Can we handle cost of a healthy, aging population?
While sniping healthcare reform headlines argue about the merits or lack of merits of universal healthcare coverage, a study published in the October Health Affairs poses a question about what it would mean were healthcare focused on slowing aging as opposed to slowing or preventing disease.
The seven-person research team tallied the numbers and the result is that we are not fiscally prepared for a healthy, slow-aging population. While not a rallying call for ice floes or a Kevorkian take on end-of-life matters, the study indicates that more future-building work needs to be done if science continues to successfully extend lives in such a way that they are not hobbled by disease.
The practical side of the thought experiment is that the healthcare system is already trying to cope with portions of this idea. Costs associated with Alzheimer's disease, for example, are expected to reach $203 billion this year, and $1.2 trillion by 2050, according to the Alzheimer's Association. Caregivers, meanwhile, provided around $216 billion in unpaid labor looking after Alzheimer's patients in 2012. Push this out into other disease states, like diabetes and obesity, which are not only linked to other high-priced and chronic conditions, but also span a longer part of a patient's lifespan, and the finances for disease management, without the benefit of delayed disease are already piling up.
Yet the current state of senior planning, which includes accessing programs like Medicare, is such that the financial environment is not yet ready for a healthy, aging population, regardless of the social good. To arrive at this finding, researchers compared four scenarios: the current state of things, delayed cancer onset, delayed heart disease onset and delayed aging, which broke out as follows:
- Status quo: 65+ population rises from 43 million in 2010 to 106 million in 2060
- Delayed cancer: added around 0.8% to 65+ population
- Delayed heart disease: added around 2% to 65+ population
- Delayed aging: added 6.9% to 65+ population, with “6.1% more elderly Americans than in the status quo scenario after only 20 years.”
The non-disabled column, which would be in the social-good category, would look as follows:
- Status quo: 71% of elderly population not disabled
- Delayed disease states: similar to the status quo
- Delayed aging: 5% fewer disabled elderly seniors added to the population between 2030 and 2060.
The costs associated with delayed aging: $295 billion more than the status quo, and researchers project that living longer would add $420 billion to the entitlement deficit by 2060, with 70% of that burden coming from a larger population drawing on Medicare and Medicaid.
What we're not dealing with here is a youthful disease-free population. The researchers note that data indicates that our current status is one in which science has increased lifetimes, but “the functional status of older Americans halted in 2002,” suggesting that the quality of life part of treatments has idled, which means the focus on anti-aging needs to also focus on “compressing morbidity and extending healthy life.”
The researchers note that preparing for a future in which both goals of treatment – life extension and health – meet up, requires adjusting the financial environment and proposed measures such as delaying the age at which seniors can tap into Medicare, as well as investing in the anti-aging model of care itself, both to lower disease rates and because of the speed with which the benefits of the approach would materialize.