Medical expenses for an individual in their last year of life are approximately equal to their medical expense during the rest of their life. The same pattern exists for automobiles. When your car is continually in the shop, breaking down more frequently, one thing after another to be fixed, your car is approaching the time it ends up in the junk yard.
The fact that this pattern of accumulating breakdowns happens both to humans and machines shows that the process is more general than biological life and death.
One implication is that dying is not just a medical problem. Cause of death is conventionally attributed to some particular disease or injury. But the inference that once the major diseases and hazards are conquered, people will live enormously longer, is incorrect. Longevity cannot be produced merely by curing diseases.
Look at the leading causes of death across the centuries. Pre-historical people had an adult life span of about 30, if they survived childhood. Plagues and epidemics such as cholera became major causes of death when populations grew through intensive agriculture, and even more so in urban places, which is to say when they become more densely settled and geographically networked. Public health measures raised longevity, making it possible for people to die of diseases like tuberculosis and pneumonia. Hygiene, medicine, vaccines, diet and exercise allowed 20th century people in wealthy societies to live to their 60s and 70s. These advances have kept people alive long enough so that they most frequently die of heart disease, cancer, and increasingly as they live into their 90s, dementia.
Progress in health and medicine have extended the life span, letting people live longer while their bodies are breaking down, just like their cars.
The pattern of breakdowns increasing with age is universal, applying to all material entities. It is the basic principle of geology. Old mountain ranges are lower and less jagged, losing height and shape over millions of years. New mountain ranges and coastlines are produced by relatively sudden tectonic shifts; after which movement of air and water, along with chemical reactions, plant penetration and decomposition, carve them into monuments; on their way to becoming planes and basins.
The Buddha, dying around 560 B.C. at age 80, allegedly said: my body is falling apart like an old cart. Death certificates in our bureaucratic world are filed under a specific cause, but for most deaths it is co-morbidity. Even when we say cancer, this just pushes the problem further back in the causal chain: why did that person get that cancer at that time? The underlying process is things fall apart, and the older they are the more ways there are to fall apart.
Systems theory enables us to say more about the pattern of when things fall apart. The more moving parts there are, the more interconnections and linkages, the more possibilities there are for local breakdowns. And the more complicated the entity, the more likelihood that local breakdowns will interact with other breakdowns, resulting in a concatenation of failures throughout the system.
Charles Perrow's Normal Accidents shows disasters result from a combination of minor accidents, each of them random, plus randomly happening at the same time. For example, the Three Mile Island nuclear power plant leaked radiation and nearly melted down in 1979. The flow-chart of the plant is very complicated to describe, which points to the main ingredient of the problem. In one chamber, the uranium core was cooled by water under high pressure; in a second chamber, steam filtered for radiation was used to run electric generators. On that day, four different failures occured: a clogged line measuring moisture sent a false signal; a water-flow valve had become blocked; human operators told a relief valve to close, but it was stuck; a dial showed it had been shut when it wasn't. The end result was that operators-- at a huge control panel, with lights flashing, alarms sounding, and phones ringing-- initially thought the danger was pressure and temperature were falling, when the opposite was happening. They soon realized that some dials or controls weren't working, but which ones? The complexity of the system, combined with the coincidence of small failures, made the situation incomprehensible for the operators. Other failures and breaks multiplied as the reactor overheated; later investigators never agreed on what caused all the problems.
Two main dimensions affect the likelihood of concatening breakdowns. First: the amount of complexity in the system. This is at its extreme when two complicated computer systems are combined; for example when two airlines merge their scheduling systems. Or when a highly computerized system of hardware is repeatedly updated during several decades of development. The Air Force F-35 was designed to handle all kinds of combat missions, previously carried out by different aircraft, and to automate everything human pilots could do. In addition, computer architecture was repeatedly changing during this period, so that different generations were interacting in unpredictable ways. This became a vicious cycle, with numerous failures in testing prolonging the process and generating more mismatches.
Conversely, the simpler the entity, the more durable it is. The model-T Ford was famed for its simplicity and longevity. The Kalashnikov automatic rifle was develped to make it as simple as possible, with the fewest parts. Invented in 1947, it continues to be widely used more than 70 years later.
The second dimension is the degree of physical proximity of different systems to each other. Perrow gives the example of a passenger plane which has a small fire in the kitchen galley. This is a local problem, easily managed; but it becomes serious if there exists wiring to other electric systems in the nearby panels-- a problem that increases when many things are crammed into a limited space. The amount of space that constitutes crammed is relative to the reactiveness of the moving parts. When there are a large number of big ships passing through narrow straights-- especially large warships, oil tankers or container vessels-- their huge momentum allows them to change course only slowly. Furthermore, in a confined waterway, they affect the currents pushing each other in unpredictable ways. Hence, even in the era of high-tech sensors and communications, collisions continue to happen both among US Navy warships and commercial and tourist vessels.
On the continuum of propensity for "normal accidents" or concatenation of breakdowns, systems designed by humans with their advance sciences are at the high end. One might say that the highly computerized, mechanized, and globalized world of machinery is analogous to human populations responding to advances in health and medicine by falling prey to new diseases: our successes in recovering from our problems increases the complexity and connectedness of the system, thus increasing the conditions for further concatenating breakdowns.
At the other end of the spectrum are entities which have few specialized parts and linkages. These can be of extremely large size, like mountains and other geological formations; or extremely small, such as self-replicating viruses of extreme simplicity, closer to crystals than to most living species. Viruses are among the oldest life forms; geological formations undergo the longest attrition.
The human body is at the high end of the spectrum of complexity, above all in the brain, nervous system and chemical pathways throughout the body, entwining emotions with signals. What we call psychosomatic processes (among which we might count current developments like autism and depression) have grown along with the complexity of how we program our brain pathways, including our social and physical linkages with our environment. And all this is crammed within one's body, where random breakdowns happen right next to all sorts of inner linkages. It is not surprising that, over a period of years, the interlocking breakdowns become more and more frequent.
I have already sketched the historical trajectory of diseases emerging into greater prominent as earlier diseases have been controlled. It is in this context that we should view current longevity science. Are there specific aging or anti-aging genes? Does gene therapy, or ingesting supplements containing molecules or other building blocks, make living creatures live longer? Experiments on yeast, worms, and flies are a long way from dealing with the concatenating breakdowns of complex organisms, let alone aging humans.
Even giving the benefit of a doubt and a hope for further discoveries, consider the practical and social implications of a large proportion of people living for decades past age 100. If longevity medicines of some kind are successful, is there any reason to believe that the fraction of one's lifetime medical expense in one's last years will decline? The weight of medical care has loomed increasingly larger precisely in the wealthier and more scientifically advanced economies. As noted, modern medicine is good at keeping people alive longer when they're sick.
From an objective point of view, we retire and eventually die, making room for others. From a subjective point of view, at some point dying is not necessarily a bad thing. Everybody who lives into the 80s and 90s notices that you get shorter, losing flesh, muscle and contour. Like mountains losing their sharp edges, faces and bodies lose their shape. What would we expect to look like if we lived to 130 or 150?
It is other people who do not want you to die; who do not want to lose you. But losing happens anyway. Death is a subtype of something more encompassing. Better to say: hope you had a good life. And wish the same for those who are younger.
