It depends on how well you want to live near the end. Rich people have no problem meeting all there needs except for the inevitable. Middle income people may want to buy Long Term Care insurance, so they can sustain a pretty comfortable middle class life style until the end. Otherwise you end up impoverished when the state takes everything and puts you in poor-house care. Of course, that means no inheritance for your kids, but if they can't take care of themselves by the time you die, screw 'em.
Are you saying that a facet of American culture is long term health care is a matter of money, and if you don’t have enough, then you get to slowly rot in the back bedroom or under a sheet of cardboard out on 5th Street?
In some cultures it is appropriate to put Grandma “on ice” when the long term care balance sheet tips.
This might be an area of opportunity for us as Americans to intentionally carve out a cultural practice that is more humane.
Or is there anything intentional about cultures?