Libertarians argue that we need to privatize government benefits for senior citizens, but they generally defend life-extending medicine so long as it's paid for out-of-pocket. Progressives want to defend and expand universal provision of health care, but generally reject greater access to enhancement medicine as an expensive waste of resources.

The irony is that both are wrong. Universal healthcare systems and antiaging medicine are precisely the means by which we can control healthcare spending in the coming decades, ensure top quality health care, and keep our parents and ourselves alive.

Wasteful America

First let me address my fellow countrymen. With 45 million uninsured and only 60% of US workers getting insurance at work, Americans still spend twice as much per person per year on health care as Europeans and Canadians with their universal systems. Yet we have either worse or equal health outcomes. As healthcare costs continue to balloon, more Americans will fall out of coverage and more restrictions will be placed on our choices.

Neither the healthcare policies proposed by the Bush administration nor the Kerry campaign offer serious cost containment. The Bush proposals would cost an additional $90 billion (all figures US) by 2014, and only expand coverage to 5% of the uninsured. The Kerry plan would cover more than half of the uninsured and reduce out-of-pocket costs, but cost the federal government an additional $650 billion by 2014.

US health care needs radical surgery, not massage therapy. We need to create a universal healthcare system to expand coverage to all Americans with either a single-payer or universal voucher system.

Universal solution

Universal health care is a counterintuitive answer to healthcare inflation for some since it would provide more to the un- and under-insured. But universal care systems are more cost-effective for a number of reasons.

One is that they are better at treating diseases preventively. Universal healthcare systems are better at directing resources to public health and primary care instead of the excessively specialized medicine that Americans use. Uninsured Americans delay care until their conditions require expensive treatments, and the US Institute of Medicine has estimated that the uninsured cost the country between $65 and $130 billion annually due to their poorer health alone.

Universal healthcare systems also eliminate the administrative overhead generated by hundreds of thousands of employers contracting for health insurance with 1,500 insurers, who in turn battle thousands of hospitals and millions of providers over reimbursement. A universal, single payer system's administrative savings alone would pay for covering the uninsured in the US.

And finally, universal healthcare systems give society one big purse string to pull to control costs, instead of hassling patients and doctors with managed care. This makes the people's democratic representatives and healthcare providers directly accountable for the funding and quality of health care instead of hundreds of thousands of MBAs second-guessing doctors' decisions.

Antiaging economics

Unfortunately, health costs are also inflating under universal healthcare systems, if not as fast as in the US. While healthcare spending inflated 2.3 times as fast as economic growth in the US between 1997 and 2002, healthcare spending still inflated 1.7 times as fast as economic growth in the rest of the industrialized world during that period. Even though Europeans and Canadians are spending far less, they are also struggling and tempted by privatization.

Fortunately, 21st century medicine offers a way to radically reduce the cost of health care while improving its quality: by shifting spending from the treatment of illness to the prevention of illness through slowing the aging process.

Again, providing new, expensive therapies to the growing number of seniors so they can grow even older is a counterintuitive approach to cost containment. If the growing numbers of seniors and their use of expensive high-tech medicine is causing the crisis, won't keeping them alive longer with expensive tech, so they can use expensive tech longer, cost even more?

No. Healthcare costs aren't being driven up by the simple existence of therapies or seniors. They are driven up by the need to use those therapies to treat seniors' aging-related diseases and disabilities. Today, the average 75-year-old American has three chronic medical conditions and takes five prescription drugs. If seniors didn't get sick, they wouldn't need expensive diagnostics, drugs, treatments and nursing care. They would remain engaged as net producers of value in society, rather than net consumers.

Currently, after about age 50, average spending on the treatment of age-related conditions increases with every year of life. Emory University health economist Kenneth Thorpe recently demonstrated in Health Affairs that aging-related conditionsheart disease, cancer, stroke, pulmonary disease, hypertension, arthritis, diabetes and so onare the principal drivers of healthcare inflation in the US, accounting for 11 of the 15 most expensive conditions.

Aging-related disabilities are also an enormous financial burden, adding about $26 billion a year in health costs in the US. The US National Center for Health Statistics reported in 2003 that the average senior citizen with no activity limitations costs about $4,600 in health care and long-term care, a moderately disabled senior costs about $8,500 per year, and a nursing home resident costs about $45,000 per year. They concluded that seniors who live longer healthy able-bodied years cost the same or less in the long-run than those who live fewer, sicker years.

Seniors in Europe, with universal health care, not only live longer than Americans, but live two to three more years without disability. But we can do much better.

A therapy that stopped aging itself would keep seniors active, health and fit into their second century, reducing the costs of both disease and disability for decades.

Fortunately we are very close to breakthroughs in antiaging therapies. British biogerontologist Aubrey de Grey estimates that just $100 million of research funding a year for 10 yearsjust 0.4% of the current US National Institutes of Health annual budgettargeted at the seven major biological aging processes could create a therapy for "negligible senescence"i.e., stopping agingwithin 20 years. Currently, total federal spending in the US on research into and prevention of aging-related diseases is just 0.3% what is spent on treatment.