Health Spans, Life Spans, and Health Care Costs

Special Guests: Richard Jackson, Bob Bixby, Tori Gorman

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On the latest Facing the Future, I was joined by Richard Jackson, president and founder of the Global Aging Institute, Concord Coalition Executive Director, Bob Bixby, and Concord’s Policy Director, Tori Gorman. We discussed Jackson’s issue brief on whether health spans are keeping up with life spans, his third publication in a series titled “The Shape of Things to Come.” We also discussed developments on COVID-19 relief legislation and Fiscal Year 2021 appropriations.


[Note: Portions of this week’s Facing the Future can be seen in the video clips posted below.]

Jackson discussed his third issue brief in the partnership series with The Concord Coalition, “Are Health Spans Rising Along with Life Spans?

“There are a lot of things that demographers and economists can tell us about the impact of the aging of the population on the budget, on the economy, on society, with a relative degree of certainty,” Jackson said. “But there are also a few big questions subject to considerable debate … perhaps the most consequential, up-in-the-air question of all is whether health spans are rising along with life spans.”

“Why? Because whether they do or not will have a big influence on our ability to extend work lives and control health care spending,” he said. “Health care is potentially the most explosive dimension of old age dependency … the elderly consume per capita about three times as much in acute care services than the non-elderly and about 20 times as much in long-term care services.”

Will health spans rise along with life spans and facilitate productive aging? Jackson is cautiously optimistic. Will rising health spans help control health care costs? He is skeptical.

The good news is that the rate of disability among the elderly is falling, Jackson said. And healthy life expectancy, free from disability, has increased. However, he said there are major caveats to those trends, including the poorer health of up-and-coming generations.

And there’s a question as to whether elderly individuals are becoming less disabled in large part because we spend so much on their health care, with more frequent care, treatment, and medication.

In the data on population health and trends in health spans and life spans, Jackson said it often falls among socioeconomic lines.

“It’s stark, it’s dramatic, and it’s shocking when you look at the numbers,” he said. “All of this falls along socioeconomic lines; life expectancy and health expectancy for the highly-college educated continue to rise and it’s stalled for most other groups.”

“Aging policy can’t be just about aging, it has to be about the entire society,” Jackson added. “There’s a large body of literature that concludes the biggest payoffs long-term, and what determines the health of the elderly, is investments 60 to 70 years before in the health of children.”

Listen to the podcast and watch the video to hear more, and read Jackson’s latest issue brief in its entirety by clicking here.

Gorman joined the program to discuss the “Coronabus” working its way through Congress and on to President Trump, which packages COVID-19 relief, Fiscal 2021 appropriations and a variety of additional legislative areas into a massive bill.

“The appropriations package, all-in, is about $1.4 trillion, but I did want to point out that is money included in the budget baseline already … we always knew that’s what we would have to spend to keep the government operating for Fiscal 2021,” Gorman said. “The only new spending above the baseline is COVID-relief money and the smaller pieces of legislation added to the package.”

Gorman called the “Coronabus” legislation the “proverbial kitchen sink,” not a good way to engage in policymaking, and one of the worst examples of last-minute legislating that she has ever seen.

“Part of it is just a function of it being a presidential year, where Congress is relatively unproductive anyway, and then add in other factors, like tribalism and a lack of consensus and compromise, they just didn’t get a lot done this year,” she added.

The “Coronabus,” which is nearly 5,600 pages in length, was the last train leaving the station and it attracted a lot of legislative add-ons.

Gorman broke down the good, the bad, and the ugly of the legislation. Beginning with the good, she praised the fact that more COVID-19 relief will finally be on its way and that the government would be funded for the rest of the fiscal year.

On “the bad,” there were elements that seemingly failed the temporary, timely, and targeted standard that Concord has called for in any emergency response legislation. Some examples included checks issued to individuals and independents that are not targeted to need, resurrection of some tax deductions largely unrelated to current business or economic needs, tax extenders and other extraneous legislation, and sticky issues like direct state and local aid that were simply excluded from the package.

Gorman stressed in “the ugly” that the broken, delayed legislative process was a dereliction of duty by policymakers.

“A sense of urgency should prevail,” she said. “The months-long bickering and foot dragging while our countrymen and women suffered was a horrible dereliction of duty by the United States Congress.” Gorman added that we would not even have this legislation if it were not for a small, courageous group of bipartisan lawmakers that were willing to challenge their political-party leadership.

The other really ugly aspect of all this is the likelihood of finding a number of budget gimmicks and backdoor spending devices that wind up allowing Congress to spend more than it would have been able to under existing law or otherwise mask the true cost of the legislation.

Hear more on Facing the Future. I host the program each week on WKXL, (N.H.), and it is also available via podcast. Join me and my guests as we discuss issues relating to national fiscal policy with budget experts, industry leaders, and elected officials. Past broadcasts are available here. You can subscribe to the podcast on Spotify, Pandora, iTunes, Google Podcasts, Stitcher or with an RSS feed. Follow Facing the Future on Facebook, and watch videos from past episodes on The Concord Coalition YouTube channel.

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