Retirement Planning: Reducing Return Target and Risk?

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Submitted by Coronita on August 26, 2021 - 12:57am

Hypothetical situation, asking for a set a peers.

*Individuals have 19-20 years left to 65 where he/she/they can start drawing on their IRA/401k/Roth etc and has $1million or more already accumulated in their retirement account(s) portion. No debt, mortage, etc.

When should these set of people start to reign in their retirement accounts and reallocate from higher risk higher risk funds to something lower risk, lower return, for stability?

For instance, if these people have $1million, even without future 401k/IRA contributions, at 4% annually, 19 years from now this would be about $2.1m. If that person continues to makes $20k annual contributions to their retirement account(s), at 4% return, 19 years from now that's $2.6m.

Should folks start thinking of taking the "safer" route now, or is 19 years way too far out to reign things in and things should be kept in higher risk allocations, trying to go after that 7-8%+ return? 7-8% consistently for the next 19 years doesn't seem realistic, or am I wrong? If so, then is 4% more realistic.

Submitted by scaredyclassic on August 30, 2021 - 7:49pm.

gzz wrote:
Returns have been high in the past few decades because of rapid technological progress and growth in the skilled working-age population.

Tech progress is slowing however. Not in every field, but in most of them. And one by one, the working age population in developed countries has stopped growing and is now in reverse. The main exception are those with high levels of immigration, however those nations are either importing people with lower skill levels than the shrinking native population and cannibalizing the skilled population from other low-growth nations (eg., China to USA, Slovakia to Germany).

Another factor that led to strong returns in the recent past was the "great moderation" where returns became more predictable and with lower and lower inflation and market interest rates. This made long-lived assets like real estate more valuable. That trend isn't done yet, put it's in its fourth quarter.

I'm in the 4th quarter myself

Submitted by ucodegen on August 30, 2021 - 9:38pm.

gzz wrote:
ucodegen, using long term US stock market returns has serious survivorship bias issues.

How did Russian stocks do from 1871? Farmland in Poland? Confederate and Third Reich bonds?


It looks like you didn't read what I referenced in the FIRE group simulation using historical data. You set a choice of investment selection categories and run a historical regression on how those choices would pan out over time.

gzz wrote:
To put it another way, any asset class we have long term historical data on is cherry-picked and better than average, simply because so many asset classes had drastically negative, -100% returns.

Incorrect, only cherry picked asset classes have had -100% returns. Index funds are using large groups that are averaged together. Again, on the ref I had for FIRE and the sim, take a look at what type of asset classes. You can also change inputs and run against multiple simultaneous scenarios.

gzz wrote:

What number to use then?

In my view, it is mistaken and often hubris to assume one's investments will do better than treasuries. So about 2%.


You should have lead with this. That said, realize that one of the more conservative and yet successful investors is still primarily in stock, less than 15% bonds. The way I look at it is that I am buying part of a business with stock. With bonds - you are buying someone's debt. You need to make sure that they have means to pay off debt from earnings and not inflate it away(in the case of governments). In the case of corporate debt, it gets paid back from revenue generated by the business and I prefer having the business. The only advantage in having corp bonds would be if the business goes T-U. In that case you have 'almost' first order of picking over the bones of that business.

Submitted by ucodegen on August 30, 2021 - 9:31pm.

gzz wrote:
scaredyclassic wrote:
Inflation adjusted?

No. But expected inflation is very low too.


Here is a historical graph.
https://www.macrotrends.net/countries/US...

Plot the 2% line through the graph.

Submitted by ucodegen on August 30, 2021 - 10:26pm.

Coronita wrote:
I am looking at one of my Vanguard accounts I had since 2002. I think it's the oldest one out of the 26 accounts and it is consistently invested on index funds. Average return has been 7.1%...But there were years that it looked awful, like a deep downturn.

I ran a series on S&P 500 returns from 2000 (because that was a group of 3 really bad years 2000-2002) with data from https://www.macrotrends.net/2526/sp-500-... and got 5.25% annual - not including dividends received from index during that time. If I eliminate the 3 bad years and go from 2003 to 2021 I get 9.00%
Coronita wrote:

Personally, that's what I'm trying to avoid. Those deep downturns don't matter if you have another 10-15 years to wait it out. But it would suck if you are drawing from it right after a downturn.

Looking at the recent data, recovery from 2000-2002 occurred in 2007, but there was a bad downturn in 2008.. but again recovered in early 2013. This does not take into effect dividends from S&P 500 companies.
Coronita wrote:

I've been talking a lot more with people who are seriously considering early retirement. just thinking....

I guess it's part of the ongoing The Great Resignation....lol...


Resignation to ones fate?? Anyway, I was laid off in 2008, found I was getting seriously low-balled on job offers and then family issues came up. I ended up living off of investment proceeds. When family issues eased, I found that I was making more on my investments than any wage being offered... so I guess I could say I officially Retired with Resignation.. I liked the work, but management tends to drive me nuts. I think I have experienced too many pointy haired bosses (one of them even looked the part)

Submitted by ltsddd on September 5, 2021 - 1:32pm.

Coronita wrote:

The is considerations to retiring early. Like soon.

If that's the case. I highly recommend you start budgeting as if you're already retired. If you think you'll need $100K to live in retirement then $100K should be your budget for the next few years. This "dry-run" will give you more clarity.

I personally have been doing this for the last few years and the numbers have been significantly smaller than I originally thought (I kept adjusting it downward).

Coronita wrote:

Passive income of $120k/year. Imho, it's going to be tight, but assuming early retirement, doable to live off of the passive income.

I assume the passive income you mentioned is primarily from your rentals. Here's the question for you. How do you plan to spend your time in retirement? Do you still plan to dedicate the same amount of your time to the management and upkeep your rentals?

My views about rentals have changed drastically over the last few years as I think ahead towards my own retirement. I plan to spend more time travelling and being on the road and having to deal with rentals doesn't seem to be compatible with that plan. More importantly, I am not as thrilled or gung-ho about fixing house problems as I did 10 years ago.

Coronita wrote:

But the question is, what about the the retirement accounts. Assuming early retirement, they can be touched after 59 1/2 years, which would be 13 years away, instead of 19. So maybe bank that at 4% with a 50/50% split between equity and some income/dividend/fixed income basket in case things go sour for the next 10 years, and there's maybe 9 more years after that to recover.

Do you need to tap into your retirement accounts to finance your retirement? If you don't then why change your investment style? If your portfolio has been working fine for you the last 20 years, it should be expected to be working, more or less, the same way in the next 20 years. Nevertheless, I would ask the same question as I did with the rentals - what do you plan to do in your retirement? Do you still want to spend the same amount of time reading up on stocks and mutual funds, etc..?

In retirement I don't want to have to worry about growing my wealth as much or anymore. Of the many strategies I read on how to invest safely during your retirement, I like the bucket of money (or a variation of it) the best. Just put it on auto-pilot by splitting your $ into 3 buckets and rebalance once a year and not worry about it.

FInally, congratulations on being financially independent.

Submitted by Coronita on September 8, 2021 - 9:14am.

ucodegen wrote:
Coronita wrote:
I am looking at one of my Vanguard accounts I had since 2002. I think it's the oldest one out of the 26 accounts and it is consistently invested on index funds. Average return has been 7.1%...But there were years that it looked awful, like a deep downturn.

I ran a series on S&P 500 returns from 2000 (because that was a group of 3 really bad years 2000-2002) with data from https://www.macrotrends.net/2526/sp-500-... and got 5.25% annual - not including dividends received from index during that time. If I eliminate the 3 bad years and go from 2003 to 2021 I get 9.00%
Coronita wrote:

Personally, that's what I'm trying to avoid. Those deep downturns don't matter if you have another 10-15 years to wait it out. But it would suck if you are drawing from it right after a downturn.

Looking at the recent data, recovery from 2000-2002 occurred in 2007, but there was a bad downturn in 2008.. but again recovered in early 2013. This does not take into effect dividends from S&P 500 companies.
Coronita wrote:

I've been talking a lot more with people who are seriously considering early retirement. just thinking....

I guess it's part of the ongoing The Great Resignation....lol...


Resignation to ones fate?? Anyway, I was laid off in 2008, found I was getting seriously low-balled on job offers and then family issues came up. I ended up living off of investment proceeds. When family issues eased, I found that I was making more on my investments than any wage being offered... so I guess I could say I officially Retired with Resignation.. I liked the work, but management tends to drive me nuts. I think I have experienced too many pointy haired bosses (one of them even looked the part)

I appreciate you sharing this. Quick question. Given how in demand tech workers are these days, have you considered re-entering the workforce as a contractor? Seems like the barrier to entry is pretty low and the numbers are looking really good. If all else on your own terms. Or do you hate bureaucracy that much ? :)

Submitted by Coronita on September 8, 2021 - 9:15am.

ltsddd wrote:

Do you need to tap into your retirement accounts to finance your retirement? If you don't then why change your investment style? If your portfolio has been working fine for you the last 20 years, it should be expected to be working, more or less, the same way in the next 20 years. Nevertheless, I would ask the same question as I did with the rentals - what do you plan to do in your retirement? Do you still want to spend the same amount of time reading up on stocks and mutual funds, etc..?

In retirement I don't want to have to worry about growing my wealth as much or anymore. Of the many strategies I read on how to invest safely during your retirement, I like the bucket of money (or a variation of it) the best. Just put it on auto-pilot by splitting your $ into 3 buckets and rebalance once a year and not worry about it.

FInally, congratulations on being financially independent.

You know, you got a good point. I think I'm playing it too safe for my retirement accounts and since I can't touch it for at least 12 years, I should go back in... Thanks.

Submitted by gzz on September 8, 2021 - 11:57am.

Curious why you need 120k in retirement with no mortgage on your primary.

25k for medical, 10k for cars is pretty rich, 5k on average for for home improvements.

That leaves 80k a year or $219/day. Easy to spend that while traveling in first world areas. $250/day of lux travel times 100 days a year comes to 25k. first class flights, 5k a year.

That then leaves 50k a year.

Your passive income likely will increase over time, even by my pessimistic assumptions for long term returns. Your medical expense will drop when you hit 65 and get medicare, and you will start getting I assume about 25k a year in social security, plus whatever your spouse gets.

I think both you and escoguy are making up reasons to delay retirement and continue working. The 120k requirement for you, the "let me deduct 30% from the value of my primary assets" for him.

I don't mean to be judgmental with this observation, early retirement when you're fit and have something to contribute is at least slightly immoral, so I see it as you all as inventing reasons that don't seem to hold up to scrutiny to do the right thing morally.

Submitted by flyer on September 8, 2021 - 12:54pm.

Even though we continue to generate passive income from many sources, we made these decisions in our 40's, and had planned for far more than we thought we would ever need from all income sources. I can tell you, if you believe you will live into your 90's, and want to live well, without concern or restriction, under all possible economic conditions, and not depending on government assistance, I feel it would be wise to overestimate your financial needs in "retirement," early or otherwise, by a long shot.

Submitted by Coronita on September 8, 2021 - 9:05pm.

gzz wrote:
Curious why you need 120k in retirement with no mortgage on your primary.

25k for medical, 10k for cars is pretty rich, 5k on average for for home improvements.

That leaves 80k a year or $219/day. Easy to spend that while traveling in first world areas. $250/day of lux travel times 100 days a year comes to 25k. first class flights, 5k a year.

That then leaves 50k a year.

Your passive income likely will increase over time, even by my pessimistic assumptions for long term returns. Your medical expense will drop when you hit 65 and get medicare, and you will start getting I assume about 25k a year in social security, plus whatever your spouse gets.

I think both you and escoguy are making up reasons to delay retirement and continue working. The 120k requirement for you, the "let me deduct 30% from the value of my primary assets" for him.

I don't mean to be judgmental with this observation, early retirement when you're fit and have something to contribute is at least slightly immoral, so I see it as you all as inventing reasons that don't seem to hold up to scrutiny to do the right thing morally.

25k for medical is conservative if you actually have health issues. Also, what if your kid has the same health issues?

And no my medical expenses will not be dropping. My baseline medical expenditures are annually is
1. 1 abdomen MRI annually
2. 1 Upper endoscopy (camera down the throat)
3. 1 Lower endoscopy (camera up the ass)
4. 1 Capsule Endoscopy (camera in a pill that goes through small intestines)
5. 1 Ultrasound for thyroid
6. 1 trip to the ER probably every 2 years to clear random bowel obstructions that seem to happen any time.

MRI is around $15k if not covered by insurance
Endoscopies 2-4 is around $30k if not covered by insurance
Ultrasound is around $4-5k if not covered by insurance
ER visit depends on length, but last time 1 day stay was around $25k.

Don't even get me started with dental... Fortunately, my teeth are decent. But do you folks have any idea how expensive dental is if you actually need major work done? Look up the prices for a root canal, tooth extraction, oral surgery, crown, or implant. Implants are around $5000 at least, and most dental plan have a cap at $2000-3000/year.

You will not get that much for social security if you retire early. And unless they fix the medicare fund, that might be depleted in 15 years.

Early retirement doesn't mean sitting on your ass all day rubbing it in people's face that you were born with money, like some people do *cough* high altitude piggington handle person *cough*. Early retirement means, being able to do what you want to do more under your terms and or maybe spending more time doing like teaching stem class to kids...

I think a lot of people fear losing their job because of the financial loss and not making ends meet. Me? Financial loss from job loss never worried me... I'm fearful of losing my job, because I would take that as an insult that I had to leave under their terms not mine and not having been able to give the last word, middle finger to an ahole boss...

As far as me being fit... I had my fair share of health crisis when I was in my 30ies. Some of it was career ending in some regards, and some that took my life down different paths. I never skipped a beat on working, earning, building even when I was in the hospital. I already paid my health concerns due. Which is also why covid doesn't really scare me. If it's your time, it's your time. Doesnt mean if you want to live, you can be totally irresponsible. But there's a point when you do what you can and let the cards fall however the fall.

Covid should be an eye opener for folks. Some easily get it, even with a vaccine. Doesn't matter what financial background, race, religion, intelligence, etc. Some that get it, it's no big deal. Others, have bad luck and get screwed over by it. I'm not surprised some people are re-evaluating what's important in life ....

Submitted by sdrealtor on September 8, 2021 - 11:01pm.

Oh to be a healthy single 30 something lifelong bachelor

Submitted by flyer on September 9, 2021 - 7:41am.

Another interesting thing to do in "retirement" is to help fund other people's dreams. There are a lot of people who don't make the cut on Shark Tank, or with major film studios, etc., but still have products and intellectual properties with great potential in the global marketplace, and it's an exciting venture to partner with them to bring their ideas to fruition. We've been involved in these type of projects for quite awhile, and it's something you can continue to do indefinitely. Definitely keeps life interesting.

Submitted by Coronita on September 9, 2021 - 9:05am.

uh huh

Submitted by an on September 9, 2021 - 9:25am.

flyer wrote:
Another interesting thing to do in "retirement" is to help fund other people's dreams. There are a lot of people who don't make the cut on Shark Tank, or with major film studios, etc., but still have products and intellectual properties with great potential in the global marketplace, and it's an exciting venture to partner with them to bring their ideas to fruition. We've been involved in these type of projects for quite awhile, and it's something you can continue to do indefinitely. Definitely keeps life interesting.
Great idea... Now, I just need to find someone to give me $10m so I can start doing this.

Wait, I think that's too small, maybe $50-100m?

Submitted by gzz on September 9, 2021 - 11:38am.

-healthy single 30 something lifelong bachelor-

Well that was me up until March 2021.

Now I'm 40 w/preggo life partner.

Still healthy though!

Submitted by gzz on September 9, 2021 - 11:50am.

Flu, did you try the SSA calculator as I suggested?

I just checked mine. If I "early retire" this year and make 0 further ss contributions and start collecting ss when i am 67, I will get ~$18k per year. If I wait until I am 70, it will be ~22k.

I am sure you would be much higher than me. I only had $10k+ of social security earnings for 14 years, or 15 including this year.

I would guess you are more like 25-30 years of contributions. They use the highest 35 years to calculate the benefit.

The website also lets you get a free replacement social security card. Mine was lost a long time ago, so it was nice to get a replacement with a few clicks.

Submitted by sdrealtor on September 9, 2021 - 12:05pm.

gzz wrote:
-healthy single 30 something lifelong bachelor-

Well that was me up until March 2021.

Now I'm 40 w/preggo life partner.

Still healthy though!

Congrats and your life is about to change dramatically. Its like walking through a door and turning around only to see a wall. There's no going back and life will never be the same. Enjoy the journey!

Submitted by Coronita on September 9, 2021 - 12:59pm.

gzz wrote:
Flu, did you try the SSA calculator as I suggested?

I just checked mine. If I "early retire" this year and make 0 further ss contributions and start collecting ss when i am 67, I will get ~$18k per year. If I wait until I am 70, it will be ~22k.

I am sure you would be much higher than me. I only had $10k+ of social security earnings for 14 years, or 15 including this year.

I would guess you are more like 25-30 years of contributions. They use the highest 35 years to calculate the benefit.

The website also lets you get a free replacement social security card. Mine was lost a long time ago, so it was nice to get a replacement with a few clicks.

According to this calculator,
https://www.ssa.gov/cgi-bin/benefit6.cgi

if I retire early next year, I'm eligible for $2026/year starting at age 62.

If i retire after 65, it's $2943/month

hmmmm....

Submitted by plm on September 9, 2021 - 1:43pm.

Nice website, I put in a request to get a replacement social security card as well. The actual statement and the calculator for retiring showed only about a $300 difference. The difference being the actual statement assumes you keep working till 62. So no real point in working till 62 unless you care about the $300/mo. I figure the amounts are going to be less anyhow as it will be out of money by 2034 and demographics says there isn't much hope that there will be more people paying in to keep it afloat.

You would think the Democrats would use some of that 3.5 trillion to shore up social security. That would let them keep control forever as all the seniors will remember that and vote for them.

Submitted by The-Shoveler on September 9, 2021 - 1:54pm.

The closer I get to retirement the more I realize I don't want to.

Submitted by flyer on September 9, 2021 - 3:16pm.

You'd be surprised how many people are looking to invest in great ideas, AN.

We initiate the deals, and then get others involved, so it's a pretty big party.

We've had some hits and some misses, but the net has been great.

Use your connections, and go for it.

Submitted by an on September 9, 2021 - 5:00pm.

flyer wrote:
You'd be surprised how many people are looking to invest in great ideas, AN.

We initiate the deals, and then get others involved, so it's a pretty big party.

We've had some hits and some misses, but the net has been great.

Use your connections, and go for it.


I have connections, just don't have $50m to throw around.

I can't walk into Greycroft for example and say, hey I want to join your fund, here's my $10k. They would laugh me out the door. However, if I say, here's my $10m, that would probably get them at least thinking about it.

Submitted by ucodegen on September 9, 2021 - 5:33pm.

Coronita wrote:

I appreciate you sharing this. Quick question. Given how in demand tech workers are these days, have you considered re-entering the workforce as a contractor? Seems like the barrier to entry is pretty low and the numbers are looking really good. If all else on your own terms. Or do you hate bureaucracy that much ? :)

I have periodically entertained the idea of re-entering.. but at the same time I do enjoy the current independence. I can get up when I want, go to bed likewise. Pre-COVID, if I wanted to hike a mountain.. I could do it, mid-week if I wanted. The extra free time has allowed me to do a better job on my retirement investments (and allowed me to learn more). My CAGR(Compound Annual Growth Rate) is around 16% for the past 10 years and approx 19% for the past 6 years, at the same time I have been living off the funds. I have also managed to keep the tax exposure low(most assets have been held at least 3 - 4 years), and much of the funds are not in FAANG though I do have some.

I guess you could say my 're-evaluation' of my life's plans came a few years after being laid off near when I turned 50 (I'm over 60 now). The company I worked for laid off a large group of people including many senior engineers that were core engineers that created much of the company's IP and products (new CEO). It made me wonder about why sacrifice so much of my life doing work for which the return was not proportionate to the effort. I understood the products and potential future products much better than management but management was pulling in the benefits off of the senior engineers work.. only to 'dismiss' the engineers when they wanted to make the 'financial numbers' look better.

I initially came back as a consultant. My first work was at my former employer. I also did some consulting at other locations. The pay was ok, but the work was sporadic. This was before the large jump in salaries that occurred more recently. The current market is largely around cell phones, which I find interesting.. but I can't see myself enjoying doing apps. I find cell phones useful, but they are almost like crack to some people. After working on one of the worlds largest multiprocessor and distributed 'laser tag'/war games (training system for the US military), doing a game or app for a phone just doesn't 'ring my bell'.. neither does working for a social media company(I know how much they can track and how much info they can extract from their clients.. gives me the creeps.)

On you last question

If all else on your own terms. Or do you hate bureaucracy that much ? :)

I don't think its the bureaucracy as much as the type of people that are attracted to it and work in it, particularly at the upper levels. Sometimes I felt like I was dealing with Captain Queeg. I have also come across some of the newer engineers thinking the older people are completely outdated - and ignoring the possibility that the older engineer may have worked on or created the very thing these newer engineers are using on their job or are modifying and that some older engineers might now why something is done a certain way.

I guess the answer came out a bit longer than the quick question. I don't know if the answer to something like the decision to retire is quick. It was more a weighing of options, looking at how I want to spend my remaining years and deciding to keep my sanity.

Submitted by ucodegen on September 9, 2021 - 5:45pm.

Coronita wrote:

MRI is around $15k if not covered by insurance

Seriously??? geesh... welcome to the inflation of health costs!! I had an abdominal MRI done 2007, with contrast. I did ask if I got a discount for cash pay on the spot.. which they said that there was.. and it ending up being just under $700 at Sharp Hospital.

Coronita wrote:
You will not get that much for social security if you retire early. And unless they fix the medicare fund, that might be depleted in 15 years.

Last projection for depletion of the SS fund that I saw was 2034. https://www.ssa.gov/oact/trsum/ search on 2034.

Submitted by Coronita on September 10, 2021 - 2:09am.

ucodegen wrote:
Coronita wrote:

MRI is around $15k if not covered by insurance

Seriously??? geesh... welcome to the inflation of health costs!! I had an abdominal MRI done 2007, with contrast. I did ask if I got a discount for cash pay on the spot.. which they said that there was.. and it ending up being just under $700 at Sharp Hospital.

Oh, I wish I was kidding. I'm pretty sure that $700 MRI wasn't the MRI that I need to get...

And I was wrong. $15,000 was what it was maybe a few years ago...

The hospital bill for using the MRI alone is well above that these days, slightly over $16k....On top of that there's the cost of the doctor/radiologist reading it for $1800, and then the cost of my doctor just doing all the procedural screening $500... And an Xray they require to take if you swallowed a pill camera from your previous capsule endoscopy, because they want to confirm the capsule camera was excreted before the run the MRI, even if you visually confirmed you pooped it out.. (because a metal capsule and MRIs don't mix and they don't trust you even if you tell them you saw it pooped out)

mrimri

It's always fun dealing with insurance after a procedure, even if it was pre-authed....Sometimes it's pre-authed and still denied... And it takes about 5-6 back and forth to get them to pay anything. And then when they do, it's usually the up to $2500 deductible and the 10%copay up to the annual limit like some health plans.

Thankfully, I'm not really sick. I have time, patience, etc to deal with the insurance company.

Lots of insurance do not insure MRI or try to get you to go to a different facility that doesn't do the correct thing because it might be marginally cheaper. It works for things like if you break your leg or stuff, but if you need a bunch of specialists to monitor a condition, like you want to be at a good GI + Oncology place, and in my experience, the best place to do this is at a medical facility that also does research and has access to research.

People can talk all the want about the sort of connections they have, the amount of money they have, how much they have access to easy investments. In reality, when you're old, none of that matters nearly as much as how quickly you have access to some of the leading researchers that specialize in your diagnosed condition, and often times, money can't really buy you that access easily. Because for many of the leading researchers in certain specialization, they are already booked with patients and no longer accepting new ones. So it's not like you can easily just use your money to be seen. People will know when they get there.I had to do a lot of reaching out to get a hold of a lot of doctors in my group to try to figure out a lot about who I should see, talk to, and then find a way to even get seen because like i said, lot of these folks already are booked solid with existing patients and aren't open to new ones. And you really have to be your own advocate and do your own research, because a lot of doctors don't know what the latest is. Doesn't matter how much money you have.

I've been to Cleveland Clinic in Cleveland, Sloan Kettering New York, Mayo Clinic in Mn, Dana-Farber in Boston, Johns Hopkins in MD, UCLA in LA, Cedar Sinai in LA. To get a 5th, 6th, 7th, 8th opinion years ago...

Side note: fun fact about Cedar Sinai...

Cedar coordinates a lot with UCLA so a lot of doctors from UCLA also are contractors that work for Cedar. So you got to be careful going to Cedar. It's a great facility if you already done your homework on the type of doctors to see. But there are also a lot of doctors there that operate as an independent contractor that are only looking after their $best interest$ and not your health interest. But if you found a good one, like I did, they know their shit....I had one really bad experience with a surgeon that wanted to slice and dice me open to make money, and a great experience with an oncologist that was fighting against surgery and wasn't trying to earn my business. He was willing to coordinate treatment with UCSD if I didn't want to go to Cedar in LA...I got a second opinion from a great surgeon and researcher then at Cleveland Clinic that did years of research, bunch of papers, trials etc, who ultimately advised against surgery and told me to first stick with the oncologist's recommendations(he's now at Columbia https://columbiasurgery.org/james-m-chur...)

Be careful about a lot of for profit specialists...
Lots of the doctors charge a lot, ironically aren't even the top of their game in their field. They are basically built their for-profit business off of the work of some of the leading researchers. I'd prefer going to directly to the source of that research, and bypass the more expensive middlemen/women that try to directly profit off of their work. Many doctors are utterly useless and shouldn't be practicing imho, probably bought their way into medical school with a fancy diploma from a pedigree school paid by mommy and daddy, but that's about it. Aren't leading researchers. no thanks.

UCSD is a pretty high rank research facility. I wouldn't recommend going to their ER for day to day stuff since they take everyone and it can be hellish to get treatment in their ER (speaking from experience), but a lot of cutting edge research and eveb though some of the lead researchers are no longer at UCSD, they still connect with UCSD.

But back on topic. Yes, medical care can get really really expensive as you get older. So, especially if you know you have a pre-existing condition, that has to be factored into any sort of plan for early retirement imho. Also, as much as we like to think with the ACA, that everyone has medical insurance, you also have to be careful with that assumption because lots of things medical insurance doesn't cover. So even when I switch employers, medical insurance is something to look at.

Sometimes people say, well if I really get sick, I'll just put a bullet in myself...(and I think i said that a few times here, tongue and check).. Well, in theory that's a simplifying solution, and if that's the case one doesn't even really need to plan that much for retirement. But the reality of this is unless you are a loner that no one cares about you, it's not really a solution...Because while that might be perfectly fine with for you, it messes up everyone else that cares about you...Unfortunately, that was a lesson learned too. So to some extent you have to do your part and put up a good fight, up to the point of diminishing returns.....And especially if you have a kid that has the same condition that will most likely go through the same thing, you got to put up a fight so your kid sees what you do, and learns to do the same thing and not give up early.

The one positive thing about dealing with this when you are in your 30ies. Is that you're well prepared for it by the time you are in your 50ies one way or the other, at a time when most people in their 50ies are just starting to recognize that they might eventually have to deal with something like this when they are in their 60+.

The absolutely worst part of all this is... The annual bowel prep I'm stuck doing....The actual endoscopy is no big deal. They generally knock you out so you don't even remember it, unless you are like me, when you insist you only want to do a light sedation because you want to stay awake while they are doing the lower one because you think it's cool and interesting...and only knock you out for the upper one, which in theory you can be fully awake with that one, except it's a little weird to have a tube down your throat while you are awake..try not to gag..Ive tried that once, and it wasn't that pleasant. But the main reason is that unlike everyone else, I need to be put under every year at least once. Not sure what the long term damage that might do, as there are some suggestions that it could lead to memory loss. So most procedures I try to do with only localized sedation and try to stay awake. I have this game I play when they knock me out. I stare at the clock to see from the time they put the sedative in, how long I stay up, counting the seconds on the clock trying to remember everything that happened until the sedative kicks in.

Submitted by scaredyclassic on September 10, 2021 - 8:57am.

I have never had any health problem.

The thought of medical care terrifies me.

I recently experienced some arthritis. Death is coming for us all

Submitted by Coronita on September 10, 2021 - 10:08am.

scaredyclassic wrote:
I have never had any health problem.

The thought of medical care terrifies me.

I recently experienced some arthritis. Death is coming for us all

Nothing to be scared of. Just be prepared.

God the most painful thing I experienced with a bowel obstruction and getting stuck in an ER filled with people sick...It literally felt like someone was dragging a knife down my intestines as stuck food slowly passed down...The worst part was as painful as it was, ending up in a packed ER, I was priortized as low priority so doctors/PA couldn't even shoot me up with painkillers while I waited in the ER hallway for a room...I ended up barfing all over the hallway and it was an ugly mess to cleanup....Then the found me a semi private room and put painkillers in me and put me through a CT scan.. The CT scan dye was so much fluid that it freed up the blockage.

My doctors tell me that is known to happen every so often when you get older, and for some of her patients, it happens every few weeks. Mine seems to be roughly 1 time half year...Fortunately, I'm not a very picky eater so I can just go on a liquid diet and not really feel I'm missing out on anything.

When I put myself on a blended/liquid diet, I lost like 15 lbs in 2 weeks.

Submitted by scaredyclassic on September 10, 2021 - 10:51am.

When I look in the mirror I do not recognize myself.

Submitted by Coronita on September 10, 2021 - 11:09am.

scaredyclassic wrote:
When I look in the mirror I do not recognize myself.

I look pretty much the same since I was 30. maybe a little a little better shape. Hair thinner, but that's about it. I'm told Asians don't really start to show their age until 60ies, and then it rapidly declines from that point. sunscreen helped.

Submitted by ucodegen on September 10, 2021 - 11:17am.

Coronita wrote:

Oh, I wish I was kidding. I'm pretty sure that $700 MRI wasn't the MRI that I need to get...

And I was wrong. $15,000 was what it was maybe a few years ago...


The MRI spec looks the same, the location I visited was different. I had mine in early 2008. Late 2008 was when UCSDs MRI supposedly came on line. Sharp had already had theirs for a while (cost might have been run off). I also think that Sharp was doing MRIs for different Hospitals at the time. Their machine was nearly booked up.

My MRI took a while, they were looking for an obstruction in the biliary tree. There was a sequence of several images using different spin decays and freq. They also used a very large amount of contrast (almost all the machine could hold). Somewhere around in this mess I call an office space, there is a copy of the MRI on CD/DVD. I had asked for the 'take home package'. ;-P

On my billing, the Physician Services was not done at Sharp, but the actual MRI was.

There is not much difference in type of MRIs. One of the big differences is the physician work on analyzing the image. From a Physics point of view, MRIs are simple.. but the sensing mechanism on them is tricky. Very simply, the MRI pulls all the dipole atoms in the body into alignment, then a perpendicular electro-magnet fires effectively pulling the dipole atoms and causing them to precess within the primary magnetic field (I like to consider it 'plucking' the diapoles). The MRI listens to the cacophony of precessing dipoles and figures out where each signal comes from. The pulling magnet is the grid or structure they put over your chest, abdomen, head - or wherever they are sensing (some MRIs have these 'integrated' into the MRI). The amount of energy required to pull/tip is why that part of the MRI gets warm during the MRI. The big, main magnet is the doughnut shaped device you are inserted into. It is also the part that makes it dangerous to have metal on you. The coils inside are bathed in liquid nitrogen to get the wiring of the magnet to be a near superconductor. The main magnet is never turned off during the time the MRI is installed. It take a long time to power up (very high inductance).

I do know that what the insurance actually pays, and what the actual cost is varies greatly from what a person's bill shows. So much for transparency and consistency in medical billing. Current google lookup shows amounts between $680 to $1750 for abdominal MRI.

Coronita wrote:
They generally knock you out so you don't even remember it, unless you are like me, when you insist you only want to do a light sedation because you want to stay awake while they are doing the lower one because you think it's cool and interesting...

I tend to want to be conscious during a procedure... partially because of curiosity.. and partially because I refuse to surrender my consciousness...

In terms of qualities of doctors/surgeons.. etc I wholeheartedly agree.

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