Early Retirement Extreme Forums

This is a spin off from the mandatory heath insurance thread.
I am a lot more afraid of losing my competence/self-reliance than I am of death. I do not wish to die by someone switching of life-support or spend the last week of my life gasping for air through a tube. In terms of health insurance, I think it's undisputed that a majority of the money is spent on this kind of situation.
Of course you have situations where people actually recover and live for several more years.
I'll also admit to the likelihood that my opinion may change when I'm personally in such a situation.
Currently, I am not afraid of death. I engage is semi-risky behavior (ocean racing) which does involve risk of death with a certain sense of detachment. (Fate is fate. Life is but an illusion.).
I think we're experiencing the curse (some Greek thing, I forget), where someone was granted the wish to live forever; only he'd get older and older and more and more decrepit rather than staying young forever which is of course what he originally intended.
Money is not really an objective (more does not make me that much happier) but if it were, would $300 more per month for decades make people happier than 6 more months at the end of their life? I think it would.

I agree! Everyone did just fine going to the grave long before the invention of health care:)

Okay, Jacob, I'll be the one...
Can you find something reporting the results of an investigation of some sort from a peer-reviewed journal, or similar credibility, in the past 5-10 years, that shows the majority (greater than 50%) of health care dollars being spent of the last week of life... or last 6 months even... What have you got?
I couldn't agree more with those who argue against mandatory health care insurance. IMO, that's the product of a simple mind... Q: "How do we solve the problem that some people don't even have health insurance?" A: "Make it a law, so people have to have it!!!" What?!?
I think of the Amish with this argument. Don't laugh... I've seen many Amish children as patients because their parents would be charged with neglect if they didn't bring their kids in for treatment. I essentially never see Amish adults. I respect these people, and part of that respect is allowing them to follow what they believe is right. What's wrong with an adult saying that he doesn't believe in modern medicine, and letting nature (or a deity) take its course? Or not wanting electricity, fossil fuels, professional wrestling, big macs, and all of the great things these things provide... I believe in the freedom that allows people to make these choices for themselves.
I also believe in the freedom to express myself anonymously (at least semi-anonymously) on this site, which unfortunately for me has been stupidly compromised... From now on I read only.... Cheers!

@Mo

This is the NPR program during which I heard the "50% in last weeks of life" discussion.

http://www.npr.org/templates/story/stor ... =128828629

I recongnize that it focuses on policy and doesn't have the juice of a peer-reviewed study such as those found in Lancet or JAMA. But my point was only that there are costs to health-care decisions other than simply the dollars spent on medical technology or physician services. How can we begin to value the dignity and peace of mind that accepting the inevitability of death not simply as an abstract concept but as a rapidly occuring reality for oneself? If I had less fear of death, then -- like the Amish you cite -- I would retire immediately even if that meant foregoing medical insurance or some of the available life-extending medical services.

@Mo - I can only get it to 30% for the last year. This is for Medicare.
http://www.cbsnews.com/stories/2009/11/ ... 1689.shtml
Somebody who is hooked up in intensive care will probably overrun this.
This paper says that hospice and advance directives are generally assumed to reduce costs by 25-40% during the last month.
http://jama.ama-assn.org/cgi/content/ab ... 75/24/1907

I think the key is to stay quite active until the very end.
Our ancestors, and still the elderly in other countries, were [are] active right until their deaths.
Seems like the people who've spent the last 40 years of their life avoiding any movement are the ones who have decade(s) long declines and drawn out deaths.
My medical plan:

1. avoid the "preventative"... IE: 8/9 prostate cancers require no treatment until death. Other things, like stupid H1N1 vaccines require treatment in the hundreds of thousands or millions to save one life... The treatment is often much more dangerous than the "disease."
2. Never accept bogus claims that "modern" medicine can outsmart evolution. Prescriptions all address specific problems, not the entire system... All medical knowledge is child's play compared to the natural world.
3. When at all feasible, err on the side of caution. This causes expense... But this isn't a lab environment; you have 1 trial.
4. Stay as active as possible until death. At the very least walk several miles daily.

@Mo - I know the Kaiser Center for Health Research has studied the costs to death (unintentional pun) and end-of-life has a massive cost compared to the rest of one's lifespan.

@Mo "which unfortunately for me has been stupidly compromised"
Huh? Did I miss something?
Re death:

As far as I know life is incredibly more interesting than the alternative. I don't want to give it up after 80 years, even if that's "natural".
So I'm looking forward to working less and taking better care of myself while living a life without chronic stress.
Unless they change a lot, I don't expect much solutions from the pharmaceutical industry and from the current generation of mainstream physicians. Much of what they do seems focused on generating profit and treating symptoms, not on prevention and restoring long term health.
Sure I'm naive, but I'm hoping for anti-aging research to get some real traction. So far we've lost a lot of precious time because anti-aging medicine still is a taboo and politicians and religions "are not helping" to say the least. Unfortunately in the eyes of the public, the domain is still associated with snake oil and science fiction.
But as more and more people get involved, progress accelerates. The support of wealthy people like Kurzweil means a lot. What Sergey Brin (Google billionaire) is doing for Parkinson may revolutionize medical research and medicine itself. People are making essential research happen any way they can. SENS Foundation and Imminst are examples of organisations that work hard for this cause.
As a backup solution, I also want to look into cryonics. I don't have much hope that it will work, but a tiny chance is better than none. And the progress that is being made in suspended animation is encouraging.
Yeah all this sounds nutty, but you'll later realize the idea just took some getting used to.

This is a great site, and the forums really have expanded the site.
You guys have a lot of good thoughts on health care spending. The popular media often indicate that large amounts of money are spent on "end of life care"-- though "end of life care" doesn't have a standard definition. Studies published 15-25 years ago (conducted even earlier) are often cited. I'm a bit skeptical of the rhetoric, without confirmation from a study with a transparent and logical method.
The mid-post revelation that I had revealed enough personal information to allow someone to identify me (something that really only matters to me) lead to a regrettable outburst. My apologies to all, especially Jacob.

I'm hoping there will be massive progress in life extension research... while modern society hasn't fallen apart. Running out of oil (or other planetwide catastrophes) could ruin everything. Another example of denial threatening our future.
@Mo
Jacob may not appreciate me saying this, (and may have better suggestions), but one solution is to use several user accounts.

My current username isn't the one I used to comment on blog posts, because I want to avoid people to recognize me by connecting the dots.
If you think specific messages reveal too much, you could probably ask Jacob to modify of delete them.
Maybe it would be useful to include this code in the headers of the forum pages:

<META NAME="ROBOTS" CONTENT="NOARCHIVE">

That way there's less chance that deleted messages remain archived elsewhere. (Google's cache, etc.)
A different but complicated solution might be to customize the forum software so that we can set an expiry date for certain messages. In some Usenet newsgroups this is common practice for messages (for example) that don't convey a very professional image.

Our family had a close call this week with a medical catastrophe. My grandmother (visiting us from her country), through a freak unpredictable occurrence, developed acute liver failure and landed in the hospital. Since she did not have health insurance, my parents will be looking at a hospital bill possibly of tens of thousands up to a hundred thousand dollars -- for a 1 week stay in the hospital including the intensive care unit.
Fortunately, it looks like she will be fine now. But without the care she received, she likely would have died. Therefore we had no choice but to admit her to the hospital.
Also fortunately, my parents can afford the bills. But this brings up several disconcerting issues regarding ERE.
1. Sky-high health care costs are not only limited to end-of life care. It may be required for totally reversible conditions that would otherwise cut life short significantly.
2. Health insurance is not a luxury. It is needed to prevent a wipeout of lifelong savings.
3. We need to not only think about ourselves, but also our extended family. If an emergency (even non-medical) befell my cousin, uncle, or nephew, and no one else was available, I would not turn my back. I would assume the costs.
This could require a much larger retirement goal than would otherwise be needed to just provide for myself. It may force me to look more at absolute numbers, in addition to just percentages and withdrawal rates.

@Bigato, are you saying that if you were in @Sree's grandmother's situation, you would just have accepted dying in your home, rather than being saved in a hospital, as it sounds like she has?

These topics are much on my mind today. I was just visiting with a former co-worker, who is dying in a hospice. She is about 80. She had been in a nursing home, but her husband was telling me that the only thing keeping her alive (and just temporarily -- she has a terminal condition) was a drug that cost $15,000 per month and it was making her miserable. So he took her off it. He was so relieved to see me. He said so many others just couldn't deal with it and stayed away.
I have spent time with other dying people, watching them going from the house to the home to the grave. I think its a big problem that most people just don't or haven't spent time with someone who is near death. We try to hide death instead. If more people had some experience with it, we wouldn't have as many silly debates about trying to create a "one-size fits all" health care system or "rules" for "the best way" to die.
The truth of it is none of us gets to choose how we will die (unless you are going the hemlock route). Most of us want it to be quick and not too painful, and to be at home and/or with our loved ones. I try to live healthy and avoid chronic disease. Yet there's no guarantee I might not end up wasting away from something. And I would rather they take me to a place to die peacefully than trying to care for me themselves.
Ultimately, everyone dies alone. And there's no right or wrong way to do it. But if you know someone who is near death, take some time to sit with them. It may not benefit them, but they and their families will appreciate it and you will learn a lot about life from it.

@bigato: maybe for many things, but I don't know.
OK, as an easy example (and obviously the one that matters the most to me;), I have asthma. I am not overweight, I eat real food and strength train and cycle and run. I am young and very healthy in every other way. Except that I have occasional asthma attacks that without rapid emergency care would kill me. And without health insurance I might be either dead or homeless (though probably not both).
So, I can't get around this through behavior modification, it's not a lifestyle problem. I cannot avoid the triggers--I mean, I don't smoke, but someone else's personal decision to smoke in a place I can't avoid could wind me up in the ER. I can get a flu shot but I can't avoid catching a cold which causes an immune reaction...

I've heard of those studies that most health care dollars are spent in the last six months of life. And having been down this road more than once I believe it. My question is--how do you know when you are entering the last six months of your life? Suppose you get cancer and they tell you it's a highly treatable form. Then four months into treatment they say oops, we were wrong. You only have two months to live. By then you're in the hole for 100k.
And oftentimes they leave you plugged in those last couple of days while they line up organ recipients. I'm not sure how the studies account for that. The patient may rack up another 20k in bills but end up donating 7 different organs. Is the extra cost worth it then?
Hard questions.

One shouldn't underestimate the benefits of trauma and acute disease treatment that modern medicine can provide. If you want to do your own appendectomy or set your own broken bones, good luck. Then again, people with perfect diets who get the perfect amount of exercise and who lead perfect lifestyles all live with no diseases and die of old age. And those unfortunate enough to get sick of a easily treatable disease that's fatal when left untreated should just die because it's natural and likely due to one's imperfect lifestyle.

I hope you are not following the example of the smoking habits of Ohsawa and Kushi. The way they died was not pleasant or desirable (heart disease and colon cancer, respectively) and was probably related to that bad habit.
If you want to read about someone with similar beliefs about the relationship between disease and lifestyle, you might look up Bernarr MacFaddon, who was a fascinating character who lived (very healthily until the end) from the late 19th to mid-20th centuries. He ate healthy, got lots of exercise (usually walked 10-20 miles per day) and frequently fasted. He was extremely healthy and still skydiving and marrying much younger women into his 80s. And never saw a doctor, which eventually caught up with him when he died of a urinary infection that would have been easily curable with a little medical help.
Read his story here -- its fascinating and very much like a modern Greek tragedy in many ways: http://www.bernarrmacfadden.com/

Nowadays, it always seems to happen this way:
1. Al Gore's big houses were the constant object of discussion rather than his message about environment degradation.
2. The long but pointless discussions on Erin Callan (and her high heels, rather) in the middle of the 2007 financial crisis.
3. And now, Alessio Rastani's personal life and the fact he lives in an apartment rather than the message he tried to give to people to wake up.
Oshawa like many during his generation, probably picked up smoking due to many factors, among which "Willie the penguin" and other such mascots no doubt played a big part... No one knew the connection between tobacco and ill health then. Besides life expectancy was short in that time, so no one realised it until later anyway. Besides, his protege Tomio Kikuchi is going strong in 85. The ideas should be more important than the personalities who present it.
Lives cut short because of an unforeseen incident/accident: Life throws it every day at us! E.g., Joe Ossanna (early UNIX pioneer) and Job B. Higgins (classical singer) were very talented and gifted people both run over by drunken drivers at a rather young age. Had they lived longer?.... Yes it would have been very nice, but hindsight is always 20/20.
To live for 80 years is achievement enough for anyone, I feel.... Any longer is better, but, why discuss that?
EDIT: Removed 2nd anecdote to new post.

The talk of trauma and fractures by another member, reminded me of a personal incident.
Most cultures (Europe also) have had a long History of traditional bone setting practitioners (they just did it like a public service).
Anyway, in the 80s, my father and his colleague were involved in an unfortunate automobile accident (my father, who normally drives was riding pillion that day because the colleague wanted to try the bike! Ah dumb luck, some might say?) and my father ended up with a fractured arm.
My father, despite being able to afford Western orthowhatever treatment and in a place where there was access to it as well, refused it outright, and despite being in pain, opted to travel by overnight sleeper train to a place which was popular for traditional bone setting as practiced by traditional healers.
Post treatment, he retained 100% of limb usage, while Orthopaedic medicine doctors were actually telling him that he might only regain 80%-85% of the limb usage on account of the bone loss, yada yada........
There is more than one way to skin a cat.... Like bigato says, "How could I give you proof of that via a web forum? I can only point you in the direction if you want to seek. Study about your condition. Make experiences with your diet. See what science knows about it. Make more experiences." (I think he means experiments)
As to the bone setting I was talking about: I found these links on traditional bone setters that I was referring to. These "doctors" are always prefixed with a place name: "Puttur"
http://en.wikipedia.org/wiki/Puttur,_Andhra_Pradesh

http://my.opera.com/Tushar.Kapila/blog/ ... ur-doctors
http://www.maduraimessenger.org/printed ... tradition/

This one was hilarious: The writer is actually a foreign correspondent working in India and her writing style as well as her "conviction" in the end did not surprise me one bit. I would have fallen off the chair if she ended the article by saying she was coming away with a new found respect for a World that she didn't know existed before, and one that will continue very well without her esteemed "support" or "patronage".
Sure Orthopaedic is good, but there are so many different ways, if only we cared to look.
The Archdruid shares his thoughts on Modern and alternative medicine: http://thearchdruidreport.blogspot.com/ ... ealth.html

You know, I'm not disagreeing with you guys. I just think its generally a mistake to throw all one's health eggs in one basket.
I definitely agree that health is more related to what you eat and do everyday than any other contributing factor. Yet, there is a time and place for medical interventions (Western or otherwise).
I'm generally an empiricist when it comes to this. In practice, that means I only follow the eating and exercise advice of people who (a) can follow their own prescriptions over a decade of time or more; and (b) appear to be healthy and long-lived without significant medical interventions. That tends to eliminate a lot of advice.
And there are also those random factors -- e.g., lives cut short as you alluded to. It also works on the other end of the spectrum, where some people just live longer perhaps in spite of some of their bad habits.
I curiously (and empirically) watch my own parents, who at 77 and 82 have outlived many of their peers and several of their siblings (notably, the ones who smoked). My Dad is still hiking up and down mountains in Montana. They live lives of "quiet moderation", with no real overarching philosophy about it and a few medications that they may or may not really need (in my admittedly anti-medication opinion). Yet, I don't think I would advise them to live any differently, because it seems to work for them.