What should we do about the financial burden of health care? This question has vexed our political class for decades. Not even the passage of Obamacare in 2010 has managed to settle the issue. Now President-elect Biden will get a turn to address our nation’s most intractable long-run challenge. To succeed where others have failed, Biden should focus on a solution that improves health outcomes while reducing the cost of care—treating biological aging.
The fundamental problem with health care in the U.S. is that it is expensive. In 2018, the latest year for which data is available, national health expenditures stood at 17.7% of GDP—$3.6 trillion. Politicians vigorously debate whether and to what extent consumers, employers, or the government should pay for care, but victory by any side only papers over rising costs. The reality is that we all pay $3.6 trillion a year one way or another—through higher taxes if the government pays, through lower wages if employers pay, or directly with our own money in out-of-pocket scenarios. To solve the problem, we need to slash the $3.6 trillion cost of care.
Not all methods of reducing costs are equal. The few times politicians have tried to control health costs, they have done it through rationing. This is inevitably unpopular and politically unsustainable. Obamacare’s Independent Payment Advisory Board—remember “death panels”?—was repealed in 2018. Unlike rationing, which generates lower costs through a reduced supply of care that almost invariably leads to worse health outcomes, we need solutions that keep people out of hospitals and doctors’ offices in the first place, by making them so healthy that they don’t need as much care.
The most exciting opportunity for such an improvement in health productivity is to understand and address the biology of aging. Our population is getting older—by the mid-2030s, there will be more Americans over 65 than Americans under 18. Age is the biggest risk factor for cancer, cardiovascular disease, and neurodegeneration. Without treatments to slow or reverse aspects of biological aging, an aging population means we are in for a health care cost tsunami. With such treatments, Americans would experience more healthy, productive years of life. Chronic diseases would be delayed, a phenomenon public health experts call “compressed morbidity.” This translates into lower medical bills.