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This is the White Coat Investor podcast where we help those who wear the white coat get a fair shake on Wall Street. We've been helping doctors and other high income professionals stop doing dumb things with their money since 2011. This is White Coat Investor podcast number 400. As the new year begins, it's crucial to take a proactive approach to tax planning and leverage every money saving opportunity. Over the past decade, clients of Cerebral Tax Advisors have seen an average return of 453% on their investment in Cerebral's tax planning services. As a White Coat investor recommended firm trusted by physicians nationwide, Cerebral uses court tested IRS approved strategies to reduce personal and business taxes. Cerebral founder Alexis Galati comes from a family of physicians and brings over 20 years of expertise in tax strategy and multi state tax preparation. Schedule your free discovery session today@cerebral taxadvisors.com all right, welcome back to the podcast. This is podcast number 400. That's right, 400 of these episodes we've done and since we do what you know, about 50 of them a year. Given that there's 52 weeks a year, that means we've been doing this for eight years now. It's a long time to keep a podcast going. Most podcasts that get started don't even last a year, so pretty remarkable. We're excited about hitting that number this year. We're also excited this is the beginning of 2025, so hopefully you're going to have a great financial year in 2025 and we're here to help you do that as best we can. I need to take a minute to go back A couple of months ago and we were awarded the White Coat Investors Scholarship for 2024. We failed to thank our sponsors, particularly our platinum sponsors for that scholarship for their support and there were three of them that I want to mention in particular today. They are all insurance agents. Bob Baiani with DrDisabilityQuotes.com Matt Wiggins at Doc Insure LLC and Larry Keller at Physician Financial Services. Thank you for supporting the White Coat Investor scholarship. Of course, all of the money they donated to that went to the scholarship winners and we're excited to help reduce those docs indebtedness as well as to boost physician financial literacy by running that program through our medical, dental and other professional schools. I also want to make sure you guys know about our end of the year sale. There's only a few days left. This buy one get one sale ends January 6th. If you buy any WCI course you get our continuing financial education 2023 course for free. That's like 50 hours of content. Absolutely. For free for buying any of our other courses. So check that out. That link is wcicourses. Com. Okay. I wanted to talk about an article. This article came out in Vox last month. And of course Vox is known for a bit of a progressive viewpoint. That's okay, but keep that in mind as we talk about this article. The article was written by Eric Levitz and the title was A Big Insurer Backed Off Its Plan to Pay Less for Anesthesia that's Bad. The subtitle what the Fight Between Anthem and Anesthesiologists Was Really About. And this was as those of you in anesthesia know, they basically wanted to pay anesthesiologists less. They felt like they were making too much money, basically. But their plan to do that was actually to put a limit on how long they would pay for anesthesia. Even if the procedure went longer than it was supposed to, they wanted to not have to pay the anesthesiologist for their time beyond that amount, which obviously sounds kind of crazy at first. What are we supposed to do? Wake them up before the procedure's done? Right. Why is the anesthesiologist being punished? Because the surgeon's slow. And all these other questions come into mind. And so of course, patients worried that they would have that cost passed on to them, which probably wasn't going to happen in the first place. It just means the doctors make less money. It works out. And they're treating doctors unfairly by paying them for less than the work they actually do. And this article pointed out that, yeah, this would have cost anesthesiologists, not their enrollees. But the author took the perspective that, hey, you know, these guys are getting paid too much. And so one of the subtitles in the article was that providers, not insurance companies, are the primary drivers of high healthcare costs. And he goes on to say private insurance companies have earned the public's distrusts. They routinely put profitability above their policyholders wellbeing. The system of private health insurance provision also has higher administrative costs than a single payer system in which the government is the sole insurer. But the avarice and inefficiencies of private insurance are not the sole or even primary reasons why vital medical services are often unaffordable and inaccessible in the United States. The bigger issue is that America's healthcare providers, hospitals, physicians and drug companies, charge much higher rates than their peers in other wealthy nations. And that's a bit of a tired comparison because let's be honest. Everything costs more in America. Everybody makes more in America. No matter what your profession is, no matter what your job is, go travel the world. Guess what, stuff's cheaper in other places. And so you shouldn't be surprised when healthcare is cheaper there as well. I just returned recently from a trip to Africa and guess what? Healthcare is real cheap in Africa, but it's not the same healthcare you're getting here for sure. But the other thing is that this idea that doctors are a major driver of healthcare expenses just isn't true. If you look at the percentage of the healthcare dollar that goes toward physician payments, it's about 20%. It's about 20%. But you know what? That is not going to physician salaries. Only 8% of the health care dollar goes to physician salaries. So let's say you want to pay doctors a quarter less than what they're being paid. They cut all of their salaries by 25%. How much does that save on your health care dollar? It saves 2%. Right. It's kind of the same old tired thing when people talk about, well, let's keep people from going to the er Cause that's what's driving up the whole expense of our healthcare system. Well, emergency medicine payments, both to hospitals, doctors, everything is only about 3% of the healthcare dollar. Right? It's a tiny percentage. Even if you cut it in half, you're only saving one and a half percent of what is spent on healthcare in this country. There are much bigger drivers of healthcare expenses out there. And the insurance companies and the inefficiencies created by them are not a small chunk of this. They are a large chunk of this. Yes, hospitals are a big chunk as well. Pharmaceuticals are a big chunk as well. There's plenty of inefficiency in the system. But even if we run all of that inefficiency out, you're probably not saving that much money. Maybe you can cut it by 20% by getting all that inefficiency out of there. The fact is, healthcare is expensive because we can do some pretty awesome stuff. Now that stuff takes people that have been trained for a long time and are taking on a lot of risk. And it takes equipment that takes a long time to develop and is really expensive, made out of very high grade materials, and it's expensive stuff we're doing. It's pretty amazing stuff we're doing, but it's not cheap. And America has decided, hey, a lot of this stuff we're willing to spend money on. And that is why healthcare is so expensive. And I sometimes wonder if my third job is going to be working on helping to fix our crazy healthcare system, because it truly is crazy. But this idea of heaping all the blame on doctors just making too much money probably is not the answer to fixing our healthcare issues in this country. All right, I had somebody ask for a guest to come on the podcast and I had no idea who I could call. But they asked for somebody who has left the medical field to work in the insurance industry. So if you fit that bill and would be interested in doing a short interview on this podcast, there's some demand for to hear your story. So email us@podcastor.com if you fit that bill. Let's get into your questions now. Here's a question by email. I wanted a bit of clarification since my hospital retirement staff don't know the answer to this. If I max out the employer and employee max of $69,000 in my 403, does that mean that I cannot put in 20% of my 1099 income in a Solo 401? My establishment has a 401A where all the employer contributions go and is coupled with the 403 at the end of the year. We don't need to contribute anything to the 401 plan. But that means I can contribute $46,000 after the max for a backdoor Roth on my 403. This will be all great if I can also contribute 20% of my 1099 income to a Solo 401. Please let me know your thoughts. Yeah, this is a bummer. Okay, one of the rules and if you have access to multiple retirement accounts, you really need to read my blog post called multiple 401 rules. But it goes through all the rules and one of the rules, the last one I have listed on that page is really a bummer. For those of you with 403bs who also do some self employment work, most of the time if you have two separate unrelated employers, right, and you have a 401 at one, then you have your side gig, your 1099 work and you open a solo 401 there. Both of those accounts get a separate 415 limit. You know that 415C limit is the total contribution amount last year was $69,000. I don't have it on top of my head what it is for this year, $72,000 probably something like that. You get that total limit with both of those 401s. Now your employee contribution, you know, $23,000 or $24,000 or whatever that is. This year you only get one of those shared among all of the 401s you have, but you get the total limit for each of them. Well, that's not the case for a 403. Your 403 and your solo 401k share, one 415 limit. So if you're maxing out your 403 in this case with this email, it was last year, it was $69,000. You can't put anything as solo 401. You can't make an employer or an employee contribution. I'm sorry about that. You can always save more in taxable, of course, but that's the way it works. Okay. Another one came in, said my CPA is suggesting I do a SEP IRA next year with my 1099 side hustle. Considering that I have the opportunity to do a mega backdoor Roth through my regular W2 job, and the SEP IRA has a different 415C limit from the 403 plan, I'm thinking that combining that with a cash balance plan for my 1099 and doing a mega backdoor Roth through my work 403B, I will come out ahead on tax savings despite the fact that my wife and I will miss the $14,000 Roth. She is also a 1099 nurse practitioner can set up a customized Solo 401 with Roth option or do a SEP IRA and later roll it over into a Roth. Let me know what you think. Well, let's talk about this, right? We're talking about retirement account contribution limits, and you're in a pretty complicated situation here. Again, I refer you to that multiple 401 rules post. But the real question is, we boil this down here. There's a lot of moving parts here. First of all, your spouse ought to do a Solo 401. A Solo 401 is almost always better than a SEP IRA for multiple reasons. And occasionally you find a reason where that's not the case. For the most part, you want a Solo 401. But the real question as we boil this down is does your SEP IRA get treated any differently than a solo 401k would in this situation? And I think that's probably not the case. I think it does not. But I wasn't 100% sure. So I checked with Mike Piper. You guys know Mike Piper. He blogs at the Oblivious Investor. We've had him on this podcast multiple times. And he actually got back to me very quickly and he agreed with me. He said this. I haven't been asked this before, but after looking, I'm pretty confident this is not a workaround. You can't just use a SEP IRA and get around this limit that you have with 403s. Right. The issue with 403 plans, he says with respect to the 415 limitation comes from section 415 which says 403 plans count as under your control. So when we do the aggregation of plans under 415, the 403 is going to be problematic when combined with any type of plan. It actually is under your control, whether that's a solo 401 or, or a SEP IRA. Okay. So you cannot because you can't combine a 403 with a solo 401K. You also can't combine a 403 with a SEP IRA and get a totally new 415C limit. They're going to share the same limit. All right, and that's just a bummer if what your employer offers is a 403. And I'm real sorry about that, but that's the way the rules work. Okay, new subject. Let's talk a little bit about gifting.
