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Hi, I'm Adriene Hill. This is Crash Course Economics,
嗨，我是埃德因·希尔。这里是经济速成班，
and today we need to have a little talk about a subject that most people try to avoid: death.
今天，我们要讲一个大多数人都尽量避免的话题：死亡。
We're all going to die.
我们都会死。
Now, I know from our demographic analytics that most of you are young,
现在，我从我们的人口统计分析中得知你们大多数人都是年轻人，
and you're statistically likely to live quite a bit longer, but it's still gonna happen someday.
根据统计，你们可能会活得更久一点，但总有一天你还是会死。
And how and when we die has some significant economic impacts.
我们的死亡方式和时间会对经济产生重大影响。
So let's all listen to the Crash Course song, watch the credits, have a small existential crisis,
那么让我们一起听着速成课的歌，看看学分，在一个小小的存在危机之下，
and then we'll get down to the economics of death.
开始讲死亡经济学。
Let me start by pointing out that my co-host, Jacob, isn't dead.
我先说我的搭档雅各布并没有死。
He's in Canada, where he's writing a textbook and making econ videos for his YouTube channel, ACDC Leadership
他正在加拿大写一本教科书，并为他YouTube频道的“ACDC Leadership”制作经济学视频，
and probably still wearing ACDC belt buckles every day.
他可能每天仍戴着ACDC皮带扣。
Now a couple of disclaimers. One, this is not Crash Course Philosophy.
现在有几个免责声明。第一，这不是哲学速成课。
We're not gonna get into the moral issues surrounding death.
我们不会涉及死亡的道德问题。
We don't know what happens to you after you die.
我们不知道你死后会发生什么。
Although, we will talk a little about what happens to your money after you die.
不过我们会稍微谈谈在你死后，你的钱会怎样分配。
Two, we're gonna focus on how death and dying impact the economy of the United States.
第二，我们将关注死亡对美国经济的影响。
And it's not because we're American exceptionalists or something.
这并不是因为我们是美国例外论的支持者或者什么。
It's because we read and write in English, and information on the U.S. is readily available to us.
而是因为我们用英语阅读和写作，我们很容易获得关于美国的信息。
We know that attitudes and practices around death differ throughout the world,
我们知道世界各地对待死亡的态度和做法不同，
but most of our conversation is gonna focus on death in America.
但我们的大部分话题都将围绕美国人的死亡。
And no, Stan, not death to America, we focused on that in world history.
不，斯坦，不是美国的死亡，我们会在世界历史关注美国。
Alright, a little good news. On the whole, throughout the world, life expectancy at birth has been increasing.
好了，说一点儿好消息。总的来说，全世界的出生时预期寿命都在增加。
According to the United Nations,
根据联合国的说法，
the global average life expectancy has risen from 65 years for people born between 1990 and 1995, to 70 years for those born between 2010 and 2015.
全球平均预期寿命从1990年到1995年的65岁增加到了2010年至2015年的70岁。
But there are still some pretty big disparities.
但各国的差距相当大。
People born in Africa have a life expectancy at birth that's 12 years less than the global average.
非洲人的出生时预期寿命比全球平均寿命少12年。
And 21 years than the number for those who live in North America, so that's not great.
比北美人的平均寿命少21年，太糟糕了。
In the United States, life expectancy has changed dramatically in the last 50 years.
在美国，预期寿命在过去50年里发生了巨大变化。
Americans live longer than they used to, and more and more of them die of natural causes.
美国人比过去活得更长，越来越多的人死于自然原因。
Accidents and murder and violent death in general are way down. People are living longer.
因事故、谋杀和暴力死亡的人数都在减少。人活得更长久。
The Pew Research Foundation reports that by 2010 in the United States 31% of deaths were among those aged 85 and older.
皮尤研究基金会(Pew Research Foundation)的报告称，截止到2010年，美国31%的死者都是85岁以上的老人。
This was a huge change from 1968, when 12.5% of people who dies were in that age range.
这与1968年相比是个巨大变化，当时这个年龄段的死者占12.5%。
It's not all roses though. I mean, this is still an episode about dying.
但事情也不是尽如人意。我的意思是说，这期仍是关于死亡的话题。
When we look at this data by income level, the numbers look a little different.
当我们从收入水平来看这些数据时，它们看起来有点儿不同。
A recent study found that income levels affect life expectancy a lot.
最近一项研究发现，收入水平对预期寿命有很大影响。
In 2010, an upper income man in the U.S. was expected to live to age 89.
2010年，美国一名高收入男性预计将活到89岁。
The same lower income man would live to 76, and the shortened life span has a big economic impact.
同样的低收入男性可以活到76岁，寿命缩短对经济的影响也很大。
In effect, the rich receive a lot more government benefits over the course of their lives.
实际上，富人一生中能得到更多的政府福利。
That 89-year-old upper income man would collect an average of 522,000 dollars in government benefits during his life,
这位89岁的高收入男性一生平均得到52.2万美元的政府补助，
while the lower income man would only collect an average of 391,000 dollars.
而低收入者平均只得到39.1万美元的政府补助。
So, how do our on average longer lives affect the economy?
那么，我们的平均寿命延长如何影响经济呢？
Well, economic thought about this stuff varies.
人们对这些东西的经济思考存在分歧。
Some economists argue that increased life spans are, in a very basic sense, good for the economy.
一些经济学家认为，从非常基本的意义上说，延长寿命对经济有利。
When people live longer, they have more years to consume stuff, contributing to economic growth.
当人们活得更久时，他们就有更多的时间来消费产品，为经济增长做贡献。
On the other hand, long life tends to come with more health problems,
另一方面，长寿往往伴随着更多的健康问题，
and memory-related illnesses have become much more prevalent.
与记忆有关的疾病也越来越普遍。
In 1968, the Centers for Disease Control and Prevention documented 293 deaths from dementia, senility, and Alzheimer's.
1968年，美国疾病控制和预防中心(Centers for Disease Control and Prevention)记录了293例痴呆症和阿尔茨海默症致死的病例。
In 2010, those illnesses accounted for more than 100,000 deaths.
2010年，这些疾病导致超过10万人死亡。
The CDC also reports that five million Americans suffered from Alzheimer's and dementia in 2015.
CDC还报告说，2015年有500万美国人患有阿尔茨海默症和痴呆症。
And that number was projected to rise as high as 13.8 million by 2050.
到2050年，这一数字预计将高达1380万人。
People with Alzheimer's can live for a long time with the disease, and they need a lot of care, which is expensive.
阿尔茨海默症患者可以活很长一段时间，他们需要大量的护理，代价昂贵。
The cost of caring for patients with Alzheimer's and dementia was 200 billion dollars in 2012.
在2012年，照顾阿尔茨海默症和老年痴呆症的费用是2000亿美元。
And those costs could rise as high as 1 trillion dollars by 2050. That's a lot of money.
到2050年，这一成本可能会上升到1万亿美元。那将是一大笔钱。
As you'll recall from our economics of healthcare episode,
你们应该还记得我们讲过的医疗保健经济学，
the U.S. already has the highest per capita healthcare spending in the world.
美国已经拥有世界上最高的人均医疗支出了。
And end of life care accounts for a huge part of that spending.
而临终关怀在这一支出中占比很大。
In 2012, 50 billion dollars of Medicare spending covered care for patients during the last two months of their lives.
2012年，500亿美元的医疗保险支出用于支付病人最后两个月的医疗费用。
And that doesn't account for the cost that families absorb caring for dying family members at home.
这还不包括家庭成员在照顾家中垂死家人时所付出的成本。
Medicare doesn't cover all the cost of home healthcare,
医疗保险不覆盖家庭医疗的所有费用，
and direct care from family members often results in lost wages.
而家庭成员的直接照料往往导致工资损失。
It's also worth asking exactly what we're buying with all this money.
同样值得问的是，我们到底用这些钱买了什么。
Surveys indicate that the vast majority of people would prefer to die at home.
调查显示，绝大多数人宁愿死在家里。
But more than 70% of Americans die in nursing homes or hospitals.
但超过70%的美国人死于疗养院或医院。
Patients end up receiving a tremendous amount of care at the end of their lives.
病人在生命的尽头得到了大量的护理。
The question we need to ask ourselves is whether that intense and expensive level of care improves life or simply prolongs suffering.
我们需要问自己的是，这种高强度、高成本的护理是会改善他们的生活，还是只会延长他们的痛苦。
The answers to those questions tend to be mixed.
答案往往喜忧参半。
And here we stray into the thorny territory of medical ethics.
由此我们进入了医学伦理学的棘手领域。
Studies indicate that many doctors and patients are uncomfortable with the idea of having cost of care factor into end of life decisions.
研究表明，许多医生和病人对临终还要考虑护理费的想法感到不舒服。
No one wants to be denied a course of treatment based on budget concerns.
没有人希望因为预算问题而被拒绝治疗。
One widely agreeable option for cutting costs in end of life care has grown out of a movement
一种被广泛接受得降低临终护理费的选择已经施行，
meant to improve the quality of people's end of life experience.
它旨在提高人们对生命终结的体验质量。
Hospice and palliative care treat patients' symptoms and manage their pain as they die,
临终关怀和姑息疗法对病人的症状有治疗作用并控制他们死时的疼痛，
rather than performing more and more procedures in an attempt to prolong life.
它们不是做越来越多的手术来延长病人寿命。
In 1982, the United States passed a law that allowed Medicare to cover hospice benefits for patients with terminal illnesses.
1982年，美国通过了一项法律，允许医疗保险覆盖绝症病人的临终关怀福利。
While studies indicate that expanded access to hospice and palliative care do work to lower end of life costs,
虽然研究表明扩大使用临终关怀和姑息治疗可以降低生命终结的成本，
they're by no means a single solution to rising expenditures.
但对于不断增长的支出，它们绝不是单一的解决方案。
For now though, let's put aside the complex mysteries of American healthcare costs and agree that dying is expensive.
现在，我们抛开美国医疗成本的复杂谜团，并同意死亡的代价是昂贵的。
And we haven't even started counting what it costs to actually be dead.
我们甚至还没有开始计算死亡的代价。
Once we get beyond the costs associated with dying, we're still left with the costs of disposing of our bodies.
我们即使摆脱了与死亡相关的成本，仍留有处理尸体所需的成本。
Let's talk about what happens to you when you die and how much it costs in the Thought Bubble.
我们在“Thought Bubble”中来谈谈你死时会发生什么，以及需要多少费用。
According to the National Funeral Directors' Association,
根据全国殡葬协会（National Funeral Directors' Association）的统计，
the median price for a funeral with viewing and burial in the United States was 7,181 dollars in 2014.
2014年，在美国，包含遗体告别仪式和土葬的丧葬其平均价格是7181美元。
The median price of a cremation and funeral was 6,078 dollars.
火葬和丧葬的平均价格都是6078美元。
And while the two seem comparable,
虽然两者似乎差不多，
the costs of burial are quite a bit higher as that 7,181 dollars doesn't include a burial plot or headstone.
但丧葬的费用要高一些，因为7181美元不包括墓地或墓碑的费用。
That 7,181dollars does include a bunch of stuff though.
7181美元包含很多东西的费用。
Your funeral starts with something called the basic non-declinable service fee, which should run you about 2,000 dollars.
葬礼以一种叫做基本不可降低的服务费开始，它大约要花2000美元。
That means for a funeral professional to even look at your body, it's gonna be two grand.
这意味着殡葬专家只要看看你的尸体，就能得到2千美元。
And if you want any sort of funeral, you'll need to pay up.
如果你想要任何形式的葬礼，就需要加钱。
The rest of the costs of a funeral are declinable,
葬礼的其他费用是可以降低的，
but if you want a public funeral, you're probably gonna want to pay them. Let's add it up.
但如果你想要一个公开葬礼，那么你可能会想付钱给他们。加钱吧。
The median price of transporting a body from the hospital or home to a funeral facility is 310 dollars.
将尸体从医院或家中运到殡仪馆的平均价格是310美元。
Embalming will run you 635 dollars.
防腐要花635美元。
Other preparation of the body, like make up end dressing is about 250 dollars.
其他的尸体准备工作，比如尸体化妆的费用大约是250美元。
Use of the funeral home facilities and staff for viewing and ceremony, that'll be about 915 dollars.
殡仪馆设施和告别仪式用具的使用费大约是915美元。
The median hearse rental is 318 dollars. Printing up memorial cards runs 155 dollars.
灵车的平均租金是318美元，打印纪念卡需要155美元。
And the median price of a metal casket is 2,395 dollars.
金属棺材的平均价格是2395美元。
Add a headstone and burial plot,
加上墓碑和墓地，
which like all real estate can vary widely in price depending on what kind of neighbors you want.
它们就像所有的房地产一样，价格会因你想要什么样的邻居而不同。
With everything included, the price of a funeral in the U.S. can run as high as 15,000 dollars or more.
在美国，一切费用加起来，一个葬礼的花费可能高达1.5万美元甚至更多。
Thanks Thought Bubble.
感谢“Thought Bubble”。
All this is to say that dying in the United States is really, really expensive, even after you're dead.
所有这一切都说明，在美国，死亡的代价非常非常昂贵，即使死后也如此。
And funeral costs can be hard to absorb,
葬礼的费用很难让人负担，
especially when combined with the massive doctor and hospital bills that can be a side effect of dying.
它与大量的医生和医院账单绑一起时让人更难承受，这可能是死亡的副作用。
If you're lucky enough to die at an advanced age, as most people in the U.S. do,
如果你足够幸运在年老时死亡，正如大多数美国人那样，
Social Security does pay out a 255 dollars death benefit.
社会保险确实会支付255美元的死亡保险金。
But that's not gonna cover your costs. That won't even get you embalmed.
但它并不能抵消你的费用，甚至不够你做防腐处理的费用。
So what can we do to reduce some of the costs of dying?
那么，我们能做些什么来减少死亡的成本呢？
The government does take a roll in reducing the cost of death.
政府在降低死亡成本方面确实起了作用。
The Federal Trade Commission regulates the funeral industry
联邦贸易委员会负责监管殡葬业
and has very strict rules about what a funeral provider can and can't charge for, and which charges are required.
而且作出非常严格的规定，规定葬礼承办人哪些可以收费，哪些不能收费，以及哪些费用必须收费。
And a lot of changes to Medicare in recent years have looked at ways to cut costs
近年来，许多医疗保险的改革都着眼于削减成本的方法，
from paying for hospice care to reimbursing doctors for discussing death with their patients.
从支付临终关怀费用到补偿医生与病人讨论死亡的费用。
Which takes us very nicely to what we as individuals can do to reduce some of those costs. Make a plan!
什么能很好地帮助我们个人做些事来减少一些成本？制定一个计划！
Study after study recommend that the best strategy to manage expenses for end of life care and funeral expenses is planning.
一项又一项研究表明，管理临终护理和葬礼费用的最佳策略是计划。
Doctors, funeral directors, and all manners of experts advise us to put an advanced directive in place.
医生、葬礼承办人和所有礼仪专家都建议我们提前作出合适的指示。
Write a will, make a plan for your assets, and get some life insurance.
写遗嘱，为财产做一个计划，买一些人寿保险。
The problem is mortality is a difficult thing to think about.
问题是，死亡是一件很难去考虑的事情。
To quote one 17th century Frenchman, one cannot look directly at either the sun or death.
引用一个17世纪法国人的话就是，一个人不能直面太阳或死亡。
Which is to say, people just don't like contemplating their own death.
也就是说，人们不喜欢思考自己的死亡。
According to the Pew Research Foundation, in 2013,
皮尤研究基金会(Pew Research Foundation)的数据显示，2013年，
only 37% of Americans reported that they had given a "great deal of thought" to their end of life wishes for medical care.
只有37%的美国人表示，他们对自己的临终医疗愿望给予了“大量的思考”。
And only 33% had put their wishes in writing.
只有33%的人将自己的愿望写了下来。
But when it comes to medical costs or dying,
涉及到医疗费用或死亡时，
putting advanced directives in place with doctors and loved ones can be very effective.
与医生和亲人提前做好指示是非常有用的。
If you don't want doctors to go to extreme and extremely expensive measures to preserve your life at all costs,
如果你不希望医生为了保持你的生命不惜一切代价采取极端昂贵的措施，
make sure everybody knows about it.
那就确保每个人都知道此事。
When you're not in a position to make these decisions for yourself,
当你不能为自己做这些决定时，
you wanna be sure that whoever's making the decisions knows what you want.
你要确保做决定的人知道你想要什么。
And when it comes to funerals, some of those costs can be dealt with before you're dead.
至于葬礼，有些费用你可以在死之前就处理掉。
Life insurance is readily available in the United States,
人寿保险在美国很容易买到，
and is a pretty straightforward way to insure that your loved ones at least aren't stuck with the bill for burying you.
它是一种非常直接的方式，可以确保你的亲人至少不会因为埋葬你而陷入困境。
And what does happen to your debt when you die? Do your relatives have to pay it?
当你死后，你的债务会怎样？你的亲戚需要付钱吗？
Well, it all depends on the type of debt and the state that you live in.
这完全取决于你的债务类型和你居住的州。
If you die owing credit card debt, and your estate doesn't have the money to pay it off,
如果你死于信用卡债务，而你的遗产又无力偿还，
in many circumstances, your family won't be legally obligated to pay it back.
在很多情况下，你的家人没有法律义务为你偿还。
The creditor is just out the money.
债权人的钱没了。
But that doesn't stop debt collectors from trying to get families to pay up.
但这并不能阻止收债人试图让你的家人还债。
If you find yourself being asked to pay off a dead relative's debt,
如果你发现自己被要求偿还死去亲戚的债务，
it's worth investigating the state law to find out if you really have an obligation to do so.
那么去查看一下州法律，看看你是否真的有义务这么做，这很值得。
If you do make it through all the end of life costs, and you're still solvent,
如果你临终的所有费用都解决后仍然有偿付能力，
you're also gonna need a plan for your assets.
你还需要为你的资产制定一个计划。
We don't have time to get into the realm of financial planning and estate taxes.
我们没有时间讨论财务规划和遗产税领域。
But the good news is if you've made it this far,
但好消息是，如果你能做到有余钱，
you're probably a good planner, or at least have gotten some good advice.
你可能是一个优秀的计划者，或者至少得到了一些好的建议。
The least you can do is to have a will to guide the distribution of your assets.
你至少能做的是制定一个遗嘱，来指导你的资产分配。
A good financial planner can let you in on all the ways you can move your money to the areas you really love,
好的理财规划师可以让你通过各种方式把钱转移到你真正喜欢的地方，
while avoiding expenses like probate court and estate taxes.
同时避免遗嘱认证法庭和遗产税等产生的费用。
The fact is nobody likes to think about death.
事实上，没有人喜欢思考死亡。
But get over it! There are huge economic reasons on both the societal level and on the personal level to face up to it.
但是克服它！无论在社会层面还是在个人层面上，我们都有巨大的经济原因去面对它。
While a cost effective death is good for society, it may be small comfort to your family,
虽然划算的死亡对社会有好处，但对你的家人来说它可能只是小小的安慰。
but if everything is taken care of in advance,
但是如果你把所有事情都提前处理好，
your family can focus on grieving rather than straightening out your finances.
你的家人就可以专注于悲伤而不是解决你的财务问题了。
Thanks for watching. See you next week when we talk about the other unavoidable: taxes.
感谢您的收看。下周我们将讨论另一个不可避免的问题：税收。
Thanks for watching Crash Course Economics, which is made with the help of all these fine people.
感谢您收看经济速成班，它是由这些好心人帮助制作的。
They're also working on coming to terms with their own mortality.
他们也在努力适应自己的死亡。
You can help keep Crash Course for everyone forever by supporting the show at Patreon.
你可以通过支持Patron上的节目帮助速成班永远免费对所有人开放。
Patreon is a voluntary subscription service, where you give what you can every month and get rewards.
Patreon是个自愿订阅服务的平台，你可以每月捐助来支持该节目，并获得奖励。
Thanks for watching, and don't forget to make an advance directive.
谢谢收看，别忘了提前做个指示。
