I know it sounds kind of extreme, but it works and all my dogs are happy, healthy and gainfully employed.
I have seen a few items about doggy medical insurance and kind of wish I had known about it when they were pups, last vet visit was 2,376 dollars, and that was just for checkups, shots, and some meds for my older girls.
I was tongue in cheek emulating those who consider Noem a monster for the deed, then the publishing of same.