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Old 10-25-2009, 09:40 AM   #41
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Had I done what you suggest I might not be here today, I could have "let go" at age 57, just as my grandfather did. But like a fool I live on to repeatedly thank the medical industry and quibble not about the financial cost.
Uh oh!

Let me rephrase what I wrote. I would not decline medical care for myself, nor say that we should deny it to people who couldn't afford it. I was making a point that people in the medical profession always know, that people at the end of their life cost a lot of money. And often, the family members if not the patient want to hang on at all costs. This would be fine if it came out of their pockets. But if funding and other resources are limited (what isn't?), then some trade-offs would be needed.

So, I would not say that any person isn't worth a now routine operation like appendicitis for example. I was thinking of the more severe illnesses, where the treatment is expensive and the outcome far less than certain. I often wonder if a person needs more than $500K or $1M to stay alive that the quality of that life would not be severely degraded. Does that money buy anymore than some relative short time of a bedridden life, totally relying on life support systems? I would think I would plead to be let go. I think doctors know when a patient case is hopeless. They walk a very delicate line when breaking the news to the patient and family members. It is easy for them to be accused of rationing healthcare or being gatekeepers.
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Old 10-25-2009, 10:00 AM   #42
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Some of this may be good old day syndrome. I have faith in America and future Americans will be just fine. Things are not good right now and for now appear to me to be headed in a much worse direction.

But hard times and tough issues have always been around. America will correct course. Productivity will increase. Technology will advance. Wealth and prosperity will return. FIRE will come down to individual responsibility and desires. Success will be there for those who work hard and do the right thing.

Geez. Sounds like I'm running for office. Yuck. But I do believe in these things.

Any BTW...for all the complaints about health care costs. I would not want to be sick anywhere else other than the good old US of A. Best health care around. The cost structure has to change and improve. But the quality of service and choice should remain or what was the point?
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Old 10-25-2009, 11:05 AM   #43
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Half our crew in the hospital, the med bills alone are going to kill us. ---Clay Morrow, Sons of Anarchy
One of the most engaging soap operas on TV - faithful viewer here. Some very real feeling family/relationship dynamics.

Medical care is an interesting problem - medicare is spending an amazing amount keeping MIL ticking - her clock is running down, but she's still cogent and interested to go out and watch the space shuttle go over - still, could probably keep a thousand or two African children alive on what she costs. OTOH, callously, if the baby Africans were kept alive wouldn't that result in even more load on the global system down the line? My impression is that doctors are committed to giving the most aggressive defence - survival is the sole goal, quality of life is secondary, and cost is not a factor. I haven't had a doctor yet twig to having any idea what a given procedure costs - for that I have to try and pry the info from the counter help. Can understand the reasoning that leads to willful ignorance on their part of cost - allowing cost to be a concern might hamper their defense, maybe remove a weapon from their arsenal. Pretty sure that times are changing, and that the move to involve the patient in the health care process and decisions will have the effect of reducing heroic life sustaining efforts for doctors without making them be the ones to choose life or death.
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Old 10-25-2009, 11:07 AM   #44
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I often wonder if a person needs more than $500K or $1M to stay alive that the quality of that life would not be severely degraded. Does that money buy anymore than some relative short time of a bedridden life, totally relying on life support systems?
It is fine for us to pontificate about these things. And, in retrospect (after the treatment has been done and the suffering/quality of life/quantity of life issues are known) the correct course of action is often clear. But, when we are at the bedside and the test results come back, and the future isn't clear, things are not cut and dried. At that point we're not talking about statistics and probabilities and mean life expectancies--we're talking about a loved one who wants to live another year.

Lots of young folks say they wouldn't want to live the life of a 90 year old. That sentiment is rarer among 89 year olds.
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Old 10-25-2009, 11:09 AM   #45
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It is fine for us to pontificate about these things. And, in retrospect (after the treatment has been done and the suffering/quality of life/quantity of life issues are known) the correct course of action is often clear. But, when we are at the bedside and the test results come back, and the future isn't clear, things are not cut and dried. At that point we're not talking about statistics and probabilities and mean life expectancies--we're talking about a loved one who wants to live another year.

Lots of young folks say they wouldn't want to live the life of a 90 year old. That sentiment is rarer among 89 year olds.

AMEN. Easy to think others should lay down and die. A bit different when the decision rests close to home. These are choices best left up to the individual and family.
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Old 10-25-2009, 11:46 AM   #46
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I have spent countless hours at the bedside of my father who was bedridden for many months prior to his death. Perhaps I should not bore people here with all the details, about how doctors shook their heads, one after another, and about how our family was all torn up about what to do. That experience has prepared me to make my own decision when my time comes, I hope.

About prolonging life at any cost, I maintain that should be entirely up to the family should they chose to expend their assets to pursue that goal.
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Old 10-25-2009, 12:37 PM   #47
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...
About prolonging life at any cost, I maintain that should be entirely up to the family should they chose to expend their assets to pursue that goal.
And there's the rub. I don't think anyone minds a person or family spending as much or little as they want on health care. Problem is asking that others spend for that care - like on medicare. Another wrinkle is:

All life is sacred
one life is not more precious than another
if the above is true, then
cost to save a life should not be an issue
and
a person's means should not determine the length of their life.

but -
with limited means saving one life may cost many.

Do we side with Spock?
it is logical: the needs of the many outweigh [the needs of the few]....or the one.
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Old 10-25-2009, 12:39 PM   #48
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Well, back to the original question for a moment: I'm trying to get my kids started toward ER by funding Roth IRAs for each of them. I will continue to do so as long as I'm financially able. I prefer to give them an inheritance now than after I'm not around to see it help them.

So, whether this forum will continue is perhaps up to us. I'm at least trying to get my kids interested in the concept. They see what LBYM, saving, etc. have done for DW and me. With a little help from me, maybe they'll catch the ER "fever" as well.

Now, back to our discussion of health care, end-of-life decisions, etc.
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Old 10-25-2009, 04:36 PM   #49
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Your mileage will vary, of course. I can only relate to my experiences with relatives or people I know.

Despite modern medical advances, there is only so much doctors can do. I keep having to remind my family that if money can buy cures for all diseases, including old age deterioration, billionaires would all outlive us. I kept repeating that to no avail. They simply could not accept the fact that no money could bring my father back to health. Working part-time, I had free time to spend with him in the hospital, to witness useless testing procedures being performed. All my family cared about was that all sorts of things were performed, whether they actually made sense. I had the logical mind to ask the hospital staff what would a test prove, and if the results were positive, what would they do next? More often than not, the tests were inconclusive, and if the results were positive, they would not do a thing; my father was too weak for any operation. He would die in the OR.

We did not care if the tests made sense, much less how much they cost. Medicare paid for it. But it wasn't just the money, because it caused my father some discomfort needlessly. The doctors knew it was hopeless, but the ones who told the truth were scolded by my family members. Of course it did not help that my father couldn't accept his fate either. In a lucid moment, he said that he simply could not die, that he still had two houses to be sold in exchange for whatever treatment they could give, should Medicare refuse to pay. Loving him as I did, what was for me to say?

That's why I said by observing how people died, I have prepared myself for when my time comes. I have another relative who resigned to the fact that his life was ending. I did not know if he had other complications besides kidney failure, but in the end he refused dialysis so he could die. He saved himself and his family much torment.

Now, back to medical care cost in preparation to FIRE, we have another friend in his early 60s who already retired. Though he does not share his net worth, my estimate is that he has more than $2M. Yet, he lives extremely frugally, a true Uncle Scrooge to the point that he got himself a bad reputation. His reason? He has been single all his life, and without children or any close relative willing to take care of him, he says he must prepare for long-term nursing home care. Good grief! If a man with that kind of money worries himself sick with health care costs, I wonder how people of lesser means would be able to enjoy life.

Back to my original post, my point was that we should not let these uncertainties in life scare us into forgetting to live now. Billionaires cannot buy that much more time, and doctors cannot heal themselves. Of course, some people would go as far as to try to buy some comfort in the afterlife.

There's a lady who's sure
All that glitters is gold
And she's buying a stairway to heaven.


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Old 10-25-2009, 05:44 PM   #50
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Hope is an incredibly powerful human belief. As long as there is hope, any hope, we will fight on. Survival is a deeply seated instinct which ensures the continuity of our species. It takes courage to invite death when hope has not completely faded away.

But let's not confuse courage with bravado. It's one thing to say "the heck with prolonging life at any cost" when one is 50 and healthy, and quite another when the doctor has his hand on the plug. Courage can only be measured in the face of certain death.

Many of you seem at peace with your own mortality and that's admirable. I hope that I will have the courage to let go when it's time, but I am just human... I can only pray for courage and dignity in my last hours.
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Old 10-25-2009, 07:14 PM   #51
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I am from the pre baby boom "lost generation." I think we had the
advantage of being able to move up the ladder faster and make
more money relativelly speaking than those that that followed. We
were also on the tail end of the "defined benefit" pension era. Personally,
I would never have been able to retire early without the generous lump
sum payout that I received. Even at that, I would have been hard
pressed without my sideline laundromat business and substantial
inheritances from my parents and DW's.

Bottom line, I think earlly retirement will be much harder for today's
wannabees.

Cheers,

charlie
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Old 10-25-2009, 09:27 PM   #52
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But let's not confuse courage with bravado. It's one thing to say "the heck with prolonging life at any cost" when one is 50 and healthy, and quite another when the doctor has his hand on the plug. Courage can only be measured in the face of certain death.
The bold-face above is mine. It is true that none of us has been there. However, as many of us here are in our 50s or older, we can't help but notice that our bodies are not young anymore. Our teeth start to fall out, our hair starts to thin. We begin to feel our joints aching. I myself hobbled for a while due to plantar fasciitis. Our blood pressure and cholesterol already rose. I still remember the time I knocked down a bottle of Cognac with a friend during a weeknight, and still was able to show up at work on time the next day. No more! I don't even take long driving trips, leave alone driving at night. I may look young, but I feel old.

So, for me it has been long past the time I have to face the fact that I eventually die, perhaps even sooner than I think (70?). In my case, I was also affected by the ordeal that my father went through. He was never ready for it, and was tormented until the last minute. I loved him, but there was nothing I could do to help, nothing I could do but to be by his bed side and listened. I just wish he could be at peace.

Quote:
Many of you seem at peace with your own mortality and that's admirable. I hope that I will have the courage to let go when it's time, but I am just human... I can only pray for courage and dignity in my last hours.
I am human too! I just try to talk "the talk", and hope that I will be able to walk "the walk" when it comes to that.
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Old 10-25-2009, 10:18 PM   #53
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The bold-face above is mine. It is true that none of us has been there. However, as many of us here are in our 50s or older, we can't help but notice that our bodies are not young anymore. Our teeth start to fall out, our hair starts to thin. We begin to feel our joints aching. I myself hobbled for a while due to plantar fasciitis. Our blood pressure and cholesterol already rose. I still remember the time I knocked down a bottle of Cognac with a friend during a weeknight, and still was able to show up at work on time the next day. No more! I don't even take long driving trips, leave alone driving at night. I may look young, but I feel old.

So, for me it has been long past the time I have to face the fact that I eventually die, perhaps even sooner than I think (70?). In my case, I was also affected by the ordeal that my father went through. He was never ready for it, and was tormented until the last minute. I loved him, but there was nothing I could do to help, nothing I could do but to be by his bed side and listened. I just wish he could be at peace.
My point is that, nobody, not even one's closest family members, can truly understand what one goes through on one's death bed. I have learned long ago that we are truly alone when facing our own mortality. I have had a taste of it several years ago and I know for a fact that no one in my family, not even my wife, can relate to what I have been through.
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Old 10-25-2009, 11:43 PM   #54
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You are right that no one but the patient knows how it feels. However, what traumatic experience you went through was not the same as what happened to my father. You were young and you obviously recovered. My father died mainly of old age, when the body gets worn out and tired. It is the latter case when I talk about accepting one's fate.

As an example, if an auto accident victim's life is hanging by a thread, I would certainly hope for him to recover. I would cheer him or her on, whether we were related or not.

But if I were on a death bed, with kidney and liver failures, with fluid building up in the lungs and the diaphragm, causing my belly to be distended and had to be drained with inserted tubes, my heart kept going by two pace makers, all muscles in my body having dissolved and my arms and legs becoming literally skin and bones, being fed intravenously and also by a feeding tube through the nose, not being able to swallow, nor being able to turn in bed, the immunity so weak that a fever caused by a systemic infection of drug-resistant staph raged on for weeks despite constant injection of vancomycin which was called the drug of last resort, well I think I would want to call it quit. Short for God to appear by bed side to save him, there was no hope.

That was what I was talking about, how older patients like my father died. I am preparing myself, just in case.
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Old 10-26-2009, 08:47 AM   #55
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Lots of young folks say they wouldn't want to live the life of a 90 year old. That sentiment is rarer among 89 year olds.
Maybe. But I think that's because we (collectively) often associate being 90 with being feeble, infirm, in pain, losing our hearing and/or sight, unable to take care of themselves and that sort of thing. And in some cases it might be a desire to not outlive their kids or their money.

I think most people would like to have longevity if it came with good health and a high quality of life.
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Old 10-26-2009, 10:16 AM   #56
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Maybe. But I think that's because we (collectively) often associate being 90 with being feeble, infirm, in pain, losing our hearing and/or sight, unable to take care of themselves and that sort of thing. And in some cases it might be a desire to not outlive their kids or their money.

I think most people would like to have longevity if it came with good health and a high quality of life.
You adapt to what you have. My father was feeble, infirm and unable to fully care for himself in his early 60s. But he loved life and wanted it to continue.
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Old 10-26-2009, 10:48 AM   #57
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Well, back to the original question for a moment: I'm trying to get my kids started toward ER by funding Roth IRAs for each of them. I will continue to do so as long as I'm financially able. I prefer to give them an inheritance now than after I'm not around to see it help them.
Part of my reason for asking the original question was not just the decrease in job benefits, but also the relative drop in salaries and the financial pressures on families that makes it increasingly difficult to save for retirement. I think the forum will continue as the LBYM approach to life is the real key to ER, but maybe the average age of ER will go up and we'll adjust our lifestyle expectations.
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Old 10-26-2009, 11:01 AM   #58
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You adapt to what you have. My father was feeble, infirm and unable to fully care for himself in his early 60s. But he loved life and wanted it to continue.
Exactly. My mother was the same, in her 90's. She was in a wheelchair or in bed much of the day, and nearly blind, and her hearing wasn't what it once was, but her mind was still active and rational. She told me at 97 that although she felt at peace with the universe and was ready to die when her time came, that also she loved life and enjoyed each day in the meantime. She had friends and activities and fun even when she was 97, and only began to wander mentally a few weeks before her death at almost 98 as her various body parts/systems started shutting down.
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Old 10-26-2009, 02:34 PM   #59
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Part of my reason for asking the original question was not just the decrease in job benefits, but also the relative drop in salaries and the financial pressures on families that makes it increasingly difficult to save for retirement. I think the forum will continue as the LBYM approach to life is the real key to ER, but maybe the average age of ER will go up and we'll adjust our lifestyle expectations.
I'm not sure that I see "drop in salaries and financial pressures", at least compared to 50 years ago.

IMO, the number of retirees we can afford is driven by the number of workers. If couples have three children each, their generation can retire with more years left than a similar generation that had two children for each couple. This is pretty obvious when we look at Social Security, but I think it's equally true when we think about funding retirement with private savings -- e.g. the return on stocks is going to be pretty lousy if employers have to spend most of their revenue competing for a small labor pool.

I hope the answer is that employers feel better about older parttime workers. That's a win-win, but so far it seems that most only want employees who are willing to run hard for 45 hours a week.
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Old 10-26-2009, 03:26 PM   #60
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I'm not sure that I see "drop in salaries and financial pressures", at least compared to 50 years ago.

I should have said "real wages" and not salaries. Real wages have declined since the early 70s and with the drop in pensions, 401k matches and increasing health care costs it's going to be increasingly difficult to be in the position to ER. I'm not sure that the concept of ER even existed before the 1970s. Let's face it for most of history 99.9% of people had to work until they died.
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