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Retirement, Hospital Bills, and Other Sexy Topics

February 2023

We all know that we need to save money for retirement. We plan, strategize, hire financial advisors, and save our cash diligently for years to one day retire and live out our “golden years” in comfort. Many of us envision retirement as full of time and freedom to do whatever we want – travel, run around with grandkids, or golf all day. But the sad fact is that when they retire, most people will instead plan their day around doctor’s appointments, spending all their hard-earned money on prescription drugs and hospital bills. A recent study showed that 95% of older Americans have at least one chronic disease (e.g., high blood pressure, heart disease, diabetes, etc.), and 80% have two or more. This is not the retirement I envision for myself, my patients, or you.

I have a patient who, for privacy, we’ll call Lou. Lou is 36, has a family history of high blood pressure, and over the past 2-3 years, has gained about 25 pounds (thank you, covid). He recently went to a dentist appointment and had his blood pressure taken – his reading was 167/93 (normal blood pressure is 120/80), so he got worried and made an appointment to see me.

In my office, his blood pressure was a little better at 147/90 but still a bit high. I asked about his current lifestyle – his diet, how much exercise he was getting, how much stress he was under, his sleep routine, what self and soul-care practices he had been committed to, etc. As we talked, it was clear that every facet of his lifestyle had taken a downturn since he began working remotely at the start of the pandemic. And now that things were “back to normal,” he was still working from home and hadn’t resumed any of the healthy habits that he had pre-pandemic.

Lou is at a fork in the road – either he’ll start shifting toward significant lifestyle change or continue on the slow downward spiral toward chronic disease. I told him that he didn’t have to make any massive shifts today but that we would work together to make small, meaningful, incremental changes that, over time, would lead to significant improvements in his overall health.

When I talked about each facet of lifestyle that we needed to address, here were his responses:

“I don’t have the time or money to eat plant-based…it’s too expensive, and I can’t cook!”

“I’m terrible at meditating – my mind is too active. I can’t sit still that long.”

“I’ll sleep when I’m dead – I’m trying to get a promotion, so I have to work extra hours.”

“I know I need to exercise more. I know I do. It’s just so hard to find the time.”

TIME and COST are the most common reasons patients give as barriers to plant-based eating and lifestyle change.

I’d argue that NOT eating more plant-based and NOT incorporating more healthy lifestyle practices into our lives will cost a hell of a lot more.

Let me take you through the process of getting just ONE medication filled:

  1. Schedule an appointment to see your medical provider (average COST in TIME: 2-4+ weeks).

  2. Schedule time off work for your appointment (COST in MONEY: lost wages).

  3. Appointment day: they will ask you to arrive 20 minutes early, so the kind soul that you are shows up 20 minutes early, only to wait 40 minutes in the waiting room with all the other patients who are coughing, hacking, and sneezing all around you. You, of course, are not sick but you’re wearing your mask correctly because you are a kind soul. As you look around, you notice everyone who is coughing and sneezing is wearing their masks like a beard or an earring, and you quietly curse inside (COST in TIME 40 minutes and the mental energy of trying to not lose your shit as you wait).

  4. The nurse finally calls your name, and you think, “Yes! Finally!”. But don’t get too excited because she’s only taking your vital signs and will soon leave you to wait - cold and alone for another 20 minutes in the exam room. It’s. Always. So. Cold. (COST: TIME 20 minutes and the energy cost of keeping your core temperature up).

  5. Your medical provider finally comes in to see you, performs a quick history and physical (this will be the absolute fastest part of your entire experience) then tells you that you need to start a new medication for your blood pressure. You agree because you’ve been worried about your health too. You haven’t been feeling like yourself – you’re tired and lack the vigor you used to have. “Is there another option?” you ask. “Do you think this is why I’m so tired?” You may get a few minutes to talk about lifestyle modification or a referral to a nutritionist, and your visit is over. On your way out, you make a follow-up appointment so you can come back in 4-6 weeks and do this all over again. (COST in TIME: about 8 minutes).

  6. Wait! You’re still not done! Your doctor sent your prescription electronically, so you go back to work, making a mental note to pick up your prescription on your way home.

  7. 5:00 pm rolls around. You leave work to pick up your prescription at your local CVS and much to your horror, there are five people ahead of you in line. Most everyone is wearing pajamas and slippers, and again – everyone is coughing. You stand quietly and patiently in line while the person in slippers at the pharmacy desk is ranting to the pharmacy tech about an error with their prescription. Seventeen minutes later, you are at the pharmacy desk, and now you are arguing with the pharmacy tech because your prescription isn’t there. “My doctor’s office said they’d send it!” you plea. But alas, you are sent away. “You’ll have to call your doctor’s office tomorrow”, the tech says dryly. (COST: TIME 35 minutes and your fraying sanity).

  8. By the time you finally get your prescription the next day, you’ve spent a total of what feels like 127 hours on the phone and at the pharmacy.

When we think about cost, we often only consider the immediate cost. My patient Lou complains about the cost of groceries and the time it takes to cook for himself, but the trip to the pharmacy for one medication costs money, too – and a lot more time and mental energy. We must also consider the other massive costs associated with chronic disease, such as specialty care (cardiology, endocrinology, etc.), procedures, hospitalizations, prescription drugs, insurance premiums, and copays.

In 2019, the average health expenditure per capita in Japan (one of the healthiest countries in the world) was $4,360.47. The US (one of the least healthy countries in the world) spent $10,921.01; in 2021, that number grew to $12,914 per person. The US's National Health Expenditure (NHE) rose to a whopping $4.3 trillion in 2021 and accounted for 18.3% of our Gross Domestic Product [*].

This is insane. We are doing this wrong.

However, it’s hard to imagine and consider downstream costs when we’re stressed about paying our rent. I’ve been there – I get it. We feel immediate cost in the moment. But the immediate cost of plant-based eating and lifestyle modification isn’t all that much. It just takes planning and intention, which does cost more in TIME. It’s definitely easier and faster to roll into a drive-thru for a cheap meal on the go than to meal plan and pack a lunch.

But just like saving for retirement, we must also invest in our bodies and health. If you don’t, that nest egg of money you’ll (hopefully) have when you retire will most likely be spent on prescription drugs, healthcare bills, and up-fitting your home with support bars to help you get off the toilet.

Let’s start thinking of our health as another bank account that needs savings. When we make healthy choices that support our health, it’s a deposit, and unhealthy choices are withdrawals. The goal is to make enough deposits to carry us through retirement without chronic disease.

Like compound interest, the investments or healthy choices we make today will pay off 10-fold in the future. Similarly, withdrawals such as eating unhealthy food, skipping a workout, binge watching Netflix late into the night instead of sleeping, or having a super stressful day will tax and pull from our health account.

Of course, sometimes these withdrawals are unavoidable, or even super fun and worth the cost (for me, it’s a handful of candy and a bucket of popcorn at the movies) – but they are, in fact, a withdrawal. So maybe the next day, I will make an extra deposit by eating an apple and walking a little farther than I usually do at lunch. And I’ll do so happily because the withdrawal at the movies was totally worth it. But, just like a regular bank account, if we constantly pull, tax, and withdraw from our health bank without making regular deposits, the balance will not tip in our favor as we age.

Whatever your age, it’s not too late to start “banking” healthy choices. Think of your trip to the grocery store, the gym membership (that you actually use), and a consistent meditation practice as worthy investments – then make a deposit every damn day. Take the walk, eat the apple, pack the lunch – your future self will thank you while sitting on the beach reading a book instead of freezing your tuchus off in my office.



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