Life expectancy

From MSNBC comes this article on life expectancy. (see here)

First do not get me wrong. I think extending life expectancy is good, especially if we can improve the quality of life during elderly years while we extend it.

However I am concerned about how we are going to pay for it. Health care professionals are aware that the "average Joe" is concerned about it, but their reasoning on how to fix the problem leaves something to be desired.

Here is what the health care professionals have to say about it. I am cherry picking the article.

- The health of this large group of the near-elderly is of major concern to American taxpayers, because they are now becoming eligible for Medicare and Social Security.

- Life expectancy in the U.S. has been rising almost without interruption since 1900, thanks to several factors, including extraordinary advances in medicine and sanitation, and declines in some types of unhealthy behavior, such as smoking.

- Still, health officials are trying to draw attention to unhealthy behavior, and this year chose to break out data on people 55 to 64.

So what is wrong with all of that? They're going to make the problem worse. They think the way to solve the Medicare funding problem is by getting older people to adopt healthier lifestyles. Ahem, this defies common sense. I will use myself and my father as an example. I smoke and my father did not. I am more apt to develop a smoking related disease which will end my life at an earlier age then my father did. Is this not desirable if we only look at it from a budget perspective?

While my smoking related disease might cost society a good deal of cash when I die, if I did not develop the disease it would not save society any money. My father, who did not smoke, developed heart disease, prostrate cancer and Alzheimer's anyway. While he was successfully treated for the heart disease and the cancer, Alzheimer's got him. The long, slow, torturous decline from Alzheimer's ended up costing society a whole bunch of cash. I would venture that this treatment, combined with his previous treatments for heart disease and cancer, would eclipse the cost of treatment to me if I happen to develop lung cancer at an earlier age. Meanwhile, in addition to the major medical care he required, he also would have been consuming medical care resources as he dealt with all the other age related medical issues that sprung up.

Unhealthy living does not cost society money it saves society money. People who smoke for example will be paying Medicare taxes all during their productive years and then on average expire at a younger age as they approach the age where they become a Medicare consumer. Instead of raising tobacco taxes on smokers, we should be sending them thank you notes for helping to solve the Medicare funding problem. While they should have to pay more for life insurance they also should get a rebate on their Medicare taxes (which they could use to pay the higher life insurance premiums - grin).

If we are only wanting to solve the budget problem, people in the 55 to 64 year old age group should be encouraged to chow down at McDonald's, take up smoking, and involve themselves in risky recreation such as snow skiing and skydiving. On average any children they had will have fled the nest and be paying Medicare taxes of their own, so the drain on Social Security to surviving dependents should be nominal.

Perhaps this is a little ridiculous, but the health care professionals are being ridiculous too! They are suggesting we have the right to be concerned about others unhealthy lifestyles because we are going to end up paying for it in the long run when, in fact, the opposite is true.


Blogger Michael said...

You cannot simply "reason out" health economics, but you have to calculate it. I'll leave that up to the actuaries but inevitably what they tell us is that healthy lifestyles do save money.

With your example of smoking, yes, you (not necessarily "you", but all smokers "averaged out") die earlier. However, for a greater proportion of your life, you (i) require more health services and (ii) are economically less productive from poor health.

Now, if smoking did not affect your productive capacity at all in your "smoking years" and simply caused "sudden death" then yes, you could argue from an "economic" point of view that it wasn't a health burden. However, from a "public safety" point of view, we don't like things that cause "sudden death" (hence seat belts on cars, drink driving laws, banning dangerous drugs and medications, etc.)

So, since we are working on the model that most people prefer to stay alive for as long as possible, it is in fact cheaper in the long run for people to stay as healthy as possible for that life span. Economically it may make sense to "euthanise" all our "health expensive oldies" but thankfully we don't quite live in that sort of society yet.

Michael Tam

12/10/2005 11:12:00 AM  
Blogger Michael said...

Two examples where you cannot necessarily rely on "common sense" for health economics:

Example 1:
It was not so long ago that we used to advise women to do monthly breast self-examinations to feel for lumps. The idea was that women knew their own breasts best and early detection of breast cancer would lead to better outcomes (in terms of survival and cost).

However, when it was actually studied the outcome was that a lot more women presented with benign lumps leading to more tests. Overall, a lot more worry (for the women), no improvement in breast cancer survival and increased health costs. Thus, the WHO recommendation now is no longer for women to do self breast examinations, but rather, to have it done by their GP once in a while when they have a check up.

Example 2:
Helmets certainly reduces your risk of having a severe head injury if you have a cycling accident. However, a recent study has demonstrated (for the UK) that if the laws for cycle helmets were removed, it would lead to a significant increase in cycling.

The estimated cardiovascular benefits (and lives saved from that) far outweighed the mortality and morbidity from head injuries from accidents.

What to do? As it happened the helmet laws stayed - the government in this case felt that preventing the immediate mortality and morbidity of head injury was justified over the greater public health implications. This is not an unreasonable trade off since arguably, there are better ways of encouraging people to reduce their cardiovascular risk than by exposing them to a smaller, yet potentially lethal danger.

Just two examples looking at the complexity of health economics. As before, you cannot simply "reason it out". It actually has to be calculated and you'll just have to believe me when I say governments do have a whole department of bean counters who do just that.

Michael Tam

12/10/2005 11:48:00 AM  
Blogger Little David said...


I simply disagree with you.

All the real health negatives of smoking show up at later ages when, due to age, the productivity of the worker is starting to wind down anyway.

By the time the health effects start showing up, for the benefit of society, we should be wishing the individual dies anyway.

I am not speaking out in favor of euthanasia, I am only speaking out in favor of letting a young person enjoy life as they see fit. When it comes time for them to "pay the price" with reduced life expectancy we reap the benefits.

But of course you would disagree. Your occupation benefits from ever increasing demands upon limited service availability. Grin.

12/10/2005 11:56:00 AM  
Blogger Michael said...

And yet interestingly enough, the bulk of my work is getting people to not have to see me again... ;-)

There is is enough work for doctors already without having to deal with completely preventable causes of illness.

Michael Tam

12/10/2005 09:13:00 PM  

Post a Comment

<< Home