“This cold is tiresome. What good is medicine if it can’t cure a cold!”
–Napoleon Bonaparte, Lev Tolstoy, War and Peace.
(Ok, so Tolstoy took many liberties in his portrayal of Napoleon. But, whether Napoleon actually said this or no, it’s still true that we can’t cure a cold.)
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Heathcare is one of the expenses that most confounds would-be FIRE adherents, and for good reason. Many of us live in the U.S., as I do, and our healthcare system is unpredictable and inefficient. As Tanja of ONL (Our Next Life) rightly points out, there’s some tendency for bloggers to think, hey, I exercise and eat my veggies! My healthcare costs will be predictable! Sadly, it’s not true. I’ve already blogged about how my parents have both taken excellent care of themselves in terms of diet and exercise. Mom has stayed quite healthy for her whole life. Dad, not so much – he’s had a whole string of hospitalizations, surgeries, and health problems. Some could be cured, others only treated. Genetics have played a large role in his problems, and I know I’ve inherited some of those genes.
All I can really do is make a lot of contingency plans and hope for the best. Here’s what Mr. RN and I are likely to try out in the future.
Plan A: Stay on our Marketplace HDHPs
For now, we’re sticking with our crappy HDHPs (High Deductible Health Plans). Why? Well, we’re both in great health and only go to doctors for routine checks at this point, so the low(er) premiums for these plans make them the best plans for us. Also, we can continue attempting to max out our HSAs (Health Savings Accounts), letting our money grow tax-free well into the future. I feel pretty ambivalent about this choice, of course. My primary care doctor recommended I be screened for skin cancer every year or so. It’s hard to get motivated to see a dermatologist when I know I’m going to have to pay $200 out of my own pocket.
Plan B: Get a Better Marketplace Plan
Our state’s online marketplace does offer better plans compared to our HDHP. If we both continue to be self-employed, this may be the way to go. The decision is complicated, though. One needs to buy at least a “silver plan” to get any kind of subsidy. But some folks have bought a crappy plan, reached the out-of-pocket maximum quickly, and then enjoyed “free” healthcare after that. This, apparently, is the way to go if the out-of-pocket costs are still going to be lower than the extra $$ required in premiums for one of the more expensive plans. If we have a child or two, we’re going to have to look closely at this option.
Plan C: Ms. RN Gets a Job with Good Insurance
I’m extremely lucky in that I can fairly easily obtain a job that offers good health insurance. Now, obviously, this comes at a great cost in terms of lost self-employment earnings, lost time, etc. But if this were the best bet for my family, I don’t think that I would mind. This is also a good incentive for me to continue working, at least a little bit, after I’m financially independent – I need to keep my professional credentials sharp.
Plan D: Mr. RN Gets a Job with Good Insurance
Mr. RN would likely have a little bit more trouble getting a job with good health insurance, but it would also be a possibility for him. Heck, along the way he or I might coincidentally decide to accept a job that happens to have excellent insurance – wouldn’t that be great! Anyway, I’ve written about Mr. RN’s career building before (cite*). In marrying me, he has accepted that if something awful happens pre-FI, he may well have to take a crappy job that he hates. The same will be true for both of us if we choose to have a child.
Plan Z (Wildcard): We Move to Mr. RN’s Homeland
Mr. RN has spent his life here in the U.S. However, he also happens to have dual citizenship, since his dad was an immigrant. His dad’s from – wait for it – a country with a much more reasonable health system than the U.S., paid for (almost entirely) by taxes. But wait . . . where could that be? Oh yeah, almost any other rich country on earth. Anyhow, Mr. RN could move there tomorrow if he wanted to, and I would be able to follow both as his spouse and as someone qualified to perform a job that’s very much in demand in that country.
This really isn’t our top choice, as we’d rather stay near our friends and immediate families, but it could very much be a reality in the future. Particularly if we had a child whom we knew would receive better care in another country.
Plan Z1: We Move Somewhere Else
This is basically the last resort. Instead of moving to what I jokingly call Mr. RN’s Homeland, we could move to some other country that has a better healthcare system. We already have the savings to do this, so it’s not outside the realm of possibility. I know that to readers who are not in the U.S., this may seem extreme, but this may well have been what my parents had to do if the ACA hadn’t passed when it did. Also, I’ve seen more than one person on the internet talking about attempting to “time” the conception of their child so that the child’s birth would occur on X date, letting the family meet their deductible early in the year so that their remaining basic healthcare would be covered.
In the Meantime
I’ve made lots of calls to politicians’ offices, begging them to preserve the ACA for people like my dad. Advocacy is critically important around the issue of healthcare. And, unfortunately, it’s one cost that seems to unify most American earners. I can’t think of anyone I know who hasn’t worried about healthcare costs, and I know some pretty loaded people. I’m going to continue to donate money to and vote for politicians who understand that the status quo is unacceptable.