This sums up the difference between Mustachians and Bogleheads pretty well ...

[honeybbq]

Going through this right now with an elderly family member. Rather than being in some Medicare picked home (wherever they have space), the individual can stay in their own home and have round the clock care. Familiarity is important when you are old and confused. You don't have to move and lose the things that ground you, be it your couch you've had for 20 years or that sticky drawer in the kitchen. The cost of round the clock live in care is ~15k a month. They are lucky to have the assets to do this (at least for some time) before having to give up most of what they know and go with whatever Medicare has in store for them. We got to help pick the individuals and company and meet them first. Having choice is something you'd give up if you have no money.

I completely agree with the sentiment, but as a minor correction, it's Medicaid (which varies greatly from state to state), not Medicare which cares for the elderly with no assets.  This is partly the reason the current proposed tax cuts worry me - "The Republican budget would gouge $1 trillion from Medicaid, more than 60 percent of which pays for long-term care for seniors who have already impoverished themselves to qualify."  http://thehill.com/opinion/white-house/353914-unjust-gop-budget-and-tax-plan-cuts-the-safety-net-for-seniors

Ack you are totally correct. I'm going to edit. Thanks for the correction.

[honeybbq]

The cost of round the clock live in care is ~15k a month.

$180,000 a year?!?  Do you have 3-4 full time people working there?! 
https://www.payingforseniorcare.com/longtermcare/live-in-caregiver.html
https://www.npr.org/2012/05/01/151472617/discovering-the-true-cost-of-at-home-caregiving
These sources suggest that your estimate of $15k a month is far off.

It's not an estimate. This is what it costs. It's 2 people, 12 hours a day each. ~20 bucks an hour.

[bacchi]

These sources suggest that your estimate of $15k a month is far off.

For quality, reliable care, this is accurate.  If you hire through an agency like  Home Helpers, you'll pay a minimum of $18/hour, and the caregiver will get $12/hour.   You'll often get a caregiver who often doesn't show up on time, cancels at the last minute, doesn't follow instructions, and even worse.  However, you won't have the hassle of finding caregivers and screening them, or handling employer taxes, etc.

If you hire caregivers on your own, you're going to need to pay, even in a rural area, at least $16-18/hour for the kind of person you would want to care for your parent, and you'll have to find at least 3 to cover all hours of a week.  Then you have employer match for SS, etc., on top of that, plus all the hassle of doing payroll.

This is for a parent who truly requires round-the-clock care.  Fortunately, most people can make do with someone dropping in for 2-3 hours morning and night, and having a family member sleep over.  Or if the house is big enough, paying a reliable older woman $2-3k a month + use of car + personal living space to live in. But with advanced illness or dementia, especially the combative/aggressive type, round the clock care using multiple caregivers is a necessity and is expensive.

I know this from extensive personal experience.

The length of time one would need 24/7 care is limited. Living the median 21 months at $15k/month is $315k, which is entirely affordable unless you're living an ERE lifestyle. Post-70 dementia patients live for an average 4.5 years, which would take $810k; it's probably most of the starting stash for the average MMM poster but still doable.*

Of course, there's also the question of what the caregivers decide to do with their future inheritance. They may decide that an assisted living center is better for grandpa and, coincidentally, also better preserves grandpa's investments. If you're in Arizona, your court appointed guardian may fleece you of everything you have and stick you in a home regardless of your or your heirs' intent. https://www.newyorker.com/magazine/2017/10/09/how-the-elderly-lose-their-rights


* Unless you're on the tail end of the SWR, you'll have millions more than planned. Even bogleheads have the same problem, though, as their lifestyles are larger. In their case, they or their guardians can sell the Tesla and downsize from the McMansion.

[Travis]

MMM comes up every now and then as a source of discussion/ridicule on Bogleheads a few times a year.  Usually it's in the form of the Retirement Police accusing Pete of being full of shit for occasionally taking paying work or bartering his time for something.  They also accuse him of lying about his income because of the blog.  He makes a ton of money from it, but unless something has changed recently he doesn't spend any of it and doesn't count it in his 'stache.  Very few of the commenters over there understand that his philosophy is about happiness, health, and anti-consumerism with retiring early as a means, not an end.  He gave a lecture about a year ago where he said the goal for everyone should be "work like you don't need the money."  With this particular discussion it seems like more of them over there are finally understanding that.

They are definitely a different demographic and have different goals in mind.  I go there when I have nuanced financial questions.  Sorry MMM Forum, but that is their strength. As far as general use out of their forum, they have so many posters it is impossible to keep up.  And with their focus on the financial side, the posts can get repetitive quickly so I don't visit very often.

[MrMoneySaver]

keeping fit and healthy and maintaining that into old age. I know you can't guarantee that you won't need long term care, and accidents and deterioration happen anyway, but if you live an active lifestyle both physically and mentally, and eat well, and surround yourself with loved ones, in a walkable neighborhood, you have far greater chances of being more mobile and keeping your mental capacity for longer.

Doesn't matter for this discussion. It doesn't change the endpoint.

Perhaps if you lived the less healthy lifestyle, you'd become infirm at age 75. And if you lived the healthier lifestyle, it would happen at, say, 95. The basic trajectory of the human body is the same, and all the exercise and healthy eating in the world won't change that. Having the infirmity happen later just means your stache needs to be even larger!

The only way to avoid the home care/assisted living/nursing home phase is to die a sudden death. And you can do that at any age.

[bacchi]

MMM comes up every now and then as a source of discussion/ridicule on Bogleheads a few times a year.  Usually it's in the form of the Retirement Police accusing Pete of being full of shit for occasionally taking paying work or bartering his time for something.

This somewhat contradicts the selfless boglehead concern about us (MMM crowd) running out of money when we are 75 and need care. If we're getting jobs and drifting in and out of retirement, it decreases the withdrawal rate. Making even $10k/year reduces the SWR to 3% on a $1 million stash.

They are definitely a different demographic and have different goals in mind.  I go there when I have nuanced financial questions.  Sorry MMM Forum, but that is their strength. As far as general use out of their forum, they have so many posters it is impossible to keep up.  And with their focus on the financial side, the posts can get repetitive quickly so I don't visit very often.

Oh, yeah, definitely. We have some good, detailed, discussions about returns and asset allocations but they have a lot more with more contributors.

[arebelspy]

I live that Spartana. Well said!

[one piece at a time]

Going through this right now with an elderly family member. Rather than being in some Medicaid picked home (wherever they have space), the individual can stay in their own home and have round the clock care. Familiarity is important when you are old and confused. You don't have to move and lose the things that ground you, be it your couch you've had for 20 years or that sticky drawer in the kitchen.

Why not spend 20 years from 40 to 60 building a soul and a mind that can cope with having a different damn couch? I know the decline happens, but we can plan for it. By way of analogy, if you've spent 10 minutes every day doing some strength training for your body you'll still probably trip over that step when you're 80, but you might not fall, and you might not break your hip.

[MrMoneySaver]

Because when dementia is destroying someone's neurons, all that mind- and soul-building is literally being erased.

[ooeei]

BH is focused on the last 10 years of your life

MMM is focused on the middle 40 years of your life

[SimpleCycle]

I like both forums, but spend far more time here.  Mostly because I am a hippie Boglehead who is looking for support in a lower consumption lifestyle, and have the areas that MMM is weak on nailed down better.

Healthcare costs are a huge deal and I think the mantra of “live a healthy life and you’ll be fine” is incredibly naive.  Not every disease is caused by lifestyle.  I happen to have one of those, and while it doesn’t shorten my lifespan, it makes me uninsurable in the non-group market if I RE and the ACA goes away.  Which means I can absolutely FIRE with the understanding I might have to return to work to access health insurance, since I can’t afford to self insure with my particular health risks.  I’m lucky enough to know all this going in.  What I worry about is someone who can’t predict that they’ll need a lot of healthcare.

We’ve been through huge end of life issues with several relatives and honestly it is hard to plan for.  I️t’s fine to have your plan be to go through Medicaid spend down.  I️t’s very different to not have a plan and end up surprised by end of life costs, especially if the person has a spouse who also needs to live on the stash.  My experience is you don’t get to choose the level of care you will need and qualify for.  The risky period is needing care, but not needing enough care for Medicaid to be required to pay for it.

I actually selectively stay away from the investing and insurance advice given on MMM.  My risk tolerance is higher than average, but not anywhere near 100% stocks and car insurance at the state liability minimums level.  I’m more of a Boglehead there.

[SugarMountain]

Interestingly, I've never gotten into bogleheads even though I apparently fit into their demo much better (50, high income, decent stache, not a great saver compared to most of the MMM crowd).  I got sucked in by MMM's early blog posts and have never left, at least lurking, occasionally posting.  That said, at this point I probably should spend some time over there.

[paddedhat]

I have just searched the MMM blog for any posting related to affording assisted-living, disability, becoming disabled, having a heart attack or stroke, nursing home expenses, college expenses, affording children, etc. and could not find one post. In contrast, these types of posts are reasonably frequent on the BH site

yeah, the search doesn't work very well : )

Like a few years back, when several awesome members here (who are far more intelligent that me ) put a lot of effort into analyzing my severely disabled wife's retirement situation, and what the best option was. out of several disability pension choices?  JMHO, but that's one BH poster with a bit of a credibility gap, when it comes to the the depth of discussion here.

[MustachioedPistachio]

MMM is also about freedom. About choice. Not to sound macabre, but if I get to the point where I can no longer live a decent life, I or my living will will choose suicide, physician-assisted if legal and/or available. Dementia/Alzheimer's is basically 'you' having died anyway, frankly.

 

[koshtra]

While I'm basically with Laura33, here, I will say that the end of life trajectory is actually not the same. Healthier people die not just later, but quicker. "Compressed morbidity," they call it, and I'm shooting for it :-)

[StarBright]

I spend time on both sites...for different reasons...

MMM when I need a reminder that I do not need to save enough for a 1.483% withdrawal rate in retirement.
BH when I need a reminder that I do not need to wash and reuse ziplock bags or sell all my possessions except a bike.

J/k 

We get value from both and appreciate that they are both there for me to learn as we move along in our journey.

+1 (or two or whatever).

I'm a worrier so BH is really more up my alley - but demographically (older millenial/xenial) MMM is the better fit for me. So I feel like I go to BH for learning and MMM for community.

[BDWW]

Because when dementia is destroying someone's neurons, all that mind- and soul-building is literally being erased.

But not as fast as someone he hasn't. Physical and mental exercise both delay the onset and progression of most forms of dementia and Alzheimers.

[sol]

All of this talk about the costs of long term care and end-of-life medical expenses reminds me of the old saying...

"The first wealth is health."

It's also the best form of wealth.  I'd much rather retire at 40 with 1 million dollars than at 50 with 2 million or 60 with 4 million, because a 40 year old retiree can spend decades being fit and healthy.  Part of the reason the BHs needs more money for medical care in their old age is that they have neglected their bodies earning all of that money.

Be free, Bogleheads!  Cast off your shackles and LIVE.

[robtown]

I always imagined. . .

-The average BH member to be a suit wearing white man in his 50s
-The average MMMer to be a beach bum

I'm a white man that is 61 years old today.  I'm a mediocre MM but have been frugal.  I've had a few investment failures and a couple 100k - $1M could have, should have (or not) events.   My FI is March 2020 and I'd quit tomorrow if my stash was larger.

[Travis]

A few months ago when I was preparing to move to AZ, I asked both Bogleheads and here for advice on affordable living within the quality of life perimeters I laid out.  I got a lot of good actionable advice from the family here and continue to do so.  Over there I got some advice, but "affordable" wasn't a part of the discussion. It was all about "live here, don't drive there, why are you so interested in riding a bicycle?"  Nobody there was suggesting I buy a $300k house, but life optimization was not part of their calculus.

[ysette9]

I agree with others that there are some very smart people on BH and their wiki is something I link to people starting their financial education journey all the time. But in terms of choosing which group of kids to eat lunch with, you guys win, hands down. I’ll never forget when I got flagged by a moderator there for posting “F-that!”. I complained over here and one of MMM moderators corrected my post to read “Fuck that!”. Ahhh, this community is a gem.

Seriously though, the optimism is more in line with my world view. I surround myself with happy people in real life because it make my life experience more enjoyable. I want the same for my online travels.

[jlcnuke]

I always think of the "$40k gift to buy a car question" when I think about the difference between BH, ER.org, MMM, and ERE.

Basicly: if someone gave you $40k and said you had to use some or all of it to buy a vehicle what would you buy.

A BH would put the who $40k as a down payment on a $100k luxury car and work longer to pay for it.
An ER.org person would buy a new $40k sensible sedan.
A MMM person.would buy a used Prius for less than $20k and invest the rest...in Vanguard.
An ERE person would buy a $10 used bike at the thrift store and use the remainder to retire on.

Edited too fix speling.

I've seen a different spectrum/equation/situation myself.
An ERE person would retire with $100,000 if it meant they had to live in a tent for the rest of their lives and forage for food.
A MMM person would retire with $600,000, assuming that it would provide 4-5% real returns (despite historically it not providing close to that) and planning to "deal with it" if/when it doesn't work out for them.
An ER.org person would plan to retire with "whatever is needed to establish a 4% SWR at 62 for your current spending levels and an extra 2.5% SWR for every 5-10 years earlier than that age you want to retire because the historic numbers say that is what is 95% safe".
A BHer would plan to retire with enough money to live twice their current lifestyle, assuming (historically) they would end up leaving 5x their current net worth to heirs they may or may not care about, who probably don't need it, while spending more in a year than an ERE person will retire with.

[Dibbels81]

Back when I visited the site, the average BH seemed to be a still employed ~60 year old millionare shitting their pants over the prospect of a 3% withdrawal rate. Also, I would have received a lifetime ban for saying the word "shit."  MMM is 10x better. The worst retirement police in internet history lurk in the BH forum.  I have huge respect for Jack Bogle, however.

[MrMoneySaver]

the average BH seemed to be a still employed ~60 year old millionare shitting their pants over the prospect of a 3% withdrawal rate.

I was there yesterday; still accurate.

[Rhoon]

My plan for when I'm elderly and can't take care of myself: I married a woman 10 years my junior. She'll be plenty young still when I'm in need of a diaper changing. That and I told her to take me out behind the barn and put me down once I don't know the difference. ;)

[Mariposa]

If I become demented in my older age, I will want no extreme medical measures to prolong my life: no feeding tube, intubation, CPR, hospitalizations, antibiotics, or chronic medications. I would want measures strictly for comfort only. This way, I'm likely to have a significantly more compressed decline than the average. Just hope the system respects my wishes.

I don't agree with everything this guy says, but:

https://www.theatlantic.com/magazine/archive/2014/10/why-i-hope-to-die-at-75/379329/

[aperture]

Last month the physician working in the office next to mine had a stroke while talking to a patient.  He died three days later without regaining consciousness.  It was just the kick in the ass I needed to be 1000% certain that it is time to retire wether the market is where I want it, or the president is who I want or my health care plan is all it could be.  Without health, I will only leave a larger pot of money to my wife and children. 

I really appreciate that this community is oriented around maximizing life more than maximizing the portfolio. 

[Paul der Krake]

Wow, tribalism much? Both communities are mostly great, and both have posters that are... out there.

Bogleheads strong points:
- real forum software
- grounded investment advice, with some rock star posters such as Bernstein, Swedroe (RIP)
- phenomenal wiki that captures said investment advice
- clear, strict moderation rules, that they even enforce on Jack Bogle when he speaks at the annual meeting
- much longer collective investment experience spanning decades

[triangle]

My brief take is that BH is more technical or purely financially focused (i have not joined their forum to read in depth, just benefited from from their wiki), while MMM is more holistic in their approach to life and our members are more independently minded. 

While I enjoy this forum a lot, I may be more BH inclined financially in that I think too many MMM attempt to become FIRe with an error of margin that is too small for comfort. And while it is great for people to stay in shape and eat healthy it seems that a long and healthy live is based on equal parts - genetics, good health practices, and randomness. I am not so concerned about early retirees getting dementia in their last years when the stash is almost gone, but more about run of the mill disabilities/illnesses that can strike without warning and leave a person dependent or need more outside assistance than anticipated. Even if that is as simplistic as no longer being able to perform their own car/house/yard maintenance and needing to pay someone else to do it.

[Fresh Bread]

MMM is also about freedom. About choice. Not to sound macabre, but if I get to the point where I can no longer live a decent life, I or my living will will choose suicide, physician-assisted if legal and/or available. Dementia/Alzheimer's is basically 'you' having died anyway, frankly.

Because assisted dying is available, if you can pay and are able to travel, the real risk is dementia. You wouldn't meet the requirements to end your own life and you can live for years needing full time care. Two female dementia patients I know we're in homes for a decade.

Dementia is something we are planning for - being 5+yrs in a care home. Here for a private, high quality care facility that means a lump sum of $500k-1m, depending on the location and quality, or a steep monthly fee.

[TartanTallulah]

Bogleheads is a fantastic resource for information and I like to listen in on some of the discussions that are relevant to my own situation, but I can't imagine doing more than lurk there. I'm not an optimiser, investing isn't an end in itself for me, and I will never, even if I don't retire till I'm 150, accumulate the sort of stash that's considered adequate over there.

What I need is a community that has a wealth of wisdom, experience, and a willingness to step outside conventional social aspirations and take the occasional risks, because if I'm going to step away from my job and live a little before decrepitude really bites I need a place away from my colleagues (many of whom seem to aspire to work till they drop while complaining about hating the job) where I can talk to other people who have retired on a stash with only one comma and survived.

Of course, real life is full of people who are accidentally Mustachian. Members of my own family, and lots of my retired customers, feel comfortably off with £1,000 a month in hand and a little bit of cash in the bank.

The personal stuff about MMM himself being a serial entrepreneur rather than a retired person living on a shoestring may be true, but it's irrelevant. The forum community has a separate life of its own.

[arebelspy]

Wow, tribalism much? Both communities are mostly great, and both have posters that are... out there.

Hear, hear!

Swedroe (RIP)

???

[simmias]

???

He recently stopped posting on Bogleheads.  There were some posters who were extremely antagonistic whenever he would post, and he tired of it.

[arebelspy]

Ah, that's too bad.

[cerat0n1a]

Because when dementia is destroying someone's neurons, all that mind- and soul-building is literally being erased.

Of course, any of us might end up with dementia (as with cancer and many other conditions better avoided), but there are plenty of things we can do to shift the odds in our favour. Not smoking, eating plenty of vegetables and fruit to give two simple examples of well established links. There's a strong correlation between mid-life obesity and old-age dementia for example. Pete's bike wins again.

[MrMoneySaver]

Bogleheads is a fantastic resource for information and I like to listen in on some of the discussions that are relevant to my own situation, but I can't imagine doing more than lurk there. I'm not an optimiser, investing isn't an end in itself for me, and I will never, even if I don't retire till I'm 150, accumulate the sort of stash that's considered adequate over there.

That's where I am. People can disagree about how much you "need" to retire and whether a 2.5% withdrawal rate is safe, but realistically if I tried to do what a lot of Bogleheads are doing, it'd be an exercise in futility. So I much prefer the numbers we throw around here, even though some of them are still out of range given that I'm not a high earner.

[Laura33]

Oh, and if you get cancer, do you want to go to the local guy who takes Medicaid or Medicare, and do whatever procedure/drugs the government has decided to pay for?  Or do you want to do what my in-laws did and hop on a plane to the guy with the best surgical stats in the country and take his advice?

I would have no problem going to the local guy who takes Medicare/caid.  In truth, there is greatly diminishing utility in additional spending for health care interventions over the costs incurred for standard treatment from an average doctor. We don't want to believe that, because it is comforting to think we that there is a direct connection between paying more for health interventions and longer life. This is one reason why countries with socialized medicine and lower costs have just as, and often better, outcomes than the highest of high-tech American healthcare system.

I am not talking about chasing unicorns.  Three real-life examples from the past @5 years:

a.  Different doctors offer different treatments (under the "if you have a hammer, everything looks like a nail" theory).  There may not be anyone locally who takes Medicaid/basic Medicare with experience in the most effective treatment and room on his schedule.

b.  You can research success rates for surgery.  With most, there is a clear correlation between # of procedures performed and success/complication rates.  Yes, there may be selection bias, so you need to consider whether the surgeon turns away complicated cases.  In my MIL's case, the difference in the numbers between the guy who actually invented the surgery and the local guys who performed it were like 2:1.  For my FIL, that was "fuck it and get on a plane" territory.

c.  My MIL just got put on an experimental drug that runs about $2K/mo.* and is covered by Medicare, but then Medicare refused to pay.  My FIL again said fuck it and got her on the drug and fought about reimbursement afterwards.

If you ask my FIL whether working until @62 was worth it to be able to afford those choices, he would just laugh, because he still has his wife. 

Again, y'all can do what you want.  My point is just that it is not as simple as "US healthcare is wasteful."  And it is also very easy to make sweeping statements about what Future You will be happy with, without having the slightest clue what Future You will actually think when staring at a diagnosis -- especially when you have no first-hand experience with those issues.  Personal experience can be very eye-opening.

Personally, I want choices.  And money gives those choices.  If I decide another 6 months is worth the pain of chemo, I want the cash to pay for what I need and not wait to see if the insurance will come through.  If I decide I'm done, I want the cash available to get on a plane and fly somewhere where assisted suicide is legal.  I also have some medical issues that make me leery about assuming I'll be in the lucky group that is perfectly fine until they keel over at 92.  And since I don't hate my job and DH isn't retiring for @7-8 yrs anyway, there's very little downside to continuing to build the 'stache that will give me those kinds of choices. 

YMMV as always.  Just educate yourself about the real issues and real costs so you can make an informed decision, like you do with everything else.

*One thing that I didn't know is that many types of cancers are now managed as a long-term disease; there is no "cure," but there are multiple drugs available, so you take one until it doesn't work any more, and then move on to another.  This is an awesome development, as it gives patients several extra years of life (and except for a few weeks here and there, my MIL can generally do most of the things she enjoys, like getting on a plane to see the grandkids).  But it also means years of ongoing treatments and frequent scans and higher medical costs.

[MrMoneySaver]

Medicare doesn't cover nursing homes -- that's Medicaid.  And have you seen the kind of nursing homes available on Medicaid?  And how little money you are allowed to keep for "luxuries" like toothpaste before you are even eligible for government support?  And, honestly, the lack of care or interest provided by some of the employees there?  We've been through this with my great-aunt, and it was really frightening -- the places that took Medicaid were generally horrible, and the one not-horrible option we found had a huge waiting list.  And she ended up dying in a post-hospital Medicaid-approved nursing home because someone just stopped listening to her buzzing for help and didn't bring her her asthma medicine, so she suffocated in her own bed. 

Oh, and if you get cancer, do you want to go to the local guy who takes Medicaid or Medicare, and do whatever procedure/drugs the government has decided to pay for?  Or do you want to do what my in-laws did and hop on a plane to the guy with the best surgical stats in the country and take his advice?  She's still here 4.5 yrs later, with a cancer with an average survival rate of less than a year, so I'm going to call that a win.  Sometimes money really is the difference between life and death. 

I also guarantee you no 85-yr-old said "gee, I'm glad I chose my final years to be miserable."  Those final years can be just as precious to them as the younger ones, precisely because they know the story is coming to an end, so they don't take the time for granted any more.  Don't assume that you are going to value your life, your experience less when you are older -- you are still going to be you.  And having the money to make those years comfortable and enjoyable in fact makes them even more valuable.  IMO this is one of the big differences you get with the age difference between MMM and BH:  more of the BHs tend to be at an age where they have been through this with their parents and/or where the possibility of being old and infirm is beginning to feel more like a reality.

Q:  Where does outrageous optimism come from?  Why is it valid and a better approach to life than pessimism and planning for the worst?  A:  It comes from recognizing the power you hold as a capable, competent human being.  It comes from knowing that if everything hits the shitter, you have the power and ability to fix whatever the problem is -- you can cut back spending, or get a part-time job, or move to a cheaper area, etc.  The problem is, when you are 85 and infirm, you don't have that power any more.  You can't go back to work, because no one will hire you, and you might not physically be able to do the job anyway.  You can always cut, but if you're living on SS, and/or don't have a significant 'stache remaining, you're never going to be able to cut enough to cover a decent nursing home -- or maybe you can cover your own care, but in doing so drain all the assets for your surviving spouse.  Maybe you can move somewhere cheaper, but if you need family and friends to look out for you, you're leaving the people and experiences who give your life meaning and joy behind -- and, again, you're not likely to be able to cut enough to cover a 6-figure nursing home bill (much less two).  By that age, you are stuck with whatever you have managed to save or your relatives can provide.

Doesn't mean you have to go over to the far side of the conservative spectrum, of course.  Be optimistic -- revel in your power to set yourself up for success!  But add a little humility to the equation: acknowledge that you might not always be as fit, as capable, as employable, as powerful as you are now.  In the same way you spend your 20s and 30s setting $$ aside on behalf of the You you will be in your 40s and 50s and 60s, think even further ahead, about the more helpless You you will/hope to be in your 80s and 90s.   Assume that 80-yr-old You will want to live and be comfortable and respected and cared for just as much as you do now -- in fact, will need it even moreso than Current You, because that You will have less power to adjust course in response to problems that arise.  Think how would you want someone to treat your mom, your grandma, your most beloved relative or friend -- and ask yourself if you'll really want less for yourself?  Give that Future You a place at the table now, when you are making your plans.  Doesn't mean 80-yr-old You runs the show -- you always have to balance the magnitude of the risk against the likelihood of it happening, balance your needs at 80 against your needs at 50 and your needs now, balance the tradeoffs involved in seeking a guaranteed big-enough 'stache (many, many more years working). 

For me, that balance sure as hell does not involve counting on SS and Medicaid/Medicare to take care of me, because I don't want to live my final years in a shithole with people who don't even respect me (much less care about my wellbeing), surrounded by the smells of urine and feces.  Just fucking kill me now.  So I have some LTC insurance, and I am planning on a larger 'stache to (I hope) cover at least a reasonable, clean place that doesn't nauseate me.  And, hey, my job doesn't suck, so the tradeoff isn't that bad -- if my job were horrible, that would shift the calculus more heavily towards Current Me instead of 80-yr-old Me.

I'm sorry if I sound angry about this.  It's not personal -- I'm angry at the shit-ass safety net we provide for our most vulnerable, angry about the treatment some of them receive, and worried that people are making decisions that will come back to bite them in the ass, based on incorrect assumptions and minimal data.  Just do as much research into future medical/care costs and options as you would into the 4% rule or appropriate portfolio allocation or how much to spend on a used car or [insert MMM topic of choice here].

This is one of the best posts I've seen. It is truly food for thought.

[honeybbq]

Going through this right now with an elderly family member. Rather than being in some Medicaid picked home (wherever they have space), the individual can stay in their own home and have round the clock care. Familiarity is important when you are old and confused. You don't have to move and lose the things that ground you, be it your couch you've had for 20 years or that sticky drawer in the kitchen.

Why not spend 20 years from 40 to 60 building a soul and a mind that can cope with having a different damn couch? I know the decline happens, but we can plan for it. By way of analogy, if you've spent 10 minutes every day doing some strength training for your body you'll still probably trip over that step when you're 80, but you might not fall, and you might not break your hip.

Sounds so easy to avoid cancer, dementia, alzheimers, etc. I wonder why those diseases even exist?

[bacchi]

And it is also very easy to make sweeping statements about what Future You will be happy with, without having the slightest clue what Future You will actually think when staring at a diagnosis -- especially when you have no first-hand experience with those issues.  Personal experience can be very eye-opening.

The opposite is true too. People can die quickly. Will Future You curse Present You when that headache you thought was from staring at the computer screen and work stress is actually stage IV cancer and now you don't have time to hike the PCT? Or, more likely, Future You is one of the many who simply becomes less able to do a loved hobby and there are regrets..."If only I had quit 5-10 years earlier. I didn't really need the money but I sure did love riding horses."

Living in fear can also cause regrets.

*One thing that I didn't know is that many types of cancers are now managed as a long-term disease; there is no "cure," but there are multiple drugs available, so you take one until it doesn't work any more, and then move on to another.  This is an awesome development, as it gives patients several extra years of life (and except for a few weeks here and there, my MIL can generally do most of the things she enjoys, like getting on a plane to see the grandkids).  But it also means years of ongoing treatments and frequent scans and higher medical costs.

There's no doubt that more money is helpful, from paying off a border guard in Tibet (true story) to paying for medical care. Before the ACA, individual policies had lifetime limits that ranged from $1M-$5M. Those limits were set in place for a reason -- the drug companies expected some chronic patients to exceed the limits.

The question then becomes: How long are you willing to work to cover an unlikely event where you and yours exceed the lifetime limits? (I.e., what if both you and your spouse get chronic cancer and need $2x20k/month drugs?) I can afford 2 years of that cost; maybe you want to ensure that you have 5 years.

Anecdotally, my SO's grandmother turned down the 3rd round of chemo in 3 years. She was done. Those decisions are also made.

[NoStacheOhio]

I am not talking about chasing unicorns.  Three real-life examples from the past @5 years:

a.  Different doctors offer different treatments (under the "if you have a hammer, everything looks like a nail" theory).  There may not be anyone locally who takes Medicaid/basic Medicare with experience in the most effective treatment and room on his schedule.

b.  You can research success rates for surgery.  With most, there is a clear correlation between # of procedures performed and success/complication rates.  Yes, there may be selection bias, so you need to consider whether the surgeon turns away complicated cases.  In my MIL's case, the difference in the numbers between the guy who actually invented the surgery and the local guys who performed it were like 2:1.  For my FIL, that was "fuck it and get on a plane" territory.

c.  My MIL just got put on an experimental drug that runs about $2K/mo.* and is covered by Medicare, but then Medicare refused to pay.  My FIL again said fuck it and got her on the drug and fought about reimbursement afterwards.

Now, I'm biased because I work at a massive academic medical center, but I'm constantly amazed at the people who won't drive <2 hours for a center with excellent outcomes. Pick a procedure/disease, any procedure/disease, and we probably handle exponentially more of them than an average community hospital. If you have some crazy rare thing, we've probably seen 10 other people with it in the last six months or whatever. But sure, get your bypass with a general surgeon in your town because it's closer, it's not like it's a once-in-a-lifetime decision that could have massive effects on how you live the rest of your life.

/rant

If you have a broken leg, sure, community hospitals are fine, but when it gets serious, you get serious too.

[NoStacheOhio]

This post on BH stood out to me:

"I think Victoria is correct that MMM's followers are implementing this vision to quit work at 30-35 and have more time for self-actualization. That's great for the first 40 years of one's life. What about the last 40 or 50 years?

I have just searched the MMM blog for any posting related to affording assisted-living, disability, becoming disabled, having a heart attack or stroke, nursing home expenses, college expenses, affording children, etc. and could not find one post.[...]

That's only because our internal search function is a piece of shit. These topics come up here plenty, but the search bar won't show that.

I agree MMMers need to consider curveballs. My life has been one eternal curveball, so I really factor that in, as do some others here.

I read that to mean the poster searched the blog and not the forum.

[koshtra]

There's a lot of good end-of-life info now, and more coming out all the time. A book that had a big influence on me was Sherwin Nuland's *How We Die*: before I read that I really had no idea of what the odds of various exits were, and how medicine-as-we-know-it usually handles them. If you've had the good fortune of not seeing a lot of your close friends and family out, it would be worth getting a handle on what you're probably looking at, for yourselves and your family and your friends. We're all making some kind of exit sometime :-)

Basically, I think Mustachian self-help, admirable as it is, simply breaks down at end of life. It's your friends and family that look after you, or don't; and you set that up as much as you can, and fund it if you can. I find the idea that you'll still be in control as you're dying kind of ludicrous, frankly. I've seen a lot of people out, and the last phase takes basically everybody by surprise. Incapacitation proceeds faster than the realization of it does. At the end you're not calling the shots.

[Laura33]

Will Future You curse Present You when that headache you thought was from staring at the computer screen and work stress is actually stage IV cancer and now you don't have time to hike the PCT? Or, more likely, Future You is one of the many who simply becomes less able to do a loved hobby and there are regrets..."If only I had quit 5-10 years earlier. I didn't really need the money but I sure did love riding horses."

Living in fear can also cause regrets.

Oh, ITA (which, in fact, is why I bought my highly unMustachian StupidCar this year, because what's the point in having an awesome toy if your knees won't let you drive a stick shift any more and your back won't let you get in and out?).  It's always a balance.

I am not actually advocating for a specific outcome.  My point is more that the natural order of things is to prioritize current wants over future wants.  We tend to think that we are immune to this very human trait -- I mean, aren't we all here because we are putting our future needs over today's wants?  My concern is that our optimism and belief in our own ability to delay gratification may give us a false sense of confidence about our ability to predict what FutureUs will actually need.

Think about it this way:  a normal person is going to choose 2017Me over 2032Me -- they are going to buy a house and a car and go out to eat a lot, even though it means they will need to work until 2052.  Ergo, their choices are fun for 2017Me-2032Me, but screw over 2033Me-2052Me.  We, OTOH, think a lot about 2032Me, to the extent that we frequently tell 2017Me "no," because 2032Me is more important.  That feels very much like we are awesome at delayed gratification -- like we naturally prioritize the future over the present.  Because we do it every day!

But when we envision FIRE, our focus is basically on 2032Me-2052Me -- that "early" part of "early retirement," when we are FI and still young and fit and can be active and do all the things 2017Me is looking forward to.  That is a very limited future that we are focusing on -- and one that is built around what 2017Me wants ("dammit, I reallyreallyreally want to hike the PCT, I can't wait until 2032Me gets to do that!").  And that focus on 2032Me-2052Me also means that we don't necessarily think about 2062Me, or 2072Me, or those other FutureMes who will no longer be able to do all of that same awesome stuff that 2017Me is so looking forward to.  So we feel like we are delaying gratification for the benefit of AllFutureMes, when in reality we are doing it for the benefit of NearFutureMe and not even thinking about DistantFutureMe (beyond simply assuming that DistantFutureMe will want the same things NearFutureMe does). 

IMO, it is easy to overlook the fact that this laser-beam focus on FIRE is in fact focusing on 2017Me's idea of what 2032Me will want (freedom!!!), but that that vision may not in fact be at all what 2062Me will want or need.  So all I am saying is to give 2062Me a seat at the table, with all of the other Current-and-Future-Mes, and try to figure out what s/he's going to want with the same degree of intensity and focus that you are giving to 2017Me-2061Me.

[MrMoneySaver]

At the end you're not calling the shots.

Even if I exercise and eat healthy?

Kidding. Great post. I'm going to check out that book.

[one piece at a time]

Sounds so easy to avoid cancer, dementia, alzheimers, etc. I wonder why those diseases even exist?

...because people take MMMs advice and sell their motorcycle.

[Rollin]

Re: worrying about illness/disability/etc. in old age as reason for not ER'ing

Despite rhetoric to the contrary, there is a robust safety net in place for the elderly. Medicare and SS will "fill the gap," should there be one, for the vast majority of early retirees who planned prudently.  And if it doesn't, so what? How many elderly people starve or freeze to death in the U.S.? BH is fundamentally afraid of a non-bougie existence.

I've heard old people (80+) lament the high cost of care, medical procedures, etc. But none have ever said "I should've worked an extra 10 years! Goddamn my libertine desire to stop working for someone else!" If I had to choose a time to be miserable, it would be when I'm elderly. Killing your soul in middle-age to live it up as an old fart doesn't make sense.

Medicare doesn't cover nursing homes -- that's Medicaid.  And have you seen the kind of nursing homes available on Medicaid?  And how little money you are allowed to keep for "luxuries" like toothpaste before you are even eligible for government support?  And, honestly, the lack of care or interest provided by some of the employees there?  We've been through this with my great-aunt, and it was really frightening -- the places that took Medicaid were generally horrible, and the one not-horrible option we found had a huge waiting list.  And she ended up dying in a post-hospital Medicaid-approved nursing home because someone just stopped listening to her buzzing for help and didn't bring her her asthma medicine, so she suffocated in her own bed. 

Oh, and if you get cancer, do you want to go to the local guy who takes Medicaid or Medicare, and do whatever procedure/drugs the government has decided to pay for?  Or do you want to do what my in-laws did and hop on a plane to the guy with the best surgical stats in the country and take his advice?  She's still here 4.5 yrs later, with a cancer with an average survival rate of less than a year, so I'm going to call that a win.  Sometimes money really is the difference between life and death. 

I also guarantee you no 85-yr-old said "gee, I'm glad I chose my final years to be miserable."  Those final years can be just as precious to them as the younger ones, precisely because they know the story is coming to an end, so they don't take the time for granted any more.  Don't assume that you are going to value your life, your experience less when you are older -- you are still going to be you.  And having the money to make those years comfortable and enjoyable in fact makes them even more valuable.  IMO this is one of the big differences you get with the age difference between MMM and BH:  more of the BHs tend to be at an age where they have been through this with their parents and/or where the possibility of being old and infirm is beginning to feel more like a reality.

Q:  Where does outrageous optimism come from?  Why is it valid and a better approach to life than pessimism and planning for the worst?  A:  It comes from recognizing the power you hold as a capable, competent human being.  It comes from knowing that if everything hits the shitter, you have the power and ability to fix whatever the problem is -- you can cut back spending, or get a part-time job, or move to a cheaper area, etc.  The problem is, when you are 85 and infirm, you don't have that power any more.  You can't go back to work, because no one will hire you, and you might not physically be able to do the job anyway.  You can always cut, but if you're living on SS, and/or don't have a significant 'stache remaining, you're never going to be able to cut enough to cover a decent nursing home -- or maybe you can cover your own care, but in doing so drain all the assets for your surviving spouse.  Maybe you can move somewhere cheaper, but if you need family and friends to look out for you, you're leaving the people and experiences who give your life meaning and joy behind -- and, again, you're not likely to be able to cut enough to cover a 6-figure nursing home bill (much less two).  By that age, you are stuck with whatever you have managed to save or your relatives can provide.

Doesn't mean you have to go over to the far side of the conservative spectrum, of course.  Be optimistic -- revel in your power to set yourself up for success!  But add a little humility to the equation: acknowledge that you might not always be as fit, as capable, as employable, as powerful as you are now.  In the same way you spend your 20s and 30s setting $$ aside on behalf of the You you will be in your 40s and 50s and 60s, think even further ahead, about the more helpless You you will/hope to be in your 80s and 90s.   Assume that 80-yr-old You will want to live and be comfortable and respected and cared for just as much as you do now -- in fact, will need it even moreso than Current You, because that You will have less power to adjust course in response to problems that arise.  Think how would you want someone to treat your mom, your grandma, your most beloved relative or friend -- and ask yourself if you'll really want less for yourself?  Give that Future You a place at the table now, when you are making your plans.  Doesn't mean 80-yr-old You runs the show -- you always have to balance the magnitude of the risk against the likelihood of it happening, balance your needs at 80 against your needs at 50 and your needs now, balance the tradeoffs involved in seeking a guaranteed big-enough 'stache (many, many more years working). 

For me, that balance sure as hell does not involve counting on SS and Medicaid/Medicare to take care of me, because I don't want to live my final years in a shithole with people who don't even respect me (much less care about my wellbeing), surrounded by the smells of urine and feces.  Just fucking kill me now.  So I have some LTC insurance, and I am planning on a larger 'stache to (I hope) cover at least a reasonable, clean place that doesn't nauseate me.  And, hey, my job doesn't suck, so the tradeoff isn't that bad -- if my job were horrible, that would shift the calculus more heavily towards Current Me instead of 80-yr-old Me.

I'm sorry if I sound angry about this.  It's not personal -- I'm angry at the shit-ass safety net we provide for our most vulnerable, angry about the treatment some of them receive, and worried that people are making decisions that will come back to bite them in the ass, based on incorrect assumptions and minimal data.  Just do as much research into future medical/care costs and options as you would into the 4% rule or appropriate portfolio allocation or how much to spend on a used car or [insert MMM topic of choice here].

Laura33 what you wrote is very much appreciated, thoughtful, and thought provoking.

[BeanCounter]

Oh, and if you get cancer, do you want to go to the local guy who takes Medicaid or Medicare, and do whatever procedure/drugs the government has decided to pay for?  Or do you want to do what my in-laws did and hop on a plane to the guy with the best surgical stats in the country and take his advice?

I would have no problem going to the local guy who takes Medicare/caid.  In truth, there is greatly diminishing utility in additional spending for health care interventions over the costs incurred for standard treatment from an average doctor. We don't want to believe that, because it is comforting to think we that there is a direct connection between paying more for health interventions and longer life. This is one reason why countries with socialized medicine and lower costs have just as, and often better, outcomes than the highest of high-tech American healthcare system.

Also, I seriously do not want my children to spend $180k a year to make sure I have a comfortable death. That feels like such an unbelievable waste to me. Stick me in whatever home is the cheapest and come visit me on occasion, that's all I ask for.

+1
This misconception that there is a dramatic difference in cancer care makes me sick. Fucking Cancer Center of America taking advantage of folks when they are the most vulnerable. It's just wrong.
Honestly having watched my loved ones in their last years, I really am thinking I want a quick way out for myself. Fuck the nursing home. I'm taking a bottle of pills and a good bottle of bourbon and hitting the tub for a loooooong soak.

[Radagast]

Top is in is more hilarious than US stocks in free fall .

[SimpleCycle]

Oh, and if you get cancer, do you want to go to the local guy who takes Medicaid or Medicare, and do whatever procedure/drugs the government has decided to pay for?  Or do you want to do what my in-laws did and hop on a plane to the guy with the best surgical stats in the country and take his advice?

I would have no problem going to the local guy who takes Medicare/caid.  In truth, there is greatly diminishing utility in additional spending for health care interventions over the costs incurred for standard treatment from an average doctor. We don't want to believe that, because it is comforting to think we that there is a direct connection between paying more for health interventions and longer life. This is one reason why countries with socialized medicine and lower costs have just as, and often better, outcomes than the highest of high-tech American healthcare system.

Also, I seriously do not want my children to spend $180k a year to make sure I have a comfortable death. That feels like such an unbelievable waste to me. Stick me in whatever home is the cheapest and come visit me on occasion, that's all I ask for.

+1
This misconception that there is a dramatic difference in cancer care makes me sick. Fucking Cancer Center of America taking advantage of folks when they are the most vulnerable. It's just wrong.
Honestly having watched my loved ones in their last years, I really am thinking I want a quick way out for myself. Fuck the nursing home. I'm taking a bottle of pills and a good bottle of bourbon and hitting the tub for a loooooong soak.

CTCA is basically predatory, but there are differences between going to your local general oncologist, a Commission on Cancer accredited program, or a top program like M.D. Anderson.  Your local oncologist is less likely to follow established treatment guidelines and less likely to recommend a clinical trial.  And if you are interested in the most cutting edge aggressive treatments, your best bet is a top program.

I think a more major misconception is that CoC programs and top centers don’t take Medicare and Medicaid.  They may not contract with out of state Medicaid or certain Medicare Advantage plans, but all of them take regular Medicare.  Money can facilitate travel, but most people can access a top cancer program with their insurance.