I got an ambulance ride, CT scan and ER care in Brazil. My bill: $0.
I popped open the trunk door of our hatchback and commenced with that intricate game of Tetris practiced by all vacation dads.
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I'd noticed weeks before that rust was eating away at one of the hatch door's support beams but hadn't given it much thought - not, at least, until it suddenly snapped and the full weight of the door came slamming down on me.
I stumbled away and grabbed my head, only realizing how badly I'd been hurt when I pulled my hand away and saw it was covered in blood. There was more on my clothes and in the dirt below. I fell to the ground, yelled for my wife and, suddenly woozy, heard muffled voices beginning to holler for someone to call an ambulance.
Even after six years in Brazil as The Washington Post's Rio de Janeiro bureau chief, I confess one of my first thoughts was stubbornly American. Out of the murkiness, it came with sudden clarity: How much is this going to cost me?
Six hours later - after an ambulance ride, CT scan, X-ray cranial imaging and six stitches in my head - I had my answer: $0.
At a time when health care remains one of the most divisive issues in Washington - and the Congressional Budget Office estimates President Donald Trump's signature domestic legislation could leave millions more Americans uninsured - my unexpected admission to a Brazilian public hospital served as an education of sorts on a fundamentally different system.
Health care is a basic right in Brazil, enshrined in the constitution. Every one of its 215 million citizens - in addition to 2 million foreign residents - is entitled to free care in what has become the world's largest public health system.
The government says the Sistema Único de Saúde - known to everyone here as SUS - tallies an astounding 2.8 billion admissions per year. More than 7 in 10 Brazilians rely on it entirely, receiving everything from mundane care to complex surgeries on the public dime.
SUS is far from perfect. Patients wait in long lines for specialized care. Lawmakers leave it underfunded. Workers routinely go on strike. It buckled during the worst days of the coronavirus pandemic and hospitals began turning patients away, leading to scenes of desperation across the country and inflaming political divisions.
Former President Jair Bolsonaro, a hard-line conservative, sought to privatize the system but quickly backed down after public backlash, organized under the banner 'Brazil Needs SUS.' Current President Luiz Inácio Lula da Silva, a leftist who's long championed a robust social safety net, has since vowed to relieve the strain on SUS with a fresh funding package.
'We're not going to let this program fail,' he said. 'Because the poor need to be treated like people.'
Perhaps because I was more comfortable with a system more similar to the United States', my family and I had always opted for Brazil's private health care network, where the best hospitals rival anything in the developed world. Our son was delivered and receives his pediatric care in Rio de Janeiro's private system.
So on that fateful Friday morning, when my son's fever spiked in this seaside village where the only hospital is a public one, we called his pediatrician and decided to drive the four hours home. But the hatch door had a different plan. The first responders took my vital signs, wrapped my head in a thick bandage and helped me into an ambulance that had been dispatched by Hospital Hugo Miranda. Off we went.
The contrast with the American system was immediately apparent - not from what hospital staff asked, but what they didn't. No one inquired about our insurance coverage. No one even jotted down my tax identification number, which is solicited here even when paying parking meters or buying a bottle of toothpaste.
I was pushed by wheelchair from room to room. First a nook where I received a shot of pain medication. Then a cramped room where a doctor injected a local anesthetic and closed my six-centimeter wound with six stitches. Then onward to an imaging suite where X-rays were taken to ensure the injury had been superficial. And finally to an adjoining center where a CT exam was performed to verify there was no bleeding in the brain.
As the hours went by, I saw Brazil's diversity on display in the halls of the hospital. The population of Paraty is only 47,000, but the historic port town serves as the regional anchor for a vast dispersion of shoreline communities. Many people travel by boat across enormous distances to reach the hospital. On Friday, they crowded into waiting areas and exam rooms alongside the urban working class and affluent out-of-towners - all guaranteed the same level of care. For 40 minutes while waiting to be stitched up, I sat wordlessly next to a barefoot man with one eye.
In the early afternoon, I was called back to the see the doctor who'd performed my intake. She counseled rest, prescribed pain medication and antibiotics, and sent me on my way.
But while I was getting better, my son's fever had reached 104 degrees. We sought treatment for him, too. Hugo Miranda immediately admitted him; after an hour of waiting, his name was called.
Ten minutes with a pediatrician was all we needed for a diagnosis: tonsillitis.
The pediatrician prescribed antibiotics and Tylenol to reduce the fever, then called in the next patient on her list.
My son's hospital bill was the same as mine: $0.
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Find more episodes of Decoding Retirement at When it comes to planning, you know, if you're close to retirement and you're really thinking about planning, what you're probably really thinking in your mind is your cash flow that, you know, how much once I retire, you know, how much income I have coming in and how much spending, you know, I outflow do I have, right? How much will you need to pay for healthcare in retirement? Well, a number of institutions have published estimates over the past two decades plus that have lately frightened you into a state of fear and maybe even inertia. Consider the Employee Benefit Research Institute has shown that a 65-year-old couple needs $350,000 to have a 90% chance of covering all healthcare expenses in retirement, and that doesn't include long-term in the world will you pay for all that healthcare? Well, here to help me decode all that is Suduo Banerjee. He is a global retirement strategist at TO Price. Sudoko, welcome. Thank you. Thank you forhaving me. It's a pleasure. Uh, we're old friends, and I, I know the tale well, but I, I want to start here with the EBR numbers, which is a research institution, a nonpartisan one I should add that you once worked at, where we showed, and you showed perhaps maybe Paul Fronston and others showed that a 65 year old couple needs $350,000 to pay for healthcare and retirement andFor someone who might be listening, maybe they're in their 50s or 60s or so, that's a big number and thinking, I don't even have that in my, I maybe I have that in my 401k in my IRA, but what am I gonna use for living expenses? Yeah, yeah, I mean, um, so, you know, my, my first point there would be not to really focus on that number, that one single number that you mentioned where $350,000. Um, but really to understand that, you know, it's one way of looking at healthcare costs. It's basically, it's what a couple will spend over 30 years, right? It's just the sum of, of that, butwhen it comes to planning, you know, if you're close to retirement and you're really thinking about planning, what you're probably really thinking in your mind is your cash flow, that, you know, how much once I retire, you know, how much income I have coming in and how much spending, you know, I outflow do I have, right? Um, and for that, of course, you know, you need to figure out your income side and then you are looking at your spending side and right there there's one big element which is healthcare, right?So I think that's why people should focus on that, you know, doing the cash flow analysis, and which means asking how much am I going to spend on healthcare on an annual basis, right? And then you know the, all the other elements that you know, housing, you know, food, etc. right?And then how that matches up with how much income are you expecting, whether a mismatch or not, then go from there, right? But to focus on that one single number, uh, I think it does not help as much with planning because, you know,Healthcare is not something that you retire, you know, a day, then you got a check of $250,000 to someone and healthcare is taken care of. It doesn't work like know, it's an ongoing process. Every year you have to make decisions. So I would say that focus on that cash flow and the annual numbers. So we have done a lot of research as you mentioned, where we provide you know a lot of different numbers but looking from that annual, you know, uh, point of view, um, so I would say, you know, maybe start there. Yeah, I mean, this is just rough back of the napkin. 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Suddu though, I said that we were going to talk about long-term care costs, but I, the first thing I want to talk about is since we were just talking about investing your HSA, I, I want to talk a little bit about the research has traditionally shown that you should allocate your assets based on your age, that you would take 100 minus your age, and that would be the percent allocations that you would split between stocks and bonds, but you have a contrary point of view? Uh, not contrary, so we actually just published some new research, um, uh, just, you know, this week, and it's, uh, it's using data from our, you know, 401k recordkeeping business and we worked with some academics from MIT and Stanford, butThe, the, the key, the, the interesting finding was that so we try to estimate their preferences, like, you know, their equity allocation preferences and how that changes with age, and we also track their actual, you know, how they manage their allocations. So when we looked at preferences, so at younger ages, you know, the preferences are pretty similar, like, you know, it's pretty homogeneous for they all want to be highly invested in equities, which makes sense, you know, people have very little money, they want to grow their portfolio. They all want to be highly invested in equities. But when we look at the older, you know, groups, 50 and above, we see there is a lot more heterogeneity in their allocation preferences. So some people don't want equities at all. Some people want to be, you know, fully invested in equities, and there are a lot of people, you know, in middle, you know, some most people are in that 60 to 80% range in that age group. Uh, so, so that tells us that, you know, there is, there needs to be more personalized solutions, you know, as people get closer to when we track what they're actually doing with their money in their 401k, the interesting finding was that, you know, as people get older, they are more actively making changes to their, uh, uh, to a 401k, which makes sense, right? But the more interesting part was that the older they're getting, we see more and more of them making their their portfolios more aggressive, so they have a higher equity allocation. They're moving towards a higher equity so, so that, that's a very interesting, um, and we did not really dive into the reason why people are, you know, uh choosing higher equity allocation at older ages. We have some theories, like, you know, it could be that just trying to catch up, they're, you know, lagging behind. There are also some research which suggests that as people get older, they are they gain more investing knowledge, their risk preferences, you know, they might be more tolerant of risk and things like that, but that's, you know, for our future research, but this is what we found that, you know, people at older ages, basically there's a lot of, you know, variation. So that's our point. The point trying to make is that more personalized solutions probably make sense at that age. Yeah, I mean, it sounds like the actual advice in this case would be to at least not do this willy-nilly arbitrarily, but to know why you're becoming more aggressive with your asset allocation and, and not just sort of, uh, you know, flip a coin and say, I'm going to invest more in whatever international equities this day because my neighbor has, or whatever the case may right, so I promise we would talk about long-term care, um, which is the, it's the one thing that many people worry about, right? They, they, they think that they will face some sort of tragedy at some point and they'll end up in a nursing home. They don't know how they'll pay for it. They don't know whether they should buy a long-term care insurance policy. They don't know the degree to which they could self-fund their home equity is a break class option. They talk about qualifying for Medicaid to pay for long-term care, but your research seems to suggest that it's a very idiosyncratic risk that, in the main, not that many people will need long term care. So, but to me, I don't know if I'm going to be in the 3% or the 97%, right? Yeah, so it's, it's, it's a tough decision, honestly, because what, this is a classic example of what we call tail risk that, you know, for most people, if you look at the average, you know, people don't spend anything on long term care out of pocket, right? Um, but a very small percentage, you know, uh, will spend a large amount, right? And this is sort of a classic case where, you know, you, you would think that, you know, it' insurance, right? It's, it's, it's a uh situation to be addressed by insurance because uh it's a tail risk, but as you know very well that the long term care, you know, insurance market has not, um, you know, um uh perform or function, you know, very well over the years, you know, they're having a lot of problems and the least of which is that the, the policies are very expensive so people, you know, they don't want to you know, spending so much on, on these policies and never needing the care, so that's the uncertainty of it. Um, in terms of how to think about, you know, whether you insure, you get insurance, whether you sell fund, I so, so for some people, it's an easy decision like if it's you lower end of the, you know, income spectrum or so that most of you don't have, you know, a lot of liquid assets. Most of your income is going from Social Security, you go with Medicaid, right? You're on the opposite end with the higher end, you're probably able to, you know, self-fund yourself. It's people in the middle, uh, who you really have to think about it, whether they want to protect their assets, uh, from, you know, um, uh, Medicaid or I think it's, it's a tough decision. There's no like rule what they should do, but I think we can provide some guidelines as to if you are thinking about, you know, getting, uh, long term care insurance, if you're seriously thinking about long term care insurance, what things you should have in mind. So, uh, so my colleagues, you know, uh, at Trice, they have done an excellent job. They have produced a very good guide on long term care you know, if your listeners are interested, I would highly doubt it, um, towards that. But some of the key takeaways want is when is the right period to get a long-term care insurance, um, because the, the trick is you don't want to be too late when, you know, you have health issues crop up and your premiums will really go up and you don't want to get it too early when you are spending your premium in your, uh, spending on premiums for a long I think somewhere between 55 and 65 is, you know, um, a good uh period to consider long term care insurance. And then the other one is really to figure out, you know, what's your living situation going to be if you know that, you know, if you think that, you know, I'm going to be at home and then I'm going to move into a continuing care, right? So then it's easier to get the type of insurance that you want because there are some umbrella policies which would cover, you know, almost any living arrangement, and those are more you have more targeted, you know, if you have figured out your living situation and you get a more targeted policy, then your cost might be lower. So there are all these different things and there are, you know, benefit limits and all that. So keep all that in mind, to do your research, basically. Yeah. I want to save time to talk about your years in college as a Buckeye sup though, but, but first, I, I want to double back on a topic that we begin with, with in terms of paying for health care expenses over the course of retirement. In your research, correct me if I'm wrong, you've shown that for costs, your Medicare Part B, your Medicare Advantage, your Part D, uh, premiums, whatever those may be, that you would pay for those perhaps out of cash flow as you go through retirement, but for other expenses out of pocket deductibles, copays, etc. that you might use a different bucket of money. Is that fair to say? Yeah, yeah,exactly. So the way, I mean, I mean, we talk about it is, you know, think of premiums and you're out of pocket as two separate elements. So premiums, the reason is that premiums are basically, you know, they're predictable, they're face. Even the year to year changes are minimal. So you have a very good idea how much you are going to need for your health insurance premiums, right? So you can basically build that into your cash flow, your into your income flow, right? Uh, the, the, the more trickier part is the out of pocket expenses where you might not know exactly how you know, something might happen, you know, in some years. So the idea is that you keep sort of a cash reserve for that and we have shared numbers, you know, based on your age and whatever, uh, how much you might expect. So you keep, you know, whatever you're comfortable with $5000 10,000 dollars, you keep that as a reserve. You spend that at the end of the year, you fill that up, you know, again, and start the new year. So that's, that's how we think about it, yeah. Yeah, I should remind our listeners that they can go to the T. Rowe Price website where you have at least 3 if not more research papers that sort of hand walk people how to uh approach this paying for healthcare in retirement. So, and they're, they're quite good that we can only do a sort of a uh a shallow dive here today, I said I wanted to talk about your college years. You, uh, you wrote plays, you directed plays in college as a Buckeye, and I'm curious, what, uh, parallels do you see between maybe writing and directing plays and, you know, you're sort of your role today now as a retirement, uh, strategist. Um, that's, that's a, you know, a difficult connection, but, um, I, I gave up on that dream a long time ago because I just realized it's, it's really hard, uh, to make a career, you know, in, in creative arts, um, but I, I do see one connection, which is really writing, uh, because I, I like to write, and what that has stayed with me over the years andUh, I really, so I value the, the, the skill of writing now more and more because when I'm writing about, you know, all the research papers or anything like that, I think you get a clarity of thought when you are writing in, in that way, I sort of envy you know, journalists like you who get to write on a more daily basis. Um, but, uh, but I think that, that has stayed with me and that has helped me because I still like to, you know, spend some time, you know, it doesn't happen every day, but write some of these thoughts, uh, because that really helps me even think about the research itself, yeah. Yeah, I, I forget exactly whose quote this is, but uh they said something to this effect that writing is easy. I just wait till beads of blood form on my forehead and then the words spill though, I'm afraid we've run out of time. 23 minutes goes by in the blink of an eye, but thank you ever so much for talking with us and sharing your knowledge and wisdom. Uh, we'll have you back on a future episode to, to talk about things we didn't get to today. So thank you. Yeah, absolutely. And thank you for having me. It was an absolute pleasure, um, and, you know, look forward to staying in touch. Thank you. So that wraps up this episode of Decoding Retirement. We hope we provided you with some actionable advice to help you plan for or live in retirement. If you have questions about money or retirement, you can email me at YF podcast@ and I'll answer your questions in a future episode. And lastly, remember you can listen and subscribe to Decoding Retirement wherever you find your favorite podcasts. This content was not intended to be financial advice and should not be used as a substitute for professional financial services. Are you ready to master the markets and dare I say, become a better leader in the process? Well, Yahoo Finance has you covered with our new full suite of original podcast content, whetherIf you're a seasoned investor, but you're just starting your financial journey, we offer invaluable market insights and strategies to help boost your portfolio, build your wealth, and make you a successful investor. Join us on Yahoo the Yahoo Finance app, or wherever you get your podcasts.
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- Forbes
Electronic Health Record Giant Epic Rolling Out New AI Tools
Epic Systems is launching several new artificial intelligence tools for medical care providers and patients while working with health insurers to improve the patient experience. Epic, which has been led by its 82-year-old founder Judy Faulkner for 46 years is best known for its dominance in the electronic health record software space, is pushing deeper into AI in a healthcare industry known for its complexities, fragmentation and consumer frustration. Epic's technology is already used be more than 3,000 hospitals, more than 71,000 clinics and some 325 million patients worldwide. Meeting this week at its Verona, Wis., headquarters for its annual users group meeting, Epic executives said the AI tools will help all aspects of healthcare and include the virtual assistant 'Emmie' that can act as a 'digital concierge' that answers patient questions a week before appointments to help improve patient education. The three-day meeting, which included a three-hour presentation Tuesday open to the press at headquarters and virtually, included exchanges and role play between employees acting as patients and providers. As one example, executives talked about a broader launch of Emmie virtual assistant for scheduling and understanding visits to providers. 'Available in the future, Emmie will answer his call with voice and to provide billing assistance and will make outbound calls to help him schedule his appointment," Karsten Smith, VP of Health Plan Applications said Tuesday of a potential patient experience with the virtual assistant. Epic's well-known MyChart patient portal that is already used by millions of people, doctor's offices and health systems will be adding AI features that include the ability for patients to get questions about test results answered. Meanwhile, Epic is also working on ways to reduce 'manual chart extraction' that takes up valuable clinician time the company said will help improve patient care and help alleviate medical care provider burnout. The AI tool will extract a summary for a doctor so the physician wouldn't have to scroll through years worth of records, potentially. And a new area for growth for Epic is working with some of the nation's largest health insurance companies, including several who met with Faulkner and her team earlier this year. A tool to help with coding and writing prior authorizations and making sure that the patient meets any medical criteria for prior authorizations is being adopted by health insurers. The AI tool includes ways to let the doctor know the patient meets all of the health plan or employer criteria for coverage. Doctors complain prior authorization has delayed needed treatment and put patient health in jeopardy while wasting physician and patient time to jump through hoops. Over the past several years, prior authorization increasingly has become a concern for patient access to needed services, according to almost 30% of physicians responding to an American Medical Association survey in 2023. Epic's work with health insurance companies comes in a year that more than 50 health insurers including Cigna, CVS Health's Aetna, UnitedHealth Group's UnitedHealthcare and Humana committed to 'streamline, simplify and reduce' prior authorization, the process of insurers reviewing hospital admissions and medications.
