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Life Expectancy And The Budget

Brad Plumer thinks about rising life-spans:

But here's an honest question: would longer lifespans for old people necessarily put Social Security in a tighter bind? After all, you would think that much of this lifespan gain might come from people living healthier lifestyles in their prime years (diets, not smoking, etc.), which would decrease a lot of expenses later in life and enable people to get by with relatively smaller benefits.
Eh...I dunno about that either way. What I think we do need to be worried about is the horrible, horrible impact that Americans' increasingly healthy lifestyles (and, yes, despite rising obesity people are still healthier on average thanks to less smoking) have on the finances of Medicare. It's way more expensive (for the government) for people to stay healthy physically and start suffering from dementia, etc. than to just get sick and die. In addition, a non-trivial portion of people with unhealthy lifestyles die before reaching Medicare age. A world of healthy living is a world of very, very high nursing home costs and so forth. Now if you just used the awesome coercive apparatus of the state to force everyone to live healthily and then stopped all public sector health care expenditures, people would be longer-lived and government spending could fall considerably. Spending money on health care for old people is a surprisingly ineffective way of increasing lifespans, since such a high proportion of treatment costs come at the (inevitable) very end of a person's life.

January 3, 2005 | Permalink

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Comments

Hm. The worst part about "old person" diseases like dementia, Alzheimers, et. al. is that -- since they only crop up long after you've had kids -- there's no way for the human race to evolve its way out of this problem.

Posted by: Brad Plumer | Jan 3, 2005 4:45:34 PM

Hm. The worst part about "old person" diseases like dementia, Alzheimers, et. al. is that -- since they only crop up long after you've had kids -- there's no way for the human race to evolve its way out of this problem.

That's actually not true, so long as human societies involve families that tend to provide support for each other, though the pressure is likely to be somewhat weak. OTOH, evolution is mind-bogglingly slow, so I suspect whether or not there is evolutionary pressure, the changes it produces over any timeframe would be insignificant compared to medical technology advances.

Posted by: cmdicely | Jan 3, 2005 4:48:31 PM

But I do think health care improvements that reduce disabilities will be clearly a good thing -- both by reducing disability payments and boosting productivity. (Assuming the bulk of these costly disabilities aren't life-threatening.) Does that outweigh the negatives? Dunno. I'm trying to goad Professor Samwick or some other actual economist into doing all the hard number-crunching here. Bwa-ha...

Posted by: Brad Plumer | Jan 3, 2005 4:50:16 PM

"It's way more expensive (for the government) for people to stay healthy physically and start suffering from dementia, etc. than to just get sick and die."

That's right. Smokers for instance engender about the same levels of health care costs as non-smokers for the simple reason that they don't live as long.

Posted by: David | Jan 3, 2005 4:56:57 PM

matthew, of course, is absolutely correct to keep pounding away on the fact that if it's entitlement spending we're worried about, we should start the worrying with medicare, not social security (and no, i haven't a clue what to do about medicare either, other than to rescind bush's awful prescription drug benefit as the trifecta: unaffordable, poorly designed, and unliked by its supposed beneficiaries).

as for longer life spans and social security, the clear corollary of course is that people can and will work longer, making the inevitable increase in the age of eligibility for social security (inevitable if we resist bush's efforts to destroy social security altogether, that is) a rather painless change.

Posted by: howard | Jan 3, 2005 5:10:02 PM

as for longer life spans and social security, the clear corollary of course is that people can and will work longer, making the inevitable increase in the age of eligibility for social security (inevitable if we resist bush's efforts to destroy social security altogether, that is) a rather painless change.

I don't understand why we don't simply mandate a slow rise in the retirement age 15 years from now (or whatever number = (retirement age - minimum age for AARP membership). Since current seniors will not be affected, they can't be mobilized against it. And it seems like a fair compromise to me -- if you're expected to live longer, you're going to have work longer to get these benefits from the government.

Posted by: Guy | Jan 3, 2005 5:17:55 PM

"Now if you just used the awesome coercive apparatus of the state to force everyone to live healthily"

I vote yea! Having just started my semi-annual Atkins regimen, I am feeling mean enough to demand that everyone else go on a minimal carb(no sugars or starches or alcohol) diet, with one hour of aerobics and one hour of resistance every day. At gunpoint.

If we could just transfer our minds onto the internet, we wouldn't have any of these problems.

Posted by: bob mcmanus | Jan 3, 2005 5:20:04 PM

I believe the costs of caring for a group of lifetime smokers would be less than the costs of caring for a same number of lifetime obese people. I'm not advocating a return to smoking and earlier deaths, but don't underestimate the costs of obesity. Lots of chronic stuff like diabetes, circulation issues, clogged arteries, all starting at a relatively early age. Not to mention the reduced productivity due to mobilty, flexibility loss.

I say this because at work the other day we had a meeting in a room with no tables, just chairs. Paperwork was distributed and most stacked it on the floor near their feet. I was stunned after the meeting at the number of (nonelderly)people who had difficulty reaching down by their feet to pick up their papers. And who had difficulty fitting into the chairs, and who had to wait for the elevator to go down one flight of stairs. It sort of dawned on me then that fully 3/4s of the people in my office (of 27) were overweight, with 1/4 being obese and another 1/4 approaching obesity. Now, I bicycle with people who are overweight. They enjoy eating but they are active so they can lean over and touch their feet while sitting if need be. But the people in my office were whining and huffing as if something was really being required of them to go up a floor and sit in a folding chair for 20 minutes. If this is typical and it continues to get worse, well, it ain't gonna be pretty and it can't be cheap.

Posted by: yikes | Jan 3, 2005 5:21:00 PM

I question the assumption that healthy living just delays the onset of the same kind of medically expensive decline that unhealthy living living leads to, or worse from a budgetary standpoint, results in a super costly dementia coupled with otherwise good physical health. I don't know about Alheimer's, but would think most other dementias are caused by some kind of physical ailment that might be alleiviated by a more healthy lifestyle. To pick an admittedly non-random example, TIA's (transient ischemic attacks), the kind of dementia my grandmother had, was caused by generalized arteriosclerotic disease. If she had been physically healthier, she wouldn't have had the TIA's in the first place.

Also, it's been my experience that most folks who have had a vigorous and lengthy old age tend to die quickly when they do die, without dying becoming a long drawn out affair - those with long-term chronic health problems tend to also have longer slower declines before death.

Posted by: deirdre mcglynn | Jan 3, 2005 5:22:28 PM

"tend to die quickly when they do die, without dying becoming a long drawn out affair"

This strikes me as probably a matter of medical science and technology and market effects. Diabetes will get studied more than a disease that comes on unpredictably and kills suddenly, because there are many more diabetic patients. A death is "drawn out" because there are so many things doctors know that can prolong life.

For instance, imagine that a cure for Alzheimers would involve a new filter for dialysis machines (which can used to extract heavy metals and poisons).

Posted by: bob mcmanus | Jan 3, 2005 6:14:32 PM

It's way more expensive (for the government) for people to stay healthy physically and start suffering from dementia, etc. than to just get sick and die.

This is probably not an argument that many seniors are going to rally around.

Posted by: Kuz | Jan 3, 2005 6:39:30 PM

Deirdre - Your post made me think of a good friend of mine. She vigorously ( but not too strenuously) exercises 4x per week. Cares for her immune system. Eats organic, range fed, non hormone, etc. etc. meats and veggies. Yet she gets every cold and flu that goes around. And is confounded when her fat (not too) and sassy friend (me) rarely catches anything, although we work in similar settings. A healthy life style is a great thing obviously, but it cannot completely overule genetic disposition. You may have a great cholesteral level/mix. But, if your grandmother had problems, there is a good chance you will, too. Stop being so smug.

Posted by: amelia | Jan 3, 2005 7:21:04 PM

Me, personally, I'm not too concerned about the foreseen population explosion among the aged. The way I figure, we are quite overdue for an influenza pandemic, one that would hit elderly and infirm populations the hardest. Depending on how long it takes for a killer flu (or some other communicable pathogen) to cook up in Sotheast Asia, we could see a few million dead some winter.

Nature has a way of taking care of these things.

Posted by: jlw | Jan 3, 2005 9:03:55 PM

i wouldnt worry too much about the ageing of the American population. as living standards for the majority continue to decline, and we more and more resemble oligarchical Russia or some 3rd-rate banana republic, our lifespans will begin to likewise decline, which will take some of the pressure off the retirement system...

Posted by: scorpio | Jan 3, 2005 9:20:37 PM

Matt, You need to withdraw the suggestion that healthy living is more expensive. Smoking is a major risk factor in strokes. ICYDK- Strokes impair function and make people dependent on care for long periods.

All those people parking in the Handicap spaces that don't seem to have much wrong? Many have emphysema, a lung disease that last a long time and requires prolonged treatment. These people cannot walk more than a few steps without being winded.

Breast Cancer used to be the #1 cancer among women. Breast Cancer is now #2. Lung cancer is #1 and it is all due to smoking. Unhealthy living not only consumers health care expenses, it can also take productive workers out of the labor force long before retirement age. This means their lifetime contributions are less but the demands on the system are about the same. The demands on the system are not due to SS. Health care is the 600 pound gorilla.

Posted by: bakho | Jan 3, 2005 10:28:19 PM

We just have to wait patiently until the crystal in our palm glows red. Then, off we go!

Posted by: Gummitch | Jan 5, 2005 1:07:57 PM

I don't have all the details to hand, but Prof Raymond Tallis of Manchester University (England) has done some research on the costs of old people which leads to optimistic conclusions. (Try Googling on his name.) Putting it very crudely, people are living longer but they are also staying healthy for longer. Most of the strictly medical cost of old age (hospital or intensive nursing care) comes in the last year of life, whether that is at age 70 or age 90. Chronic disability (including Alzheimers and other forms of dementia) is also less of a threat than often supposed. And in any case it is likely that attitudes to euthanasia (whatever name it is given) will change radically in the next 50 years, just as attitudes towards contraception and abortion changed radically from the 1950s onwards. (Though the change may be slower or less certain in the US than in Europe or Japan, due to the high proportion of religious loonies in the population.)

Posted by: David B | Jan 5, 2005 2:00:04 PM

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