Editor’s Note: The Curse of Longevity

March 1, 2008

For every U.S. healthcare dollar spent on the average 35- to 44-year-old, about $4.50 is spent on the average person aged 75 and older. This phenomenon, though seemingly self-evident, is relatively new. Read what our executive editor has to say about American healthcare “becoming a victim of its own success.”


Have you ever seen the movie “Logan’s Run”? It’s a 1970s sci-fi classic about a futuristic world in which all citizens are required to commit suicide at age 30. Logan is happy catching aging “runners” who go on the lam, until he himself turns 30 - and runs.

This film, one of my childhood favorites, was on my mind in October when Robert Reischauer, president of the Urban Institute, offered up a caustic remark during a forum on the state of American healthcare economics: “I suppose the best thing, economically, would be if everyone lived a healthy life until the age of about 75, then got hit by a car.”

Reischauer was only half-joking. Among the reams of sobering statistics he brought with him was this: For every U.S. healthcare dollar spent on the average 35- to 44-year-old, about $4.50 is spent on the average person aged 75 and older. (His presentation, along with mine and others, can be found at the Web site of St. Louis’ Signature Healthcare Foundation, by clicking the 2007 policy forum link under the events tab.)

This phenomenon, though seemingly self-evident, is relatively new. In 1953, Reischauer noted, the difference in spending between those two age groups was almost zero.

American healthcare has become a victim of its own success. In 1953 living to 75 was the mark of good genes and clean livin’, and not many folks made it that long. (Average life expectancy was about 68 in the early ’50s.) Today, if you can avoid runaway Toyota Highlanders, you’ll probably last well into your Golden Years. And while it’s perfectly reasonable for people to expect active medical intervention to delay and diminish the physical decline that typically accompanies those years, it’s clear that that intervention also extends the number of years that most people spend in decline before death.

For example, it was reported in January that 36 percent fewer Americans will die of heart attacks this year than did only nine years ago - a gain due mostly to advances in treatment, not prevention. Indeed, we were also reminded that Americans continue to get fatter. “Soon, high blood pressure rates will be on the rise, and we will be overwhelmed with a new epidemic of cardiovascular disease that will hit people at a younger age,” Dan Jones, MD, president of the American Heart Association, says.

Do the math: Thanks to expensive, sophisticated care, more people will live longer lives despite chronic illnesses that would have killed their parents. I am forced to ask: Are we absolutely certain that this is a good thing? Can we - should we - continue to disconnect actions from consequences by extending lives ever-longer while our lifestyles remain sedentary and gluttonous?

And yet, who can blame the patients for wanting to live as long as possible? Or the doctors for wanting to treat them with everything their profession has to offer?

Not I. It’s inevitable that people are going to continue to live longer in a modern society. And most of medicine’s advances are truly wondrous. But can we at least think about how all of these advances affect our ability to disseminate the limited resource of healthcare to an ever-growing and ever-sicker population?

Of the $2.3 trillion we spent on healthcare last year, 64 percent was paid out to care for the sickest 10 percent among us. That group of older (and thus sicker, in general) Americans is about to explode: from 35 million in 2000 to 71.5 million in 2030. In that year, the percentage of Americans over 65 will exceed Florida’s current over-65 percentage. In other words, in 22 years most of the country is going to look like Boca Raton, from sea to shining sea.

Are we ready for that? Or are we thinking only about how to live longer? And longer. And longer.

Bob Keaveney is executive editor for Physicians Practice. He can be reached at bkeaveney@physicianspractice.com.

This article originally appeared in the March 2008 issue of Physicians Practice.