Cost effective for sure . . .

At this week's grand rounds our medical director suggested googling "Czech Republic tobacco New York times" if we wanted a thrill. The hit is a Bob Herbert column that's a few years old but it's still pretty relevant on several levels. It seems that officials over there in Dvorak land were worried about the high medical costs of tobacco-related disease. Philip Morris commissioned a study to prove them wrong.

It turns out that "The premature demise of smokers saved the Czech government between 943 million koruna and 1.19 billion koruna ($23.8 million to $30.1 million) on health care, pensions and housing for the elderly in 1999, according to the report." I believe someone actually made a similar calculation for the United States. Eliminating smoking would mean big costs in future social security and Medicare expenses as people had the temerity to live on into old age.

I point all this out because it is an inconvenient truth: we will never save money in the long run by preventing disease and promoting health unless we somehow achieve a state in which most people live in good health and then quickly drop dead; and more people keep working well past 65. That's not where we're going, unfortunately. The more people live into old age, the more expensive their medical care will be, because we are absolutely nowhere near arresting the aging process.

I realize this is a downer, but it has to be factored into our thinking about the future. We face rising unfunded pension obligations, medical costs, incalculable unfunded need for infrastructure replacement, and a whole lot of other problems we need to solve, and a declining percentage of the population that's of what has traditionally been considered working age. I think we're just going to have to try to encourage more people to defer retirement. That doesn't have to be a drag if work can be rewarding.

Update: I wrote this before I came across this on the front page of Kos. I swear.