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Not surprisingly, this gray boom wouldn't come cheap. If life expectancy increases 10 years in 2012 and later, by 2028, annual Medicare expenditures alone would more than double relative to current levels, reaching $1 trillion. They'd double again to $2 trillion by 2050 and top out at $3 trillion in 2080. Total expenditures including Social Security and disability would be $10 trillion by that final year. In the real world, of course, life expectancy doesn't increase in the sudden way it does in FEM models, but it can increase fast as America's addition of almost 30 years in a single century shows. We may not have to deal with the sticker shock of the FEM experiment, but the financial burdens on societies will inevitably grow as people live longer.
What drives up the medical portion of the costs so fast is that the mere ability to hang around till you're nearly 90 doesn't mean you're hanging around healthily. A study by the nonprofit Commonwealth Fund found that up to 20% of people entering Medicare are already suffering from five or more chronic conditions, such as hypertension or high cholesterol. Most of those ills are treatable, but not always inexpensively, and every extra year of life is another ring of the cash register. What's more, routine ills have a nasty way of turning into not-so-routine ones. "If people are getting older but still developing conditions at the rates we get them now," Goldman says, "you'd have half the elderly population suffering from heart disease."
Even when people do age healthily, that doesn't necessarily mean they're saving money. A 2005 Rand study looked at four common risk factors for health hypertension, obesity, diabetes and smoking and tried to determine what the cost effect would be if the conditions were partly or entirely eliminated among the elderly. The results were mixed. Eradicating hypertension would save Medicare a total of $890 billion in the 2005-to-'30 period. Cutting obesity 50% would save $1.2 trillion. Completely controlling diabetes, however, would actually increase spending by $246 billion. Eliminating smoking would boost costs by $293 billion. Why? Because diabetes and smoking cut off more years of life than hypertension or obesity. When you restore those years, seniors stay around long enough to make other claims on Medicare and those claims may exceed the money saved by eliminating the original problems.
"We call these 'first-order effects,'" says Mark Mazur, a U.S. Treasury tax-policy expert. "People have a longer time in retirement, so they're making greater claims on both Medicare and Social Security."
But wouldn't a nation of people who lived longer also work longer and thereby offset some costs by continuing to pay into the national tax kitty? Not necessarily. As it turns out, most people would choose to or be forced to punch out at normal retirement age anyway. According to the newer Rand analysis, an extra 10 years of life assuming no change to Social Security or Medicare would boost the Federal Government's income-tax haul just 3% by the mid-2030s and a mere 6% by 2080. "You could tell yourself a story that people would be productive longer," says Mazur. "The question is what kind of work would be available."
A different and often voiced concern is that those seniors who did continue to work would clog up the labor market, hanging on to jobs and denying them to younger people a particular danger in a static or contracting economy. But Mazur believes that worry is overstated, in part because old people and young people rarely seek the same positions though with manufacturing jobs being replaced by service jobs, the difference in physical abilities between the two groups is less important. Still, a likelier consequence of more seniors in the labor force would simply be that careers would play out more slowly, with what is now a 30-year climb up the company ladder perhaps taking 40 years. Younger workers themselves might ease the pressure by spending the early parts of their careers doing lower-paying, service-oriented jobs say, for Teach for America or the Peace Corps if they are given some incentive to do so.
Even if a 65-plus population explosion didn't make a mess of the job market, it could certainly help make a mess of the planet. The U.S. trash and carbon footprints are already huge, with every one of us throwing away roughly 1,679 lb. (760 kg) of garbage per year and generating 20 tons of atmospheric carbon. Now imagine adding 43 million more of us.