The Economics of Modern Death: How Money Shapes the End of Life

Death and dying are becoming more and more expensive, but few of us are counting the cost.

Every year, about .8% of the American population dies. That’s 2.5 million people succumbing to heart disease, cancer, strokes, illness, accidents, and violence. For the past 75 years, this percentage hasn’t changed. What has changed, though, is the cost. Dying isn’t cheap.

In America, the entry-level funeral costs about $8000. For that much, you get a memorial service, embalming, a decent casket, a concrete vault, a grave, and a headstone. Want some upgrades? The sky’s the limit. A solid cherry casket can cost as much as $15,000. A private mausoleum starts around $25,000. Even at its cheapest, today’s funeral is ten times the cost it was in 1960.

We don’t feel the cost of elaborate medical treatment in the same way we feel the cost of a final resting place.

But a funeral isn’t the biggest expense. Most of the money spent at the end of life is on medical care. To put it into perspective, funerals are a $17 billion a year industry, while cancer treatment is $125 billion a year, heart disease and strokes cost $193 billion, and Medicare spends $492 billion. Specifically, Medicare spends six times more on medical expenses in the final year of life, and twenty times more in the final month. For metastatic breast cancer, the cost of treatment for the final year averages $94,000 per person.

In a time of advanced medical care, the process of dying is getting more expensive. Yet we don’t feel the cost of elaborate medical treatment in the same way we feel the cost of a final resting place.

Why? Because we pay for funeral services out of pocket. That is one reason so many people are turning to cremation. Only about 4% of people who died were cremated in 1960. In 2011, it was 42%. That number is expected to hit 50% by 2020. At under $2000, the cost is much more in line with what people can afford.

In the case of funerals, economic forces are altering supply to fit demand. But thanks to insurance and government assistance, this hasn’t happened with end-of-life medical care. For many people, there is no functional economic restriction on extending one’s life with a series of costly treatments and medications. The treatments themselves are pricey, but consumers do not really have to consider these costs. The irony, as Atul Gawande argues in his new book, Being Mortal: Death and What Matters in the End, is that all this generally does more harm than good. Our extended lives are spent undergoing treatment, suffering from procedures and medicines, in a haze of pain killers. Advanced medical treatment can make us live longer, but often all we’re getting is a slower crawl toward death.

Like most religions, Christianity has a lot to say about life and death. Yet even Christians appear to trust the market more than religious convictions. Christians have never practiced cremation — burial and entombment have always been the norm because Christians believe that the dead will have a bodily resurrection, just as Jesus did. Cremation was for the pagans. But in the face of the growing costs of burial, many Christians (myself included) have changed their minds.

As for medical care, two core Christian convictions should govern the decisions made at the end of life. First is the supreme value of all life, which is rooted in our view that humans are created in the image of God and thus have inherent dignity. Second is the idea of eternal life, which tells us that our lives here and now are vapid in comparison with the lives we’ll have after we pass through death. But neither of these convictions appears to touch the decisions many Christians are making about end-of-life care. Instead, like the rest of society, Christians embrace every available medical technology without reflecting on the cost, both financial and otherwise.

How are we dying today? We’re dying according to our economics. We don’t have a death panel full of medical bureaucrats; we have a thriving medical market that will drown us with treatment.

What can we do? Gawande says that we should talk about it. He writes that there is so much research supporting the value of conversation and discussion on end of life issues that if it were an experimental drug, it would be approved by the FDA. This is wise, but I would add that those discussions should touch on our religious traditions and convictions as well. Death, after all, is not just a modern problem; and our choices at the end of our life should not be determined solely by economics.

Dave Albertson
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  • bakabomb

    Speaking as someone involved in healthcare for most of a 40-year career so far — and one who’s seen in too many older members of my congregation the slow-motion death of Alzheimer’s — I have every intention of sparing my loved ones the anguish and expense of that kind of end to my life should I ever receive that diagnosis. I’ll follow the courageous example that Brittany Maynard set just a couple of days ago, whether or not my state gets around to sanctioning it.

    The same holds true if I contract a slowly fatal disease or condition as Ms. Maynard did. I reserve the sole right to make that decision about my own physical life and its ending.

    Should that time ever come, I have the means, motive and opportunity to accomplish it without leaving a mess for others to deal with (my overriding concern). And no concerns about divine judgment will hinder me for a second. I’ve answered the question to my own satisfaction: I refuse to force my loved ones to watch me become an unrecognizable travesty of my former self, and in the end something barely kin to a human being — while allowing our current profit-motivated healthcare system to bankrupt them in the process. I will gladly, and utterly without regret or fear, make my case before the Divine Judge and throw myself on the mercy of the Court.

    As for burial, the means I’ve chosen will automatically take care of that non-theological issue. And the family will still have a particular spot where they can go to remember me, should they so choose. Not even a few hundred dollars for a cremation will be required. Better it should go towards the younger generation I’ll leave behind. “O death, where is thy sting? And where, o grave, thy victory?”

    • Mick

      Now if we can only get the folks championing the right to die allow the unborn to decide their own fate also

      • bakabomb

        Thanks for your response. The brevity of your comment leaves open a couple of windows for reply.

        1) There’s really no fundamental, logical reason to assume that all those who champion the right of adults to choose an early “opt-out” will have — or ought to have — a similar lockstep opinion regarding the rights of the unborn, either one way or the other. A person can have legitimate reasons to favor the first and oppose the second, or vice versa.

        2) It’s equally fallacious to “compare apples and oranges”. Jesus has nothing specific to say on either subject (and Psalm 139 is beautiful poetry, like all the Psalms). Clearly, adults with terminal diagnoses have achieved “the age of reason” and possess the mental faculties to make an informed decision for themselves. Just as clearly, this hasn’t been demonstrated to be the case with the unborn. And all current scientific knowledge tells us that this is, in fact, not the case.

        Let me also add that we do not know, nor does Scripture explicitly state, at what moment the soul enters the body. That’s a matter of orthodoxy and doctrine, and on such points intelligent Christians may differ.

        • Mick

          Well I admit there was a touch of sarcasm involved . But you combined so many issues in your reply it would be hard to deal with all of them . But for one a Christian view is different then a non Christian view , at least hopefully from our focus and reasoning .
          When arguing for either choice I prefer using logic and science . As a Christian though I would add a Biblical perspective also . For both beatify there is life right before death and at the beginning of life . The issue of course is how we value that life ……… . How we articulate that view when dealing with death , compassion of course should be always understood for we are dealing with issues that have eternal consequences and effect our culture also . . For how the view of the importance of life is changed . Have already heard arguments defending this young person’s decision based on the cost of Hospice . Of course the logical conclusion is when would the state start to judge the importance of life and ending it based on cost . Pain I totally understand , killing someone to save money I find quite immoral on all accounts . Plus the concern of people feeling pressured to relieve care takers and such .
          But as a Christian I argue Biblicaly that life is not ours to decide to destroy , as a Christian our life is the Lord’s . The whole purpose of Christianity is less of us , and more Of Christ in us and our lives , to the point if possible the Lord’s desires become one with us . When a person has a soul enter their body is something I did not concern myself with , the concern I have is God created life , and as a Christian guessing when God puts a soul into a life is not even a theological concern of mine . I err on the side of life . God’s creation I support and life is not for me to consider less important then others or more at its stages .
          Interestingly enough as a side note , at one time our culture would have considered suicide immoral by the Christian or non . When abortion became law of the land a small minority suggested it would lead to assisted suicide based on the way our outlook on life would change , at that time it appeared impossible to believe that could happen . In our day of scientific knowledge and enlightenment is quite astonishing more do not realize that man has always set himself up as superior to the past , more intellectually astute , but yes yet still so susceptible to the latest materialistic culture and morality based on self . When is enough pain to end life , that is a decision I pray I never need to face , and in such pain I totally would understand another choosing to end it , or myself for that matter . But as a believer I have no right supporting the end life at the beginning or the end based on personal beliefs , it is quite contrary to the Christian understanding of life . Life is gift . Returning it on our own most recent cultural view of its importance perhaps is not the best avenue to support .

  • Guest

    the bible is very clear when it comes to sin. Yes we are not to judge, but speaking the gospel and the truth does not mean we are judging. Jesus tells us all to speak preach the gospel. Only God judges who will and will not enter the gates of heaven. But we are called to speak the truth. That doesn’t mean judging people’s hearts though. It’s funny that when we speak about homosexuality the “we shouldn’t judge” people come out. But funny they aren’t to be found when we speak about all of the other sins. Somehow it’s ok to rebuke all other sin but not homosexuality! Just a thought.