The world will have 1.3 billion people over 65 by 2040, according to a new report from the US Census Bureau. According to Reuters, “An aging population will push up pension and health care costs, forcing major increases in public spending that could slow economic growth in rich and poor countries.”
The financial burden for caring for these senior citizens is only part of the problem. The ethical concerns are another and a much more difficult issue to address.
The current assumption in the US is that the government and private insurance companies will provide universal health care in America if the Administration’s programs are approved by Congress, which will be accomplished at a cost of over $1 trillion over the next decade. Experts, including the CBO, believe that even an investment this large will not be enough to cover the entire burden of making sure that every man, woman, and child in this country gets complete medical care.
Most large developed nations have some equivalent of universal health care. China and other large developing nations have provided hospitals and doctors for most of their people, but health care delivery in rural areas is spotty and the strain of caring for hundreds of millions of elderly citizens could strain the Chinese central government, even though it has run huge surpluses for several years and has reserves of nearly $2 trillion.
The ethical conundrum that all of these large countries will face –and it is a problem that will be even more severe in underdeveloped countries — is whether caring for the aged will become such a large financial and social obligation that health care to the old will be rationed. People over 70 who develop cancer may only receive the most modest treatment. People who are over 75 or 80 with cardiovascular disease may be treated for their symptoms only. The elderly who might receive significant intervention to impede their declining health in 2009 may receive little or nothing in the way of similar care in 2040.
National health care as it exists now in a number of countries favors aggressive treatment of acute and chronic illnesses in the young and middle-aged while the old get little more than palliative care. The old are left to die from diseases and conditions that could be treated. The government in some countries in the future, with the support of their citizens, may opt not to take on the massive expenses that will improve real quality in the lives of the elderly and that can extend their lives by years, if they are statistically people who are near the end of their lives.
What may happen as the global population of people over 65 increases is a “lifeboat effect”, an environment in which there are limited resources to keep all of the people healthy which will result in some being denied aid or being cast overboard altogether. It is an incomprehensible way to treat people who are aged for a population used to different ethical and medical standards. This may be part of the future, driven by fiancial concerns, and it may be unavoidable.
The alternative to rationing healthcare to the old is to set up systems, country by country, where each year hundreds of billions of dollars worldwide are devoted to longevity. Some nations may decide that each and every person has an inalienable right to live as long as modern medicine can provide. That decision may put an extraordinary tax burden on any nation’s working population. It may slow GDP growth. It may force the middle aged to take days, weeks, and months away from their jobs to care for their parents, further reducing productivity and the taxbase.
The issues of acute care for the elderly are not several generations away. These issues are likely to become part of the debate about national budgets in countries where economic growth is no longer 5% or better. These economies may not be able to support universal health care without massive increases in taxes to both individuals and businesses. A much higher taxbase may still be inadequate in countries where large percentages of the population are elderly and economically unproductive.
The old and young will fight for healthcare and economic resources as the ranks of the elderly swell.
Douglas A. McIntyre
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