"Why has longevity become a source of dismay?"

Following on from my last post on the attitudes of pro-longevity bioethicists, here's an open-access piece by Tom Koch. It opens with these questions:

Why has longevity become a source of dismay rather than a cause for celebration? How did we turn the greatest triumph of 20th century public health and medicine into a problem for the 21st century?

This is the view from inside the paradigm of state-regulated, state-controlled medicine. Centralized systems of privilege, cut loose from price signals, inevitably devolve to rationing and crumble beneath increased demand. That increased demand is feared even when it is a great good, such as medical technology. This state of affairs stands in stark opposition to the free market, in which increased demand is a sign of great success - it is the opportunity to create progress through trade, research, and competition. A monolithic system crumbles under growth, while the competitive market thrives. Looking back at the SAGE Crossroads podcasts on (political) economics and engineered longevity, we have this:

Again I say if this were a privatized system, we would all say "gee it’s wonderful. All these people want more health care, this industry is thriving". Let me put one other analogy. Suppose we made cars a government entitlement. Instead of cheering when auto production went up, we’d say, "Oh my God, we can’t afford this!". How you finance it may greatly affect the psychology and actually the freedom of the economy to take advantage of these new opportunities.

Koch concludes in his article:

much of what we think of as geriatric [medicine] is in fact medicine for fragile persons. Geriatric expertise in the maintenance of people with multiple conditions can serve the critically ill of every age.

Blaming people who are over the age of 65 for the rising costs of our publicly funded health care systems permits us to focus on one class of patients. In truth, health care is expensive at every age and not something to be begrudged anyone because of age. The alternative is that we should all die young, at the first hint of illness, or figure out how to live healthily and forever.

If we lived in a world in which government had nothing to do with the provision of medicine, there would be no begrudging, no need for battles over centrally planned resource assignment, no rationing by fiat of the uncaring and distant. There would instead be a ferociously competitive marketplace, responsive to needs, and there would be generous medical charity for the unfortunate; we would do very well by that. It is a great pity that we stand very far indeed from such an ideal.


Ahem. What a bunch of drivel.

First off: the older one gets, the more likely one is to need expensive medical care. The entire setting of rates for health insurance acknowledges that fact.

What would help all of us most would be excellent preventative care and excellent personal health habits. That would go a long way to cutting healthcare costs, and many are beginning to see that fact, including employers and state governments.

Next, we need to cut fraud in Medicare and insurance billing (which is rampant!) and reduce overhead from medical care, mainly by changing our "insurance for-maximum-profit and highest pay for CEO's" insurance business models.

Plastic surgery is thriving as a private, non-insured business, but not everybody who would like to have plastic surgery can afford it. Obviously, it is elective. But, much of the expensive health care administered is literally life or death, or alleviates serious physical misery. Do you propose that such care is "elective?" No way "charity" could provide enough of such care!

My elderly next door neighbors are receiving constant hospitalization, operations, ambulance trips, all kinds of medical care at great expense. They have very good insurance. They would definitely be dead by now, without it.

Would I want to follow in their steps, if I could afford such care?

No. I see little value in such a frail existence and such suffering.

The key is not just to live long, but to live strong.

Until we achieve that, "miracle" medical treatments just prolong suffering by the elderly and very ill. People go along with it because they are so afraid to die, and because they think they should obey the doctors. Including for very preemie babies.

The problems of the cost of treatment now hit all of us much earlier than in old age. I know many middle-aged and even younger people in treatment for cancer, which is very expensive.

It is a life or death treatment, of course. Not elective.

I would like to see a national health insurance network, providing a safety net and preventative care, paid into by all, PLUS optional private insurance plans which one can purchase if they have the desire and the money. Like France.

I have seen & participated in the French system & it works well.

Unlike the British system, which is horrible.

In Hong Kong, at least years ago, their public healthcare system for the poor was financed by horse race betting. Worked well.

Posted by: s sommer at August 23rd, 2008 9:04 AM

Came here from Instapundit and emailed him the following:

"Why has longevity become a source of dismay rather than a cause for celebration?"

Assuming this as not a rhetorical question, Koch may not be following his own thought all the way.
There are a fair number out there who believe that *people* (well, other people who don't have their superior intellect) *are* the problem. They make dumb, unthinking decisions (i.e. not the decisions favored by those who believe in their own superiority) (probably while clinging bitterly to guns, religion, and bias) and they should at the very least be restrained from making such decisions if not forcibly made to accept correct decisions made for them by their betters.

This is, of course, the driving motivation among the many bien pesants who are not just Stalin/Mao power mad psychos.

Thus, having these morons living even longer only increases the chances that they'll gum up the works even further, while *simultaneously* increasing their demands on 'the system' and decreasing their useful input.

Quite simple, really. The dumb bastards should work hard, follow orders, and die relatively young.

Posted by: JorgXMcKie at August 23rd, 2008 9:29 AM

**Ahem. What a bunch of drivel. **

Thank you for posting that warning at the start of your comment, s.sommer, although you forgot the word "follows".

**What would help all of us most would be excellent preventative care and excellent personal health habits. **

In a free market, price signals would be the dominant force achieving that (as we see with the recent spike in the oil price, which has done more to promote conservation that twenty years of envirocultist propaganda). Live in an unhealthy fashion under a free market, no one bears the costs but you. A socialized system removes that signal, so the incentive to adopt such habits is lost on the part of those with short-range, childish mentalities. These people drive the costs up.

In the meantime, doctors begin to discover that the most money can be had from working to the system instead of being good doctors. Currying favor with bureaucrats pays off (http://www.westandfirm.org/blog/2008/08/tales-from-canada.html), while providing good care doesn't. At first, most doctors resist this temptation, but the selection pressure in favor of doctors and administrators whose skills are best suited to working the system instead of delivering good care, eventually alters the character of the medical workforce, attracting and favoring bureaucratic minds over medical ones (http://www.westandfirm.org/blog/2008/08/two-medicare-anecdotes.html).

As time goes on and the costs spiral, the state is forced to find a substitute for the price signal in order to manage costs. Since socialized systems override freedom by nature, the solutions invariably involve expanding that curtailment of freedom. In addition to the rationing and contraction of covered services and Stalinist-style treatment of doctors (http://www.westandfirm.org/blog/2008/08/putting-doctors-on-medicare-rac.html), nanny state laws such a bike helmet laws, dictating ingredient lists to restaurants, and Prohibition-style bans against cigarette smoking all result from the "for your own good" precedent established by socialized medicine. Finally, the government decides that it has no choice but to triage patients according to its own standards (http://www.westandfirm.org/blog/2008/08/government-guaranteed-care-unless-its.html).

None of this is a prediction: it has already happened in the various implementations of socialized medicine around the world; you can find page after page of examples at the We Stand Firm blog I have been citing (www.westandfirm.org). My particular experience is with the system in Canada, which -- as I expected -- has deterioriated significantly in the ten years since I emigrated to America.

Whether s.sommer knows it or not, those things are the end-of-road of his statements about "reducing fraud" (which the system encourages) and "excellent personal habits" (as dictated by government).

But for him not to know this would require a monumental feat of evasion. Since the late 1990's, I have been convinced that some of the most dishonest people in the world are American advocates of socialized medicine, especially in light of the evidence as presented in socialized systems worldwide (and all of which is instantly available on the Internet, direct from local news sources). Nothing has happened to change that conviction since.

Posted by: Seerak at August 23rd, 2008 1:44 PM

Oh the inhumanity! How can you begrudge all those trust fund liberals who eagerly await their inheritances? How long must they keep buying used Beamers?

Posted by: Swen Swenson at August 23rd, 2008 3:52 PM

Seerak, my best guess is that anybody who persists in thinking that completely independent financing of all medical care, with no insurance programs of any kind, is relatively young, healthy and has not had responsibility for offspring.

Libertarianism makes sense to a degree, but is not the answer to everything. Sometimes, cooperation as a society is worth it.

Unfortunately, seriously bad health events can easily overwhelm even the most financially capable. And, sick people are not productive people. A healthy population benefits all of us.

I agree that doctors are being subverted by the system. I have many doctor friends, and they are the first to express their frustration and complete hatred of the system as it is now.

The Canadian system has many of the faults of the British system. But, why do Americans tend to focus only on the failures of other systems? There are many places in the world where their health system is working better and more cost effectively than our own, France, Germany and many others.

Why not learn from them & then put an even better spin on it?

American doctors have largely not even computerized their records yet, while the vast majority of doctors in Western Europe did it a long time ago. We are not the pinnacle of success.

When someone uses the term "socialized" and defends the "freedom" to smoke as an essential "right" and thinks that any individual today can afford to be on their own paying for serious emergency health care... I can only think "idealist youth."

Not realistic, not practical, not accountable for anybody but himself, perhaps. Or, maybe has had good luck with health.

But, that good luck can run out & probably will. Will change your mind, when you or someone you love is very, very sick.

Posted by: s sommer at August 23rd, 2008 10:08 PM

Don't look now, but it's not government intervention that turned your grandparents' simple fee-for-service healthcare into the monster that we have today, it was the good ol' free market that allowed insurance companies to strike sweetheart deals with corporations and invented the preferred-provider category of healthcare billing, that now has three different prices on every line item of every invoice, and all three of them lies.

Removing government intervention from the system will not eliminate malpractice lawsuits for failing to cure a case of the flu in 3 days, nor will it prevent hospitals from requiring doctors to use their expensive in-house scanners as a condition for admitting privileges instead of allowing them to use the low-cost imaging center down the street.

Nor will "generous medical charity" pay for the massive educational effort needed to wean couch potatoes from their cholesterol-laden fast food diets so that they don't have to be given massive amounts of high-intensity treatment when atherosclerosis inevitably catches up with them.

The idea that healthcare can be privatized is an attractive myth, but a myth nonetheless. If you really believe otherwise, you need to move out of the city and into some area where they don't have public water or sewer. I'm in one of those areas, but I'm going to have to hook up to the public system soon because the flood control district claims that all the wells are causing ground subsidence. Darned gummint, trying to disrupt the free market that allows all the enterprising developers upstream from me to destroy my property values with their shopping centers and parking lots that don't absorb the rainwater the way the ranchland used to do, eroding the creek banks and turning my backyard into a floodway.

Posted by: Jeff at August 23rd, 2008 10:44 PM

PS If Seerak is so confident that "charity" can afford to pay for all the medical care needed by those who cannot pay in an emergency, how does he explain the hospitals going under due to the illegals filling up the emergency rooms, with no way to pay?

If "charity" is not enough to save the hospitals from the waves of illegals' bills, how is it going to step up & cover everybody else?

We have the most expensive healthcare system in the world, but not the best. That is a fact. We need to face up to the facts and find a better way to handle healthcare.

We cannot afford to go on as we are. One of the major causes of bankruptcy in the US is serious illness and medical bills, even for families who HAVE health insurance!

One thing we should learn from the sub-prime meltdown and the derivatives mess is that industries do NOT do a good job of "policing" themselves! Hello! It is called GREED.

It has just been so long since we had a government that actually served the people, that we have lost sight of its' real purpose.

Posted by: s sommer at August 24th, 2008 3:11 PM

A mixed charity system can work. Louisiana had a Charity Hospital system which worked very well for several decades. This was one of the few legacies of Huey Long that actually did some good.

It was socialist in that the state government picked up half the cost of the hospitals while the rest came from fees and charity. People were billed for their hospital stays and usually had to pay something. If they had insurance it was billed but most of them were poor people and if they could not pay then the fee was waved.

Wealthier people did not go to the charity hospitals because there was a longer waiting time.

The system worked well until the politicians killed it. They burdened the system down with all sorts of mandatory care, and they robbed the system of billions of dollars over the years (we are talking about Louisiana after all.)

But such a system might be made to work right if it could be protected from the vultures.

Granted, the illegal immigrant problem would have to be dealt with in order to make it work.

Posted by: kyle8 at October 15th, 2008 4:28 AM
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