TIME GOES BY | REFLECTIONS: On Longevity

by Saul Friedman

This began as an essay on longevity, the advances the United States and much of the world have made in increasing life expectancy. Then I came across this piece from The New York Times of October 24, 1880. The story, entitled, Living Too Long, began:

“Generally speaking, one of the last and least of our anxieties is that we may live too long. Throughout youth and maturity, the prospect of longevity is very apt to be pleasant, for the thing itself seems desirable – far more so in the distance than if at hand.”

As usual, The Times came to no conclusion although the article made a strong case against growing too old without telling us how long is too long? In 1880, the life expectancy in the U.S. for white males was 40. Today it’s 78.2, somewhat less than Japan (82.6) and most of Europe, (in the 80s) all of which provide universal health care.

But it’s not my aim to promote access to good health care, but to examine a strange phenomenon. The world has had great success since 1880 in achieving a longer, heathier life for people almost everywhere. Indeed, life expectancy in most of the world has grown by 10 years just since 1960. And yet, too many Americans, politicians and ordinary people seem to fear longevity, and some are questioning whether we’re living too long.

A woman I met years ago who was the subject of my column on the problems of older Americans, had just placed her husband, suffering from Parkinson’s disease, in a nursing home and she didn’t know how to pay for it and continue to keep up her own home and living standards. “Who knew I would live this long?” she said. She was only 70.

A few weeks ago, a reader told me quite candidly that people on Medicare or Social Security were selfish and should forgo these programs, “that will keep you alive for a few more years; better to use the money to send your grandchildren to college.”

That we on Medicare and Social Security’s are living too long and are a drain on the rest of society is not a new idea. Twenty five years ago, the Atlantic Monthly, with the help of an ugly caricature, depicted older Americans as “Greedy Geezers.”

And about that time, then Gov. Richard Lamm of Colorado told a meeting of lawyers that elderly people who are terminally ill “have a duty to die and get out of the way” rather than try to survive by artificial means. People who allowed themselves to die, he said, are like “leaves falling off a tree and forming humus for other plants to grow...Let the other society, our kids, build a reasonable life.” He figured it’s better to be humus than to watch your grandchildren grow up.

In 1996, as a former governor, Lamm was at it again calling for Medicare to be cut tenfold because it was spending too much prolonging lives. And he predicted tht, as the society ages, “we have to learn to run a nation of 50 Floridas.” As we shall see, that sour vision of the future has cropped up more recently.

But the criticism that Medicare spent too much money on the last years of the lives of beneficiaries, along with efforts by Newt Gingrich’s Republican Congress to privatize Medicare and cut its funding, prompted Medicare in 1995 to begin its hospice program.

Medicare paid fully to care for patients whose doctor attested that they had less than six months to live. Patients who volunteered to enter hospice had to agree that they could receive only palliative care – pain killers and bedside help - to make them comfortable. But they were denied curative treatment, including their own routine medicines, even if there was a chance it would prolong their lives.

But the hospice program gave lie to the notion that death is the answer to saving money. Fortunately, as medical advances such as chemotherapy, open heart surgery and more sophisticated diagnostic techniques like the CT-Scan and PET-Scan became available and common, it was no longer as easy as Lamm suggested to call patients terminally ill, or to predict how much longer they had to live.

Few doctors will tell a patient how long he or she has to live for the course of an illness is not predictable for everyone. Cancer patients today may survive into their eighties. And the severely disabled, like Stephen Hawking, may contribute handsomely to the living.

As a result, Medicare now recognizes that the six-month prediction of a doctor, which is still required, may be extended indefinitely under current Medicare rules. Indeed, some patients get well enough to opt out of hospice care. In addition, Medicare dropped its prohibition on curative care and now permits a cancer patient to continue chemotherapy while in hospice.

Nevertheless, Medicare hospice will take over the care of a patient and is there to provide care for the patient (and comfort for the family) at the end of life.

Thus, it has become obvious that there is nothing predictable about aging except that it will end. Everything else is a matter of luck, background, chance, environment, genes and perception. We are not as old as our parents were at our age. And likely they didn’t live to be our age.

You know the cliches: 40 is the new 30; 60 is the new 50; and so on. As the boomers came of age, AARP recognized the changes in the perception and the realities of aging when it lowered its membership eligibility age to 50. In short, longevity is to be celebrated rather than feared.

One of the first writers to call for a celebration of longevity was social historian, Theodore Roszak, who wrote the classic study of the Sixties and coined a new phrase, in The Making of A Counter Culture. In his 1998 book, America the Wise, he called on the nation to celebrate and welcome the wisdom of America’s booming population of older Americans.

“The future belongs to maturity,” he wrote. “Never before has an older generation (more than 80 million Americans in their sixties, seventies, eighties and even nineties) been so conversant with so many divergent ideas and dissenting values.”

His book was published before the full force of the digital explosion, but the older generation, the aging boomers and even those who may be called elderly, are not lagging behind younger Americans in their skills with computers and accompanying gadgets. Indeed, the geniuses at Apple, Google, IBM, Microsoft and Amazon are beyond their boomer years.

Roszak’s 2001 update of America the Wise, entitled The Longevity Revolution, says of longevity, “It is inevitable. It is good.” His optimism is shared by the godfather of the study of aging, Dr. Robert N. Butler, a geriatrician and founder of the New York-based International Longevity Center, a think tank on issues facing older America.

Butler won a Pulitzer Prize for his 1975 book, Why Survive, a pioneering study of what it’s like to grow old in America. His was not an encouraging picture of “old age.” He became the first director of the National Institute on Aging, and has done more than any one to call attention to the potential and problems of longevity. And despite the longevity alarmists, much has changed for the better.

His latest book, in contrast to his first, celebrates the rewards and possibilities of aging in America. Entitled The Longevity Prescription, Butler, who is active in his eighties, begins with a chapter on “Embracing longevity.” He notes that in the beginning of the 19th Century, life expectancy was 35. “In round numbers we can anticipate living ten thousand days longer than our ancestors could a century ago.”

Butler established the first school of geriatric medicine at New York’s Mt. Sinai Hospital, and speaking as a doctor, Butler says,

“The average American does not need to resign himself or herself to spending these added decades descending slowly and unhappily into disease and disability...You are not your parents’ genes.”

And he proceeds to dispel some of the myths of aging and he prescribes some reasonable things all of us can do to prevent illness and remain active and mentally alert. “No matter what your age, there are ways to enhance your longevity.” They seem as obvious as his admonition to quit smoking (Butler was a smoker), but they are too often overlooked.

His advice includes, how to maintain mental vitality; why you should nurture old and new relationships; and how to get effective medical care.

I have interviewed Butler, was a participant at his first Age boom Academy at his longevity center and I know that he and Roszak are ardent defenders of Social Security and Medicare and advocates for single-payer, universal health insurance. To these ends, the new version of Roszak’s book exposes the rich predators who see longevity as “the Gray Peril,” driving America into bankruptcy because of the increasing costs of Medicare and Social Security.

Chief among these attackers of entitlements is former Nixon Commerce Secretary Pete Peterson, a Wall Street billionaire who now runs the right-wing Concord Coalition, which would privatize Social Security and Medicare. Roszak wrote that Peterson, who published a dire warning about the growth of entitlements in The Atlantic in May,1996, believes that they are unsustainable, unprincipled and unfair.

But more striking, said Roszak, Peterson’s warning treated older Americans as “an alien species of obnoxious, geriatric layabouts thronging the sunny shores of Florida.” He too warned that we should be prepared to become a nation of Floridas.

Nevertheless, Peterson’s long crusade has found comfort in, of all places, the Obama administration. Under pressure from conservative Democrats as well as Republicans, Obama created a commission to deal with the rising deficit. And as expected, the deficit hawks are not singling out the cost of wars and the military, but entitlements, including Social Security, which is sustained by payroll taxes and adds nothing to the deficit. And contrary to too much misleading reporting, it remains financially sound for at least another 30 years.

Peterson, who made millions as a hedge fund manager and took advantage of tax breaks, “continues to lecture on the need to cut Social Security and Medicare for retirees who have a tiny fraction of his wealth,” said economist Dean Baker.

Because of the recession and high unemployment, the Social Security system will pay out more in benefits this year and next than it takes in payroll taxes, but that happened in the recession of 1981-2 and in 1983, Ronald Reagan approved a fix that saved Social Security for 75 years.

Thus Baker chastised the Wall Street Journal for saying the Social Security trust fund will show a deficit; the trust fund earns interest on the bonds it sells to the Treasury and will show a surplus of $100 billion this year.

But on the larger issue of entitlement spending, Princeton’s Uwe Reinhardt, the nation’s leading heath economist put the hysteria about the cost of entitlements in perspective. In a lecture for the Woodrow Wilson School in Washington, he noted that outlays for all Social Security programs, though not part of the budget, will remain flat at six percent of the Gross Domestic Product for the next 60 years, while Medicare spending will rise from the current 3.59 percent to 8.74 percent in 2050.

But not to worry, Reinhardt said. By 2050, even at an annual growth rate of 1.5 percent, the GDP per capita will grow from the current $40,0,000 to $78,200.

“Why should I worry about who will be running the world in 2050,” said Reinhardt, “when they will have so much real GDP to play with.”

Finally, Pete Peterson and his Wall Street allies are smart enough to know, for example, that Social Security is not a budget problem. So why are they attacking it? For the same reason George W. Bush sought to turn the insurance and pension program into millions of 401(k)s: think of how Wall Street will celebrate if the brokers and bankers can get their hands on the bonds in the trust fund, worth $2.5 trillion.

I don’t think that will happen unless the Republicans, who are calling for the partial privatization of Social Security, get another chance to govern. Then those of us who welcome our own longevity will have reason to be afraid, very afraid.

TIME GOES BY | REFLECTIONS: On Longevity