This is Part 2 of our interview with Victor Basiuk, Ph.D., a well-published expert on the impact of science and technology on international relations and national security policy, on an aging global population and the potential of healthspan. Please note Dr. Basiuk’s opinions are his own. Please go here to see Part 1.
Q: Last time, we talked about the challenges an aging society presents to the U.S. But how could extension of healthy aging benefit the U.S.?
VB: There are more reasons than one, but the single most important reason is that extension of human longevity without age-related diseases would release huge resources from the health care sector, resources which could be used to balance the budget, reduce the national debt, and revitalize the economy. As far as the federal budget is concerned, the principal beneficiary of the cost reduction would be Medicare, which largely covers the aging population. According to the 2014 Report of Medicare and Social Security, which provided cost projections for the next 75 years, Medicare will rise from the 2013 level of 3.5 percent of GDP, or $582.9 billion per year, to 5.6 percent, or $3.2 trillion, in 2040, and then to 6.9 percent, or $31.7 trillion, of GDP in 2088.
Funding of health care by the federal government is not limited to Medicare. In FY 2015, the federal outlays for Medicaid are expected to be $331.4 billion. At least 50 percent of the Disability Insurance (DI) component of Social Security (about 9 percent of the total outlays for Social Security) stems from age-related diseases. When projected into the future, the savings in DI alone from healthspan would amount to trillions of dollars. This would significantly help to offset the additional cost to Social Security because extension of healthspan would increase human longevity, resulting in larger outlays for Social Security.
The total cost of health care for the federal government is huge and is growing rapidly. According to projections by the Congressional Budget Office, spending on the major federal health care programs will grow from 4.6 percent of GDP in 2013 to 8 percent in 2038, or $4.2 trillion per year.
Extension of healthspan could significantly help resolve the situation by eliminating the need to treat age-related diseases for an extended period of time.
It is, however, important to point out what, exactly, is “extension of healthspan” and what are its economic implications. As presently referred to, extension of healthspan is a certain limited period of time—say, 15 or 20 years—without age-related diseases, which, biogerontologists believe, is achievable. The economic impact of such an increase of healthspan, although quite significant, would be only a temporary reprieve. This is because after the period of healthspan expires, the risk of diseases will return. The re-emerging diseases will require funds to deal with them, and they will be costly.
Q: So what can be done about this?
VB: The temporary reprieve of extension of healthspan cannot be completely eliminated, but its economic effects can be minimized by what is referred to in science as “compression of morbidity.” Recent studies of centenarians, people who live 100 years or longer, revealed that most of their lives they have few, if any, age-related diseases; these diseases emerge only a few years before their death. Apparently, centenarians have genes that compress age-related diseases (”morbidity”) toward the end of their lives. If such genes were discovered and translated into drugs, the economic impact of the extended healthspan will be much greater because these diseases will have to be dealt with only for a few, not many, years. Therefore, it would be essential that any major program to extend healthspan includes research for morbidity-compressing genes—and there are ongoing studies for this purpose that have produced some partial results—because only if such genes are discovered will extension of healthspan be a truly major breakthrough with significant benefits for society.
Q: The benefits of healthspan are obvious, we’ve established. How do you think extension of healthspan can be accomplished?
VB: As I see it, there are three options for implementing extension of healthspan:
- To leave things as they are now, i.e., to let individual researchers, universities, and companies conduct research on human longevity and extension of healthspan without much coordination, clear priorities, and a focus on healthspan. This is a very slow process that will eventually produce extension of healthspan, but it will take many years.
- To establish a Manhattan-like project, which would focus on extension of human healthspan, not on human longevity. The principal characteristics of the Manhattan Project, which produced the first nuclear weapon, that are relevant for extension of healthspan were: a single focus, intensity of pursuit of its objective, and independence from other scientific institutions.
- To establish an International Manhattan Project for Extension of Healthspan (IMPEHS), which would have the principal characteristics of the Manhattan Project, but would also include the European Union, Japan, China, and perhaps also other nations. The United States is the leading nation in research on extension of healthspan and could accomplish it unilaterally, but to put it on an international basis would have certain distinct advantages:
(a) It would lower the costs of research for the United States. Such costs have been estimated at about $10 billion (according to some researchers, it could be done for less) for five to 10 years, but with other nations chipping in they could be lowered to perhaps $3 to $5 billion.
(b) It would be very useful for the United States as an instrument of soft power, which includes world leadership in foreign affairs.
A Manhattan Project for Extension of Healthspan, if established, would significantly expedite the implementation of extension of healthspan.
Q: Do you think the extension of healthspan is achievable enough to make an impact in the near future?
VB: In recent years, biogerontologists have made substantial progress in this area. The scientific infrastructure for extending longevity and the corresponding delay in the onset of age-related diseases has been built, and this has been clinically demonstrated on mice. Moreover, in April of this year, the Dog Aging Project, headed by Matt Kaeberlein at the University of Washington, has been initiated. The project is expected to achieve a 10 to 25 percent increase of healthspan in dogs within two to five years. The Dog Aging Project uses rapamycin, which has been very successful in extending healthspan in mice, as the principal anti-aging agent in its research. Findings of this project would likely be useful for research on human healthspan and may expedite its progress. Leading U.S. biogerontologists believe that with adequate funding (and at this time extension of healthspan is starved for money) they will be able to extend healthspan for humans up to 20 years within five to 10 years.
In short, if funding is available soon and assuming that research will take 10 years, a conservative assumption, and allowing a year or two for procedural and organizational delays, the lead time for discovery of extension of healthspan would be 11 to 12 years. To this must be added four to five years for the extended healthspan to produce a meaningful economic impact, bringing us to a total of 16 years or the year 2031. At this time, the U.S. debt-to-GDP ratio will be about 82 percent, which is precarious, but not necessarily critical. However, the debt-to-GDP ratio is projected to reach 101 percent by 2040, which suggests that a fiscal and/or economic crisis will be very likely between 2031 and 2040. Of course, depending on world events and other contingencies, such crises could occur much sooner than that, especially since our ability to respond to, and prevent, such crises will be increasingly narrowing with the growth of the national debt. Therefore, action in the area of extension of healthspan is quite urgent.