Good topic @Scott2 and interesting ensuing discussion.
On a general or philosophical note, I've attempted to accept that there is a lot I can't control when it comes to planning for health care in my last decade or two of life. Aside from major structural changes to the health care system or medicare policies in the US, there are simply a lot of unknowns when it comes to personal or familial health in one's 70's and beyond. My parents and friends' parents are all at that stage. It appears that once major health issues emerge or serious physical/mental decline takes place, there is only so much that finances and the health care system can do.
I think a lot of the FIRE discussions on this topic and plans for long-term care or advanced medical planning is a manifestation of controlling or planning for something over which we have little control (though things like good sleep, movement, resistance training, and nutrition are all great areas to optimize and focus on at any stage).
I was recently watching the mad fientist discuss this with some of the Bogleheads:
https://www.youtube.com/watch?v=Vd4V-XuXgOM
Near the end of the interview, a Boglehead asked about his plan for long-term care. He briefly talked about the difference between the UK and US health care systems, but didn't get into details about his plans and acknowledged that it was an important variable to consider. What struck me is the lengths to which that community would go to mitigate that risk.
I've mentioned elsewhere that I tend to subscribe to @BSOG's perspective in terms of thinking more in a medium-term timeframe when it comes to finances, and I think that probably applies to health as well:
viewtopic.php?p=194073#p194073
It is probably better to focus on what's in front of me, and adapt as problems or circumstances emerge.
Scott 2 wrote: ↑Sat Feb 17, 2024 9:09 am
So the FIRE path merges into the traditional retirement path. A couple decades of freedom to, at no real cost to the retiree. If anything - the FIRE boards are filled with seniors sitting on run-away wealth. Selection bias sure, but it is a very likely path.
On the ERE, and especially Semi-ERE path, things look different. There's a large amount of physical, social and skill based capital one relies upon. Much of that, while it can defer the aging process, eventually diminishes. What's the plan? My instinct is to maximize the social safety nets, essentially forcing a shift into the traditional path.
As others have noted, the ERE or SemiERE path will probably merge into the traditional retirement path as well if you just focus on finances.
In terms of my personal nuts and bolts, I'm guessing I'll be better off than the average retiree as I'm kind of in the LeanFire or CoastFire camp. It is likely DW and I will have 30-40K coming in from pensions and social security, along with whatever is left in the portfolio. I'm guessing that will healthy considering DW wants to work again at some point, and the slow travel/SemiERE/rising equity glide path plan seems like it will work out. This doesn't include any potential inheritance.
We are both open to medical tourism as well, and I don't have any ethical concerns about that strategy. It is basically just paying for a similar service without the extra, bloated costs added to American health care bills. That might be somewhere like Mexico with a home-base in the US, or it might be somewhere like SE Asia or Europe with a permanent base there.
The biggest concern I have is cognitive decline from something like dementia or alzheimers. That would create a lot of problems in terms of managing the portfolio and navigating the health care system. I'm not sure how financial capital adequately mitigates that.
What the last month on the road has taught me, along with a couple of the unfortunate medical circumstances of forum members here, is that I should live my best life now while I am still relatively young and healthy. While I'm still in my "go-go" years. I already notice a difference in how I feel traveling at 40 vs. traveling at 25 (cranky back, sore feet, less tolerance for long bus trips, etc...), so I'm glad I'm doing this now rather than working longer to pad the stash.