Fight Aging!

The cure for aging is often naively envisaged as a single treatment, but this won't be the case in reality. Aging is caused by a variety of distinct parallel processes all running at the same time, producing forms of damage that accumulate in and between cells. These consequences interact with and exacerbate one another in a stochastic fashion to produce quite different individual outcomes within a process that is basically the same for everyone. It is the grand lottery: which vital system will give way first. So aging will be brought under medical control one piece at a time, because dealing with each root cause is a very different type of project, suited to different career specialists and research teams. Research doesn't run to any more of a fixed schedule than the processes of aging, and it's hard to say when and for which of the causes of aging the first effective treatments will emerge. There won't be a single cure for aging, and neither will the treatments making up the first generation rejuvenation toolkit for humans emerge all at once. There will be a period of transition, probably just two decades or so judging from the present pace of development in the life sciences, in which all of the unpleasant physical aspects of being old and causes of mortality will be eliminated slice by slice.

It is obviously the case that medical expenditures per year will drop dramatically when old people are no longer physically old. At present the vast majority of medical expenditures are needed by the old: it is hard and expensive to keep a failing system working when you are not addressing the underlying reasons for its failing state. Physically young people have little need for treatment, and the rejuvenation therapies of tomorrow will be cheap in the long run. Everyone ages for the same root causes, and the damage of aging is the same, and further you could run a good few decades between treatments with few consequences. Thus treatments will largely be mass-produced infusions, administered by bored clinicians who have to do little more than push a button. That is not a recipe for great expense: all the really expensive processes in medicine are expensive because they require a lot of time and attention from highly trained individuals, but that will not be the case for rejuvenation therapies that work by repairing the underlying cellular and molecular damage that causes aging.

Equally it is obviously the case that if you live for thousands of years as a physically young individual your lifetime medical expenditures for insurance alone, while small year by year, will eventually outweigh the expense of a short aging life span of a century. But so what? You don't hear people complaining about lifetime costs of food going up if they were to live longer. Life is opportunity, a process. You earn, you spend. It only stops being that way when you become too sick to earn - which is for most people only the case due to aging.

In the transitional period between today and a future in which the last piece of the rejuvenation toolkit is in place, piecemeal progress will produce interesting and sometimes counterintuitive effects on medical costs. To my eyes living an extra year without suffering an pain is an opportunity, and if it means you spend more to do it, so be it. You could always choose the alternative. Never forget that we live lives of privilege in comparison to the billions who have gone before, people who didn't have the luxury of the medicine we have now, never mind the medicine we might have tomorrow.

Sadly much of the public discussion of medical costs is distorted by the present baroque system of entitlements and regulation. Few people in wealthier regions of the world pay for medical care directly, money often comes from government funds, and thus the incentives are aligned against progress and efficiency. Prices have no connection to reality, competition is muted, and providers have little direct incentive to deliver good services, or improve upon their offerings. Everyone involved recognizes that the system is terrible, but their short-term incentives are to go along with it, even as it becomes progressively worse and more harmful to progress and quality over time. This is largely why there is a lot of attention paid to measures of life time medical costs, as there are people who want that number to be lower because it is paid for by entitlements, or because it is inflated by a broken system of regulation that stifles price competition, and so forth.

Here is a fairly coherent paper on the subject of cost and piecemeal medical progress. It is useful from the point of view of forming a mental model of what is likely to happen in the years ahead as aging is brought under control one slice at a time. Many of us will live through the transition decades from a point of no treatments for the causes of aging to a point of comprehensive rejuvenation therapies, so it is perhaps worth thinking ahead just a little:

Disease Prevention: Saving Lives or Reducing Health Care Costs?

Disease prevention has been claimed to reduce health care costs. However, preventing lethal diseases increases life expectancy and, thereby, indirectly increases the demand for health care. Previous studies have argued that on balance preventing diseases that reduce longevity increases health care costs while preventing non-fatal diseases could lead to health care savings. The objective of this research is to investigate if disease prevention could result in both increased longevity and lower lifetime health care costs.

Mortality rates for Netherlands in 2009 were used to construct cause-deleted life tables. Data originating from the Dutch Costs of Illness study was incorporated in order to estimate lifetime health care costs in the absence of selected disease categories. We took into account that for most diseases health care expenditures are concentrated in the last year of life.

Elimination of diseases that reduce life expectancy considerably increase lifetime health care costs. Exemplary are neoplasms that, when eliminated would increase both life expectancy and lifetime health care spending with roughly 5% for men and women. Costs savings are incurred when prevention has only a small effect on longevity such as in the case of mental and behavioural disorders. Diseases of the circulatory system stand out as their elimination would increase life expectancy while reducing health care spending.

The stronger the negative impact of a disease on longevity, the higher health care costs would be after elimination. Successful treatment of fatal diseases leaves less room for longevity gains due to effective prevention but more room for health care savings.