
Ask HN: Does increasing our life expectancy save or cost money? - aniijbod
In the light of the controversy arising from the recent New York Times article about the economic impact of preventative care, should we be asking this question too?
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FLUX-YOU
Healthcare costs in the US shows no signs of dropping long-term.

There's also no radical developments which change or automate prescribed or
preventative care, with some illnesses resulting in very expensive hospital
stays.

Healthcare salaries are also not expected to drop long-term, and will probably
increase.

Cancer rates also go up as you age, resulting in chemotherapy and other
expensive forms of healthcare and tests.

Insurance also fights to avoid paying out, and they're probably not keen to
stop doing this, either. You generally become more expensive to insure as you
age.

Healthcare law is also subject to intense debates within the US, and every
change of administration brings risk of those laws changing.

Costs of developing drugs and procedures is also probably not going to go down
either, resulting in pharma companies having to charge more per pill to recoup
their costs (even if you ignore price gouging from Wall Street investors and
free handouts to poor people).

And in the background, you have chronic illness costs (diabetes) and insurance
premiums which always add up the longer you live. As well as environmental
regulation and disasters which may expose you to harmful stuff.

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reasonattlm
No radical developments? Near all medical expense is at present due to age-
related disease. When the distinct and understood causes of aging can be
treated as medical conditions, which at present they are not, then that
expense will be reduced. Rejuvenation biotechnology to repair the causes of
aging is a going concern. The first legitimate, actual, real rejuvenation
therapies that turn back one of the root causes of aging are in early human
trials and preclinical development. They are largely low-cost. Efforts to slow
aging by slowing those causes are a larger going concern. Those approaches are
similarly largely low-cost. It is clearly the case that a tipping point has
been reached in support for efforts to treat aging in order to, eventually,
indefinitely postpone the mortality, cost, and suffering of old age.

Just ahead, in the next few years, there is the start of a massive shift in
medicine for the old, medicine associated with the greatest costs. It is
beginning now.

~~~
aaavl2821
Have any well designed human studies shown a particular intervention is
associated with a significant increase in lifespan?

Call me skeptical, but we can't even treat Alzheimer's and Parkinson's, and
the leading cause of death in the US is still cardiovascular disease after
decades of drug development

Plus, unless these drugs enable immortality I'd imagine they would just enable
more people to live to older age, and then more people would get high cost
illnesses

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Turing_Machine
I don't think the question is that simple.

Does "increased life expectancy" mean more healthy, productive life or does it
mean more time at the end in a hospital or nursing home? That would make a big
difference, or so it seems to me.

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reasonattlm
It is considered to be somewhere between very technically challenging and
actually impossible to significantly increase life span without making people
healthier. Without fixing the underlying damage that results in raised
mortality with aging.

The medicine of the past few decades has really aimed at doing just this,
however, extending life without fixing the underlying problems. It is the
heroic model of medicine, throw everything at the symptoms rather than the
cause: compensating or patching over the problems, tinkering with metabolism,
intervening in consequences or secondary contributing factors, but never going
near the root causes.

It has been expensive. It has eked out only marginal, incremental gains. It is
a history of failure dotted with the occasional hard-won success. It has
conditioned people to think that this model is the only way forward. It is
wrong, bad, and the research and development community need to adopt a better
way forward.

I think that when senolytic therapies to clear senescent cells become more
widely used, that will be a pleasant surprise - to find a pharmaceutical
approach to age-related conditions that improves the situation for near all
individuals and pathologies of aging, cost-effectively. It reduces
inflammation, partially resolves loss of regenerative capacity, turns back
atherosclerosis, restores loss of tissue elasticity to some degree,
effectively treats osteoarthritis, clears out many forms of bad immune cell,
removes a contributing cause of Parkinson's disease, and so for for a much
longer list. The reason it will be so much better is that it targets a root
cause of aging, a form of damage, and directly repairs at least some of it
(25-50% in some tissues for some of the approaches).

One of the candidate therapies, dasatinib/quercetin, costs ~ $30-100 / dose.
Take it once every few years.

I think it very hard to argue that this is going to cost the world money. The
reason why present strategies have poor results is because they are terrible
at achieving their goals. They have tiny effects. Do better, and the picture
changes.

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maxxxxx
It will most likely cost more money unless you keep people perfectly healthy
until they die. Cheapest would be to have people work up to a certain age and
drop dead immediately.

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truculation
I would guess it costs more money _for now_ , since now we can expect an
increasingly long period of disease and disability before death. This period
is made possible by improved medical care and palliative care, which is
expensive. For example, a dementia patient might cost $300k over 7 years.
Medical guidelines (enforceable by law) include many intended life extending
therapies such as antihypertensives, antibiotics, anti-blood clotting agents,
and so on. By extending _unhealthy_ life, these increase the total amount of
care. And as I said that care is getting more expensive. So it's a double
whammy.

However, if and when _life extension technologies_ are developed then we'll
have preventative maintenance for the human body. Many common diseases and
disabilities will be avoided plus we won't ever reach the geriatric care
phase. The periodic choice would then be between more extension (relatively
cheap) and assisted suicide (cheap). So this would save money.

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tw1010
Maybe a better question is if it increases or decreases the aggregate wellness
of the individuals in our society. (Using a sort of utilitarian metric to
motivate our actions.) Maximizing GDP does not necessarily correlate with what
we actually care about improving as a collective.

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ictebres
The way we have been increasing life expectancy is incremental improvements to
treatments of diseases. Trying to fix symptoms of aging one by one ends up
expensive: We find better treatment which not only extends life span but paves
the way for diseases that are harder/more expensive to treat.

The research I am excited about is to fight the aging process itself, which is
the root cause of many costly/rough health problems old people have to live
through. So if we find a novel way to extend life span and maybe in turn put a
limit to the biological age, it would bring down the costs due to less cancer,
dementia, etc.

So I’m really excited about the research in life extension. Although even if
it works, it won't be easy to apply it 'correctly'.

~~~
notriddle
The problem is that there _isn 't_ am aging process. There's a bunch of
changes that happen to you over time, all of which people think of as "aging."

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wpietri
Looking at pure "life expectancy" from interventions is a bad frame for this
question; you can't answer it effectively. You have to look for other frames.
Consider, for example, the QALY: [https://en.wikipedia.org/wiki/Quality-
adjusted_life_year](https://en.wikipedia.org/wiki/Quality-adjusted_life_year)

~~~
alasdair_
Is there a definition of "perfect health" in the QALY framework? One year of
life in twenty year old body is probably better than in one that is sixty, for
example.

I ask because at some point we could be asked to consider treatments that
could take the "perfect health" score above 1.0. I'd argue that people who do
potentially dangerous things like taking steroids already do something like
this, valuing a "1.1" year of health now over a potential number of "0.5"
years later.

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analog31
For a biased answer, look at per-capita health care costs versus life
expectancy for different countries. One problem is that cost is driven up and
down by a variety of other factors as well.

And then, any country's life expectancy is based on a mixture of causes, e.g.,
I've read that it's declining in the US due to things like the opioid
epidemic, suicide, and so forth.

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aniijbod
Here is the link to the New York Times article "Preventive Care Saves Money?":
[https://www.nytimes.com/2018/01/29/upshot/preventive-
health-...](https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-
costs.html)

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jryan49
I think the simplest argument is that if people do not work their whole lives
and they live longer, they would cost money instead of save money. They may
however provide value to their kids in other ways.

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alexashka
Is this a rhetorical question?

We know at what age ranges people are most productive, and least productive.

Are we increasing the number of most productive years or least productive
years? You know what the answer is.

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firethief
No, it does not save or cost money. That is not even a good simplification of
the effects it has in the economy.

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andybak
Linking to the article would be helpful.

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a13n
Aren't text posts with links penalized?

~~~
dang
No, but the links are by default not clickable.

[https://news.ycombinator.com/newsfaq.html](https://news.ycombinator.com/newsfaq.html)

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thesmallestcat
> the controversy arising

Could you be more specific? Are you talking about a Hacker News thread or
something else?

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cm2012
Since Alzheimers onset is still younger and not rising, cost.

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cagenut
its just impossible to address this question straight on, as it can only be
engaged from the context of being deep in some finance-is-truth ideological
rabbithole.

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a13n
What's worth more, time or money?

