We spend thirty years building the pot. We model the returns, the assumptions, inflation, growth rates, spending rates and tax. And then there is one variable that probably sits underneath every single one of those numbers, and most of us never model it at all: our health. What happens to the plan, and to the numbers, when our health is not what we expect it to be?

That is the question at the heart of retirement planning in Ireland that rarely makes it onto the spreadsheet, along with healthcare costs in retirement, and it is why I asked Dr Jordan Grumet back on the podcast. Some of you will remember him from our conversation about The Purpose Code. Jordan is a hospice doctor in the US and hosts the Earn & Invest podcast. He also has a new book out called The Healthcare Heist.

I want to be very clear from the off: Jordan's book is about the American system, and the American system is not ours. But there is an awful lot in this conversation that does travel here, and one part of it in particular is really, really interesting.

What the Dying Teach Us About Money

I tend to think of Jordan as the hospice doctor. He has sat with people in the last weeks and days of their lives, so I asked him what that teaches you about money that no book would.

His answer starts with how much of adult life goes on worrying about money. First it's the job and the lifestyle, then building for retirement, until the future becomes what he calls "a shimmery mirage". The things that actually matter to us, the book we want to write or the dream job we might not get, are scary enough that it's easier to say we don't have the money or we're not stable enough yet.

And at the end of life, that is what people talk about: whether they lived a life true to themselves and stayed close to the people who mattered. Jordan hears an awful lot of regret, though not only regret. Some people get there and say they did do the important things. Others realise they still have a few days or months, and pick up the phone. As he puts it, you can't become a professional baseball player at 80, but you can go to one last game.

For me personally, it's about trying to minimise regret. Having no regrets is my north star, as I wrote in the wealth of our health. You're never going to avoid it entirely, but it is a fabulous motivator to do the thing, whether that is a relationship or a pursuit of something interesting. Jordan put it better than I could:

"Regret is a gift when you're young enough to act on it. It's not nearly as much of a gift when you're on your deathbed."

Why Americans Can't Retire Early

Here is where the two countries part ways. When most of us in Ireland plan for retirement, we worry about health but rarely about how we will pay for healthcare. In the US, Jordan says, it is the exact opposite.

Americans get Medicare at 65. Retire at 55 or 60 and you have to find your own cover for those five or ten years, and Jordan reckons it is almost the number one reason people don't retire early. The money is often there. What they don't know is how they'll cover healthcare. His own family pays $36,000 a year for health insurance, because his wife is retired and he no longer has an employer paying for it. Add co-pays and deductibles and he puts it at $45,000 to $50,000 a year for a family of four.

That is the backdrop to his book.

The Healthcare Heist

Jordan left medicine partly because it wasn't his true sense of purpose. The other half of the story, the half he talks about less, is that practising medicine had become progressively harder. Electronic records and insurance compliance were part of it. Worse, in his words, the system was making doctors and patients into combatants rather than allies. He found himself spending more time working for third parties than for himself or his patients.

What brought it home was a knock on the door one evening. A process server handed him a summons: he was being sued over a patient he didn't even remember. The records showed he had done nothing wrong, and the case still ran for five years. At the end of it, the family's lawyer dropped him from the case, admitting he had never thought Jordan did anything wrong. He had wanted to use him as leverage against the nursing home.

"I had become a pawn in a game that had nothing to do with me and it had nothing to do with my patients."

His argument is that an awful lot of money is being taken out of the US system by parties who serve neither patients nor doctors, which is why the US spends, by his estimate, double to triple per person what most countries do, without better outcomes. As he puts it, Americans are paying for universal healthcare. They just don't get it.

Ireland's Two-Tier System

Right. Here is where it comes back to us. In Ireland we have a two-tier system. There is the public system we all pay for through our taxes, and then there is private health insurance, which around 46% of the population holds, about 2.55 million people at the end of 2025 according to the Health Insurance Authority. It is entirely voluntary, an extra level of care or access for those who can and want to.

Jordan's point about that structure is a simple one. Where you already get a baseline of care for your tax money, private insurance has to earn its place. If insurers start paying out less or pushing people towards poorer care, people can stop buying it and fall back on what their taxes already provide. He admits the public route would not always be ideal or as fast. That freedom to walk away is what keeps the private side honest. In the US, without a public baseline before 65, people have no such choice.

The HSE has a budget of around €29bn for 2026 and is criticised constantly for its efficiency and effectiveness. More than a million people were on a hospital waiting list of some kind at the end of September 2026, according to the National Treatment Purchase Fund. The reality is, it is certainly not perfect. But in the context of that versus the alternative Jordan describes, I think an awful lot of us would keep what we currently have.

Planning for Healthcare Costs and Long-Term Care

So here is what we take into our own planning. When we build long-term cash flow forecasts and drawdown plans, we factor in inflation on the basket of things we spend on. Jordan's warning is that healthcare does not behave like the rest of the basket: where a system goes the way the US one has, he says premiums far outpace normal inflation.

The bigger risk is long-term care. In the US, he says, most people pay relatively little for care at the end of life, while a minority pay hundreds of thousands, or millions, if something like Alzheimer's leaves them needing skilled care for years. It is a barbell: most people at one end, a few at the very expensive other end. And there is no way of knowing in advance which end you'll be on.

The Irish costs and supports are different, and that is a conversation for another day. But the principle travels. A good plan asks what your pot can sustain if all goes well. It is also a case of asking what happens to the plan if one of you needs care for several years, and making sure that question has an answer before it is needed.

Health as a White Swan Event

When I asked Jordan what he would say to an Irish listener in their fifties, he went back to the way we think about money. We build a financial framework so that one day money doesn't control all our behaviour. Health, and healthcare, should be the same: something that happens in the background, not a constant worry.

He also gave the idea a name: Most of us know a black swan, the event nobody saw coming. Jordan talks about white swan events.

"It's actually an event that you could see coming, but can still cause financial disaster."

In the US, he says, medical care and medical funding is a huge white swan event, and a lot of the rest of the world isn't there yet. His advice is to be really thoughtful about not letting our own system become overly corporatised. And ultimately, the care piece belongs in the planning piece. Not the doom and gloom version, but the practical version: what it would mean for your finances and your lifestyle.

If you'd like to see where you actually stand, our Retirement Readiness Scorecard takes about ten minutes. And if you are thinking about how far ahead to plan, I've written about how long your retirement plan should actually last. You'll find Jordan's books, including The Healthcare Heist, at jordangrumet.com. His own recommendation for anyone five to ten years from retirement is How to Retire by Christine Benz. It is US-based, but thoughtful on the different ways to finance retirement.

If I haven't made a bags of explaining why a US book matters here, the short version is this: what we have is worth protecting, and your health is worth planning for.

Figures here are as reported at the time of writing and change over time, so check the current position with the relevant body or a qualified, independent advisor.

I hope this helps.

Paddy