Episode 13: Preparing For A Better End with Dan Morhaim – Transcript

Wealth On Any Income Podcast Episode 13 with Dan Morhaim

Rennie Gabriel  0:09  
Hi, Everyone. Welcome to the Wealth On Any Income Podcast. I'm your host, Rennie Gabriel, we talk about tips, techniques, and the attitudes and mindset around creating wealth. So that work can become a choice instead of a requirement. And we're raising philanthropists.

So welcome to the very first episode where I'm interviewing a guest. And the guest this morning is kind of special from the standpoint that Dr. Dan Morhaim and I went to elementary school together 60 years ago. And he brings a rather unique background to the conversation - with 40 years as an emergency room physician, with 24 years as a Maryland state legislator, 16 years on the faculty of John Hopkins, the author of numerous articles in the medical and general media, and now we're going to be talking today about his book, with the title Preparing For A Better End. We know this is a challenging topic, one we might prefer not to think about, but it is unavoidable. And one, Dan will share how taking a few simple steps can address many of the concerns we all face, and it is in this country, not cheap to die. So I'm going to ask Dan some questions, this interview will probably be about 15 minutes or less. And so let's start with  Dan. Dan, what were the experiences that might have opened your eyes to what people need at this point in life?

Dr. Dan Morhaim  1:53  
Well Rennie - thanks, thank you very much. Thanks for all all that you're doing with Wealth On Any Income. And it's great to have known you for so long. This is an issue that we, you know, do want to avoid, it's uncomfortable, I get it. But we are the first generation in human history that likely has some say about how we die. And my interest in this came out of being an emergency medicine physician, and finding that I was doing things to patients, that was not really care. But we were doing it anyways. And what I wanted was to be able to respect people's values, do what they wanted, and have them be empowered, because their values and their decisions ought to direct the care that they receive. And so that's how I got into this issue. And of course, I confront it like every other human being, and when the end comes for me, like most people, I want to be at home with family and friends around, pain-free. I want the best that medical science has to offer - I love medical science. The advances I've seen in my career, and at the same time, when it's no longer servicing a purpose, I want to take advantage of the services that are available to help me transition from this life into the next.

Rennie Gabriel  3:02  
That's so perfect, and the reason it's such a close tie in to the Wealth On Any Income is because I speak about providing Complete Financial Choice™. You're talking about having the choice with your life, I talk about having a choice with whether you choose to work or not work. And what you're talking about in your book is the most important because it's the last one you're going to make it at the end of your life. So who would you say is the target market for the book?

Dr. Dan Morhaim  3:33  
Well, everybody over the age of 18 - every adult. I'd like to see advanced care planning be as normative as renewing your driver's license, but more traditionally, for people maybe 30-35 years old and up who are maybe dealing this with this for themselves, or for their parents or their grandparents. And clearly anybody that's a senior citizen has probably thought about this. But it's not just for old people, the three most famous cases in American medical legal history were women under 30. And at this stage in our lives, we know that there's probably more behind us than ahead. But when you're 20 years old, I;d say from my ER experience people get in trouble catastrophically so they need to be prepared too.

Rennie Gabriel  4:16  
Yeah, thank you. Yeah, it's it's not limited to the elderly,

Dr. Dan Morhaim  4:21  
Not limited to the elderly. And we look great Rennie - so I think we're going to keep on for another 15 or 20 or 30 years. But when it does come it ought to be as well-managed as we're trying to manage the rest of our affairs. And there are financial implications as well. Certainly not only on a personal level, but on a societal level because of the amount of money that's spent on end of life care -  some of which is useful and some of which may not be.

Rennie Gabriel  4:49  
I like to talk a lot about mindset when it comes to money and it's a fit for the feelings that people have, at this point in life. What are the kind of typical feelings things that people experience at this point?

Dr. Dan Morhaim  5:03  
I think it's anxiety, but most often it's fear of the dying process, advanced illness and fear that they'll be in pain. And those things can be very well managed, I outline that in the book - in detail about the kinds of things that can happen, and how you can manage them. And the book is a combination of stories, all real-life stories, the names are changed - obviously - and practical advice. Here's some of the things that can happen. Here's how you might want to manage them, according to your views and values. And these may be dynamics that do not play out just in the last days of your life, but over the last years of your life. If you got a bad diagnosis, how are you going to manage it? A difficult diagnosis - you may have years of good medical treatment, but you ought to call hospice early, arrange for palliative care, have these conversations. There's one other dynamic that's interesting, and you hear this from people who do have serious illness, they say, you know, I'm sorry, I got the cancer, but it's awakened me to the value of life and the people that I love. We shouldn't have to wait for that experience to have that happen. And the other thing that goes on in this dynamic is once you do this simple work - which is basically completing free documents that are legal in every state called Advanced Directives that have been around since 1991. We collectively don't do this in a culture that says it values, individual autonomy and rights, but if you do that, and then you just put it away, you don't have to think about again, you're going to feel a whole lot better about what might happen to you.

Rennie Gabriel  6:41  
Yeah, as long as someone knows, or has access to those directives, because if you just put it away, and no one knows you've got it, that's not going to be of any value.

Dr. Dan Morhaim  6:51  
You're exactly right. Step one is complete them. Step two, is make them available to the people who need to know; your family members, trusted advisors, physician, attorney, whatever. And step three is we clinicians - and I'm speaking as 40 plus years as a frontline, ER doctor at a big urban Trauma Center in the middle of Baltimore - is we need to learn to honor them, but we don't see them, so it's a struggle. And medical care is only going to get more complex, the kinds of decisions we're talking about are taking place right now this minute in every hospital in the United States. And I want people to be empowered about their own values.

Rennie Gabriel  7:30  
Yeah, and along with the advanced medical care that's available, there also the skyrocketing costs that the family can be burdened with, when the person in care ends up leaving,

Dr. Dan Morhaim  7:44  
People can choose, I want the full court press or you know, sort of the other end of the spectrum, pull the plug, but most of us don't do that, we choose the middle path - give me all the best that medical care has to offer, but when the end is becoming apparent, you know, I want a natural death. But on a macro scale, let me just use Medicare as an example. Medicare is about $800 or $900 billion dollars, about 300 billion is end of life care. Now, imagine if we all completed our advanced directives 100% of the population instead of about 40%. And about about half that in the minority population, by the way. If completed, we'd probably save 10-20-30% of that 300 million. And that's actually been done in a community called La Crosse, Wisconsin, where they raised the rate of completion of advanced directives to 98% and saw their health care costs collectively drop. And then they could spend the money on more valuable aspects of healthcare. 30% of the money you spend in your life is on health care spending the last weeks of your life.

Rennie Gabriel  8:48  
Yeah, and if you're talking about 30%, of 300 billion for end of life care, you're talking about saving about 100 billion dollars.

Dr. Dan Morhaim  8:57  
Right, and that can go to prevention, can go to children, disabled people, all the other kinds of programs, and research all the other things that we would would like. When I talk to people, I say, 'Where would you like to be in the last days, hours, minutes of your life?' and everybody says the same thing at home with my family and friends, pain-free. Well, that can be cheap. Nobody says, killed in a fiery car crash, shot in a drive-by, nobody says I want to die in an intensive care unit long passed any hope of recovery of a long, chronic terminal disease tied to monitors and machines with my family kept 100 feet down the hall. Nobody says that.

Rennie Gabriel  9:36  
 I'm so surprised.

Dr. Dan Morhaim  9:38  
Well, we can actually shift the likelihood to having that kind of experience, which is, you know,  not only good financially and personally, but it's a spiritual family experience that people used to have maybe 100 years ago, it was much more normative. We're cut off from that experience and so we're missing something on the grand scheme and the grand cycle of life.

Rennie Gabriel  10:01  
Yeah. And, you know, when you talk about a billion dollars saved here and a billion dollars there - you're talking about some real money.

Dr. Dan Morhaim  10:08  
Yeah, you know, the usual way, unfortunately, that we deal with rising healthcare costs is we designed a system that's beyond complexity. We burden employers and employees, we increase deductibles and self-pay and co-pays and all that stuff. Here's a way you could save money on a macro scale, by just having people's rights respected if they will act and complete the paper work.

Rennie Gabriel  10:36  
Yeah, and they're just choosing ahead of time, that's all it amounts to.

Dr. Dan Morhaim  10:43  
My book is Preparing For A Better End and the website is the betterend.com. And a very good source for advanced directives - it's free. My book is not free, but it's very nominal.

Rennie Gabriel  10:55  
I bought a copy, I have it.

Dr. Dan Morhaim  10:57  
MyDirectives.com and the books been endorsed by a great diverse group of distinguished people from the medical community, political and faith-based and business community. So I'm very pleased with that.

Rennie Gabriel  11:08  
So I'm going to put it in my show notes that if they go to thebetterend.com, they can get one of these resources for free. And, you know, they'll also see how to order the book, so that's perfect. Is there a question that I should have asked you that would give more value to the audience? And then answer it.

Dr. Dan Morhaim  11:31  
Yes, we recognize this is uncomfortable, can be an uncomfortable topic, but what I've learned and I was out campaigning for office and people saying 'Delegate Warhaim', and I got elected six times, you know, 'What are you? What are you working on?' I'd run through the issues and also ask - have you completed Advanced Directive? And people said, 'That's not a way to get votes. What are you Doctor doom and gloom here?. But actually, the opposite happened, because everybody's thinking about this at some point, or maybe even experiencing it, but not sharing it, they may have a relative who's going through the dying process, and they're struggling. So actually, people will be relieved, if you're the one who brings it up in a family discussion. If you're the one that - it may take several times to do it - it may take several weeks or months for people to absorb, I get that that was my experience. as well. But it's actually, it's a really good thing to bring up and have the discussion and thought because it makes you think about the value of life and the value of the people you care for. So it's kind of daunting at the beginning, I get that. But if you do it, you'll find that it really works well for you in ways that you won't expect.

Rennie Gabriel  12:37  
Thank you so much, Dan, for my first interview with the human being instead of just me doing the podcast alone, I thank you for being my first guest. And this is a great topic an important topic, and certainly a perfect fit for creating wealth and avoiding the kind of costs that can happen at the end of life. So I thank you for being on the show. I appreciate it. And it's just great to have been friends for 60 years.

Dr. Dan Morhaim  13:10  
Thank you. It's an honor and a pleasure to be with you Rennie -  appreciate it very much.

Rennie Gabriel  13:14  
Thank you for joining me today for the interview with Dr. Dan Morhaim. Healthcare directives can provide your desires at the end of life, eliminate family friction over what to do and save tens of thousands of dollars to hundreds of thousands of dollars for your family. Here's your opportunity to grow. Go online and type in healthcare directives and get a free version for your state or location. Or contact an estate planning attorney and have one added to your living trust or will. Even a free version is better than nothing. Come back next week as I continue to read from my award winning best-selling book Wealth On Any Income. Bye bye for now.

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