For me and Mark, 2021 has been a year of hard-earned lessons, both in life and financially, and the best way to share those lessons is to start with a story.
But first! Wallet Activism is out in three short weeks, and it would mean a ton to me if you’d consider preordering it, both to show that people want more books that don’t pretend money is apolitical or values-neutral, as well as to support my work. Check out my last post for a full rundown on everything I’m offering to those who preorder. And you can preorder from Bookshop.org for hard copy, from Green Apple Books for a signed copy or Kobo/ePub version, or from Amazon Smile for Kindle. (Make sure the smile. is there so a part of your purchase goes to the nonprofit of your choice.) The audiobook will be available on release day… no idea why it’s not showing for preorder.
Now to that story.
One day back in July, Mark was riding his mountain bike on the Tahoe Rim Trail, something he loves to do, in an area he’d ridden plenty of times before. Every year, all summer long, and as much of the spring and autumn as possible, Mark is on that bike. And given who he is, he’s both adventurous and careful, always looking to improve his technique and fitness so he can ride more and more challenging terrain, but do it safely. That’s let him reach an expert level without taking careless risks. He’d just gotten through a techy (meaning technical, or rocky) section and relaxed a bit when he felt his wheels wash out. Though he didn’t go over the handlebars or hit his head, he landed hard on his left side ribs right on top of a jagged spur of granite.
He knew right away that it was bad. When you mountain bike a lot, you fall a lot. He’d had plenty of minor falls and had come home scraped up tons of times, but this was different. A trained wilderness first responder, he did a self-assessment and didn’t think he had a spinal injury, so he decided he’d try to self rescue, a fancy way of saying walk out. He was a few miles from the trailhead, which wouldn’t have taken long under normal circumstances, but this day it would take nearly three hours. He felt dizzy several times while walking out and had to rest, he feared he’d punctured a lung, and he accepted after a bit that he probably couldn’t drive himself to the hospital. I got the call and raced to get him, barely scraping my low-riding 18-year-old Honda Civic over the sharp rocks that make up the “road” near the Rim Trail. At last, I met up with him, and I knew by looking at him that it was worse than he’d let on over the phone.
We raced to the hospital as fast as we could without jostling him too much, and we were grateful to have a small town hospital where we could walk right in and get seen straightaway by a doctor who is also a friend. That doctor saw how pale Mark was and quickly gathered up the trauma team. There were detailed vital checks, a CT scan, a serious talk with a surgeon, and the verdict: he’d shattered his spleen and had bled a lot internally. The other verdict: he needed a higher level trauma center at a better equipped hospital. We looked at each other, slightly panicked, because we knew things got tricky with our health insurance if we left California. “It’s an emergency. They have to cover it,” multiple people assured us. Clearly this was not the time to put money above health. Mark got loaded into an ambulance and driven down to Reno, and I followed not far behind.
Two weeks later, Mark walked out of the hospital, minus a spleen, recovering from two operations, with five days in the ICU under his belt and a brand new scar down the middle of his torso. Today, about three months since then, he’s fully recovered and back to riding, though now he carries emergency antibiotics because he lost the immune function of his spleen and joined me in the immunocompromised club.
Throughout his stay, we’d ask each other, half jokingly, half terrified, “How much do you think the tab is up to?” We were clearly talking hundreds of thousands of dollars, it was just a question of how many hundreds.
We Think About Risk All Wrong
Back when we were saving up to retire early, people would ask me, “Aren’t you afraid of running out of money?” The answer most people interested in work-optional life would give is, “Nope! I’m not afraid.” But I would be honest. “Yes, I’m afraid of running out of money, but I’m also afraid of spending all of my healthy and able-bodied years working. I’m afraid that all the work stress will damage our marriage beyond repair if we keep doing high-pressure work for decades. I’m afraid that I’ll never be able to quit because I’ll fear that no amount of money saved is a guarantee of never running out.” When I put it that way, most people understood.
It wasn’t a question of taking the “safe” path of continuing to work until traditional retirement age or the “risky” path of retiring early. It was a question of which risk we were comfortable taking on.
Within the financial independence community, there’s an oft-cited lie that you can control your own health if you ride a bike, lift weights and eat salad, and countless variations on the theme.
We’re both proof that that’s not true. There’s no “controlling” anything, there’s only improving your odds. I taught six spinning classes a week for nearly a decade and eat a healthy and veggie-filled diet, and now, in my early 40s, my mobility is already compromised thanks to my genetic disability Ehlers-Danlos. Mark rides his bike nearly every day, and despite being an attentive, skilled rider, he had a crash that could easily have been the end of his riding or even his life.
There’s no “safe” option of riding bikes and a “risky” option of taking a car or being more active. It’s a question of which risks we’re taking on.
When we lived in LA, everyone we knew who rode a bike to work had been hit by a car at least once. Here in Tahoe, most mountain bikers we know have had at least one season-ending injury. Making the “healthier” choice comes with a different set of risks, and that’s completely absent in the conversation.
Don’t Cheap Out When It’s Your Health
As we watched the health care statements from Mark’s emergency care pour in, we were more relieved than ever that we’ve never compromised about having real health insurance, expensive as it is.
In the end, Mark’s bills tallied almost $400,000. Of course, we’re only on the hook for a few thousand of that, thanks to not cheaping out on our health coverage. In one fell swoop, we’ve gotten our money’s worth for every dollar we’ve spent on health insurance over our lifetimes.
What’s saddest to me about the insufficient way we talk about risk is that certain ideas tend to go together. The “I can control my health with diet and exercise” folks are the same ones who likely think they’re fine going with a health care sharing ministry instead of real health insurance, or even going uninsured. To those folks, let this be your cautionary tale: In one tiny slip on some gravel, Mark could have completely upended our whole life plan. Shelling out $400,000 or even a quarter of that, which we could have easily had to pay if we were on a health care sharing ministry plan, is a big freaking deal, and could have resulted in us having to go back to work for years or sell the house and move somewhere much cheaper that doesn’t offer the things we love in California.
Yes, health insurance can be expensive, and I still stand by my arguments against the cheaper HSA plans. But you only get one life. Cheaping out on your health is not the place to try to save money.
What We’re Changing
Though I was with Mark for most of his hospital stay, which was super fun* for both of us in COVID times (*not fun), we still went through different things. He had lots of pain, the frustration of trying to rest and heal in a hospital when nobody lets you sleep, and a significant recovery from abdominal surgery and six broken ribs. I had the terror of worrying he could die, the frustration of trying to manage his care in a system with people working very hard and doing their best but still dropping the ball in the many handoffs, and the panic of worrying that his care might not be covered. (It mostly all was. We’re still fighting about the ambulance transfer to the bigger hospital.) I won’t speak for Mark, but the experience most certainly changed me.
As we (mostly I) still work to process everything that happened, we’re trying hard not to forget the lessons we learned from the ordeal. We’ll never consider cheaping out on health insurance, no matter what. That one was probably a given already. But we’re also looking into special insurance that would let us (mostly Mark) get evacuated by helicopter if he got hurt again somewhere in the backcountry. We’re getting ahead of the preventive care we put off, getting everything screened that can be screened, to lessen our chances of getting a nasty and expensive surprise down the road. (It does help that we’ve hit the out of pocket max for the year and all additional care is now free. But by law, if you have health insurance, all preventive care, screenings and immunizations are fully covered.) And, more than we have before, we’re talking about the risks we take in a more realistic way, not foolishly assuming that nothing bad could ever happen.
Not long after Mark got home, the Caldor Fire came within feet of some friends’ homes down near South Lake Tahoe. That fire provided a good metaphor for thinking about risk. The firefighters are like diet and exercise. They can try hard to fight that fire (keep you healthy), but it’s ultimately the fire that’s in charge. It would be madness to think, “Well, I don’t need insurance against wildfire because there are firefighters.” You manage risk on both sides: you make sure the firefighters have the tools they need and you keep your home insured. You don’t skip one because you have the other. Because you can do everything right and still get sick or injured. You can do everything wrong and be just fine.
Every choice we make in life comes with a set of risks, whether we acknowledge them or not. You can delude yourself into thinking you can control everything. You can throw up your hands and say, “Well, everything’s risky so might as well not worry about anything.” Or you can look at risk more realistically, do what you can to protect yourself given that risk, and then live with the peace of mind that comes from knowing you did what you could.
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Categories: we've learned