Aging and Health: Different views
“OpEd in The Atlantic” Excerpts
That’s how long I want to live: 75 years.
This preference drives my daughters crazy. It drives my brothers crazy. My loving friends think I am crazy. They think that I can’t mean what I say; that I haven’t thought clearly about this, because there is so much in the world to see and do. To convince me of my errors, they enumerate the myriad people I know who are over 75 and doing quite well. They are certain that as I get closer to 75, I will push the desired age back to 80, then 85, maybe even 90.
I am sure of my position. Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value.
But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.
By the time I reach 75, I will have lived a complete life. I will have loved and been loved. My children will be grown and in the midst of their own rich lives. I will have seen my grandchildren born and beginning their lives. I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make. And hopefully, I will not have too many mental and physical limitations. Dying at 75 will not be a tragedy. Indeed, I plan to have my memorial service before I die. And I don’t want any crying or wailing, but a warm gathering filled with fun reminiscences, stories of my awkwardness, and celebrations of a good life. After I die, my survivors can have their own memorial service if they want—that is not my business.
Let me be clear about my wish. I’m neither asking for more time than is likely nor foreshortening my life. Today I am, as far as my physician and I know, very healthy, with no chronic illness. I just climbed Kilimanjaro with two of my nephews. So I am not talking about bargaining with God to live to 75 because I have a terminal illness. Nor am I talking about waking up one morning 18 years from now and ending my life through euthanasia or suicide. Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide. People who want to die in one of these ways tend to suffer not from unremitting pain but from depression, hopelessness, and fear of losing their dignity and control. The people they leave behind inevitably feel they have somehow failed. The answer to these symptoms is not ending a life but getting help. I have long argued that we should focus on giving all terminally ill people a good, compassionate death—not euthanasia or assisted suicide for a tiny minority.
I am talking about how long I want to live and the kind and amount of health care I will consent to after 75. Americans seem to be obsessed with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible. This has become so pervasive that it now defines a cultural type: what I call the American immortal.
I reject this aspiration. I think this manic desperation to endlessly extend life is misguided and potentially destructive. For many reasons, 75 is a pretty good age to aim to stop.
Americans may live longer than their parents, but they are likely to be more incapacitated. Does that sound very desirable? Not to me.
This was confirmed by a recent worldwide assessment of “healthy life expectancy” conducted by the Harvard School of Public Health and the Institute for Health Metrics and Evaluation at the University of Washington. The researchers included not just physical but also mental disabilities such as depression and dementia. They found not a compression of morbidity but in fact an expansion—an “increase in the absolute number of years lost to disability as life expectancy rises.”
If life-expectancy trends continue, that future may be near, transforming society in surprising and far-reaching ways.
September 17, 2014
Should research find a life-span breakthrough, the proportion of the U.S. population that is elderly—fated to rise anyway, considering declining fertility rates, the retirement of the Baby Boomers, and the continuing uplift of the escalator—may climb even more. Longer life has obvious appeal, but it entails societal risks. Politics may come to be dominated by the old, who might vote themselves ever more generous benefits for which the young must pay. Social Security and private pensions could be burdened well beyond what current actuarial tables suggest. If longer life expectancy simply leads to more years in which pensioners are disabled and demand expensive services, health-care costs may balloon as never before, while other social needs go unmet.
Postwar medical research has focused on specific conditions: there are heart-disease laboratories, cancer institutes, and so on. Traditional research assumes the chronic later-life diseases that are among the nation’s leading killers—cardiovascular blockage, stroke, Alzheimer’s—arise individually and should be treated individually. What if, instead, aging is the root cause of many chronic diseases, and aging can be slowed? Not just life span but “health span” might increase.
Drugs that lengthen health span are becoming to medical researchers what vaccines and antibiotics were to previous generations in the lab: their grail. If health-span research is successful, pharmaceuticals as remarkable as those earlier generations of drugs may result. In the process, society might learn the answer to an ancient mystery: Given that every cell in a mammal’s body contains the DNA blueprint of a healthy young version of itself, why do we age at all?
October 8, 2014
Why Americans Are Drowning in Medical Debt
Healthcare is the number-one cause of personal bankruptcy and is responsible for more collections than credit cards.
After his recent herniated-disk surgery, Peter Drier was ready for the $56,000 hospital charge, the $4,300 anesthesiologist bill, and the $133,000 fee for orthopedist. All were either in-network under his insurance or had been previously negotiated. But as Elisabeth Rosenthal recently explained in her great New York Times piece, he wasn’t quite prepared for a $117,000 bill from an “assistant surgeon”—an out-of-network doctor that the hospital tacked on at the last minute.
It’s practices like these that contribute to Americans’ widespread medical-debt woes. Roughly 40 percent of Americans owe collectors money for times they were sick. U.S. adults are likelier than those in other developed countries to struggle to pay their medical bills or to forgo care because of cost.
California patients paid more than $291,000 for the procedure, while those in Arkansas paid just $5,400.
Earlier this year, the financial-advice company NerdWallet found that medical bankruptcy is the number-one cause of personal bankruptcy in the U.S. With a new report out today, the company dug into how, exactly, medical treatment leaves so many Americans broke.
Another contributing factor is that hospitals charge wildly different amounts for the same procedures. In the most extreme example NerdWallet analyzed, the highest charge for an inpatient stay for severe intestinal bleeding was 54 times higher than the lowest charge. At most, California patients paid more than $291,000 for the procedure, while those in Arkansas paid just $5,400.
It’s worth noting that the Affordable Care Act’s individual mandate and Medicaid expansion might alleviate some of this debt strain over the coming years. But otherwise, patients have few options beyond attempting to research hospital charges ahead of time—which is probably the furthest thing from a person’s mind when they are most in need of a hospital.
Links are from The Atlantic. The operative word in all these articles is AGING.
My side note: When I was bleeding internally researching hospital costs was the furthest from my mind. All I understood was I was hemorrhaging and needed help immediately.
Minnie E. Miller
Writer, Essayist on social reform