Healthcare And The Budget Deficit: Longevity Isn’t The Problem

I spent much of the day before Thanksgiving in the emergency room of a hospital barely a mile from Plymouth Rock. My 93-year-old mother was experiencing a spike in her blood pressure, and although she showed no signs of distress the healthcare protocols at her assisted-living facility dictated that she go to the hospital for tests. The doctors found nothing unusual, and she was discharged within a few hours. But with a couple of hours to use up in the ER while mother was sleeping or being examined, I began to think about the connection between the budget deficit and her medical care.

God knows she gets a lot of it. With access to multiple healthcare plans as a result of being 93, a veteran, and a former school teacher, she sees medical professionals more than all the other members of my immediate family combined. So my mother is emblematic of the trend that many policy analysts say has made healthcare costs the biggest driver of the budget deficit: people living longer, and thus consuming more medical services in their elderly years. If you view the problem that way, then the biggest blessing of modern science — greater longevity — is also our biggest budgetary curse. People are living so long now that the burden of caring for them is hobbling federal finances, right?

Maybe that pattern isn’t as obvious as it seems, though. It’s true that life expectancy at birth for a typical U.S. woman has zoomed up from 51 in 1900 to 80 today, but that doesn’t tell the whole story. The most important factor depressing longevity in 1900 was infant mortality, and another important factor was the number of women dying in childbirth (the average woman gave birth to five or six kids, often in primitive circumstances). When you look at average life expectancy in 1900 for women who had reached the age of 50 — in other words, had survived infancy and their child-bearing years — you discover that on average they could expect to live to the age of 72.

In other words, the huge gains we have made over the last century in extending lifespans didn’t result so much from caring for the elderly, but rather from caring for the young. Remember, the germ theory of disease didn’t even begin to take hold among medical professionals until the second half of the 19th Century, so key innovations like sterilization of treatment areas and antibiotics still lay in the future. It was not uncommon in 1850 for physicians to conduct an autopsy and then go directly to the delivery of a baby without washing their hands. Not surprisingly, sepsis was a widespread problem in hospitals back then, a problem that was particularly threatening to newborns and mothers weakened by arduous deliveries. Those challenges have now been largely overcome, as have many of the health dangers common to men at the same time.

My point here is that greater longevity isn’t the main cause of our burgeoning healthcare costs, because it was quite common for people of both genders to live into their seventies a century ago (white males who reached the age of 50 in 1900 on average could expect to live another 21 years). Rather, it is the policy choices we have made for delivering medical services that are driving up costs. The role of the federal government in providing healthcare services, the range of conditions that healthcare insurance covers, and the types beneficiaries included in coverage are much more important in determining federal healthcare costs than trends in longevity. If life expectancy had not changed at all since 1900, we would still be facing a healthcare cost crisis today given the way in which we have chosen to deliver and pay for medical services. Blaming people like my mother who have been lucky enough or smart enough to live long lives ignores the real causes of rising healthcare costs, which are mainly political in nature.