Sigmund Freud said that the certain knowledge of one's own demise is the central fact of our lives. But however we deal with that knowledge — psychologically, philosophically and religiously — we can all agree that it has enormous economic implications that reverberate throughout our lives.
As touchy as the subject can be emotionally, we can find some comfort in consciously reviewing our lot to find how we might financially soften the blow. Yes, denial has its virtues, and can get us through the day, but, boy, is it an expensive luxury. So let's talk about it and save some money.
Let's stipulate that uninsured health catastrophes are the leading cause of bankruptcy in the U.S. and that is a situation supremely worth avoiding. So we have as much health insurance as we can muster, expensive as that has now become. And we further try to reduce the financial pain by purchasing health insurance in a tax-sheltered way through our employment or PC. Or we go to the VA or get Medicare, as the case may be. The government, in one way or another, already pays for about half of the health care in the U.S., so many of us try to get under that umbrella if we can.
Likewise, we get multiple other insurances to cushion the slings and arrows of life's blows, as I have written recently — malpractice, real estate, business, disability, vehicles, long-term care, liability umbrella, etc. You can't make money protecting your assets, but it is nice to operate somewhat cushioned against ruination by a financial plan.
And we maturely prepare for the indefinite timing and details of the certain event by spending a lot of money on lawyers to get our ducks in a line. Wills, trusts, advance directives, power of attorney, professional and ethical wills and so on. Again, to sleep better, to hedge adverse circumstances and to protect those people and programs that we care about.
Well, so far nothing has happened and we have spent, or committed ourselves to spend, literally hundreds of thousands of dollars, or more, just to deal with the obvious. The lack of knowledge we have about timing and circumstances are the primary cost drivers. But, so far, that's the best that any of us can do.
And the immediate situation around one's extinction can run into big bucks too. Funerals, plots (in my area where land is at a premium, our six feet of dirt has become really dear costing five figures), memorial stones, etc., are always more than you think they are or ought to be. Funerals alone cost an average of five figures and up, even in low cost-of-living areas and most of us don't plan ahead for these things. Or, truth be told, want to. The Evil Eye, and all that, still works on our snake brains.
Let us not forget that death has tremendous tax implications and must be accounted for. Yes, it is confusing right now for even the most competent CPAs and attorneys because of Congress' dithering, but that is only an excuse for delay, not a reason to avoid planning.
Let's face it: dying is a social act and usually can't be done on the cheap. To add further perspective for those number junkies out there (and what doctor can get by without numbers?), ponder these from a survey of Californians by the California HealthCare Foundation; 60% of people say that it is "extremely important" not to burden family with these tough decisions. And yet 56% have not communicated their end-of life wishes (maybe because they haven't yet summoned up the courage to think about them!).
How about this data from the Centers for Disease Control (2005)” 70% of people say that they prefer to die at home, yet 70% actually die in hospitals or outside nursing situations of one stripe or another. Lastly — again from the California HealthCare Foundation — 82% say that it is important to them to have put their last wishes in writing, yet only 23% have actually done so. Are we seeing a pattern yet?
And issues of long-term care and how we might wish to see our final time played out is another aspect of our deaths that has tremendous financial and emotional consequences. And emotion skews, and trumps, all financial affairs.
What kind of death would you prefer, if you could arrange it? Is there even something that could qualify as a "good death”? Do you want such things determined by you? By family? By other medical professionals? I know, man plans and God laughs, but we must do what we can, mustn't we?
If you would like a little push to get started, one resource might be The Conversation Project. It has a starter kit to help you know what questions to ask and what bases to cover. Talk it over, think it over, ask for help from the pros and then act. There are no wrong answers; people just want clarity from you. And you can save a lot of money. This is reality, folks. I hope that you read this to the end, as it were.
Jeff Brown, MD, is a Board Certified Family Practitioner, currently doing geriatrics as a Medical Director, and is also a consultant for the California Medical Board. Dr. Brown can be reached at email@example.com.
Jeff Brown, MD, is a Board Certified Family Practitioner, currently specializing in geriatrics as a Medical Director, and is also a consultant for the California Medical Board .