Ask HN: Does increasing our life expectancy save or cost money?
In the light of the controversy arising from the recent New York Times article about the economic impact of preventative care, should we be asking this question too?
In the light of the controversy arising from the recent New York Times article about the economic impact of preventative care, should we be asking this question too?
Healthcare costs in the US shows no signs of dropping long-term.
There's also no radical developments which change or automate prescribed or preventative care, with some illnesses resulting in very expensive hospital stays.
Healthcare salaries are also not expected to drop long-term, and will probably increase.
Cancer rates also go up as you age, resulting in chemotherapy and other expensive forms of healthcare and tests.
Insurance also fights to avoid paying out, and they're probably not keen to stop doing this, either. You generally become more expensive to insure as you age.
Healthcare law is also subject to intense debates within the US, and every change of administration brings risk of those laws changing.
Costs of developing drugs and procedures is also probably not going to go down either, resulting in pharma companies having to charge more per pill to recoup their costs (even if you ignore price gouging from Wall Street investors and free handouts to poor people).
And in the background, you have chronic illness costs (diabetes) and insurance premiums which always add up the longer you live. As well as environmental regulation and disasters which may expose you to harmful stuff.
No radical developments? Near all medical expense is at present due to age-related disease. When the distinct and understood causes of aging can be treated as medical conditions, which at present they are not, then that expense will be reduced. Rejuvenation biotechnology to repair the causes of aging is a going concern. The first legitimate, actual, real rejuvenation therapies that turn back one of the root causes of aging are in early human trials and preclinical development. They are largely low-cost. Efforts to slow aging by slowing those causes are a larger going concern. Those approaches are similarly largely low-cost. It is clearly the case that a tipping point has been reached in support for efforts to treat aging in order to, eventually, indefinitely postpone the mortality, cost, and suffering of old age.
Just ahead, in the next few years, there is the start of a massive shift in medicine for the old, medicine associated with the greatest costs. It is beginning now.
Have any well designed human studies shown a particular intervention is associated with a significant increase in lifespan?
Call me skeptical, but we can't even treat Alzheimer's and Parkinson's, and the leading cause of death in the US is still cardiovascular disease after decades of drug development
Plus, unless these drugs enable immortality I'd imagine they would just enable more people to live to older age, and then more people would get high cost illnesses
I don't think the question is that simple.
Does "increased life expectancy" mean more healthy, productive life or does it mean more time at the end in a hospital or nursing home? That would make a big difference, or so it seems to me.
It is considered to be somewhere between very technically challenging and actually impossible to significantly increase life span without making people healthier. Without fixing the underlying damage that results in raised mortality with aging.
The medicine of the past few decades has really aimed at doing just this, however, extending life without fixing the underlying problems. It is the heroic model of medicine, throw everything at the symptoms rather than the cause: compensating or patching over the problems, tinkering with metabolism, intervening in consequences or secondary contributing factors, but never going near the root causes.
It has been expensive. It has eked out only marginal, incremental gains. It is a history of failure dotted with the occasional hard-won success. It has conditioned people to think that this model is the only way forward. It is wrong, bad, and the research and development community need to adopt a better way forward.
I think that when senolytic therapies to clear senescent cells become more widely used, that will be a pleasant surprise - to find a pharmaceutical approach to age-related conditions that improves the situation for near all individuals and pathologies of aging, cost-effectively. It reduces inflammation, partially resolves loss of regenerative capacity, turns back atherosclerosis, restores loss of tissue elasticity to some degree, effectively treats osteoarthritis, clears out many forms of bad immune cell, removes a contributing cause of Parkinson's disease, and so for for a much longer list. The reason it will be so much better is that it targets a root cause of aging, a form of damage, and directly repairs at least some of it (25-50% in some tissues for some of the approaches).
One of the candidate therapies, dasatinib/quercetin, costs ~ $30-100 / dose. Take it once every few years.
I think it very hard to argue that this is going to cost the world money. The reason why present strategies have poor results is because they are terrible at achieving their goals. They have tiny effects. Do better, and the picture changes.
It will most likely cost more money unless you keep people perfectly healthy until they die. Cheapest would be to have people work up to a certain age and drop dead immediately.
I would guess it costs more money for now, since now we can expect an increasingly long period of disease and disability before death. This period is made possible by improved medical care and palliative care, which is expensive. For example, a dementia patient might cost $300k over 7 years. Medical guidelines (enforceable by law) include many intended life extending therapies such as antihypertensives, antibiotics, anti-blood clotting agents, and so on. By extending unhealthy life, these increase the total amount of care. And as I said that care is getting more expensive. So it's a double whammy.
However, if and when life extension technologies are developed then we'll have preventative maintenance for the human body. Many common diseases and disabilities will be avoided plus we won't ever reach the geriatric care phase. The periodic choice would then be between more extension (relatively cheap) and assisted suicide (cheap). So this would save money.
Maybe a better question is if it increases or decreases the aggregate wellness of the individuals in our society. (Using a sort of utilitarian metric to motivate our actions.) Maximizing GDP does not necessarily correlate with what we actually care about improving as a collective.
The way we have been increasing life expectancy is incremental improvements to treatments of diseases. Trying to fix symptoms of aging one by one ends up expensive: We find better treatment which not only extends life span but paves the way for diseases that are harder/more expensive to treat.
The research I am excited about is to fight the aging process itself, which is the root cause of many costly/rough health problems old people have to live through. So if we find a novel way to extend life span and maybe in turn put a limit to the biological age, it would bring down the costs due to less cancer, dementia, etc.
So I’m really excited about the research in life extension. Although even if it works, it won't be easy to apply it 'correctly'.
The problem is that there isn't am aging process. There's a bunch of changes that happen to you over time, all of which people think of as "aging."
Looking at pure "life expectancy" from interventions is a bad frame for this question; you can't answer it effectively. You have to look for other frames. Consider, for example, the QALY: https://en.wikipedia.org/wiki/Quality-adjusted_life_year
Is there a definition of "perfect health" in the QALY framework? One year of life in twenty year old body is probably better than in one that is sixty, for example.
I ask because at some point we could be asked to consider treatments that could take the "perfect health" score above 1.0. I'd argue that people who do potentially dangerous things like taking steroids already do something like this, valuing a "1.1" year of health now over a potential number of "0.5" years later.
For a biased answer, look at per-capita health care costs versus life expectancy for different countries. One problem is that cost is driven up and down by a variety of other factors as well.
And then, any country's life expectancy is based on a mixture of causes, e.g., I've read that it's declining in the US due to things like the opioid epidemic, suicide, and so forth.
Here is the link to the New York Times article "Preventive Care Saves Money?": https://www.nytimes.com/2018/01/29/upshot/preventive-health-...
I think the simplest argument is that if people do not work their whole lives and they live longer, they would cost money instead of save money. They may however provide value to their kids in other ways.
Is this a rhetorical question?
We know at what age ranges people are most productive, and least productive.
Are we increasing the number of most productive years or least productive years? You know what the answer is.
No, it does not save or cost money. That is not even a good simplification of the effects it has in the economy.
Linking to the article would be helpful.
Aren't text posts with links penalized?
No, but the links are by default not clickable.
https://news.ycombinator.com/newsfaq.html
> the controversy arising
Could you be more specific? Are you talking about a Hacker News thread or something else?
Since Alzheimers onset is still younger and not rising, cost.
its just impossible to address this question straight on, as it can only be engaged from the context of being deep in some finance-is-truth ideological rabbithole.
What's worth more, time or money?
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