It’s relatively common for advocates of health care reform or government sponsored insurance to say that the US health care system is broken because we pay more for care than many countries whose citizens live longer. Indeed, much of the health care debate is conducted in terms of longevity. But almost everyone in the debates is engaged in the unwarranted over-valuation of increased longevity.
Let’s start with some basics. It’s far from obvious that the point of health care should be to extend life or raise average lifespans. It’s not even clear that extending lifespans following the diagnosis of a serious disease should be the primary goal of health care. There’s a long tradition, in fact, that argues that it is the quality of life rather than the length of it that should be the true measure. “Life is good, be it stubbornly long or suddenly a mortal splendor,” the poet Robinson Jeffers once wrote.
Since extending life often involves trade-offs that include giving up some of life’s pleasures, surrendering personal and family obligations or adopting extraordinary means of artificially prolonging life, it probably isn’t a good idea to use lifespan as a proxy for the effectiveness of health care. In fact, by assuming it is a proxy we might wind up directing resources away from other health care goals and toward lifespan extension.
There’s good reason to suppose that government in intervention in the form of various subsidies may have artificially inflated the value of extended lifespans. Social Security, subsidized drug programs and other government sponsored elder care measures decrease the costs of a long life, while penalising the short-lived. Aggregate demand for living long increases as its costs to the individual consumer are reduced.
This government sponsorship has probably already led to over-investment in longevity. Many in health care probably believe they are responding to a natural desire to live longer when in fact they are responding to a government distortion in the market. Indeed, the rapid increase in lifespans over the couple of centuries looks a bit like an extremely long-lived bubble.
No doubt some of the confusion about the goals of health care has deep philosophical roots. Philosophers since Thomas Hobbes have placed “fear of death” at the centre of human activity. The evidence for this has always been mixed, and philosophers have tied themselves in intellectual knots trying to explain heroic self-sacrifice or even the willingness of people to engage in mortal combat. Reading anyone from Hobbes to Hegel tackle these problems, it’s easy for an outside observer to conclude that it would have been simpler to ditch the ‘fear of death’ assumption.
Unfortunately, much of the health care debate seems to be built around either the idea that extending lifespans is the primary goal of health care or an good proxy for its effectiveness. With this bad measuring stick, we’re sure to wind up building a bad health care policy.
It also makes us wonder what the world will look like if the lifespan bubble ever pops.
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