Say It to Someone

We'd spent most of an hour on budgets, debt payoff, and retirement accounts when Andrea Ewalefo said the thing I'd put first if her advice had to fit on an index card. Tell someone.

She got there by way of what doesn't work. “Keeping things to yourself only make you feel more helpless,” she said, and then described what changes when you stop: “Suddenly, it becomes a problem that is solvable.” (full episode)

She was honest about the limits of the claim. She said she didn't know the science behind it. She knew what it had done for her, and she left it there. I liked that she didn't dress it up.

I hear it as a medical point as much as a financial one, because money problems don't stay in the bank account. In 2021, 8.2% of adults aged 18 to 64 who took prescription medication said they hadn't taken it as prescribed because of cost, according to the CDC's National Center for Health Statistics (NCHS Data Brief No. 470). That means skipped doses, stretched refills, pills split to make a bottle last.

The practical problem is that a lot of this never gets said in the exam room. If nobody says it, the plan gets built around a medication the patient isn't actually taking, and the next visit starts with the wrong question. Is the drug not working? Or is it sitting in a cabinet because it costs too much?

Andrea's version of the advice was about stress and shame, and I think she's right that the two feed each other. A number you haven't said out loud gets bigger every week you don't say it. Once another person has heard it, it's just a number again. Maybe a bad one, but you can work with it.

So if you're carrying something like that, a balance or a bill or a prescription you've quietly stopped filling, pick one person and say it. You don't need a plan first. Her order was the reverse: say it, then solve it.

And if the thing you've stopped filling is a prescription, tell the person who wrote it. People ask for cheaper options more often than you'd guess. In 2013, 15.1% of U.S. adults had asked a doctor for a lower-cost medication (NCHS Data Brief No. 184). Nobody who prescribes for a living is surprised by that question. We'd much rather hear it than find out six months later.

Is there something you've been keeping to yourself? You don't have to tell me. But if you want to, reply.

Dum spiro, spero. — Ugo