What's your worst-case scenario plan?

[Chad]

That's a subjective study. It's interesting, but do they actually follow through with it? Maybe...maybe not.

[oldbeyond]

Apart from the human aspect(my condolences to those who've been personally affected), I find this thread very interesting more generally as it raises the question of how much is enough. Applying ERE principles certainly makes one more resilient, but in situations like this, where it's practically impossible do DIY, cash is king, and it's difficult to set an upper limit. It isn't too difficult to see that there are "grey swans", unlikely but possible, which would require massive resources to manage. Applying ERE principles over 30, 40 or even 50 years would enable one to build actual wealth, wealth that could be critical in certain hypothetical situations(the health issues outlined in this thread, or in case of massive social or political unrest for example). In that sense there's an opportunity cost to retiring early(compared with continued accumulation, not with a typical consumerist lifestyle), but on the other hand being extremely defensive will likely cause you to slave away until you drop dead, leaving a sizable estate. At some point, the cost of insurance is greater than that of the loss. In the end, you cannot live free from risk, but only manage it intelligently. But where you draw the line in the sand is very subjective. I get excellent coverage from my government, but considering the mounting costs, I'm not sure if I should be depending on it.

[workathome]

I wonder if this overkill with regards to care is a consequence in loss of spirituality? It's a mixed bag, some who are spiritual seem more tolerant of suffering, but they might also be more happy to transition to the other side - instead of desperately holding on.

While those here are fairly rational, presumably like the doctors in the article, I think many people try to wish death away by not ever considering it.

[Ego]

I wonder if this overkill with regards to care is a consequence in loss of spirituality? It's a mixed bag, some who are spiritual seem more tolerant of suffering, but they might also be more happy to transition to the other side - instead of desperately holding on.

While those here are fairly rational, presumably like the doctors in the article, I think many people try to wish death away by not ever considering it.

Interesting thought. I come at it from a different direction. Because I believe there is probably no "other side" to transition to, I choose to face the reality that it is going to end and that end will be final so I better not spend the remaining time preparing to cushion the last moments.

Incidentally, we've lost two parents and two siblings in five years so in my household this is not theoretical. My dad had insurance on top of insurance and got the best care available, and lots of it. That care achieved little beyond prolonging the suffering. One of the more despicable aspects of religion is the dogma that suffering gives rise to virtue. That pernicious principle causes many to seek unnecessary suffering and wear it as a crown of thorns.

[workathome]

Interesting thought. I come at it from a different direction. Because I believe there is probably no "other side" to transition to, I choose to face the reality that it is going to end and that end will be final so I better not spend the remaining time preparing to cushion the last moments.

INTJ-types apparently only compromise 2% of the population. So there could be a chance you're an outlier. I'm also just guessing, but it seems logical. Death isn't talked about publicly, other than general fear-mongering in the news. The focus is on youth, sex, and how to spend money to obtain these things and avoid old age/death.

[jacob]

@workathome - As fas as I understand, the worship of youth (being young) is mainly a western phenomenon. The Chinese, for example, venerate their old. Reaching goals by technological means is more universal (a sign of "modern" times) but I would say that it's particularly strong in the US. The solution for every problem is first (and only) attempted by technological means.

On a personal note, maybe it's thanks to penicillin and eradicating major diseases, but death is just not something that happens very much anymore. I'm 38 and I have never actually seen a dead person yet(!)

Combine all these and the "duration" or time-horizon of the culture tends to become much longer. People intend a lifespan characteristic of their horizon. I think this is also why Americans are so obsessed with "safety". If life was shorter/harder (and perhaps more exciting!?), people wouldn't care about safety beyond the obvious. Wearing a seat belt would be considered "unmanly" as was the reason I was given when visiting in Eastern Europe shortly after the iron curtain fell.

[jennypenny]

Being with someone as they die changes your perspective on dying.

[Chad]

Interesting thought. I come at it from a different direction. Because I believe there is probably no "other side" to transition to, I choose to face the reality that it is going to end and that end will be final so I better not spend the remaining time preparing to cushion the last moments.

INTJ-types apparently only compromise 2% of the population. So there could be a chance you're an outlier. I'm also just guessing, but it seems logical. Death isn't talked about publicly, other than general fear-mongering in the news. The focus is on youth, sex, and how to spend money to obtain these things and avoid old age/death.

Ego (and myself for that matter) are definitely outliers, as the majority still believe in "something" after death.

[Chad]

@workathome - As fas as I understand, the worship of youth (being young) is mainly a western phenomenon. The Chinese, for example, venerate their old. Reaching goals by technological means is more universal (a sign of "modern" times) but I would say that it's particularly strong in the US. The solution for every problem is first (and only) attempted by technological means.

On a personal note, maybe it's thanks to penicillin and eradicating major diseases, but death is just not something that happens very much anymore. I'm 38 and I have never actually seen a dead person yet(!)

Combine all these and the "duration" or time-horizon of the culture tends to become much longer. People intend a lifespan characteristic of their horizon. I think this is also why Americans are so obsessed with "safety". If life was shorter/harder (and perhaps more exciting!?), people wouldn't care about safety beyond the obvious. Wearing a seat belt would be considered "unmanly" as was the reason I was given when visiting in Eastern Europe shortly after the iron curtain fell.

You bring up some items I have thought about quite a bit.

Concerning "respecting ones elders", I don't think this historically meant venerating 80 year olds. Most of who have mentally deteriorated to some degree. This was probably aimed at 50 and 60 year olds, and maybe even a few in their late 40's. It also was the only way we could pass information on for a long time. I only mention this, as it seems when others use this phrase they seem to mean all old people and that just seems foolish.

The desire for safety in America seems to have crept up significantly in the last 50 years or so. The length of our lives along with the wealth accumulation in the US has tamped down the risk taking in this country. It is harder for those born here to take good risks (Not buckling your seat belt is not a good risk, as it provides no benefit/reward.) because they seem to risk so much. Though, in actuality, they aren't risking as much as they think. There is much less "cowboy" or "frontiersman" in the American psyche than their used to be, which is a shame.

[Spartan_Warrior]

My plan is to maintain the following:

1) My physical fitness and health, so as to minimize illness in the first place;
2) Basic health insurance to prevent catastrophic out-of-pocket costs;
3) A healthy stoicism to face death as a natural part of life.

I'm in the camp who believes I would be able to refuse the really expensive "existence-sustainers" in the event of a serious life-ending situation. Not only to preserve my wealth for any dependents, but to preserve my dignity. I mostly despise doctors and pharmaceuticals now; why should dying change that? Give me a natural death at home in peace.

I like to think if I were diagnosed with terminal cancer, I'd smile, say thanks, and go home to continue the rest of my life as before. The only thing I want is pain management as needed.

[Ego]

The desire for safety in America seems to have crept up significantly in the last 50 years or so. The length of our lives along with the wealth accumulation in the US has tamped down the risk taking in this country. It is harder for those born here to take good risks (Not buckling your seat belt is not a good risk, as it provides no benefit/reward.) because they seem to risk so much. Though, in actuality, they aren't risking as much as they think. There is much less "cowboy" or "frontiersman" in the American psyche than their used to be, which is a shame.

I agree. In my experience those who are highly risk averse fall into two broad categories, those who have never experienced the consequences of being on the wrong side of a risk and those who deal with it every day. Mr. Take-no-chances is afraid of what he does not know. On the other hand, the ER nurse sees it every day and gets a skewed view of the world, making him believe disaster is more likely than it actually is.

That fear causes both to try and purchase the safest bet because that's how we solve problems, by buying solutions. What is sold as the safest bet comes with high costs and less obvious risks which only become apparent at the end of the game.

Fear is contagious. So is courage. After being around highly risk averse people for a while I find myself getting nervous. I've bookmarked a page of old Ellis Island photos that help to rejigger my perspective on what it means to take a chance.

[jennypenny]

I agree that we're overly concerned with safety these days and worry disproportionately about some things and not enough about others. That said, do you really think people who worry too much about extending their life do it just because they are risk averse? I don't know. I'm not sure there's virtue in dying anymore than there's virtue in suffering.

People frequently comment on the forum that even though they keep their budgets low, they are willing to spend more on health-realted items like health clubs and good food. Why wouldn't that extend to medical care as well? Why is that different? I guess I'm wondering what's a reasonable amount to spend per month to live with at least a moderate quality of life? $500? $1000? $2000? Does it matter if the money goes towards health/fitness when you're younger, but transitions to medical/maintainence when your older?

Do we all have to make the same choices? Why not live the way you want, then die the way you want? I guess I believe that everyone has the right to decide for themselves how they want to go out. If they want to go out kicking and screaming--and have planned their life accordingly--that's their right. It's their life. I completely understand the feeling of many here who would forgo extraordinary measures, but I also don't think that fighting for every last breath is somehow dying without dignity. God help the person who ever tries to tell me how to die, one way or the other. When it's their turn, they can choose for themselves.

[sshawnn]

Here on page 3, there are a few truths that really stand out to me (obviously shaped by my own reality.)

Being with someone as they die changes your perspective on dying. This simply can not be overemphasized and sadly a great disconnect between the dying and the survivors is often created by the process of modern medicine (drastic end of life measures.) I am exposed to both extremes on a routine basis and agree the that the How Doctors Die article is a must read.

Though, in actuality, they aren't risking as much as they think. There is much less "cowboy" or "frontiersman" in the American psyche than their used to be, which is a shame. I see this middle class fear mentality running rampant. I see a HUGE difference in how I grew up and how my own children are growing up and consider our parenting "on the wild side."

In my experience those who are highly risk averse fall into two broad categories, those who have never experienced the consequences of being on the wrong side of a risk and those who deal with it every day. Mr. Take-no-chances is afraid of what he does not know. On the other hand, the ER nurse sees it every day and gets a skewed view of the world, making him believe disaster is more likely than it actually is. Yeah, my experience yields the same two categories. Working in the children's hospital doing trauma surgeries rubbed off on me when I did it frequently. I still have to pinch myself and hold off on redirecting children engaging in a "dangerous" activity. OTOH I see other parents afraid to let their kids exert themselves because they may get "too hot."

[Spartan_Warrior]

I didn't mean to imply that going out with a fight is necessarily dying without dignity. I was more referring to situations like these (from the "Doctors Die Differently" article):

In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.

Being fully in control and choosing to fight is very different from being afraid and desperately submitting control of the situation to whatever doctor promises the most. I'd rather just die than become a medical experiment to line someone's pocket.

[Chad]

@Jenny
I was trying to talk in a broader sense of how they live their lives and how they die. Though, how they die was less on my mind when I wrote about the "safety" issue.

"Being fully in control and choosing to fight is very different from being afraid and desperately submitting control of the situation to whatever doctor promises the most."

That is more what I was trying to get it with the safety/dying issue.

[Ego]

I agree that we're overly concerned with safety these days and worry disproportionately about some things and not enough about others. That said, do you really think people who worry too much about extending their life do it just because they are risk averse? I don't know. I'm not sure there's virtue in dying anymore than there's virtue in suffering.

There are two issues here. 1. Life extension. 2. Insuring against every potential outcome. I was referring to the later. I believe those who are risk averse buy every insurance offered in a misguided belief that their kin will not suffer or will suffer less as a result of the fact that they are insured.

Do we all have to make the same choices? Why not live the way you want, then die the way you want? I guess I believe that everyone has the right to decide for themselves how they want to go out. If they want to go out kicking and screaming--and have planned their life accordingly--that's their right. It's their life. I completely understand the feeling of many here who would forgo extraordinary measures, but I also don't think that fighting for every last breath is somehow dying without dignity. God help the person who ever tries to tell me how to die, one way or the other. When it's their turn, they can choose for themselves.

Sadly there are plenty of people who are perfectly willing to tell others how they can and cannot die.

Also, there are many interventions that require zero fighting and will mechanically provide every last breath. Whether that is a dignified death depends how one defines the word dignity.

Right now I have two tenants with dementia/Alzheimer's and there are moments when my conception of dignity is surpassed.

[workathome]

My will currently states:

"If I have an incurable and irreversible medical condition in an advanced state which will result in death without the continued application of life-sustaining treatment, or there is no reasonable expectation of my recovery from a permanent state which cannot be reversed and makes me unable to recognize people and to communicate meaningfully, I direct that all necessary actions be taken to permit me to die naturally, with only the administration of medications and procedures deemed necessary to make my last hours pain free and comfortable."

What do you think? The only "catch" is who decides if it's permanent or not I suppose. I'd hate my spouse to keep me on life support for several years while in a coma.

[jennypenny]

It's cool. I knew what you guys meant.

My point was that everyone's line in the sand is in a different place, and we should respect that. I do think that if you're the kind who wants to duct-tape the plug into the wall, then you'd better stash the cash and buy LTC insurance. A person should be repsonsible for their own choices. To my mind, that also means you can't smoke for 30 years, spend every dollar you make, and then expect Medicaid to spring for a new set of lungs.

@WAH--Mine says "If I'm not strong enough to hold the plug in the wall, you can pull it."

[jennypenny]

A good, detailed article explaining LTC insurance options, how to calculate how much you'll need, and how to pay for it.

http://www.nasdaq.com/article/options-f ... s-cm328968

[Gudrun]

I've been pondering this issue since I read this thread yesterday. I think the question of how to deal with illness & ERE is really quite important in many ways apart from the issues of health insurance and how much safety margin you have in your account. Regarding medical insurance, I have always lived in Europe where it is inconceivable (at least to me) that someone should not be entitled to free medical treatment should they be ill or have an emergency. But there are also other issues involved here. Firstly, lets be clear though what we are talking about.

I really liked jennypenny's distinction between three different types of illness:

I see three main events:
(1) lifelong, non-life threatening, chronic condition (genetic issue, diabetes)
(2) catastrophic illness (like cancer)
(3) debilitating, end-of-life illness (stroke, dementia)

To me one needs medical insurance for number 2 and the medications involved for 1 and 3. If one is lucky like me living in Europe we pay a minimal amount to cover everyone. So far I agree this is about money and practicalities.

I think the rest, namely how to finance or receive care either during illness or in old age is a slightly different issue. Here the European model doesn't work perfectly either as long term care is really expensive, although it is still paid for by the state and yes, if you have assets they will want you to finance your care yourself (and why not).

But beyond that, I think there is a really important emotional issue here, which is how we face up to potentially being vulnerable and needing support from other people in the future. What will it be like for any of us if we can't wash ourselves anymore on our own? Who are we willing to trust with our fragility?

Here I think there are two things to consider:

Firstly, a personal perspective. Given that many of us seem to fit the INTJ/P personality style we may tend to be overly self-reliant, valuing independence and strength etc as individuals. Getting weak and needing help may pose a much bigger psychological issue for us than for other people. However, this would, by definition, then also be our growing edge. Trusting others isn't a bad thing. Having to learn to trust could be an amazing experience.

Secondly, a community perspective. I think the ERE model would fit both a neo-liberal perspective that values independence, agency, achievement, etc. 'I can do this and I can go it alone. I am fully responsible for my own good fortune'. etc. From this perspective getting old and ill is a decline.

However, I think the ERE model would also fit very well with a buddhist perspective. Here we also have self-reliance and attaining freedom and peace through your own efforts. But there is also a community aspect. 'I am fully responsible for myself and my own choice, but I am also connected to everyone else. I can only have true enlightenment if I help other beings on their path.' Here illness becomes change which can to be managed within a community.

I think the 'getting old and ill' scenario needs a community approach not lots of money. It reminds me of one of the ideas I liked in Jacob's book, namely that often you can save money by investing in relationships. With ERE you have the time to care for other people, to invest in them. Why wouldn't they return the favour if you pick good people? Yes, getting old or becoming ill might mean one needs a lot of care, more than we would ever ask of friends, but then we are back at the INTJ/Ps problem of letting oneself be taken care of....

So my idea of dealing with a worst case scenario is to have medical insurance, but to also invest in friends (or family if they are good people), who care. If this may seem utopian than just think about how utopian it seems to never have to work again! There is also a strong community spirit here on this forum. Why can't we come up with a better model of getting old and supporting each other than what is available to us in our societies right now? Given that most of us will probably get ill or weak at some point, how would you like things to be? Who says each one of us has to deal with this by themselves?