What do we need to do about the financial burden of health care? This issue has upset our political class for decades. Even the passage of Obamacare in 2010 failed to address the problem. Now President-elect Biden will have the turn to tackle our country’s most intractable long-term challenge. To succeed where others have failed, Biden should focus on a solution that improves health outcomes while lowering the cost of care – the treatment of biological aging.
The fundamental problem with health care in the United States is that it is expensive. In 2018, the latest year for which record data is available, national health spending stood at 17.7% of GDP, or $ 3.6 trillion. Politicians are vigorously debating whether and to what extent consumers, employers, or the government should pay for care, but the victory by all sides is only for newspapers over rising costs. The reality is, we all pay $ 3.6 trillion a year in one way or another – through higher taxes if the government pays, through lower wages if employers pay, or directly with our own. money in personal scenarios. To solve the problem, we must reduce the cost of care by $ 3.6 trillion.
Not all cost reduction methods are created equal. The few times that politicians have tried to control health care costs, they have done so through rationing. This is inevitably unpopular and politically unsustainable. Obamacare Independent Payments Advisory Board – Remember the “Death Signs”? – was repealed in 2018. Unlike rationing, which generates lower costs thanks to a reduced supply of care that almost invariably leads to worse health outcomes, we need solutions that prevent people from accessing 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 improvement in health productivity is to understand and approach the biology of aging. Our population is aging – in 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 a health care cost tsunami. With such treatments, Americans will experience healthier and more productive years of life. Chronic diseases are said to be delayed, a phenomenon that public health experts call “compressed morbidity.” This translates into lower medical bills.
Already, there is promising scientific research on reversing aspects of aging, some of which is not far from clinical application. Specifically, UC Berkeley’s Conboy Labshowedthat molecules circulating in the blood plasma of elderly people and mice cause our tissues to show signs of aging. By removing some of the plasma circulating in mice and replacing it with a solution of albumin and saline, the researchers were able to dilute these harmful molecules and cause muscle, liver and brain tissue to behave as if it were. they were younger. The researchers also studied the tissues of a small number of human subjects receiving similar treatment and found consistent results. This plasma exchange procedure is simple, inexpensive, and already approved by the Food and Drug Administration for a number of conditions (but not as a treatment for aging).
Treating the thymus gland could also dramatically change the aging process. The thymus is essential for the health of the immune system, as it is the source of T cells that kill viruses and cancer cells. As we age, the thymus gradually turns into a lump of fat, no longer producing new T cells, and our immune system begins to weaken. But in a study published in 2019, scientists were able to rejuvenate the thymus in a group of men aged 51 to 65. A cocktail of human growth hormone, zinc, and a few other inexpensive, non-patented drugs and supplements seemed to revive the thymus, and the researchers “Analysis of DNA methylation, a chemical modification of DNA, dependent on age, showed that subjects gained approximately two years of expected lifespan.
A documentreleased this year proposed a new brand of aging; stiffening of the “extracellular matrix”. As we age, the scaffolding that our cells rest on builds up a build-up of protein that makes them more rigid. This less flexible environment causes our cells to change their behavior, showing signs of old age. By developing new drugs that can remove the build-up of these protein bonds, a non-trivial but achievable task, we could make our tissues young again. There is even speculation that this stiffening of the extracellular matrix could be an upstream cause of many of the other features of aging, making it one of the most promising targets for future research.
While all of this research represents exciting progress, we are investing far too little in research that could help us advance our understanding and treatment of aging. From the National Institutes of Health’s annual budget of $ 40 billion, Less than 1% goes to the Division of Biology of Aging at the National Institute of Aging. This is a shockingly low level of funding for an area of research that could pay huge dividends. If $ 1 billion in funding (more than three years of spending at the current rate) reduced seniors’ morbidity and health spending by 1%, it would pay off just on Medicare savings in two months.
What about the long term? The idea of targeting aging for medical intervention has stirred the imagination – could we ever find a path to perpetual youth? While this kind of breakthrough is probably decades away, there is no reason in principle to believe it would be unachievable. All of the known characteristics of aging appear to be addressable. But even if it doesn’t, understanding the underlying biology is worth it if it translates into a few extra years, if not decades, of healthy, productive lives.
With COVID-19 hopefully soon behind us, why not launch an Operation Warp Speed for Biological Aging? As the Biden administration takes power, it will face many challenges, but it will also have the opportunity to set priorities. By prioritizing the study of aging, the new administration could chart a new trajectory for health spending, make our politics less confrontational, and – better yet – offer Americans healthier trips around the sun.
Eli Dourado is a Principal Investigator at the Center for Growth and Opportunity at Utah State University.
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