80%, I forget the exact percent, but basically some percent, let's just say- 85 for ease, 85% has to go for paying for patient care, and you can only keep 15% for profits and paying people, et cetera. That sounds great, doesn't it? But here's what the insurer realized. They should stop denying care, they should stop negotiating with hospitals, and they should accept the highest cost possible. Why? Because if they pay out- 2 billion instead of 1 billion, they get to keep 15% of whatever they pay out. And so 15% of 2 billion is more than 15% of 1 billion. And then the next year they just increase the premiums because they were allowed to increase their premiums if they paid out- more. Yeah. And so actuarially they would just keep on increasing premiums. The goal became pay out as much as possible, never negotiate anymore. Because that's how your bottom line is gonna increase, and that has actually happened. So if you look from about 2000 to today, healthcare premiums have far beat inflation every year. They go up way more- Yeah than inflation. and that's why we're getting to the point where healthcare is just completely unaffordable for anyone.

Adam Coelho 18:51

Yeah. Yeah, I know. it's just... Yeah, we're in very privileged positions, and I still am like, "This is- Oh outrageous." I got a sleep test for my son and myself. They're $10,000 each.

Jordan Grumet 19:04

yeah. Like- I talked to someone the other day- It's crazy who, I talked to someone the other day who has to pay out of pocket for their health insurance, and they're paying 70,000 a year

Adam Coelho 19:12

Yeah. Yeah. it's unsustainable, and i- it's just, like you said, like, all these different ways that the costs are being inflated and i- and the, these third parties are pulling money out of the system, and we're not getting any better outcomes as a result. And don't get me started on the lobbying and Citizens United. we don't gotta go into it, but Citizens United, I feel like is, probably the biggest problem that we have- Yeah because it affects everything else. And then Medicare for all, let's just cut out all these middlemen and let the doctors care for the people, and let's pay taxes, and let's use, the taxesin a good way.

Jordan Grumet 19:47

people don't realize, there are all sorts of solutions to this problem, but functionally, the best solution to this problem is if you have campaign finance reform and get rid of Citizens United, you'd probably solve a lot of our healthcare problems. Yeah. Just because without lobbying power, these third parties would lose the ability to influence our politicians, and we'd probably get real common sense legislation. 'Cause it doesn't take a brain surgeon or a rocket scientist to realize that there's some basic things that everyone should get.

Adam Coelho 20:14

Exactly, and that we're all better off when people are not, dying in their home because they're afraid to go to the- Yeah doctor. Yeah. Yeah. Totally. For something that could have been prevented had they just gone to the doctor. it's, it, and it's not like we're using all of our tax dollars efficiently, right?

Jordan Grumet 20:28

Yes.

Adam Coelho 20:29

Exactly. We don't gotta go into that. But, it's like, it, the, the whole thing with the lobbying, it's like they, these companies make a ton of profits and then they just take that money, pay off the politicians- to make more profits. It's just a virtuous cycle- Yeah that gets them richer and richer. and

Jordan Grumet 20:43

if you doubted all that this happens, you can go back to the Bush years when Bush changed Medicare and they started something called Medicare Part D back in the early 2000s, and Medicare Part D helped pay for pharmaceutical costs- Part of that legislation that was pushed through because of lobbying is that the government did not have the right to negotiate separately with pharmaceutical companies. Which is crazy. Crazy. The government buys so many drugs because of- Biggest buyer Medicare and Medicaid. Yeah. And basically they're locked out from using their economy of scale to actually negotiate lower prices. How ludicrous is that? What legislator, would ever agree to that unless they were getting paid a lot to agree to it? Exactly. It makes no sense.

Adam Coelho 21:28

It makes no sense, They are representatives of the people. They themselves also are the people, and yet they're preventing the people from being able to negotiate with corporations. It doesn't make any sense.

Jordan Grumet 21:39

yeah.

Adam Coelho 21:39

And unfortunately, things have gotten way worse since then, but we don't gotta go down that rabbit hole. You've looked into this quite a bit. What does this kind of hands in the cookie jar result in terms of our experience of the Medicare, of the medical system?

Jordan Grumet 21:54

two things. One is it's incredibly expensive, right? So this is the Mindful Fire Podcast. If you're interested in firing, one of the big reasons you may not is not that you don't have a high enough net worth, it's that you can't afford healthcare. We used to talk about fire budgets where people retiring on 40 or 50 or 60 or $80,000 a year. But if you're paying $40,000 a year out of pocket for healthcare, that becomes really hard. The other thing we often talk about is the fear of running out of money once you're retired. But if you're worried about running out of money once you're retired, long-term care is something that our healthcare system doesn't cover and can cost sometimes as much as hundreds of thousands of dollars. And so our system right now just makes it really hard to try to plan for retirement. That's in long-term planning. But let's talk about the day-to-day. How does it affect you as a patient? from the moment you walk into a doctor's office, you're faced with an electronic medical record and a doctor or nurse who's not even looking you in the eye. Because doctors, nurses, et cetera, are inundated with paperwork for compliance and electronic medical records and those kinds of things, it's getting harder and harder to get in for an appointment. Once you get in to see your doctor, if they can actually pay attention enough to you to help diagnose you with a problem, and then you go to the pharmacy and try to get your med and find out it's not on formulary or the pre-authorization hasn't been done. And the problem is a lot of patients start thinking, "These damn doctors, they're not on top of it. Why didn't they do the pre-authorization? Why don't they know it wasn't on formulary?" They don't realize that the doctors themselves have been hung out to dry, too, and don't... these formularies change all the time. Sometimes the pre-authorizations, we do them and they get there, but they don't get processed for 24 or 48 do- hours, and then the patient is stuck at the f- at the pharmacy. All these kind of things are working against both doctors and patients. So the patients feel like they're getting a lousy experience, but they're also getting angry at our medical system, and part of that anger ends up basically going towards the doctors and the nurses- and the people who they're supposed to be collaborating and colleagues with, the people they're supposed to be allies with. You find that it's actually a very tense relationship. And this leads to non-compliance. Patients who don't feel comfortable with our healthcare system or their doctors tend to get their prescriptions less, take them less often End up going to the hospital too late because they didn't take advice. All of these kind of things, which then- further increases the cost of healthcare. Of course. What we really have is a system where you as the consumer, the patient, feel like everyone's against you. You feel like your doctor's against you, you feel like your health insurer's against you, you feel like your hospital's against you. So it's, it creates a really stressful, anx- anxious interaction, and let's think about it. When you're sick, you're already stressed and anxious. you already have things to worry about, so now you're not only worried about, "Am I really sick and am I gonna get the treatment I need?" But you're worried about, "Will I just be able to navigate all the hurdles that are being put in front of me?" And so it makes- Yeah it a lousy system for patients. What a lot of people don't know out in the public is it also makes it a really lousy situation for doctors. So we feel just as thwarted as the patients do. We feel like our legs are being cut off by insurers and pharmaceutical companies and hospital systems and private equity and venture capital, the medical malpractice system, electronic medical records. All of these entities are making our job harder and harder to do. And so doctors are burning out, they're leaving medicine. There is a physician suicide epidemic. Like- it's bad on both sides. All the main stakeholders are unhappy, but because they don't see what each other is going through, there's a lot of bumping heads. There's a lot of feeling like we're in competition or fighting with each other, and stead of feeling like we're allies, and this is exactly the plan of the third parties. They wanna divide and conquer. If you take all the stakeholders and you get them to fight within each other, they're never gonna come together to overthrow a system that doesn't work. And so this is all by plan.

Adam Coelho 25:40

Sounds familiar.

Jordan Grumet 25:41

Yeah.

Adam Coelho 25:41

So it's happening at every level. yeah, and, I can understand why people would blame the doctor's office because that's who they interact with. But i- in reality, it's all the middlemen causing this problem that you'll never even see or interact with. Yeah. And- And, but it's not the doctor's fault that they... They're also having to deal with this nonsense. I think of the optometrist that we went to for my kids. Incredible, wonderful doctor, wonderful practice, was great. J- just couldn't deal with the insurance anymore. Didn't wanna deal with the insurance and as an owner of a practice, and probably went and b- worked for some other company, because- Of that headache. and that's a shame because she was providing a great service and, she even came one time when my wife was no longer even a patient and my wife was having an eye emergency, she came and helped her. and, her kids were there after she picked them up from school. she didn't have to do that.

Jordan Grumet 26:35

And there's this, this myth of the greedy doctor. And so it's like, "Well, doctors get paid so much, they're just being greedy. They just want more out of the system." But there's some things that people don't realize. First and foremost, most doctors go deeply into debt be- to become doctors. And so yes, we do get paid a lot, but if you're 2, 300, 400, $500,000 in debt, it takes a long time to pay that off. The other thing is doctors have- Yeah a prolonged training. So when our peers become accountants or go into business, they start working when they're 22, 23. Most doctors don't finish their training where they either don't get paid or get paid very little up until their 29 or 30. So you just get a really late start. The other thing is they compare doctors in the US to doctors in other country, and it is true. In the US, we sometimes make as much as double as doctors in other countries do. But the doctors in other countries often get free education, so they don't have medical debts. In the US, we tend to work more hours and take less vacation. So your average doctor in the US might work 40 or 50 hours a week, or even 60. In most other countries it's significantly less. They tend to take a month to two of vacation. Doctors in the US take a week or two of vacation. The other thing people don't realize is in the United States we generally make more than other countries. So engineers make more here. Yeah. Accountants make more here. Lawyers make more here. So we tend to make more. But if you compare what a doctor makes, 250, $300,000 a year, compared to, let's say, a health insurance executive who might make 200 to 300 million a year- Someone who does not get calls in the middle of the night to make life-saving decisions. Yeah. You start realizing that what a doctor gets paid actually is probably pretty reasonable.

Adam Coelho 28:08

Yeah.

Jordan Grumet 28:08

Doctors' salaries cover about 10% of healthcare spending. 10%. Yeah. So you could cut doctors, spending on doctors, you could cut every doctor in the United States, you'd cut their salary by 50%, it wouldn't move- the needle at all, and yet almost every one of those doctors would quit. It wouldn't be worth it anymore.

Adam Coelho 28:24

Yeah. yeah. And as you said, doctors are leaving the medical system, right? you yourself cut back dramatically- Yeah because you burnt out. what are we gonna do when we don't have- Yeah anyone that wants to work as a doctor? Because it just doesn't make sense. like you said, the training takes forever. It's extremely difficult, and costs a fortune, and you go into debt. Like-

Jordan Grumet 28:46

And it's stressful And then it's-

Adam Coelho 28:46

You deal with life and death that's just to get, that's just to get to day one. Yeah. Yeah. what, is that, is that, a real possibility, that we are just gonna have a massive shortage, or maybe we already do?

Jordan Grumet 28:54

Look, we, we already do have a shortage of primary care doctors. Now, you are gonna see in the future that it is made up for by AI, and less well-trained individuals. So nurse practitioners, physician assistants, certified nursing assistants, they're all gonna step into the breach to take over some of the care. But I'll tell you, they're gonna experience all the same things. The nurse practitioners- are going to experience all the same problems, it's just a matter of time. And so you will end up in a system, and we already... in my area, getting a primary care doctor is exceedingly hard. getting a psychiatrist that doesn't... If you wanna take, use health insurance to get a psychiatrist, most of them only take cash now. Yeah. And so we're already seeing this-

Adam Coelho 29:33

Is that gonna deal with all these problems we're talking about?

Jordan Grumet 29:34

Yeah. We're already seeing the stress on the systems.

Adam Coelho 29:37

yeah, this, this kind of, animosity between the doctor and the patient, I see it. I I feel, I don't, not to the person, but, I just get... I don't even... We have, normal healthcare usage, and the amount of bills that we receive is like- It's

Jordan Grumet 29:49

huge

Adam Coelho 29:50

I can't even manage it. what can we do about this? like you, you've explored this, so we've so far talked a lot about the, the problem- and the various problems, but like what can we actually do to address this and create a momentum to get some actual change?

Jordan Grumet 30:03

So I think there are things we can do immediately as individual patients, and then there are things we can do as a society. So let's get to the easy one. What can each of you out there listening to this right now do? there's some really easy things you can do to start taking money out of these third parties' pockets. So number one, if your insurance denies you, appeal. if you need a procedure, your doctor says you need it, and the insurance says, "We won't do it," appeal, appeal, appeal. Appeals actually do move the needle and things get overturned. Number two, if you go to your doctor and they're like, "You know what? That blood pressure's been running high for a bunch of visits, let's start you on a medicine," ask for a generic. Every time you ask for a generic and not the newest and greatest, you're taking money out of the pharmaceutical company's pocket. If you have the choice- Find a doctor or go to a healthcare center that is owned by doctors. One that is not owned by private equity or venture capital. It's getting harder and harder- to do, but you can call them and say, "Who owns your practice? Is this owned by a business- or is this owned by a person?" The more we go to these type of practitioners, the less money we put in these third parties' hands. There's also special kinds of doctors who do things called concierge medicine or direct primary care- where you pay them directly as opposed to going through insurance for at least their basic services. If you can afford it or if you're in an area that has doctors who do this, you'll get a higher quality of care, and that money will go directly to the practitioner. Those are some really easy, basic things you can do. Now, let's talk about the bigger problem. The bigger problem is what do we do with a society in which we have political gridlock and a system that is basically serving these entrenched interests? In my theory, and what I talk about in the book, is that we actually need a revolution. Now, we're not talking about pitchforks and bayonets. When I'm talking revolution, it means that we need the main stakeholders in the system to come together and become unstoppable. So who are the main stakeholders in our system? the main stakeholders are basically those giving care. I've been calling them doctors, but it's all the people who are giving care. And then there are the patients receiving care. That's it. It's not the pharmaceutical companies. It's not the insurance companies. So the question is how do we as stakeholders come together to really push for change? Like I said, right now these third parties are actually using a divide and conquer strategy and trying to convince us that, trying to convince doctors that the patients are the bad people and trying to convince patients that the doctors are the bad people. The way we get past that is intimacy, intimacy between doctors and patients, so we can come together and be allies. Well, patients are already intimate with their doctors, right? They go into the exam room. They tell them their biggest, deepest problems. They bare their souls, and then they bare their bodies when they put on a gown to be- Literally, yeah Now, the other way around doesn't happen. So we have unilateral intimacy. Doctors are not intimate with their patients. What do I mean by that? if you go back to 1900, doctors lived in the communities their patients did. So you went to the same church, your kids went to the same school- you saw them at the football game. And and when something went wrong, they'd go to your house and visit you there, and guess what? If you didn't have money to pay for it, you'd give them a bunch of eggs or a chicken- or you'd exchange some type of services. So it was a very intimate, personal relationship. So when the doctor walked into your house, they could have the cloak of objectivity, but still have an intimacy because you knew them- Mm they were part of your community. Nowadays, most people have to drive to the doctor's office. You don't go to the same church with them. Your kids don't go to school with them. So there is no intimacy by proximity. And then when you go to see the doctor, they have to be objective, right? We have to be a little bit distanced to take care of you and make good decisions. But the problem is you don't feel connected to them. So how do we get over this? The way we get over this is doctors need to do a better job of telling patients who they are. Now, I'm not talking about in the exam room. When a patient comes in and they have chest pain, you don't wanna say, "Hey, you should hear about my day." But out in the world on social media, we need to talk more about what it means to be a doctor, what our intentions are, how we took the Hippocratic Oath for a reason, because we wanted to help people, and we need to start telling the stories of who we are. Because stories connect people, and when you have shared stories around a problem, that's when we get political upheaval and change. I love to talk about civil rights. Why did the civil rights movement happen? It's because we got a revolution through the shared stakeholders coming together. How did they come together? They came together around stories like Rosa Parks- and that seat in the bus. Those are the stories that bind- Mm people together, make them allies, and then they come together- and fight these entrenched interests. This has happened before. In the US, civil rights, there's all sorts of other examples. Outside of the US, back in England in the 1900s, there was a big push to have socialized medicine, to have universal healthcare, but it could never get passed. And then there was this guy, a doctor, his name was A.J. Cronin, and he actually wrote a book called The Citadel, and it was about all the atrocities that patients faced out in the world because of the backwards system in the UK at the time. It was a fictional tale, but it became so popular and sold so much that it caused a rallying cry to change the healthcare system. The politicians finally agreed- and that book is cited with the beginning of the NHS, the world's first major universal- healthcare system that still stands today. Stories change the world, they bind stakeholders, and that's exactly what we need. And I have an optimistic message. Obamacare was the beginning of this. The fact that the legislation was put out there meant that the shareholders are starting to come together. They're starting to push on the legislative gridlock. It didn't quite get through, but it started. Obamacare increased access, and it didn't cre- decrease- the quality of care. Unfortunately, it didn't control the costs, and that's why we're having the problem we're having. You also see hope in the Democratic Socialist movement. I don't care whether you like them or not. That's really beside the point. The point is young people are looking at the system and they're saying, "Our healthcare system is broken," and they're interested in electing politicians who want to fix the healthcare system. We actually have the beginnings of a movement. I just think that the real answer is shared storytelling among doctors and patients, causing allyship to really push forward to get that political change, to make it so that the politicians feel they have no choice but to listen to us because we're so strong and mighty. Believe it or not, I think we're getting there. I think we're moving in the right direction. We're just not quite there yet, but we're seeing the movement. These things sometimes take decades to happen, but Obamacare, the rise of the Democratic socialists, this idea that there is even this concept of universal healthcare, universal Medicare- Mm-hmm fame as it was in the UK in the 1900s, it took 20, 30, 40 years to eventually get the change they needed. I don't think we're that far away, but we've gotta push for it. We've gotta get over this lobbying- and these entrenched interests.

Adam Coelho 36:50

Mm-hmm. Yeah. Man, there's so much there. It's just like- Yeah, the, the stories, right? Like everyone, hopefully everyone still, everyone knows Rosa Parks, right? Yeah. And everyone knows all those, Martin Luther King and what they w- what they did to bring the stories of the people who were being oppressed and mistreated to the forefront so that everyone was aware of it, and we all know that, right? I think of, the book The Jungle, right? It's probably very similar- Yeah, Upton

Jordan Grumet 37:17

Sinclair. Yeah

Adam Coelho 37:18

yeah, the same type of thing. Didn't get what he wanted, right? He was focused on the mistreatment of immigrants, but it created the FDA.

Jordan Grumet 37:25

so it's interesting, and I talk about Upton Sinclair in my book. So Upton Sinclair, an avowed socialist, saw what was happening in the meatpacking industry, saw how horrible it was treating basically the workers-

Adam Coelho 37:37

Mm-hmm

Jordan Grumet 37:37

and wrote the book The Jungle. He wanted to improve the lot of the workers. What it did is it showed people how horrible the management of our food was- and that caused immediate change. But if you go 20 or 30 years out from Upton Sinclair's book, that's when we have the first collective bargaining laws, and we have the- Mm rise of unions. Yeah. And so he eventually probably did have the effect- he wanted. It just took a little bit longer.

Adam Coelho 38:02

Yeah.

Jordan Grumet 38:02

And and if you see it, strangely enough, we actually have the storytelling happening in medicine all the time already, and it is already having effects. So for instance, there's a writer named Atul Gawande who wrote a book called Being Mortal. Being Mortal was all about how we're treating our elderly- how there's a lack of dignity both in our medical care and our social systems. After his book, we've had a spike in palliative care and hospice enrollment. And so it is happening. People are, he wrote all these stories about what happens in healthcare. It is happening. We just need it on a far larger scale.

Adam Coelho 38:34

Yeah. Yeah. And it's, yeah, it's interesting just, the Obamacare, he basically used all his political capital to get that done.

Jordan Grumet 38:41

Yeah. It

Adam Coelho 38:41

took everything. And it was

Jordan Grumet 38:41

it was very close, too. Unfortunately- Yeah it was cut off at the legs. It wasn't perfect. It needed a lot more, but it was the beginnings of a system. And it did accomplish- two of the three objectives. Unfortunately, the thing it didn't accomplish was cost control, and that's why we're paying the price right now.

Adam Coelho 38:56

that's a big problem, yeah. And then you

Jordan Grumet 38:58

have the union- Yeah, and then when you start stripping away the subsidies and you have rising costs- Ah all of a sudden we now have a system where more and more people are losing all that healthcare that they had gained.

Adam Coelho 39:07

Yeah. Yeah, you're right. and the subsidies are gone, right? that was never remedied. They didn't fix that.

Jordan Grumet 39:12

the enhanced subsidies. Okay. So the original subsidies are there. During COVID, they enhanced and increased the subsidies, and now it's- Okay back to the pre-COVID era.

Adam Coelho 39:20

Okay. So it's

Jordan Grumet 39:20

not

Adam Coelho 39:21

working, no

Jordan Grumet 39:21

but Obamacare has been stripped away multiple places. There hasn't been the Medicaid- Medicaid problems funding in certain states- Yeah et cetera. Yeah. So it's been handicapped quite a bit. This is not- what originally the legislation was supposed to look like. And- unfortunately, all the compromises have really affected its ability to do what it was supposed to do.

Adam Coelho 39:38

Yeah. Yeah. let's, so let's bring it back to the FIRE angle, right? One of the biggest worries that people have when thinking about actually stepping into their early retirement chapter is, how am I gonna pay for healthcare? And what if something catastrophic happens and I am gonna run out of money? And so how do you, advise people think about that in the context of the system that we live in?

Jordan Grumet 40:01

Yeah, it's a real concern. And so in the FIRE movement, we see people who are thinking about retiring in their 30s, 40s, and 50s. You don't actually get Medicare till 65, and so you're gonna have to self-fund most likely up until that point, and it is getting massively expensive. And and there's no good answer. So if you decide to use the ACA, which is basically the marketplace, the government-run marketplace, it's fine if you have very little income. So if you happen to FIRE and you find a way to very little income, you may get subsidies. But if you have a higher income or you're selling lots of equities to sustain your lifestyle, it's a cliff. And so you either have a certain gross income above or below a certain number, and once you get above that number, you get no subsidies. And if that's the case, you may find yourself spending progressively more and more over the years. The premiums have increased so much that it is becoming fairly cost-prohibitive unless you have a lot of extra money. Now, if you don't use the ACA, there's some other things, like health sharing ministries, which is usually put together by religious groups that basically if you sign on to some of their ethic, or ethics or religious, viewpoint that you then can get care, but they're not necessarily insurers. They're not overseen by the government in the same way. So there is some risk. They ultimately can decide what they wanna pay for or not pay for, which can put you in a bad place. Yeah. Above and beyond that, there is Farm Bureau insurance in some states that can be cheap but very rare. If you live outside of the country, you can do expat insurance, which is also fairly inexpensive, but you gotta live out of the country for most of the year. you can-

Adam Coelho 41:41

And it doesn't cover anything in the US. Yeah, and, well- I was just talking with a guy that lives in, Asia, e- or he's, he's- yeah, he lives in Bali and he's, it's, 60 bucks for the month or something like that. Yeah, it's

Jordan Grumet 41:51

inexpensive.

Adam Coelho 41:51

Covers everywhere except for the US.

Jordan Grumet 41:53

Yeah, and you can go without health insurance. the only issue there is, maybe you're saying, "I'm fire. I've got, extra $500,000 that's all for health coverage, et cetera." But unfortunately, there is a cost to catastrophic care. So for instance, if you get acute leukemia and need to go in the hospital and get a bone marrow transplant, you might be in the hospital a month or two and your bill will be over a million dollars. Yeah. it's just really hard to cover that out of pocket, and that's why one of the biggest- Yeah causes of bankruptcy is medical bankruptcy. People go bankrupt because they can't afford their medical bills, which again, is ridiculous- Yeah in as advanced of a country as we have. So that's one side. In the richest country

Adam Coelho 42:27

in the world.

Jordan Grumet 42:28

Yeah. And so that's one side. Then the other side is long-term care. So once you're on Medicare, you're like, "Great, all my medical expenses are covered." it's not free. You do have to pay for it. You do might have to get a secondary insurance. You're gonna have to pay for that. But the other thing is if you need long-term care, if you need a long-term nursing home or help in the home, you have to pay for that out of pocket. And nowadays, let's say you need nursing home care for a year, it's about 10 to $15,000 in most states. And so you could go bankrupt really quick paying for nursing care, and there's no real good insurance for that. There used to be long-term care insurance. It became cost-prohibitive. There's some other ways around it. It is not something that affects everyone. They've done studies that show that about 85% of people will have less than $100,000 of lifetime and long-term care that they have to pay for at least if they don't have insurance, et cetera. So 85% of people can actually budget and make sure they have enough for that. Yeah. But the other 15% could have anywhere from 100,000 to millions of long-term care. And you just don't know if you're gonna be the unlucky one.

Adam Coelho 43:28

Yeah. and it's, and you said 10 to 15,000 a year or a month?

Jordan Grumet 43:32

10 to 15,000 a month, right? Yeah. So you're looking at... and there are some safety nets. If you go bankrupt paying for long-term care, eventually you qualify for Medicaid, and Medicaid pays for it. But you have to go bankrupt, right? Which is also- Yeah is

Adam Coelho 43:45

horrible, but you have to- And then it's only a small amount that you-

Jordan Grumet 43:46

Yeah. And if you're married-

Adam Coelho 43:48

The options are very limited

Jordan Grumet 43:48

if you're married, it really, it bankrupts your spouse too. So that's an option. there's long-term care insurance, but it's become incredibly expensive because the payouts are so big. There is whole life insurance with a long-term care rider, which is probably the most reasonable way. You just pay into long-term... You pay into whole life insurance, but it's really the rider you want, 'cause the whole life insurance probably won't serve you. people also decide that their house is gonna be their long-term care. So a lot of people build equity in their house. And then if they eventually need long-term care, they either sell their house or they reverse mortgage it and get some of the money out- or take a line of credit off their house. So that's actually a very reasonable way. A lot of people either save by investing over 10, 20, 30 years to try to build up enough equity to pay for long-term care insurance, or they assume that their house will be their long-term care insurance policy.

Adam Coelho 44:37

Yeah, that's an interesting approach. Yeah.

Jordan Grumet 44:39

Yeah.

Adam Coelho 44:40

I grew up, my parents, running assisted living facilities. Yeah. And so I'm very familiar with, that whole world and it's, it's so expensive. It's

Jordan Grumet 44:48

expensive. It's very expensive.

Adam Coelho 44:50

It's crazy. it, and it, depending on where you live when I was growing up in Florida, it's e- even cheap was, like, three, four grand a month. Now, I, I did actually an entrepreneurial project where I was, talking to assisted living around the country. That, was years ago. in New Jersey it's probably, like you said, 15K a month. Yeah. In California, it's probably 20K a month, right? yeah. That's a quarter million dollars a year.

Jordan Grumet 45:11

Yep, yep.

Adam Coelho 45:11

just off the top.

Jordan Grumet 45:12

Yep.

Adam Coelho 45:13

Yeah. it's not tough. It's not good. and, and then you think about all the boomers that are about to go into that chapter, it, or many are already in it, but, that's, it's not a good sit- situation. So yeah, I mean- I guess, Kai, to summarize, for FIRE people, is there, what would you... How should they be thinking about this?

Jordan Grumet 45:30

So I think if you are FIRE, you have to remember before you FIRE, you're gonna have to figure out health insurance, and that should be part of your FIRE number. So if you're looking at your net worth and you're calculating 4% and you're not including taxes and you're not including health insurance, then you're not really gonna be able to FIRE at least safely, because your safe withdrawal rate's gonna be too high. So you gotta think about health insurance. The other thing you gotta think about is long-term, how are you gonna pay for long-term care if you need it? Are you gonna build up equity in your house? Are you gonna start a long-term care account that's a brokerage account that you just add to every year and you let it grow by being invested? Assuming, assuming your average person might have to pay somewhere around 150 to 200,000 at the end of life to pay for healthcare. Can you start putting money away now that'll pay for that? There's some other possibilities. There's something called continuity of care. So my parents did this. If you didn't pay for long-term care, when you get older and you sell your house, you can move into what's called a continuity of care community, where you start in independent living, but they also have assisted living as well as full skilled nursing.

Adam Coelho 46:32

And

Jordan Grumet 46:32

once you're in, you don't have to pay much extra to go to the higher levels of care. So that's another way of dealing with it- Interesting that's much more manageable. Yeah. So you gotta start thinking about those things now. It just has to be part of your FIRE plan until- Yeah something improves.

Adam Coelho 46:46

yeah, 'cause it, the cost, as you said, like they're rising much higher than inflation. Much higher. And so the 4% rule is taking inflation to account, but it's not taking these other costs that are rising and, Yeah and healthcare being the number one.

Jordan Grumet 46:59

Yeah.

Adam Coelho 46:59

Yeah. Wow. Wow. Interesting. This has been so interesting so far, but let's shift gears into the Mindful Fire Final Four. Are you ready?

Jordan Grumet 47:07

Yes, let's do it.

Adam Coelho 47:08

All right. So the first question is all about envisioning, and it's been a few years since you've been on the podcast. I know you have written three books so far. You have a few books on the way, but I'm curious, when you think about... And you mentioned you're an empty nester now, and so you're in a new chapter of life. And so I'm curious, what's your big vision for the next, say, three to five years?

Jordan Grumet 47:28

My big vision is slowing down, being really thoughtful about being in the moment, letting go of some of the achievements that have ruled my whole life, and trying to enjoy every moment. Just trying to, be in the moment as it comes, and recognize that I'm lucky enough. I've gotten to an age, a level of success that I've already proven everything I needed to prove in the world, and I just wanna enjoy being present.

Adam Coelho 47:54

Yeah. Simple and... Simple, but not necessarily easy, you know? Yeah. Before we started recording, we were chatting about just, the, my experience of being early retired and still ha- struggling to let go of that achiever mindset- Yeah that constant striving. Yeah. that makes sense that this is what you're looking for in the next chapter.

Jordan Grumet 48:12

yeah.

Adam Coelho 48:12

So the next question is, what piece of advi- what... The next question is, what piece of advice would you give to someone early on their path to financial independence?

Jordan Grumet 48:19

I think it is a mistake that financial independence equates with happiness. Financial independence and your money and net worth and wealth are a great tool to help you build a life of happiness, but they're not necessarily required. And so none of us knows how long we're gonna be on this earth. my father died when he was 40, well before he was financially independent or retired. And so what I like to say is think about what happiness and purpose and excitement and joy look like to you, and start there. And then think about how you can build a financial framework around those things so you can enjoy them now as well as in the future. What is always sad to me is someone who keeps on putting off their life and their happiness and joy- to reach their FIRE number. We can't always control when exactly we hit our FIRE number. We don't know what's gonna happen in the stock market. We don't know if our employer's gonna fire us or promote us. All of those things we have so little control of. So I'd love to help people get in touch with the things that are important with them now. Start doing a little bit today- whether you're FIRE, whether you're not, and then let's keep building those finances around that best life.

Adam Coelho 49:22

Absolutely. Absolutely. That... that is the core of what I'm focused on, and- Yeah helping people realize, like- FU money is great and it's very important, but what you also need is where are you actually going? What do you actually want your life to look like? Because if you race to get to the number, you're, you're gonna get there and you're gonna have no idea what you want. My approach and recommendation is start figuring that out along the way. Start experimenting with it. Start fi- living into it and realizing, most of what you want, like you said, you wanna slow down and le- and stop striving so much. You don't need $10 million to do that. You can just start doing that, and as we were talking about before, it's easier said than done, so it's gonna take some practice. Yep. So you might as well start now. For

Jordan Grumet 50:05

sure. For sure.

Adam Coelho 50:06

Yeah. And the third question, Jordan, is what piece of advice would you give to someone getting started with meditation and/or mindfulness?

Jordan Grumet 50:13

Perfect is the enemy of good. Showing up is, 80%. There is another 20%, which means getting good, and quieting your mind, and having a regular practice. But if you can show up regularly to mindfulness and meditation, that's the hardest piece. The hardest piece- is quieting yourself enough to just sit down and do it. Everything else then becomes a practice. You are allowed to be incredibly lousy when you start this, and you're allowed to stay lousy as long as it does something for you, right? As long as you can quiet your mind a little bit, even if you never quite get there or whatever you think there is. And so 80/20 rule, perfect is the enemy of good. Start building habits, and assume, let yourself go, and assume that the habits will lead to improvement.

Adam Coelho 51:49

Yeah. Great advice. I love that. And the final question, Jordan, is how can people connect with you online, find your book, The Healthcare Heist, and all the other books that you've written? where should people go to, to find more about all of what you're up to?

Jordan Grumet 52:03

So the easiest t- thing to do is go to jordangrumet.com. That's J-O-R-D-A-N-G-R-U-M-E-T, jordangrumet.com. There you can find all the places I create content. So there's the Earn and Invest podcast. There are all my books, Taking Stock, The Purpose Code, and The Healthcare Heist, as well as The Purpose Code Substack. Get it all at jordangrumet.com.

Adam Coelho 52:24

Very good. Jordan, always a pleasure to have you on the show. Thank you so much for being here.

Jordan Grumet 52:29

Thank you so much for having me.