Science may be on the verge of making us all live longer, and perhaps even a lot longer—
but hey, hang on: can we afford having more elderly people around for longer?
How do we pay for their pensions or their medical expenses?
That's something that puzzles more than one person when they hear about life extension for the first time,
and the answer is—it really depends on how you define life extension.
But let's take one step at a time: why is retirement even a thing?
Retirement time is often described as "the golden years", and that's not totally wrong—
after all, if you retire, it's quite possible that you have a life of accomplishment behind you.
Maybe you have grandkids, maybe you have a reasonably well-fed bank account if you took
good care of your finances, but whatever your circumstances,
you don't have to work for a living anymore.
Actually, it's more like "you can't work for a living anymore", at which point the whole
golden-years metaphor breaks down miserably.
Fundamentally, retirement exists for one reason:
to provide you with a livelihood once you're no longer healthy enough to provide one for yourself.
This is why retirement age is set around the time when aging starts taking its toll.
"Golden years" might not be quite the right expression to describe a time when you're too sick to support yourself.
Granted, not everyone becomes unfit for work exactly at retirement age,
and some people may have enough money set aside to not even need a pension,
but the gradual decline of our health as we approach our 70s and later ages is no mystery,
and neither is the fact that the less healthy you are, the less able to work you become.
This is the reason why the modern social security system was created in the first place,
around a hundred years ago, but things aren't the same as back then anymore.
The average life expectancy at birth was significantly lower than today, and social security was
set up to work in a system in which people generally only lived to about 80 at most.
Over the last hundred years, our lives have stretched, mostly thanks to better hygiene,
nutrition, and advances in medical technology, pulling the global average life expectancy
from a meager 34 years in 1913 all the way up to 71 years in 2015.
Life expectancy increased, to at least some extent, for people of all ages,
which means that people are living longer than the pension system—which hasn't changed much since it
was first created—expects them to live.
According to UN projections, this lifespan stretch will lead to the population of people
aged 60 and above to more than double in just over 30 years,
growing from one billion in 2017 to 2.1 billion in 2050.
Meanwhile, the other age cohorts aren't growing much at all, which ultimately will lead to
a growing number of people needing a pension, while the number of working people who are
paying for those pensions with their contributions won't change that much.
Population aging—that is, the increase in the proportion of elderly people—
is the main factor that has led economists and social security institutions around the world
to worry that a pension crisis might be on its way.
Within a few decades' time, pension systems might run out of money, leaving retirees without a livelihood.
Whether this will actually happen or not, it's possible that the problem might be solved
by better policies or clever financial measures,
but the question here is whether life extension might aggravate this potential problem.
The doubt seems fair, because at first glance, the longer you live past retirement age,
the longer you need to be paid a pension, and if pension funds are already running dry,
won't life extension just make matters worse?
Worse still, medical expenses for older people are notoriously high;
given that they typically suffer from multiple chronic conditions at the same time, if they live longer,
how is this not going to place more strain on the economy?
That depends.
As we've seen in one of the earliest X10 episodes,
lifespan and healthspan are two different yet interconnected things.
Lifespan is the duration of your life; healthspan is the time of your life spent in good health,
free of the chronic diseases of aging.
If life extension was just an extension of lifespan, without extending your healthspan as well,
then yes, it would probably exacerbate the problem of pensions,
because people's health and ability to work would begin deteriorating at the same time they do now,
but their lives would last longer than now; this means they would be sick for longer,
and they would need to be paid pensions for longer.
That's a no-brainer.
But this is not what life extension is.
The term is definitely misleading—it explicitly talks about extending life, not health—
but we probably use it for an intuitive reason, which is that if you're not healthy enough to be alive,
you're not alive; so, to extend your lifespan to any significant extent,
you also need to extend your healthspan.
If we're talking about life extension as extending healthspan to such a degree that people wind up
living a good deal longer and in better health,
rather than making the problem of pensions worse, life extension might solve or at least mitigate it,
and this is easy to see in the best-case scenario of life extension.
Suppose we got ridiculously good at life extension; we had therapies available that kept everyone
in the physical and mental shape of a 20-year-old regardless of their chronological age,
and as a consequence, people could live indefinitely, until they ran out of luck.
In this case, the fundamental reason why retirement exists—the fact that everybody's health
eventually declines too much for them to keep working—would stop being a thing, and in principle,
we could do away with pensions altogether, because people would be able to work at any age.
No pensions to pay, no pension crisis.
Another no-brainer.
I know, I know—the thought of working "forever" makes the skin of many people crawl,
but there's a couple of things to keep in mind, first and foremost the fact that the alternative to
"being able to work forever" is "becoming too sick to work at some point", and,
at the moment, that always degenerates into "being too dead and buried to work."
I don't know about you, but I know which one I am going to pick.
Besides, even if we could do away with pensions altogether, we wouldn't necessarily have to;
in a situation where aging was off the table entirely, we could decide we still want to
keep pensions around for the sake of giving people a well-deserved holiday of, say,
five years every 40 years of work—a holiday that doesn't come at the price of poor health.
Of course, how a pension system like this would work depends on the specific country and economic situation,
but arguably, it would be a lot easier for social security to pay you a pension for just a handful of years,
at the end of which you'd be right back to work and paying taxes.
Looking even further into the future, the nature of work might well change entirely;
maybe in 500 years, having to work to make a living won't be a thing anymore, or maybe
we'll have a new economic system where nobody ends up doing a job they hate out of necessity—or maybe not.
It's simply too early to know, or to worry about having to work forever.
Let's not cross our bridges till we get there.
This is all reasonable if the best-case scenario eventually pans out, but we can't expect to
get to a point where aging is under full medical control overnight; if you watched our episode
on the hallmarks of aging, you'll know that aging appears to be the product of nine different processes
that will need to be addressed separately,
and it's likely that the different treatments will become available each at its own pace, if ever.
This means that, at first, we'll probably only be able to slow down aging or to undo it only to a modest extent,
and if all goes well, later on, we might be able to undo it entirely.
We can expect a transition phase during which people will live a bit longer and their health will be only somewhat better,
which makes concerns about putting more pressure on the pension system understandable.
This issue was examined in a 2013 study published in the journal Health Affairs.
The researchers set out to estimate the health and economic returns over 50 years in four different scenarios
by running a statistical simulation to project the health and economic outcomes of older cohorts of people.
The four scenarios consisted of a status quo scenario used as a baseline,
in which the incidence of age-related diseases wasn't changed at all,
and three other scenarios where only one among cancer, heart disease, or aging were delayed.
According to the researchers, at the end of the simulation, the proportion of disabled
elderly people in the delayed-cancer and delayed-heart-disease scenarios was virtually identical
to the number of disabled elderly people in the status-quo scenario; this is because of competing risks.
At older ages, different concurrent diseases do their best to disable and kill you,
so even if you eliminate one entirely, another one will likely finish you off.
In comparison, the number of disabled elderly in the delayed-aging scenario was significantly lower
than in the status quo scenario, which is no surprise,
because attacking aging means attacking all age-related pathologies at once.
These simulated, non-disabled old people lived a little longer,
though not forever, because aging was only modestly delayed in the simulation,
pushing up life expectancy by 2.2 years; according to the simulation, this increase in life expectancy would lead
to nearly $300 billion more spent on medical expenses in the year 2060 compared to the status-quo scenario,
because the health of the longer-lived old people would still be not perfect,
and they'd be using health care for longer.
In contrast, the delayed-cancer and the delayed-heart-disease scenarios showed only a modest increase
and a decrease, respectively, in medical spending.
This would seem to suggest that, from an economic perspective,
we'd be better off fighting single diseases than aging itself, but there's a caveat.
The delayed-aging scenario was simulated in two different versions:
one in which the eligibility ages for retirement and senior healthcare insurance weren't changed,
and one with a "fix", in which they were slightly increased by a couple of years.
This is not unreasonable: the delayed-aging scenario assumed that the elderly people's
health was overall better than in the status-quo scenario; they were "a little less elderly",
if you will, despite their actual age, so they could work for a little longer.
In the delayed-cancer and delayed-heart-disease scenarios, this couldn't be done,
because even though one single disease was wiped off entirely,
the rest of the diseases of old age were still around,
impairing people's ability to work, so that rising eligibility age would be unfair.
The two versions of the delayed-aging scenario displayed dramatic differences
in medical and social security spending, compared to the status quo; in the version without a fix,
spending was ridiculously high, producing an increase in spending of over $3 trillion in 2060,
but the version with the fix produced a decrease of around $400 billion.
To put it differently, keeping people healthy and able to work for a couple of extra years
might lead to significantly reduced spending rather than a crisis—let alone if people were always fully healthy.
The study authors further suggested that, within the parameters of the same simulation,
the social benefits of delayed aging could actually amount to over $7 trillion when compared to the status-quo scenario
when one takes into account the additional quality-adjusted life-years that people would live.
Quality-adjusted life-years, or QALY, are a measure of both the length and quality of life
used to assess whether a given medical intervention is the best bang for the buck;
one QALY is one life year spent in perfect health; zero QALYs is being dead.
The seven-trillion figure is the result of placing a value of $100,000 per QALY,
which, according to the authors, is a conservative estimate, though they were a little vague on this point.
In any case, we can certainly all agree that being healthy is preferable to being sick,
at any age and for any length of time, and that you can hardly have a pension crisis
if you don't have any pensions to pay.
These facts alone make for a great reason to work on creating rejuvenation therapies
as effective as we can possibly make them.
Getting there will require some time, effort, and adjustment of policies, but when the prize
is better health for longer, it's certainly worth the trouble.
Thank you for watching this episode of X10, and thank you for your constant support whether
it's s liking, commenting, sharing, or subscribing, it all helps our channel grow
and spread the word about the science of staying young.
As usual, a special shout-out goes to the Lifespan Heroes, the fine people who chose
to support Lifespan.io, the platform crowdfunding the cure for aging;
by so doing, they support X10 as well, helping us to produce more and better episodes.
If you'd like to become a Lifespan Hero, visit lifespan.io/hero, and if you'd like to learn
more about aging and rejuvenation while having a little fun with it too,
go to youtube.com/lifespanio and subscribe.
