As readers of this blog will know, I am now a Senior Advisor to the Sheba Hospital, Israel’s largest medical facility and one of the top ten hospitals in the world. We are establishing a longevity center focused on increasing healthy Lifespan. For those who know about me only because of my career in technology, I had an earlier 13-year career in medical science, ending up as both an Associate Professor and an entrepreneur. Now I have circled back to health care. Not surprisingly, at the age of 78, health and Lifespan have become an interest.

This blog post focuses on the situation in the USA, which is the country I understand the best. However, the situation in Israel, where I live, is different due to many factors; a single-payer for medical insurance drives an increased long-term focus, a multi-generational family structure, and a high happiness factor. In addition, Israeli are not overweight (average BMI under 25), while the average BMI in the USA is 29.  

The Economics of increased health and Lifespan

Recently, I have become interested in understanding the economics of increased health and life span. Expanding health span, the period of our lives in which we are primarily healthy, should have a positive economic effect in reducing the cost of health care and keeping an experienced workforce productive for a longer time. If, on the other hand, we only increase life span by adding years in which we suffer from chronic disabilities and diseases, the opposite effect would result. Therefore, I believe the focus should be on increased health span, which will most likely result in increased life span. That means preventing heart disease, for instance, rather than keeping people alive after they have suffered major cardiac events.  

What would you pay to have an extra year of quality life? Notice I wrote “quality life.” I guess that the older you are, the more you will be willing to pay. However, I doubt that many of us would pay a lot for an extra year in the memory care facility.

Most people do not think about aging until they reach their later years. But, of course, we are all aware that we will die, even if we prefer not to think about it. But how do we imagine the last years of our life? Will it be a golden age? According to the U.S. Department of Health and Human Services, about 70% of people over age 65 will require some form of long-term care during their lifetime. This statistic suggests that many older adults will experience a period of dependency, needing assistance with daily activities such as bathing, eating, or moving around. But before this, many will suffer many years from medical conditions.  

 About 55% of Americans have life insurance; by age 65, this climbs to 80%. It is our last gift to those we love. But when we look at long-term care insurance, we discover that only 15% of Americans are insured. I wonder what this means.

Living better longer

It is possible to increase life span without increasing the years we live without chronic illness. It is also possible to increase the number of healthy years without increasing the life span. But it is also likely that increases in health span will increase life span in general. It just depends on what is going to kill you. Right now life span is growing by one year every four years. This increase seems to be speeding up. There is talk of Longevity Escape Velocity, the point where we increase life expectancy by one year every year. All the young tech billionaires want to live forever. That is because they have not lived long enough to realize this is a bad idea.

Aging is not considered a disease. Yet, most diseases are the result of aging. One could argue that heart disease and many cancers are just symptoms of the disease of age.  

The Staggering Cost of Health Care

Strangely, the National Institute of Health (NIH), the largest organization committed to improving health care, spends just 5% ($2 billion) of its 44 billion dollar annual budget on aging research. By the way, several top technology companies spend close to this amount (Amazon at $42.7 billion and Alphabet at $39.5 billion, for instance) on annual R&D. 

Yet, healthcare costs in the USA are a staggering $4.3 trillion, more than six times our defense budget. But even with all that spending, the USA does not even rank in the top 20 countries for Longevity. The average age of death in the top 20 is 82.7 years, and the average cost of health care per year is $5,700. Life expectancy in the USA is 78.7, and the yearly cost of medical care is about $13,000 per person. Of course, many other factors, including genetics, determine Longevity. It is not all due to medical care. For instance, lifestyle contributes a great deal. Exercise, diet, society, and culture all contribute. 

A study published in the Journal of the American Geriatrics Society analyzed Medicare data and found that approximately 25% of total Medicare spending occurs in the last year of life, and around 40% occurs in the last four years. Yet, only 5% of the NIH’s budget deals with aging. In addition, 80% of those over 60 have one chronic disease, and 70% have two or more.

What if we could extend the health span and eliminate much of the costs of caring for someone in their last years of life? They would still eventually die, most likely later, but the years suffering from chronic conditions could be significantly shortened or even eliminated.  

Economics Implications

The economic implications are vast if we can extend the healthy life span. I am sure there are many economists considering this. At least, I hope so. Unfortunately, I have not yet had a chance to discuss this with them, but I intend to. 

Let’s say the cost of increasing a healthy lifespan is $3,000 yearly for ten years, boosting a healthy lifespan by three years. What is the economic value of that, and who would pay? These are not easy questions to answer, for sure. But healthy aging will have a cost. We can measure the price, but how do we measure the benefit?  

Right now, people in their last quarter or a third of life are considered “Elderly.” I’m not too fond of that word. My wife has suggested a new term, Exceldery™, for those over 60 who are still highly fit, highly productive, and even excel. Society must recognize this change. A 78-year-old man like me, who is still very effective, fit physically and mentally, and equipped with vast experience, and, do I say, “wisdom,” should not be forced to sit on a park bench feeding pigeons. Yet, I am too old to be considered for the board of public companies. Fortunately, I live in Israel, where age and experience are still valued. 

Conclusion

Increasing Lifespan should not be our goal; instead, we should seek to increase healthspan, which will likely lead to increased Longevity.

To increase healthspan, we have to understand the role lifestyle plays. For example, exercise, diet, stress, and sleep are fundamental in determining healthspan.  

We need to do more research on pharmaceuticals to slow down the aging process. I believe drugs will be required to deal with obesity and diabetes. But perhaps education can result in significant lifestyle changes. A good example is smoking. In 1950, 45% of people smoked. Now that number is less than 15%. Smoking reduces life expectancy on average by ten years. Alcohol also has a negative factor. It is hard to prove what is causal or coincidental. People that smoke and drink may have other contributing factors.  

Healthy Lifespan is a big topic. I have just touched the surface and started learning about the economic implication.