Silver hairs among the golden . . .

One of the most widespread misconceptions is that the aging of the population is a major contributor to the increase in overall spending on health care. It's important to understand why that isn't true. Some of my earlier postings provide helpful background, but here's the straight dope.

It is true that people tend to use more health care and take more pills as they get older. Well, kinda. Children see the doctor frequently and gestating and delivering them is more expensive. But older people do cost more on a continuous basis. However, there is no correlation between the proportion of elderly and health expenditures in the OECD countries. Why not?

As much as 40% of health care expenditures occur in the last two years of life or so, in the process of dying. This is going to happen to everyone at some point. The longer we live, the later it happens, which actually means that we spend less this year and then spend the same amount at some time in the future. If we can succeed in compressing the time between the onset of serious illness and death, total expenditures will actually go down.

So those longer life expectancies in the European countries actually save money! The key is public health -- reduce rates of smoking and obesity, improve people's nutrition, keep folks active.

Now it is true that as more people turn 65, a higher proportion of health care costs in the U.S. will be paid for by Medicare and Medicaid. (Poor elders are eligible for Medicaid and they need it for things Medicare won't pay for, including long-term nursing home care.) That is a public policy issue we need to address. But we can definitely afford it.

In fact, we can easily afford it -- We need universal, comprehensive, single payer national health care. That way, our country's total health care bill will go down, even as we grow older. But we'll see if any prominent politician, or any reporter for the corporate media, says this publicly at any time in 2005.