‘If living was a thing that money could buy…’

If living were a thing that money could buy

Then the rich would live and the poor would die

via Joan Baez.

Rich people on average live longer than poor people, for many reasons.  On average, they grow up in less toxic environments, they lead less stressful lives, they have more time to devote to exercise and they have better choices about diet.

Life expectancy overall is increasing, and 80-somethings such as movie director Clint Eastwood and Senator Dianne Feinstein as active and productive as people in previous generations who were 20 years younger.

But for certain segments of the population—white people who haven’t completed high school, for example—life expectancy is actually dropping.

Frederik Pohl_1976_GatewayLinda Marsa, writing in Aeron magazine, describes longevity research that may widen the life gap between rich and poor.  Scientists are studying the genetic basis of aging with a view to using genetic material to slow down or actually reverse the process of aging.   These treatments will be expensive, at least to begin with, and unavailable to those who can’t pay.

Science fiction writers have already explored the implications of this.  Frederik Pohl, in his short story, “The Merchants of Venus” (1972) and novel Gateway (1977). described a society in which life could be prolonged almost indefinitely but only for those who can afford to pay.   The protagonist of “The Merchants of Venus” has a bad liver, and is trying to make enough money to buy a transplant before it goes bad.  Talk about living paycheck to paycheck!

The alternative to allocating scarce medical resources on the basis of money is to allocate them on the basis ofholyfire.n5489 merit.  That is the situation in Bruce Sterling’s Holy Fire (1996).  The 94-year-old protagonist is granted access to life extension technology on the basis of good health habits (she has little sympathy for her ex-husband, an addicted cigarette smoker) and her positive contribution to society, which consists of serving on boards and commissions having to do with health care policy.

She is allowed to participate in a clinical trial of a drug that supposedly will restore youth, but the drug affects her mind and she breaks with her cautious life.   At the end, she loses her privileges and comes to terms with mortality.

I’m not attracted by either alternative, but I don’t have a better one.  If something is scarce, then by definition it can’t be provided to everyone.  And maybe over time the medical treatments available only to the rich, or to people with good connections to the medical research establishment, will become available to everyone.

The real problem, as I see it, is one of priorities.

It is not a problem that our economic system provides incentives to work on products and services of benefit to the rich.  It is a very serious problem that the system provides insufficient incentives to work on problems important to the general public.

For example, the emergence of antibiotic-resistant bacteria is a serious health threat.  Humanity could revert to the era in which infectious diseases were incurable.  But it is not profitable to work on new antibiotics because the process is so expensive, and they are useful only until new strains of bacteria emerge.

It is more profitable for pharmaceutical companies to provide treatments, which continue through the life of the patient, than to develop new cures and vaccines, which are used only once.

We the people need a way to change economic incentives, or a parallel system of drug development based on societal needs, or both.

LINKS

Will the rich live to 120 and the poor die at 60? by Linda Marsa for Aeron.

How to fix a broken market in antibiotics by Ben Hirshler and Kate Kelland for Reuters.

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