I suppose you're wondering what your chances of dying at age (enter your age here). Well, if you read on, you'll find a graph and a fascinating formula that tells you just that and why age velocity is the solution for health care finance. Much has been written about the preventative care paradox. Living longer and staying healthier ends up costing society more than if you die young. So I have to ask the question.
Does staying healthy end up costing more in the end?
I don't buy it. One can look to the cost of a member of society and suggest that the best public policy, from an economic stand point, is to encourage policies that kill off the populace as quick as possible. The shorter you live the less resources you consume. The less greenhouse gases you produce. The less Medicare, Medicaid, private insurance, social security, food stamps, assistance and unemployment benefits you consume. The less theft you are likely to commit. The less violence you commit on others.
With fewer people consuming resources, damaging the environment and committing crimes, the world would be a better place. Right?
If you extrapolate this line of thinking out to infinity, the greatest public policy declaration a society could offer its populace would be forced abortion of all pregnancies. The cost of a human being to society far outweighs the actual cost of a medical abortion.
Does forced abortion of all pregnant women reduce social security costs, Medicare costs, Medicaid costs, food stamp consumption, unemployment benefits, crime, theft and the emission of greenhouse gases? You bet it does. By shear numbers alone, the smaller the population, the less they consume. Continuing the extrapolation, a population of zero costs the central government zero.
However, the antagonist to this argument would suggest that humans bring a lot of value to society as well. They bring innovation that creates jobs. They bring technology that increases quality of life. They bring advances that reduce damage to the environment. They bring tax dollars to the nanny state. They generate growth with a rising population. They extend life through medical and public health policies.
The longer a member of society remains productive, the longer they continue to generate consumption that drives economic growth, which increases jobs and increases the tax base which increases the ability of the government to continue their nanny state policies.
The real question here is:
Does an unhealthy person generate less net productivity through out life than a healthy person who consumes their net productivity at the end of life?
In other words, when looking at the net benefit to society, including net economic production, is it better for a less productive person to die younger or is it better to society for a more productive person to die older. Does prevention of disease have a net benefit to society? My answer is a resounding yes.
I like to bring in two concepts here
- Loss of Compounding Due To Consumption of Early Gratification
- Age Velocity
What if all of us were born with disabilities that required everyone to be 100% dependent on the government for medical, housing, food, and all cares associated with living. Without productive members of society, no government could sustain a tax base that could support 100% of its population for 100% of its needs.
Now lets imagine 10% of us were born with disabilities that required 100% dependency on the government for medical, housing, food, and other associated cares. Whether a government can finance 100% support of 10% through the tax base of the other 90% is dependent on how the government defines the support and how they define the tax base, both of which are highly political decisions which will always run contrary to economic realities (for example Medicaid/Medicare).
Now imagine if instead of being born with 100% disability, you generated, through your own actions, a lifestyle that created disability as you aged. Let's say 5% entered the nanny state as net consumers at the age of 20. And every 5 years another 5% of the population entered the nanny state as net consumers of society's resources. By 65 years old, almost 1/2 the population are already net consumers. What kind of burden does this place on the productive members and their ability to provide for the net consumers?
What we have here is the lost opportunity cost of early consumption generated by becoming net consumers at an early age. The major loss of opportunity cost to society for the early net consumers is through compounding of interest on the economic consumption of early gratification.
In other words, what you consume in health care resources at age 20, is lost forever in opportunity cost of economic value at the age of 80. If you spend $1000 on a 20 year old in health care, that $1,000 could have provided $10,000 or more in health care for that 20 year old, in 60 years, in compounding interest. The more you spend now, the less you have later, at a large opportunity cost of compounding.
Some would argue that early net consumption of economic resources more than makes up for an earlier death due to poor health from a lack of prevention. And there for we should not build public policy based on prevention.
At this point I would like to suggest my second concept. The Age Velocity. I read an intriguing blog post that suggested your chances of dying doubles every eight years, as a mathematical certainty. In other words, the older you are, the more likely you are to die, no matter how healthy you are. By the time you hit age 100, your chances of dying in the following year are about 50%, even if you are the healthiest 100 year old on earth. This is one reason comparing chemo in a 92 year old with chemo in a 20 year old with equal functional status does not make sense. Even if you were a 100 year old with the functional status of a 20 year old, your chance of dying the following year is 50%.
I call this Age Velocity. What effect does it have on net productive or consumption of lifetime resources? It means the older you are when you get sick, the less time you have to consume your resources, and there fore the more likely you are to be a net producer, even if you become a net consumer at the end of your life.
I am here to suggest, if you are a healthy, productive member of society, who made lifestyle choices which included you didn't smoke, you ate healthy, you exercised, and you avoided obesity, and you reduced your chances of getting diabetes, stroke, heart attack or cancer by 80%, the value of your lack of health care consumption in your early years, through compounding interest on your delayed gratification and lack of opportunity cost, would be markedly higher than what you could consume in your final years of age velocity.
In other words, the older you are when you get sick, the less likely you are to be a net consumer of health care dollars due to the fewer years you have to use them. This is the idea of finishing strong. Dying well by living well and enjoying health in your golden years.
I see this clinically all the time. When you are 50 and you have systemic vascular disease from your lifestyle related obesity, diabetes and smoking, lifestyle choices that have lead to CHF, PVD, stents, CABG, chronic anticoagulation, ICDs, amputations, heart attacks and on and on; When you have a younger patient experiencing all these ailments, they are less productive, generate less tax revenue, consume vast amounts of health care resources and generate a strongly net positive consumption of society resources as well as a strong loss of opportunity cost for compounding on the lack of delayed gratification.
They may die young, but they die after years and years of resource consumption. Remember, while a 100 year old may have a 50% chance of dying the following year, a 50 year old has only a .3%. The chances of dying accelerates with age, and with it the elderly lose the ability to consume.
I see this clinically all the time when 100 year olds get admitted, with weakness, their medication profile showing only a couple of vitamins and a baby aspirin. This 100 year old has been a net producer their entire life. Generating an income as well as tax dollars, saving for retirement, delaying resource consumption of health care dollars while her funds compound for 40 years over the 50 year old. The older you are, the less likely physicians are to offer aggressive interventions, the less likely patients are to accept them,, and the more likely rational patient expectations rule. Bring rational expectations together with the velocity of age and you have a prescription to solve the health care finance beast known as government funded health care.
I would suggest, the longer she remains healthy, the more productive she is to society, the larger her ability to generate a retirement fund, the more taxes she pays and the less she ultimately consumes in total resources. Being healthy is a net positive for society, because the benefits she brings to the table outweighs the consumption, when the opportunity cost of delayed gratification is added to the equation.
Until we accept healthy lifestyles as the solution to health care funding, insuring everyone and treating everyone the same does nothing but fast track America for doom. One only has to look at every country with universal government funded health care and find them struggling to pay for a populace that demands everything, but accepts no responsibility in how they live their lives.
Live well and die old, but young. That is the solution.