4 Mar, 13 | by BMJ Group
A gamesome piece by Garrison Keillor in this month’s Prospect on, dare I say it, the prospect of living to be 100 and what it might mean to him. It comes on the back of data from the Office for National Statistics suggesting that a third of babies born last year will live to be 100. “It dawns on me,” he writes, “that living past 70, the Biblical allotment, is an unnatural thing. Longevity is not nature’s plan for us. A man is programmed to degenerate. Nature only wanted me to find a female, mount her, impregnate her, raise the offspring until they could fend for themselves, and then get out of the way, go die and let the young take over.” But then, as Keillor goes on merrily to make self-evident, a great deal of what is good in life can lie well outside these pre-programmed Darwinian urgencies. An evolutionary account of why he became a novelist would make for unusual reading.
The figures around life-expectancy are extraordinary. According to Robin Ellison in the same issue, for every hour that passes, life expectancy in Britain extends at least a further 15 minutes. Some of the praise for this extraordinary advance in longevity can of course be heaped upon medicine and the allied professions. But while these figures will largely be a cause for individual rejoicing, they are not without their less attractive consequences. If we are all going to live until a hundred, how are we going to pay for it? The accretion of individual blessings can lead to collective woes. As Keillor points out, there is no guarantee that we will all arrive at 100 in full perk, just before the reaper carries us off. How are we going to meet the health costs? The maths do look unsettling. This is John Plender in the same Prospect:
Increasing longevity in the rich world ought to be a matter for rejoicing. Instead it has unleashed deep concern about the affordability of pensions and the welfare state. This is because welfare systems have much in common with Ponzi schemes—fraudulent investment operations that require an ever-increasing flow of money from new investors to fulfil generous promises made to existing investors. With pay-as-you-go state pensions it has been easy for European politicians to promise excessive retirement incomes when huge contributions were coming in from large working populations and little was going out to much smaller retired populations…Today the tables are turned.
This raises strenuous problems in distributive justice. To focus only on health, another of those “perfect storms” is on the horizon: leaping health costs, a shrinking work force, an ageing and increasingly aged population, many with gatheringly complex health needs. What is going to give? And as Plender makes clear it is not just a question of how we distribute finite health goods now, it also matters how we distribute them across time. Political promises made to baby boomers will need to be financed by tax dollars from a smaller working population who may not themselves reap the same benefits. The political fall-out from these inter-generational tensions could be toxic.
I am as much an historian as I am an economist, ie none at all, but just before Prospect turned up I was reading Tony Judt’s Thinking the Twentieth Century. Among so much else it seemed to me a lament for a certain post-War social democratic settlement in the West. I am oversimplifying dangerously, but he tracked the movement of western European states from the “warfare” economies of the first half of the twentieth century to the “welfare” economies of the latter—how only the expenditure on two world wars was able to legitimise the scale of government welfare spending that followed it. Coinciding with a post-War economic boom—at least until the seventies—this era saw an unprecedented redistribution of wealth: the consolidation, in England at least of the welfare state, the provision of universal free health care. According to Judt though we are now living through the collision of those welfare states with the end of the post war boom they helped bring about. Decisions made now about how those shrinking resources are going to be distributed, about how far the market will drive their allocation and how willing the state will be to tax and redistribute will decide what kind of society we will be living in during the decades to come. And beware an unsavoury dance between stratospheric voter expectations and the willingness of politicians seeking office to flatter them: Greece is one such outcome with all its social unrest and political demagoguery. And on that slightly mournful note I’ll leave you with Judt:
The great victors of the twentieth century were the nineteenth century liberals whose successors created the welfare state in all its protean forms. They achieved something which, as late as the 1930s, seemed almost inconceivable: they forged strong, high-taxing and actively interventionist democratic and constitutional states which could encompass complex mass societies without resorting to violence or repression, We would be foolish to abandon this heritage carelessly.
Julian Sheather is ethics manager, BMA. The views he expresses in his blog posts are entirely his own.