Unless you have a great private health insurance plan or lots of money you face a future of rationing by queuing. Even if you have great private health insurance now you won't in your old age. My advice: plan accordingly. Start preparing for it by accumulating money.
UNEQUAL access to health care is hardly a new phenomenon in the United States, but the country is moving toward rationing on a scale that is unprecedented here. Wealthy people will always be able to buy most of what they want. But for everyone else, if we stay on the current course, the lines are likely to get longer and longer.
If you think this isn't going to affect you then unless you are wealthy think again. You need to start saving for your medical care in your old age. Sure, if you are in an industrialized country government will pay a substantial chunk of your old age medical costs. But you are far more likely to get better care and the most cutting edge care if you have the ability to spend substantial amounts of money out of your own pocket for your diagnoses and treatments.
Being unable to pony up some bucks for your medical treatment might not affect your longevity or how much you suffer. Could be you'll get lucky and get a killer disease that is cheap to treat and cure. Could be then you'll go some additional years and then get "lucky" in another way: You could get a killer diseases that is incurable and has no treatment. So being poor and unable to fund any of your own medical care in your old age might not matter.
But suppose you get a disease which has a cure that is in clinical trial where you have to travel somewhere (either in your home country or abroad) to get it before it becomes widely available. Well, being able to pay for this treatment yourself could become a matter of life or death. I think that especially likely for a lot of the great cell therapies and for methods to grow replacement organs. You might need to go to China to get these treatments or somewhere else offshore.
Large number of doctors who are most in demand have dropped seeing Medicaid patients and a growing number have dropped Medicare patients too.
A result is that physicians often make Medicaid patients wait or refuse to see them altogether. Medicare patients are also beginning to face lines, as doctors increasingly prefer patients with private insurance.
Suppose your doctors are stumped about what ails you and you need to see a great specialist. The best really are much better than the average or the below average. You might find yourself in the position of needing to spend your own money to travel to see the best specialist in a field. My advice: save for it.
Tyler says Obamacare is actually going to hasten the development of longer queues for waiting for diagnoses and treatment.
Access to health care will become problematic, and not only because the population is aging and demand is rising. Unfortunately, the new health care legislation is likely to speed this process. Under the new law, tens of millions of additional Americans will receive coverage, through Medicaid or private insurance. The new recipients of private insurance will gain the most, but people previously covered through Medicaid will lose.
You have been warned. What to do about it? Cut your spending and put aside more in retirement accounts. Also, when making career choices go for the money. The utility of money is going to rise with advances in biotechnology. Some extra tens or hundreds of thousands of dollars set aside for medical expenses might save your life.
Update: It is tempting to react to the health care debate by arguing for or against different reforms or by arguing that the other side is perfidious or your side can work miracles if only given a large ruling majority. But all this is besides the point when it comes to your own personal health care. Take the most probable range of health care policy changes in the next 20 year or so. Given any of those changes will you still be able to boost your chances of getting correct diagnoses and cutting edge treatments if you have more money in the bank (or in gold or stocks if you prefer)? I say yes and plan accordingly.
Increased life expectancy in the United States has not been accompanied by more years of perfect health, reveals new research published in the December issue of the Journal of Gerontology.
Indeed, a 20-year-old today can expect to live one less healthy year over his or her lifespan than a 20-year-old a decade ago, even though life expectancy has grown.
From 1970 to 2005, the probability of a 65-year-old surviving to age 85 doubled, from about a 20 percent chance to a 40 percent chance. Many researchers presumed that the same forces allowing people to live longer, including better health behaviors and medical advances, would also delay the onset of disease and allow people to spend fewer years of their lives with debilitating illness.
But new research from Eileen Crimmins, AARP Chair in Gerontology at the University of Southern California, and Hiram Beltrán-Sánchez, a postdoctoral fellow at the Andrus Gerontology Center at USC, shows that average "morbidity," or, the period of life spend with serious disease or loss of functional mobility, has actually increased in the last few decades.
The results are not surprising. Industrialized countries have rising rates of obesity, insulin resistant diabetes, and other diseases of poor diet and lifestyle.
"There is substantial evidence that we have done little to date to eliminate or delay disease while we have prevented death from diseases," Crimmins explained. "At the same time, there have been substantial increases in the incidences of certain chronic diseases, specifically, diabetes."
The process of aging is basically the process of accumulating damage to your tissue in every part of your body. Live longer and you accumulate more damage. If medicine can keep you from dying by fixing one particularly severe problem (e.g. remove an early stage cancer, fix an aorta, provide substitute hormones for a failed endocrine organ) then you just live longer so that more pieces of your body develop clinical problems.
What we need: The ability to replace aged failing tissue with younger healthier tissue. We need new parts just like cars that break down. We need stem cell therapies, replacement organs grown in vats (or even in our own bodies), and treatments that cause the most damaged cells to commit suicide and make room for healthier neighbors to replicate. We need the ability to reverse the aging process. That's coming in this century. Will it come soon enough to save most of us from death caused by old age?
John Tierney of the New York Times draws attention to the high prevalence of chronic pain.
Chronic pain affects more than 70 million Americans, which makes it more widespread than heart disease, cancer and diabetes combined. It costs the economy more than $100 billion per year. So why don’t more doctors and researchers take it seriously?
Think about that 70 million number. It is worse than it looks. At about 23% of the population that means almost 1 in 4 people live in chronic pain. But since the injuries and illnesses that cause chronic pain accumulate with age your own odds of eventually living in chronic pain are much higher than 1 in 4. The lesson here: human bodily aging is not dignified, it is not beautiful, and it is painful.
That is the challenge raised by a new report from the Mayday Fund, a nonprofit group that studies pain treatment. The report, which been endorsed by an array of medical groups, advocates a revolution in the training of doctors, the financing of research and the education of law-enforcement officials.
I advocate the faster development of rejuvenation therapies so that we can repair the damage that causes chronic pain. I also advocate more careful living. You are just one injury away from suffering the rest of your life.
Some argue that aging is a dignified and life-enriching process. But the accumulation of damage to the body exacts a terrible price in human suffering.
A novel study that attempts to paint the most accurate and detailed description yet of how Americans experience pain has found that a significant portion of the population -- 28 percent -- are in pain at any given moment and those with less education and lower income spend more of their time in pain. Those in pain are less likely to work or socialize with others and are more inclined to watch television than the pain-free.
The study, which appears in the May 3 issue of The Lancet, was prepared by Alan Krueger, a professor of economics at Princeton University, and Arthur Stone, a professor of psychiatry and behavioral science at Stony Brook University. The work is the first of its type, according to the authors, to quantify a "pain gap" in American society, with the "have-nots" suffering a disproportionate amount in relation to the "haves."
This focus on a "pain gap" distracts from the more basic problem: our bodies wear out as we age and the accumulated damage causes pain. Our limited capacity to regenerate our bodies means that many of us suffer as we age.
One problem is that manual laborers suffer more wear and tear on their bodies.
Workers in blue collar jobs reported higher occurrences and more severe pain than did those in white collar jobs. For blue collar workers, pain was lower when they were off work than when they were working. The 13 percent of people who reported a work-related disability experienced very high rates of pain, and accounted for 44 percent of the total amount of time that Americans spent in moderate to severe pain.
But keep in mind that 56% of those suffering moderate to severe pain did not get it as a result of a work-related injury. Some get injuries in sports, car accidents, and in other activities. Others get damaged by rheumatoid arthritis and other auto-immune disorders. Still others just get worn out joints and connective tissue from the aging process. The result is chronic pain and suffering. Shouldn't we want to develop regenerative therapies to reverse this decay and end the suffering that so many of us are otherwise destined for?
Once you get the painful injury the suffering lasts for decades.
Alarmingly, those in pain were likely to suffer over years, even decades. "The pain doesn't go away in many cases, when people stop working," Krueger said. Pain was higher and more common for older individuals, but the amount of pain reported remained relatively constant for individuals from their mid-40s to their mid-70s.
We need stem cell therapies, tissue engineering techniques, and gene therapies that will fix damaged tissue and eliminate the causes of chronic pain.
San Francisco, CA (Friday, October 26, 2007) — Although estimates have been adjusted downward in light of the most recent data, researchers still predict sharp increases in the U.S. incidence and prevalence of end-stage renal disease (ESRD) in the years ahead, according to a paper being presented at the American Society of Nephrology's 40th Annual Meeting and Scientific Exposition in San Francisco.
"The expected number of patients with ESRD in 2020 is almost 785,000, which is an increase of over 60 percent compared to 2005," comments Dr. David T. Gilbertson of the U.S. Renal Data System (USRDS) and the Minneapolis Medical Research Foundation, Minneapolis, Minn. Using data available through 2005, the study updates previous estimates based on data through 2000.
The development of tissue engineering technologies and stem cell therapies to repair failing organs will some day drastically reduce the cost of medical care. The sooner these treatments come the more we will save. Treatments that are not effective typically cost more than treatments that are effective. Degenerative diseases of old age that slowly kill people over a period of years are expense to treat. Growth of replacement organs or use of stem cell therapies to do repairs will cost less once those treatments become available.
A group of researchers from Britain, Australia, Brazil, the United States, China, Japan, and Sweden has published a report in the British medical journal The Lancet arguing that barring advances in treatment the number of people in the world suffering dementia due to aging will more than triple by the year 2040. (requires free registration)
We have generated expert consensus estimates of age-specific dementia prevalence for different world regions using the Delphi technique. We estimate that 24 million people have dementia today and that this amount will double every 20 years to 42 million by 2020 and 81 million by 2040, assuming no changes in mortality, and no effective prevention strategies or curative treatments. Of those with dementia, 60% live in developing countries, with this number rising to 71% by 2040. The rate of increase in numbers of people with dementia is predicted to be three to four times higher in developing areas than in developed regions.
Obviously, lots of advances in medical treatments will occur in the interim. Some advances will increase longevity by keeping old bodies alive longer. Those sorts of advances will increase the number of people with longevity by allowing more people to live to an age where their brains fail. On the other hand, medical advances that prevent Alzheimer's Disease and other causes of dementia will surely be developed as well.
Prevention of brain aging is much harder than rejuvenation of the rest of the body. The reason for this is simple: We will develop ways to grow and build replacement parts for most of the body. But our brains hold our identities. We can't get a brain replaced with a younger brain without replacing ourselves with a different person. Now, maybe some day nanotechnological methods will allow us to replicate our memories in another brain and that new brain will think it is us. Though I would not view a copy of me as being me. But given such advanced technologies why not instead apply those nano-devices to instead fully repair the brain we already have?
The costs of millions of demented people are enormous. People with early onset Alzheimers are lost from the workforce. Regardless of age of onset the costs of caring for each patient are high because the patients gradually lose the ability to care for themselves. Both families and governments shoulder large portions of the costs. The burden per working person is rising as the average age of populations rise. Taxes will go up in all the developed countries in the next decade and levels of service will simultaneously be cut in order to pay for the growing population of old folks.
These costs of caring for the demented and of old people suffering from other maladies are a strong argument for a huge increase of government funding for research to develop rejuvenation therapies (what Aubrey de Grey calls Strategies for Engineered Negligible Senescence or SENS). Once developed such therapies will become far cheaper to administer than the costs of caring for an aging population. People who are too worn out to work will, once rejuvenated, be able to return to work. Many will once again become net payers of taxes rather than net recipients of taxes paid by younger workers.
Brain rejuvenation combined with technologies to boost cognitive function will cause an enormous increase in average human productivity. The increases in human productivity will pay back the costs of medical research many times over.
We are going to pay for the aging population one way or another. I prefer to pay for it by solving the underlying problem: reverse aging. That way of paying for it requires larger government expenditures in the short to medium run but will avoid much larger government expenditures in the long run while simultaneously allowing us to become young again.
Jane Brody of the New York Times asks an important question about the growing incidence of obesity.
I can't understand why we still don't have a national initiative to control what is fast emerging as the most serious and costly health problem in America: excess weight. Are our schools, our parents, our national leaders blind to what is happening - a health crisis that looms even larger than our former and current smoking habits?
Brody is right. Obesity is causing more damage than smoking does. Brody is reacting to a new book Diabesity : The Obesity-Diabetes Epidemic That Threatens America--And What We Must Do To Stop It by pediatric endocrinologist Francine R. Kaufman MD. Brody says type II diabetes is rapidly growing.
In just over a decade, she noted, the prevalence of diabetes nearly doubled in the American adult population: to 8.7 percent in 2002, from 4.9 percent in 1990. Furthermore, an estimated one-third of Americans with Type 2 diabetes don't even know they have it because the disease is hard to spot until it causes a medical crisis.
Type II diabetes is the type where the body becomes insensitive to insulin. It accelerates a variety of degenerative diseases (heart disease, kidney failure, stroke, peripheral vascular diseases that lead to amputations, blindness, and much more) just as type I diabetes does.
Obesity does a lot more harm beyond causing type II diabetes. Obesity causes neural cell loss in the temporal lobe and is a risk factor for dementia. Rudolph Liebel of Columbia University and other researchers have found that fat cells release over 2 dozen compounds that cause harmful changes the body. The more fatty tissue you have the more of those compounds are excreted into the bloodstream. Increased obesity may even lead to decreasing life expectancies.
Kaufman and Brody blame fast food for this state of affairs. But fast food is in large part the result of advances in agriculture that made the production of starches incredibly cheap. Measures to change grade school and high school cafeteria menus are certainly called for. Kids should be taught to avoid foods that increase obesity. Parents should be discouraged from keeping junk food around the house. Junk food vending machines should be removed from schools and places of employment. But while all these obvious measures will help my guess is they will make only a small dent on the problem.
One problem mentioned by Brody is that lots of kids can not safely bike to school or play outside afterward. Part of the danger here is the distance between schools and homes and the heavy road traffic that makes bicycling too risky. But neighborhoods made dangerous by criminals also contribute to obesity. However, part of the problem in many instances is irrational fear on the part of parents. Child kidnappings and other crimes against children more rare than news reports lead many to believe. Parents who imagine a larger threat than exists keep their kids indoors more than is necessary. Still, longer prison terms for pedophiles and child kidnappers and a generally harder line toward criminal activity would probably create conditions more conducive to good health of all children.
Our biggest problem is that we are not evolutionarily adapted to the environments we have created. We could build bike trails, lock up criminals for even longer periods of time, and make other changes to suburban and urban enviroments to make it easier safer to get exercise in our daily routines. But many of the changes would be expensive to implement and have little popular support. For most communities the needed zoning ordinance changes that would enable, for example, bike trails or pedestrian trails would had to have been implemented decades ago. The communities have already been built. There is no room for sidewalks and trails. Schools have already been built surrounded by very busy streets and highways.
A more basic problem is that today food is cheap but we evolved under conditions where calorie deficiency malnutriton was very common. So we are designed to eat too much. As biotechnology advances food prices will rise more slowly than inflation. So food will become cheaper still. Access to food will become even easier. Its preparation will become ever more automated. Blaming this on McDonalds and Carls Jr really misses the bigger technological picture.
Programs and proposals to encourage weight loss also ignore history: The long running torrent of diet books, talk show discussions, and commercial weight loss companies produce lots of yo yo dieters whose weight goes up and down many times. Sustained weight loss is the exception for dieters.
Brody mentions lots of ideas for her idea of a national initiative to control obesity. But she ignores the one obvious option that will eventually provide more benefit than everything else she mentions: the development pf appetite suppressing treatments. We need an increase in funding for research to develop therapies that suppress appetite and cause fat cells to burn off their stored fat. The appetite suppressants will be the best solution. Eventually we will even have gene therapies that permanently adjust metabolism so that appetite declines when a person begins to become overweight. A few billion dollars per year spent funding research into the mechanisms of appetite control would pay back orders of magnitude in avoided diseases, greater physical and mental vigor, and longer healthier lives.
Markets can take rather unexpected turns. The cruise ship market could grow by leaps and bounds if millions of retirees move permanently onto ships.
Living on a cruise ship is a feasible and cost-effective option to assisted living facilities, and the services offered on a cruise ship parallel — even surpass — what is provided in senior care facilities, according to a study in the November issue of the Journal of the American Geriatric Society.
“Offering many amenities, such as three meals a day with escorts to meals, physicians on site and housekeeping/laundry services, cruise ship could be considered a floating assisted living facility,” said Lee Lindquist, M.D., instructor of medicine at Northwestern University Feinberg School of Medicine.
“Seniors who enjoy travel, have good or excellent cognitive function and require some assistance with activities of daily living are the ideal candidates for cruise ship care,” Lindquist said.
Lindquist, who is also an attending physician in the divisions of geriatric and general internal medicine at Northwestern Memorial Hospital, compared costs over a 20-year life expectancy after moving to assisted living facilities, nursing homes and a cruise ship, including costs of treating acute illness, Medicare reimbursement and other factors.
She found that the net costs of cruise ship living were only about $2,000 higher ($230,000 vs. $228,000) than those associated with the assisted living facilities but resulted in higher quality over the 20-year period.
Lindquist’s plan would include integration with regular passengers, with seniors selecting a cabin to inhabit as home during their prolonged cruise, whereas other passengers would disembark as usual.
I picture David Brin's Earth novel with all the old folks wearing video cameras tied to the net. They'd get off the ships and all the locals would complain that every time an old folks' ship docks there's just no privacy in town.
I do not understand the cost totals. The per year costs for nursing homes run into the 6 figures. Perhaps the numbers above are average per year?
One might expect a bigger price gap. But think about how the competitive environment differs for cruise ships versus nursing homes. Most nursing homes do not compete in a national market, let alone an international market. Whereas each cruise ship probably faces many more competitors than do nursing homes. Also, because most cruise ship passengers do not stay on board very long and return business is important the cruise ships have to be appealing to a much larger number of people to keep each cabin filled and the cruise ships need to satisfy each of them to get them to come back.
Is there any way to extend on this idea to make medical care provision more competitive? Imagine surgery ships that ply a long coast all competing to provide the cheapest, safest, most comfortable, and effective hip replacements or knee replacements or plastic surgeries. No need to travel to Beverly Hills to get the best. If it is elective surgery you seek then you could just wait for the ship to dock that you believe has the best combination of reputation, service, and cost.
A year in an “assisted-living facility” costs Americans, on average, around $28,500 a year. In large cities such as Chicago, costs are even higher, topping $40,000. Living in a dedicated cabin aboard the Royal Caribbean's Majesty of the Seas, on the other hand, rings in at a rather competitive $33,260 a year.
Update II: In the comments below Ted argues quite plausibly that the costs of the dedicated cabin on the ship come in at a low price point because people on the ship are pretty healthy. Make them all sick enough to require assisted living help and suddenly costs would balloon. Perhaps so. Though I wonder what the labor costs are on a ship. Do they use foreigners who make less than US minimum wages?
As people live physically longer and healthier lives, mental health will become the preeminent social and political issue of our time. Living longer physically does not mean living in better mental health. Mental health is the springboard of thinking, communication skills, learning, emotional growth, resilience, and self-esteem.
With longer life spans, the potential for mental illness follows. For example, dementia, the loss of function in multiple cognitive domains, increases with age. The largest number of persons with dementia occurs in people in their early eighties. As the number of people living over 80 years explodes to over 20% of the US population by 2040, dementia will take over as the leading cause of disability. That is, if appropriate tools for stemming cognitive decline, cogniceuticals, don't materialize.
Well, I'd put WMD proliferation, inter-civilizational conflicts, robot take-overs, nanotech goo, and a few other issues up there in competition for preeminent social and political issue going into the future. However, I think Zack is right and perhaps for more reasons than he intends.
First of all, as Zack points out, the aging of populations is causing a much higher incidence of Alzheimer's Disease, vascular dementia, and other neurodegenerative diseases. Worse still, I believe that it will be easier to stop and reverse aging in other parts of the body than in the brain. So we may find ourselves getting younger in other parts of our bodies as our brains continue to age. Why? Because we can replace bigger parts in other parts of the body whereas in the brain we can not replace whole subsystems without losing a part of ourselves and we can't replace our whole brain without completely wiping out our identity.
We will be able to grow replacement hearts, livers, kidneys, and other organs. By growing a replacement we can restore some organ's functionality to youthful levels. To make our brains young again we will need to repair it in situ with gene therapy and other highly targetted therapies that repair existing neurons and remove wastes from around and within cells. Certainly such therapies will be developed and those therapies will also be used on other parts of the body as well. But other parts of the body will be repairable by a wider range of techniques and some of those techniques will very likely be developed faster than the smaller set of techniques that will be usable in the brain.
Stem cell therapies have some uses in the brain for rejuvenation. For instance, hippocampal stem cell reservoirs will need to be replenished with youthful adult stem cells. Also, stem cells will be useful for repairing some of the damage caused by Parkinson's Disease. However. stem cells are not the right solution for Alzheimer's Disease where the real need is to prevent large scale neuronal cell death in the first place.
Removal of amyloid plaques via immunotherapies and other therapies may turn out to be the trick that prevents Alzheimer's. But that will not make neurons young again. Our brains will still age and a slower rate of cell death and accumulation of cells that are in the sensecent state or otherwise impaired will still gradually reduce our intellectual capacity.
So then do we face a future of older brains in younger bodies? Perhaps, but probably only as a transitional phase. Still, this transitional phase will be a serious enough problem that efforts to develop brain rejuvenation therapies should be a high priority in anti-aging research. Many of those therapies will have uses in other parts of the body as well. But the really big win from brain rejuvenation therapies will come from increased worker productivity. An increasing portion of all work is mental work and rejuvenated brains would do more to increase economic productivity than rejuvenated bodies.
There is yet another reason why mental health is going to be more important in the future: Technological advances are going to make individual humans capable of greater acts of destruction and so the individual urges for aggression and destruction are going to become more dangerous to the human race as a whole. Of course this problem is more than just a mental health issue and I do not mean to trivialize all political conflicts by labelling them as cases of mass mental illness. In fact, let me go on record as stating my opposition to the tendency of labelling all anti-social behavior as signs of mental health problems. There are a lot of other factors to consider and we shouldn't medicalize all human behavior. Still, mental health problems really are going to become politicallly more important as humans become more powerful as a result of technological advances.
Advocates see robots serving not just as helpers - carrying out simple chores and reminding patients to take their medication - but also as companions, even if the machines can carry on only a semblance of a real dialogue.
The ideal results: huge savings in medical costs, reduced burdens on family and caretakers, and old and sick people kept in better health.
"This technology is really needed for the global community," said Russell Bodoff, executive director at the Center for Aging Services Technologies in Washington, D.C. "If you look 30 years out, we have what I would call a global crisis in front of us: that we will have many more aging people than we could ever deal with."
MACHIDA, Japan- With an electronic whir, the machine released a dollop of "peach body shampoo," a kind of body wash. Then, as the cleansing bubbling action kicked in, Toshiko Shibahara, 89, settled back to enjoy the wash and soak cycle of her nursing home's new human washing machine.
Some argue for immigration to supply workers to care for a growing population of the aged. But in order for that solution to work in the short term the immigrants must be so numerous to drive their wages down to the point that their wages are low enough to be affordable by elderly on fixed incomes. But if their wages are that low two problems immediately become apparent:
If import of cheap labor is not a viable solution then there are only two cost-effective solutions to the financial problems caused by aging populations:
It is pretty simple. Either we need to eliminate the use of human labor to take care of the elderly or we need to stop the transformation of younger bodies into elderly bodies. Now me, I prefer the second option (and I hope you do too). But since the development of rejuvenation therapies may take two or three decades it makes sense to also pursue the first option to reduce costs in the short and medium term. But since the projected costs of taking care of the elderly are going to become so huge it would also be very cost-effective to spend more on biomedical research aimed at developing rejuvenation therapies.