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].
