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Longer Life Expectancy Predicted, But How Will We Pay For It?

One of the fundamental, but seldom-discussed, issues in healthcare reform is how to take care of our aging population as people continue to live longer. According to a new study from the MacArthur Research Network on an Aging Society, by 2050 Americans may live 3.1 to 7.9 years longer than the government projects. That would result in a life expectancy for women of 89 to 93 years and for men of 83 to nearly 86 years. The researchers base their conclusion on "accelerated advances in biomedical technology that delay the onset and progression of major fatal diseases or that slow the aging process."

While this is good news, especially for the young, the life expectancy in excess of government estimates would raise costs sharply for Medicare and Social Security. If the study's projections are accurate, cumulative outlays for those two programs through 2050 could be between $3.2 trillion and $8.3 trillion higher than the U.S. Census Bureau and the Social Security Administration currently expect.

And that's only the beginning. With anticipated scientific breakthroughs in coming decades, people could eventually live to 150 years of age, says Dr. Steven Joyal, an official of the Life Extension Foundation (LEF), a nonprofit organization that promotes research on how we can live longer and healthier. The MacArthur paper, in fact, says that some experts believe the average life expectancy could hit 100 by 2060.

What's more, Joyal tells BNET, the conquest of disease and the slowing of the aging process will lead to a sharp decline in disability, allowing people of advanced age to function as well as they did when they were much younger. "In other words, a 90-year-old person could have the same mental and physical capacity as somebody 40 or 50 years old."

Approaching my own golden years, I like this idea a lot. But if the growth in healthcare costs is unsustainable today, how are we going to pay for the products of all of these medical advances, let alone continue to care for millions of people as they sail into their second century? "We really need to focus on prevention," replies Joyal. "Physicians have to partner with patients, and you have to be involved in your own healthcare. We can't rely on the medical system to fix us." If people do not start exercising, eating right, and taking their vitamins, he says, "we will face a health economic crisis of epic proportion" and "an aging workforce is that is not functional."

On the other hand, if healthcare shifts its focus to prevention and most people cooperate, Joyal says, we could enter a new era of extended life at a high level of functioning. "People may work until they're 100, 110 or 120, and still have the cognitive and functional capacity of someone half that age or even a third of that age. We believe that that will happen in the next few decades."

But what will happen if science continues to find new ways to make us live longer but the average American does not exhibit better health behavior? What if the majority of us become obese, with the associated chronic diseases, and access to health care keeps deteriorating? Will we have a two-tiered system in which the affluent, well-insured few will be able to live to 150, while the rest of us see our life expectancy decline?

Joyal admits that that could happen "if our current paradigm doesn't change." The LEF position on a two-tiered system, he says, is that everyone should be entitled to everything that medicine has to offer. "Our organization believes that people must be proactive and focus on prevention. But at the same time, if people are partners in their health, we are ethically obligated to help everyone."

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