Otter Debate: What's Driving Up The Cost Of Healthcare In America: It's aging, stupid.

When Sarah Palin talks death panels, it always seems to be Grandma that's getting the shove-off into oblivion. Why can't we pull the plug on Uncle Roy or your friend Jimmy? Because, obviously, the greatest risk of death comes from aging, and we're older than ever.

Despite this, we're also living longer than ever. What do these seemingly contradictory set of facts mean? It means that the main reason health care costs are exploding in America is due to older and older Americans getting better and better care. Just twenty years ago, statins, now a mainstay in cardiovascular treatment, were just on the drawing board. Ten years ago, Herceptin, the breast cancer wonder drug, was just in trials. Are we more medicated than we were before? Yes. But that's because the medication is working. Heart disease and cancer deaths continue their slow decline. This is great news for Grandma. But how are we going to continue to pay for these ever increasing costs?

Plus, if our aging population is the reason for our health care costs, in addition to better and better (yet mind blowingly expensive) treatments and medications to prolong life, why do other countries with even older populations and even higher life expectancies (*cough* Japan *cough*) have lower health care costs?

Insofar as the second question is concerned, I can only offer what a wise old Italian once said, "Europe can be socialist because America is capitalist." In other words, the pre-negotiated rates for drugs and treatments in Europe simply don't cover the research cost of drugs. Yet research goes on because American drug makers (and some European ones) can charge Americans out the ass. American health care might be so expensive because we're subsidizing the wonderful European health care free-ride that some would like to emulate.

You can see this same pattern in Medicare. Medicare currently does not reimburse doctors or hospitals enough for them to break even (like our friends, the Europeans). Instead, private health providers have to make up the difference by charging their privately insured patients more.

So if we can't change the French attitude about screwing American consumers over by giving their population a free ride at our expense, and we can't have the Neitzchean moral clarity to push Grandma off a cliff once she's outlived her usefulness (i.e., either socialistic[government mandated] rationing or capitalistic[ability to pay] rationing), what can we do to lower the cost of health care?

Simple, we go for broke, decide as a nation it's a good idea to live a high quality of life for as long as freakin' possible, and find more effective and cheaper ways to do so. We need to confront the real problem, aging, head on. We need to lower the cost of research by streamlining and standardizing the evidence needed to prove drugs work across multiple markets. If it's good enough for the FDA, it ought to be good enough for the Canadian equivalent, and visa versa. We need government to play it's usual role in a fundamentally R&D problem - set goals of effectiveness and cost with prizes,(and here, and here) in addition to funding publicly published blue-sky research that can serve as a foundation for the commercial sector to boot strap themselves to new drugs and treatments. We need to find more effective ways to bring new research out of university labs into pharmaceutical factories, instead of letting breakthrough results stall for a decade or more. We need to find better ways to deal with the enormous risk of researching new drugs (which make take a billion dollars or more and still fail completely in phase 3 trials) to refocus our pharmaceutical company's efforts on novel and better treatments rather than me-too drugs and inventing new diseases (restless leg syndrome, anyone?)

Grandma is living longer than ever, and she's quite happy to continue doing so. We can either have an existential crisis in which the entire nation confronts its mortality head on and lives in some sort of objectivist paradise that celebrates dying at 75, or we can plunge head long into the thankfully immature and fantastic dream of living longer and better lives through our own hard work and research. This is a nation, nay, a species that has been both to the moon, and the deepest trench on Earth. We've flown many times faster than sound, and slowed light down to walking speed. We've got telescopes probing the very beginnings of the universe and microscopes probing the very beginnings of our own microbiological structure.

You're telling me that a species capable of all these beautiful, fantastic things will forever be doomed to die at 80? Will forever been doomed to be too frail to work after 65? That, despite all of our advances, we still must fatalistically accept our own end - going quietly into that good night?

Fuck that.