Exercise, Longevity, and Long Term Medical Costs
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One longevity-related line item that doesn't come up often enough in discussion is the matter of the expected state of your wallet as you move through life. Given that you have a fair degree of control over your long-term health, do you also have the same degree of control over the funds needed for future medical treatment? Reliability theory, a consideration of aging as damage, suggests that the only paths to a longer life are those which reduce or repair the accumulated biological damage that leads to aging. Reliability theory also tells us that this will lead to a lower chance of systems failure - which we might interpret as a lower chance of the need for medical intervention at any given time.

Thus it makes sense to look at the foreseeable biotechnologies of enhanced longevity as a way to reduce long term expenditures on medicine, on average, for individuals. One might hope that everyone - and not just those who have nursed an aging car through its last years - understands the difference in maintenance costs for a well-repaired machine versus one that's showing all the signs of accumulated wear and tear. Damaged machines spiral down into ever more expensive breakdowns, and that's just as true of people as it is of the things people build. Yet much of the public debate over medicine seems to focus on the idea that living longer implies greater medical expenditure - possibly another aspect of the Tithonus Error, the naive belief that living longer though biotechnology means being old for longer rather than being young for longer.

(As an aside, unrelated to the present point, the prospects for greater expenditure in the field of medicine would be a sign for rejoicing in a sane world. It would mean an industry primed for growth, needing more workers, gathering funds for investment in new ways to serve the growing number of customers, and so forth. No-one complains when the demand for cars, shoes, or shiny internet sharing widgets increases. Yet because medicine is so completely socialized in countries like the US, you see the inevitable spiral towards rationing, rejection of expenditures, and decay of new development rather than a healthy, competitive industry).

The tools for personal longevity will, I think, remain crude for the next couple of decades. Essentially, exercise, calorie restriction, and the avoidance of sharp things. Amazing things are happening in the labs, and we can clearly see how to extend life - but amazing in the lab doesn't yet translate to available in the clinic, and won't for a while. But even with these crude tools, barring genetic bad luck (or any of the other fatal forms of bad luck), the vast majority of us have a fair degree of control over our future health and medical budget. You might look at this open access paper, for example:

The authors followed up 27,738 participants aged 40-79 years and prospectively collected data on their medical expenditure and survival covering a 13-year-period. Participants were classified into those walking <1 and ≥1 h per day.


The present results indicate that the multiadjusted lifetime medical expenditure from the age of 40 years for those who walked ≥1 h per day was significantly lower by 7.6% in men and non-significantly lower by 2.7% in women than for those who walked <1 h per day. This decrease in lifetime medical expenditure was observed in spite of a longer life expectancy (1.38 years for men and 1.16 years for women) among those who walked ≥1 h per day. Thus, a healthy lifestyle not only extended longevity but also decreased the amount of lifetime medical expenditure, especially men.

It would be interesting to see the results on medical expenditure in a similarly large study that focused on deliberate exercise as opposed to time spent walking - but I think this illustrates the point, even with the smaller differences in life expectancy and health than are typically seen in studies that compare sedentary people with those who exercise regularly.

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