50? You should be eligible for Medicare
Yet again, the U.S. has come in last in a survey measuring the state of health in developed countries. This latest piece of disheartening news put the spotlight on people over 65, the age when Americans become eligible for Medicare. The survey, produced by the Commonwealth Fund, included more than 23,000 people from 11 developed countries, and revealed that American seniors were sicker than their counterparts in other countries and are more likely to go without needed health care because of costs.
Why should this be? For one thing, Americans are more likely to enter the 65and-up age group with chronic diseases – heart disease, diabetes, hypertension – which aren't curable but could have been headed off had people gotten better care earlier.
"New beneficiaries are coming into [Medicare] with a whole health trajectory set by the care they got earlier in life," said physician Steven Woolf, director of the Virginia Commonwealth University Center for Society and Health. While he and other health-care experts I spoke to favored the common-sense approach of creating a system more like those in the healthiest countries, they conceded that Americans aren't likely to switch to anything that smells of socialized medicine.
Yet surveys show Americans like Medicare. So at the very least, perhaps Medicare could be adjusted to fit better with the realities of our biology. That would mean pushing the age of eligibility to somewhere around 50.
Just being over 50 is a major risk factor for everything from diabetes to colon cancer to detached retinas. It's as if the warranty on your body expires. This is not just a casual observation. S. Jay Olshansky, a researcher who studies aging at the University of Chicago School of Public Health, said that our worst chronic diseases can be seen as an inevitable result of operating the human body beyond its warranty period.
He pointed out that all animals that engage in sexual reproduction have finite lifespans which are connected to the age of sexual maturity. Mice hit puberty at 30 days and live a mouse-sized lifespan of about 1,000 days. Humans hit puberty at 13 and live around 75 years, and Greenland sharks reach puberty at 150 and can live to be 400. "What I'm talking about is a set of genetically fixed programs for growth, development and reproduction," he said.
Someday perhaps we can engineer ourselves to be more like Greenland sharks, but for now, humans reach the end of our reproductive lives around 50. While men don't technically go through menopause when they reach that age, they are on the same trajectory as women, actually sliding toward death a little faster in most mammals. Evolution has equipped many of us with the ability to coast for a few years after 50 – thus allowing humans to care for any late-arriving offspring. But for the most part, Olshansky said, "You're living on your reserves."
It's not so much that the over-50 body is programmed to die, but that the under50 body is programmed to survive – with all kinds of mechanisms in place to repair miscopied DNA and otherwise temporarily hold off the unyielding power of entropy. After that, you might live for decades, if you're lucky. There are no guarantees.
Medicine is much better at treating common chronic diseases when the first warning signs appear than later, when people start to suffer debilitating permanent damage from heart attacks or diabetes complications. Olshansky cites regular exercise as a key factor in improving your odds of healthy aging and a long life. And while a doctor can't make people exercise, it can't hurt to get more 50-yearolds into good primary care where they find out about their risks and learn how stay healthy longer.
The Commonwealth Fund survey also revealed another problem: A third of Americans over 65 reported that they either skipped going to the doctor when sick or failed to fill prescriptions because they couldn't afford the copays or deductibles. These are people who are balancing their medical needs with their ability to pay for food, heating and rent, said Robin Osborn, who headed the study.
Being poor hurts people's health in other ways as well. Contrary to the popular notion that the stress associated with power is unhealthy, recent science has shown that it's really the stress of living at the bottom of the socioeconomic ladder that kills. Newer studies have also cast doubt on the conventional wisdom that rich food causes chronic illness. It now looks like the fault lies in cheap food – sugar and starch – that makes up too much of the diets of low-income people.
Is there any good news about the state of American health? VCU's Woolf said that in a 2013 study he headed for the Institute of Medicine, Americans proved sicker than those in other wealthy countries until age 75, after which the U.S. started to come in line with the rest of the developed world. This may reflect a delayed benefit of Medicare, as well as U.S. superiority at high-tech medicine, but he said it also may result from a selective effect: We take such bad care of people up until 75 that by that stage in life, only the healthiest and hardiest remain.
Perhaps that's not so encouraging, but for Americans it should come as good news that we can live longer and stay healthier as we age. Until scientists figure out the secrets of the Greenland shark, we can follow the lead of other developed countries. Medicare at 50 would be a step in the right direction.