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For life expectancy, money matters (news.harvard.edu)
174 points by jonbaer on April 12, 2016 | hide | past | favorite | 164 comments



My go-to story whenever anyone says "money can't buy happiness" is this:

A good friend of mine was diagnosed with Liver Cancer around the same time as Steve Jobs. Both lived near SF, and both were put on the waiting list for transplants around the same time (+- 2 months). She was young, very sick and otherwise healthy so was a good candidate to be high on the list.

Then I heard about Steve "moving" to Tennessee [1] to get on a different, shorter transplant list - and thus receiving the transplant needed. She died shortly after, never receiving a transplant, while Jobs lived two more years.

This is not a complaint or gripe about fairness, but just a demonstration of how two very different people in a very similar predicament had massively different outcomes based almost entirely on wealth, fame and power. Money buys access, which create options, which enable health, freedom and longevity. It's so simple and obvious I don't know how people can argue otherwise.

[1] http://www.commercialappeal.com/news/southern-transplants-ho...

[2] https://www.youtube.com/watch?v=od6Nq_bN_XY


I'm on a transplant list for a kidney. The wait in the bay area is around 5 years. What I learned is you can be on multiple transplant lists as long as you can travel to the transplant center in under so many hours. Thus those who are rich enough to afford a private jet on-call can be on multiple transplant center lists.



I wonder if there is a business model that can be built whereby transplant recipients buy insurance in order to pay out the cost of the flight by leveraging other recipients. (Spread out the cost in other words so let's call it insurance).

So the idea would be in a pool of 500 recipients (arbitrary) you buy private jet time of "x miles" (an average) and/or pay out the jet time over time. Any particular purchaser would pay the average cost (not the cost for the longest jet) and also have the advantage of buying power. And you wouldn't need 500 hours (or whatever the hours you get the point) either is my guess (since some kidneys would be located within driving distance).

What do you think (as a recipient?) of that idea?

The advantage is if the jet time could cost anywhere from 0 to $10,000 (depending on multiple factors including not needing it) you pay $3000 as a hedge and are willing to take the loss if you don't need it (to help the group).


Oh, wow. No.

First, people who qualify for a transplant list and are not already wealthy probably cannot afford your insurance. I say this as someone who has a condition that accounts for a very high percentage of lung transplants and as someone who worked in insurance (and still writes insurance articles as a freelancer).

Second, please put your creativity towards helping people avoid needing multiple transplant lists to begin with. I find this "we are Borg, resistance is futile" stuff really horrifying. I wish a LOT more effort went into helping people like me keep their own lungs healthy rather than into heroics like better transplant operations where the doctors get good press and high self esteem and high pay and the patient is covered in scars and on anti-rejection drugs for the rest of their life.


Well a few things:

> and are not already wealthy probably cannot afford your insurance.

A product or service doesn't have to have a market with either wealthy people or people who are penniless. There are people out there, I'm sure you are aware, that could spend several thousand for this which is not the same as having to spend $100,000

> please put your creativity towards helping people avoid needing multiple transplant lists to begin with

This was just an idea that I was throwing out in a comment. It wasn't meant to imply that I planned to do the idea. It was something I thought of that I figured I would throw out there. Kind of like a request for comment. So saying "I wonder if there is a business model" is not the same as saying "I have an idea that I am thinking of pursuing or have been pursuing". I have other things which I spend my time on and I wasn't planning on spending any time on solutions to this particular problem. Just curious what others thought or thinking someone else might be interested in pursuing this. It's not my focus in business.


You edited it to leave out my qualifier about people who qualify for a transplant list. In most cases, you are talking a serious and somewhat drawn out health crisis. If they weren't rich before it started, they are very likely dirt poor now.

Health insurance in the U.S. is all kinds of messed up to begin with.

Also, if you want to defend your remark with "just tossing out ideas", hey, that's a two way street. Anyone reading your remark and thinking it sounds like a good idea is also being told by me "I am someone with a vested interested and informed opinion. If you want to help people like me, do something else. Don't do this."


I never said that I wanted to help people. I had a business idea that I was curious about, that is all. And I was (once again) posting a comment on HN and throwing it out there to see what people (including you) thought. Honestly I know nothing about this at all. Sorry if I offended you in some way was not my intention (obviously).

> thinking it sounds like a good idea is also being told by me "I am someone with a vested interested and informed opinion. If you want to help people like me, do something else. Don't do this."

I would hope that someone who might be inclined to think that the idea (with modifications) might have merit would research a bit and not rely on 1 comment (or 10) on hacker news. [1]

[1] (Remembering the famous "why does anyone need dropbox when they can use rsync" of a few years ago...)


While researching kidney transplant, I found out that there are companies that will already lease private jet time for such purposes. But as others have mentioned, there are other costs involved. You need to travel to each transplant center to get evaluated. You may end up going to the transplant center and the procedure is called off for a variety of reasons. After the transplant, you will need to stay for 1-4 weeks depending on complications. The doctors will want to see you multiple times over the next few months. A lot of these expenses will not be covered by insurance.


Even though it is life saving, there is more to it than just the transportation cost and believe it or not $3000 is often too much even for how important it is - people just can't afford that. See the youtube link above - you often have to prove that you can pay for anti-rejection drugs, local housing etc... after the procedure.


I feel that everybody should just be on as many lists as possible be default, and the cost of jet / air transportation would be covered by government or insurance.

With transplant cost and post op care costing well into 6 figure, a $2 - $10 grand in charter jet cost should just be absorbed.


That is an honourable goal. I wonder whether it would be the best bang for buck in terms of quality adjusted life years gained per dollar spent?


I always thought that Steve Jobs was a perfect example that even if you were rich, famous, important you can still die very young.

I know in Denmark where everything health care is run by the public sector and there is a very egalitarian access; you also have the wealthy living considerable longer than the poor.

I think lifestyle factors such as good social life, meaningful professional life matter a lot. Probably more than health care access.


Steve Jobs died regretting that he had spent so long attempting to treat his cancer with alternative medicine before agreeing to undergo surgery, according to his biographer Walter Isaacson; if he had received treatment as soon as he was aware of the cancer, it's possible he would still be alive today.


Possible but far from certain.


Actually, according to the the story that Isaacson and others familiar with the situation told, it's fairly certain that he would have made a full recovery. Of course it's possible that he would have died by now due to other causes - his plane could have crashed etc - but he would not have died as a result of cancer. In this case, his belief in alternative medicine killed him.


The version of pancreatic cancer he had was actually the one that was very curable. For all of his intelligence, he chose poorly, and paid for it with his life.


"meaningful professional life"

One thing that I've noticed is that some men I've known (and it seems to be a male problem) don't handle the step change from a high flying career to retirement at all well. Seeing people who have worked hard to enjoy a very comfortable retirement drop dead within a year of retiring is pretty alarming!

[NB They weren't in software]


It is a sort of in-joke in my family. The men die soon after they retire. Needless-to-say, I have not considered retiring at the "normal" age.


Here in Uruguay we also have public sector health care - but rich people have access to private clinics as well.

And, for example, a rich person can afford to go to the Cleveland Clinic in the U.S. (out of pocket) to get vastly better treatments that those available for the general population.


Just to make it clear. For all practical purposes all health care in Denmark is public sector; making Denmark (and other Scandinavian countries) quite different than the rest of the world.


Canada is the same as well. The system is setup to discourage private sector care (although a very small amount exists).

However, lots of wealthy Canadians just fly to the US to get the best care money can buy.


> It's so simple and obvious I don't know how people can argue otherwise.

Because its terribly depressing for many people to admit it.


It is terribly depressing for many people to admit the reverse also. That money cannot buy happiness...


It is a consolation for the poor, though. "They might be rich, but I might be happier." Just like "They might be rich, but they are assholes/corrupt/stupid/ugly".


Sounds to me like something a preacher would announce just before passing around a collection plate.


Well, not that many people are rich so... who cares?


It's not as simple as that. Consider the difference between people who were born rich and those that have worked hard to become rich. It's quite possible to work yourself into an early grave, even if you end up rich.


The cool part is, life has so many pathways.

It's just as possible to spend yourself into an early grave.


It also kind of goes against the national mythos in the case of the US, which compounds the difficulty.


Money is necessary to have a certain quality of life (quality healthcare, etc), but is certainly not sufficient to achieve happiness.


I agree most with this way of thinking. Money is downside protection but the upside benefit happiness wise is minimal. I think relationships, meaningful work, healthy diet and exercise, sleeping well, sense of community, etc. matter more for upside happiness.


It is far easier to have a healthy diet if you can afford:

- fridge space for fresh ingredients that you don't have to split with roommates

- An apartment a short distance to a grocer

- pantry space for cooking tools and dry ingredients that you don't have to split with roommates

- the cooking tools themselves

- the time and mental energy to teach yourself a new skill

- money to spend on take-out when you mess up a recipe


Add to the above

- live near where you work

Think of all the people that commute 2+ hours in the Bay Area and the stress that goes along with that.


Exactly, I always read the saying this way. Money doesn't buy you happiness directly, it buys you the security and comfort that provide a foundation for you to build your happiness on. You can be happy with little or no money, but it takes a much smaller disruption event to make it all collapse, like a house built on a shoddy foundation.


People are not created equal, some are predisposed to happiness so you are limited in how much happiness you can buy. However, if money is not buying happiness your not buying the right things.

EX1: Sometimes your better off paying down debt or investing than buying stuff.

EX2: Sometimes your better off buying stuff for other people than yourself.

EX3: Buying experiences tends to have better returns than stuff.

EX4: Sometimes the best thing to 'buy' is time by making less money.


That's a pretty empty statement. You can be wealthy and have a brain tumor, or be in prison, or get your head kicked in, or become obsessed with someone who won't love you back or do what you say. You could just have an incredible sense of entitlement, and be angry because you aren't the master of time and space.

All things being equal, more money makes you happier than less money, with decreasing marginal effectiveness. No money always makes you miserable if you aren't being taken care of.


Money is great at taking care of bullshit and leaving you with nothing else to do but pursue happiness.


very sorry to hear that, I presume many cases of normal person X didn't make it vs Steve did (well...).

but let's make it more apples to apples, and compare against one of most wealthy humans ever, that's a tiny category on its own.

This "money can't buy happiness" is meant (or should be) somewhere along - give a man earning X dollars 2X (or 10X) instead. Short term boost of happiness will quickly fade away, and what is left? Bigger TV screen, faster car, more stupid partying or 10 bedrooms instead of 2? That's what most people do when they suddenly win/inherit large amounts of cash. Most of them end up as sad stories.

If you are not happy, more cash will not change this in 99% of the cases. Long lasting happiness doesn't come from stuff you can actually buy, or if yes they cost a tiny bit (many super intense experiences can be done with little cash, ie backpacker travelling around the world which is superior to any other way including most expensive packaged vacations, outdoor adventuring, extreme sports etc.).


But if you give a man earning 0.1X dollars X, you can make a huge and long-lasting impact on the man's happiness, because he didn't have enough money before and now he does.

Money doesn't buy happiness directly; it buys security, and security enables happiness.


You cannot use "suddenly win/inherit large amounts of cash" to estimate what would happen if the poor in general had more money than they do.

The players of the lotto and the expectations for winners are distorted. Also, we hear and remember the news stories about the flaming fall from fortune more than the person who chose the monthly payments or invested the inheritance wisely and live quietly with secure housing, adequate healthy food, and a retirement plan where they previously were behind on rent and wondering where the next meal would come from.


You don't need to be Steve Jobs wealthy to adopt a domicile of convenience.

(anyone able to support themselves without working could do it)


That doesn't change that even across your entire life, probably only one in ten people need an organ transplant in the first place.

Circumstantially some people can need dramatically more or less money. Even if you take an average life in the US, the amount you need to comfortably live in rural Tennessee vs urban New York is enormous.

But discussions about money and happiness are not usually about the extreme cases and outliers, but about the average. When you have a case about "average life expectancy" you cannot refute it with the exceptions we know exist to the rule.

The principal still remains - on average, the poorer you are, the lower on the Maslow hierarchy you idle, and thus the less happy / healthy you are, simply because you have less fulfillment. Your hierarchy could be dramatically harder to climb, as is the case of a liver cancer patient, but we are not talking about edge cases, we are talking about the average. Once you climb that hierarchy, and have all your base needs fulfilled, and have effective financial security, having more money is not going to make you tangibly happier. IE, buying a yacht instead of renting a traditional boat is not a marked increase in happiness compared to having hot food to eat each night or waking up in the morning without worrying if you are losing your apartment today.


Why does the argument always go to Veblen goods (Yachts etc...) in this discussion rather than exactly what I indicate - health, wellness, options, access etc...?

Edge cases are the ones that make or break people. Holding aside the argument for socialized or egalitarian healthcare, it's undeniable that major events in someone's life (major illness, accident, death, foreclosure etc...) are a primary factor for decrease in happiness. Since it's also undeniable that money can offset or augment the impact of these events - it is very relevant to take those into account.

Said another way, everyone will eventually have an "edge case" irrespective of whether it is liver cancer or otherwise. Having means to ease the troubles related to those cases, have a direct effect on how badly they are felt.


>Edge cases are the ones that make or break people. Holding aside the argument for socialized or egalitarian healthcare, it's undeniable that major events in someone's life (major illness, accident, death, foreclosure etc...) are a primary factor for decrease in happiness. Since it's also undeniable that money can offset or augment the impact of these events - it is very relevant to take those into account.

Yes. Hence the media's trend of attempting to shift blame to people who have experienced edge events by deriding them as irresponsible or whatever. It's better for the serfs to think that "money can't buy happiness" and ignore that "money can prevent or mitigate common causes of unhappiness". It's also better if the serfs remain jealous of the wealthy, but not actually knowledgeable about the vastness of their wealth. If enough people consciously hold the thought which you detailed in mind, economic revolution is inevitable, and, failing that, violent revolution is probable.


Because the edge cases are well known to be horribly, poorly managed by individual finance. Because they instill a tremendous discrepancy on the propensity of individuals to thrive in given socioeconomic conditions, they are the exact kinds of things we should be doing our hardest to remove from strict capitalism.

The first world has already moved on to socialized medicine precisely for this reason. Besides health expenses, the circumstantial costs of differing degrees of needs satisfaction are much less varied - they effectively just become approximated by the regional costs of food and shelter.

Luxury goods are brought up because we are talking about after base needs are fulfilled, and predicate the discussion on the basis that, one, the US is barbaric in its lack of comprehensive medical access to its people, and two, the edge cases where money can still buy you better care once you migrate away from allocating medicine based on ability to pay rather than need are extremely rare, and while still being a problem, don't predicate the whole discussion.

Basically, anyone sanely arguing for any of the socialist principals around happiness thresholds or sane taxation are starting from the presumption that negative externalities of environment like health problems out of the control of the individual need to be collectively accounted for rather than individually, and to do otherwise - as is the case with Steve Jobs liver transplant - is unethical. Primarilly because while we may have a shortage of liver transfer candidates today, the fact that demand for liver transplants comes from having wealth rather than need for replacement livers is certainly stymieing research into growing livers for transplant, as is the case with most organs needed for transplants. The capitalistic nature of medicine and the predisposition of those in need of it to have the least to pay for it contributes to why we have dozens of viagra-esque medicines with billions going into research for whatever the billionaire class might want medically while essential research in edge problems, especially chronic lifelong debilitating diseases like Parkinsons, is crippled by a lack of profit potential because the sufferers are often destitute or dying.


> But discussions about money and happiness are not usually about the extreme cases and outliers, but about the average.

All those outliers and special cases factor into the average – that's the point of an average.


You're assuming people who are unhealthy, lack options, and live shorter lives are always unhappy. Assuming that "health, freedom, and longevity" lead to happiness is a value statement and entirely subjective.

Do not disregard the importance of gratitude in determining happiness. A grateful person can be happy even in the face of death and oppression. Grateful people are the outliers that always seem to confound studies on money and happiness.


>>It's so simple and obvious I don't know how people can argue otherwise.

Most people I know are confused between human emotions and happiness. No matter how much money you earn, you will still feel sad at the death of some whom you cared about, you will have all other myriad of human emotions any person on earth rich or poor will have to go through. And this shouldn't be confused with happiness.

Also I have a feeling that believing money can buy happiness and to a degree about the brutal fairness in the world in many occasions can destroy many people from inside.

People want to believe being mediocre is perfectly ok, they want to believe chance plays a huge role in ones life and that success and failure are always out of ones control.



After providing for the basic physiological and safety needs (Level 1 & 2 of Maslow's Hierachy of Needs[1]), the "happiness" returns that money can buy quickly diminish.

I think when a lot of people say "money can't buy happiness" they are assuming survival is not a problem.

[1]https://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs


>the "happiness" returns that money can buy quickly diminish.

https://en.wikipedia.org/wiki/Hedonic_treadmill


>basic physiological and safety needs

I could spend infinite money making myself "safe" - it just depends on what you are trying to be safe from.

How much is a personal security detail and motorcade? What about on-call medical staff? A food taster? etc...

It's all totally arbitrary - nobody has determined what these physiological and safety needs are comprised of for everyone. Freegans and Preppers certainly have different definitions.


Oh I completely agree about safety. There really is no security in this universe full of black holes, meteors, exploding stars, and micro organisms. However a simple bar of soap goes a long way to fight those microorganisms.

But the basic physiological requirements of having enough food, water, and shelter are not so arbitrary, though the requisite quanitity and type will of course vary.


> She died shortly after, never receiving a transplant, while Jobs lived two more years. ... [this is] just a demonstration of how two very different people in a very similar predicament had massively different outcomes based almost entirely on wealth, fame and power

So, it would seem being one the of the richest men in the world could only buy him two more years. Two sickly years, not healthy. Kind of disappointing for rich people.


I'm very sorry to hear about your friend.

Jobs had a metastatic pancreatic neuroendocrine tumour. This is a still ultimately fatal but relatively indolent cancer. It sounds like your friend had a primary liver cancer, which has a more aggressive course.


You are correct, however given the prognosis and remedy it would seem that she and Jobs both had an opportunity to remedy some or all of their conditions through the same process.


Money always finds a way. In the case of very limited precious resources, like healthy transplantable organs, what alternative do we have? Is the gift of extended hope via forced random assignment substantially better?


Yes.


All precious resources should be randomly allocated?


You seem to have expanded the argument, whereas we were talking about human organs.

No, all "precious resources should not be randomly allocated". But transplant organs should be allocated as they are [1].

For other precious resources, it depends on the resource. E.g. if we're talking about water, it's better balance farming and drinking needs, which are not the same in all areas, instead of randomly distributing it.

[1] Note that the use of "randomly" is misguiding -- organs are not randomly allocated, except in the final distribution AFTER lots of non random factors have been already used to guide the waiting list (compatibility, chances of success, urgency, distance from donor, etc).


compatibility, chances of success, urgency, distance from donor

That's the OP's point: all of these are subject to the influence of wealth.

Compatibility: better supportive care keeping the person healthier on the defective organ. (An actual mismatch, like blood type, is a random variable.)

Chances of success: depends on the medical affidavits from "second opinions" that you can afford to shop around for. This perhaps won't work in extreme cases, like an 80 year old on death's door vs. an 11 year old diagnosed with an early stage defect, but it's rarely that clear.

Urgency: Jitters over the stock price of Apple is surely going to weigh Steve Jobs' transplant as more "urgent".

Distance from donor: obviously nothing more than a trivial obstacle for the wealthy.


>Compatibility: better supportive care keeping the person healthier on the defective organ.

That's indeed subject to wealth -- but it's not the kind of compatibility the system looks for. Rather size, blood type, etc.

>This perhaps won't work in extreme cases, like an 80 year old on death's door vs. an 11 year old diagnosed with an early stage defect, but it's rarely that clear.

Maybe, but still better than "80 year old with money gets it over poor 12 year old".

Just because a system doesn't work 100% perfectly and yields to money factors, doesn't mean it's better of to replace it entirely to something money driven.

>Urgency: Jitters over the stock price of Apple is surely going to weigh Steve Jobs' transplant as more "urgent".

Urgent in the medical sense. Not in whether the patient is "more important" for his business...


From my point of view, the issue in buying and thus selling organs is that it creates an incentive to hack someone and sell the body parts piece by piece (like it is rumored to happen in China).

So as long as we can't grow organs, I think it is preferable to not create that kind of incentive.

On the other hand, you could argue that the fact there is no market will hinder some innovation. But given the scarcity of organs, I am pretty sure than producing mechanical hearts or eyes would find pretty of interested people anyway.


But it's already illegal to sell organs and yet this harvesting still happens. Anything people will pay enough for to push providers past the fear of getting caught is going to generate a black market. If the money received by the organ registry on a highest-bidder basis were earmarked exclusively to research on synthetic alternatives, I believe would probably get to a better world faster than the current state of affairs.


>But it's already illegal to sell organs and yet this harvesting still happens.

That fact that something already happens while being illegal is not an argument in itself against decriminalizing it.

Murder and rape happen too despite being illegal, for example.


For poor people there are always a stack of problems. Access to precious resources is just the problem on the top of the stack.

Even if you did solve the problem, other problems in the stack would start popping up.

Being rich always helps.


So there should be greater support for working to fix the entire situation, to build organs as needed, and remove the enormous expense and scarcity in the existing system.

Decellarization to make more donor organs viable, or enable the use of pig organs. Tissue engineering to build new organs from a patient's own cells. But people spend too much time focused on what is and not enough on how they can help to make a better situation through technological progress.

Anyone can help the New Organ project, for example, as it consists of advocacy and research prizes to accelerate progress. You don't have to be a researcher to help make a difference in the matter of organ availability.

https://www.neworgan.org/


and to make this story even worse, jobs wasted his transparent with his voodoo medicine.


As if someone is able to simply decide to be Steve Jobs, as wealthy he was, etc.


What does "deciding" have to do with it?


My understanding of your comment is that instead of my position that it is illogical to believe everyone can be as wealthy as Jobs, that everyone should get the same medical care regardless of how much money they have to spend. Right?

If so, unclear to me how such a position would play out in the real world. Please explain.


I'm not sure you mean my comment and not someone else's. All I'm saying is that "deciding" has nothing to do with the question of whether money means you can get better medical care. Who said anything about "everyone being as wealthy as Steve Jobs?"

But one way a less blatantly corrupt system could "play out in the real world" is not allowing people to arbitrarily switch states when they find the organ waiting list not to their liking, or just maintaining the whole waiting list at a national level.


You're cherry picking medical issues & care, which will not solve an issue as big as this.

If you're claiming that everyone should be forced to use the same system, unless you're able to explain how that would happened and why it would be better, I'm not going to speculate on what you believe would fix the issue.


Sorry, that is nothing new, and it proves nothing.

If money could buy happiness, they there would be zero cases of rich people killing themselves.

Your argument is like saying a car can buy you happiness because one guy with car was able to reach hospital in case of an emergency, and was saved, while another guy, with a similar emergency died on the way, because he had no car...


Didn't say it was new, but I think it does prove that you can increase longevity with money. I'd say being alive is a proxy for happiness (lets say at least 51%).

>If money could buy happiness, they there would be zero cases of rich people killing themselves.

Man that analysis is just incredibly faulty. As far as you know they killed themselves months or years later than they otherwise would have. I have way more experience with suicide than I would prefer and can tell you that money troubles are a SIGNIFICANT factor for suicidal ideation and attempts [1].

[1] Wang, Y., Sareen, J., Afifi, T. O., Bolton, S. L., Johnson., E. A. (2012). Recent stressful life events and suicide attempt. Psychiatric Annals, 42.3, 101-108.


Money cannot buy happiness, if you don't know what you need, or what you need cannot be bought.

I am not saying that all cases of human suffering falls into that category, but a lot of them do.

>As far as you know they killed themselves months or years later than they otherwise would have...

That means, they tried to buy happiness, but failed to do so, right?


It might not be able to "buy happiness" but it can alleviate a lot of unhappy stuff forced upon people, like not affording health care, living in a dump, working 2 shitty jobs, etc...


Money alone cannot make you happy, sure. But it does not follow that, therefore, being rich isn't so great, which is often what people are trying to suggest by trotting out that old saw.


So ... just to make sure I get it, your argument is there is no theoretical limit like Y approaches zero as X approaches infinity on the graph, and if there is a line it doesn't have a negative slope, because finding individual points with a small Y and large X somehow proves the line, if it exists, is flat or has a positive slope, despite the entire point of the article being that enormous piles of data imply the opposite, because ...


My argument is that there is no line...


For me, this is the most important aspect of this paper:

"People say, ‘Americans are living longer, so we ought to delay the age of retirement,’ but … it’s a little bit unfair to say to low-income people that they’re going to get Social Security and Medicare for fewer years because investment bankers are living longer.”"

As the divide between the rich and poor keeps growing [1], we need to start doing something about it in all areas, and this seems like a really important finding for that.

[1]http://www.oecd-ilibrary.org/employment/in-it-together-why-l...


They already DO get SS for fewer years, and are forced to pay into it for more years, because wealthy bankers can afford to retire earlier than people who live paycheck to paycheck.

Social Security in its current formulation (not means-tested, cap on income which is taxable for it) is pretty regressive.


Means-testing would probably lead to Social Security being killed by the cap on income should go.


Can you please explain to me what a hedge fund manager in Connecticut retiring at 35 has to do with a 60 year old Wal-Mart employee's social security?


At 62, the hedge fund manager is eligible for social security, on top of the capital gains he's been living off of comfortably for the prior 27 years. The Wal-Mart employee may never be able to afford to stop working because of the penalty on income over the minimum. That's how the system is set up.


> They already DO get SS for fewer years, and are forced to pay into it for more years, because wealthy bankers can afford to retire earlier than people who live paycheck to paycheck.

The Wal-Mart greet is not forced to pay into SS because of the hedge fund manager's wealth.

The fact that one person can retire early does not exacerbate the financial problems of someone else.


The origin of social security/pensions in France was that they set the retirement age at 70, an age 1-2% of the population made it to. (My link actually claims Germany, I can't find the French data and I'm on mobile so the intrepid reader may set out on an exploration of the pension system from here.

In such a system, the tax burden of sure porting the population is obviously minimal.

As standards of living and life expectancy improved, the proportion of people making it to pension age increased, and the pension age decreased (generally in line with expansion of social welfare programs, as well as a recognition that retirement was more of a right than a privilege for those who lasted long enough).

Is it so wrong for pension ages to creep up? Demographics certainly had. I for one expect to be working for my entire lifespan (although as a doctor this is probably easier for me than many other professions)

[0] https://en.m.wikipedia.org/wiki/Pension


You could easily live to ninety. If that happens, you expect to be working until ninety?


I expect to work until I drop. And to be enjoying it


According to the original article, life expectancy differences "were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions."

https://jama.jamanetwork.com/article.aspx?articleid=2513561

So in fact doing something about the "divide between the rich and poor" is unlikely to help. It might even be counterproductive if it reduces income (which is highly correlated) and if this effect is causal.


But life expectancy in many countries that are poorer than the US is higher, so it's not absolute wealth that matters either.

https://data.oecd.org/healthstat/life-expectancy-at-birth.ht...


I suspect that genetics (not measured by this study) and lifestyle factors (big according to this) are probably the dominant factors.

I expect that Delhi/Shanghai magnitude physical environment factors is also important. But luckily the US is a lot cleaner.


The point you're referring to relates specifically to geographic differences.

From the results section: "inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes)."

So I think the co-authors had a point when they talked about retirement age!


See Figure 8 for numbers on "Population-weighted univariate Pearson correlations estimated between local area characteristics and race- and ethnicity-adjusted expected age at death for 40-year-olds in the bottom income quartile."

The CIs for income inequality (as well as health care factors and local labor market conditions) do not exclude zero.


I'm not 100% against raising the retirement age, but it would be a lot easier on me to work until I'm 70 than, say, a garbage collector or builder.


In theory true, but in practice, the difference between being unable to work and unable to be hired due to ageism is very small.

If, for example, you're unhirable over 50 for all practical purposes, even if you can do the work until you're 70, its somewhat cruel to use that as a justification to raise the retirement age to 70.

There are stamina issues to consider. My grandmother liked knitting; in theory her retirement age should have been 85 because she was knitting until at least then when the arthritis hit too hard, but in practice she wouldn't live thru a single 12 hour shift at a textile mill, not that it matters because almost all the jobs are gone, and what very few remain would not go to an 85 year old woman. Likewise I am a pretty good software dev but I don't think I could produce under subpar conditions like an open office; its not that I can't program, its that I can't program there.


While office work is less demanding in certain aspects, it can be quite destructive in other ways, if you are not careful:

- circulatory issues (hypertension, due to lack of exercise),

- obesity,

- back issues,

- repetitive stress injuries, etc.

All of these could keep you from working.

Exercise and proper diet are key, regardless of your social status. The problem is that lower-status people usually don;t have the knowledge or don't care.


It is entirely reasonable to assume that the average office worker could continue working into their late 60s and 70s. Obviously there will be exceptions and many will not, but the majority certainly can. You're not going to have 80% attrition among management because of RSI and obesity.

I think you'd be hard pressed to find anyone fit and healthy enough to be a garbage collector from age 18 to age 70, even if they're the one driving the truck.


> The problem is that lower-status people usually don;t have the knowledge or don't care.

Or, just maybe, don't have the money or the free time.


Let's not introduce victim mentality here.

- gym memberships start from $10/month (optional, there are plenty of body-weight exercises you can do outside of gym).

- running costs nothing (in recurring fees).

- all you need is 1 hr/day, 3-4 times a week.

It is all really about knowledge and motivation.

I am not saying it is easy, but it has nothing to do with money.


1 hr/day, 3-4 times a week can be an enormous amount of time, especially when you are juggling children, work, and commuting. Higher income people can manage this more easily--often their work hours are more flexible, and the very high income can staff out their child care.

And lower income people are more likely to have jobs that require physical activity to begin with. Exercising is a lot harder if you've already been on your feet all day.

So it is not all about knowledge and motivation and while it may have little to do with money, it has a lot to do with available time.


It really varies. Most people I know in blue collar jobs work 40 hours/week and are free to do what they want after 5pm. They don't take their work home. It is usually the "exempt" professionals - lawyers, doctors, McKinsey consultants who work overtime (because they have to or they think they have to).


Some garbage collectors are very sloppy in their job just after hours, not years.. Especially when the heap is too big. :-/


Yeah, realistically those people are not going to be able to work till they're 70.


One can wonder how much comes down to poorer people eating junk food, smoking and alcohol abuse.

I've never been that well of, but at the same time I've never afforded to smoke or drink a lot. In fact nowadays I do neither. Makes you wonder how some can being poor.


This. A lot of habits that make people ill, also make them poor. I'm well-off but in relatively poor health and don't see how I could "buy" a significantly better life expectancy at this point. Sure, a shorter organ transplant list helps in some cases (not mine though), but that specific advantage can't explain 15 years on average (while smoking alone counts for 10 years or so).


I think eating fat, smoking or other kinds of addictions are a deeper symptom of depression or some other kind of a mental infinite loop from which the addiction gives you a pause.

I remember an instance in school, I asked my friend why he smoked or indulged in drinking. His answer was simply it was just not possible to go on with life without it. He had a myriad of relationships with girls, and dozen problems at home, he was a troubled kid and got into trouble often at school. A lot of what I understood- smoking gave him a pause from all that.

I would wonder poor people might be more prone to this sort of stuff due to the very obvious reasons. However this sort of addiction can happen due to various other reasons too. For eg read this: https://www.quora.com/Im-22-year-old-Indian-guy-and-I-need-y...

Even smart, intelligent people can be trapped into addictions of various kinds from which it can be hard to break out.


I believe they said that eve controlling for such obvious factors didn't explain it.


"Low-income residents in wealthy areas, such as New York City and San Francisco, have life expectancies significantly longer than those in poorer regions."

That's somewhat surprising. I wonder if the reverse holds - do rich people in poorer regions have shorter life expectancies than in richer regions?


New York City and San Francisco are also some of the most urban and mass transit-oriented areas of the US, which means walking is a default part of one's life instead of a leisure activity— getting through one's daily life means walking at least half an hour, and easily more. http://www.nytimes.com/2016/04/11/upshot/poor-new-yorkers-te...


Since two replies to this comment suggest the underlying cause might be " less toxic environments, better ecology (less polluted, less crowded areas - less infections, less harards, etc)" and " better health care", the answer is no.

According to the original paper, life expectancy in the lowest quartile "were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions."

https://jama.jamanetwork.com/article.aspx?articleid=2513561

The big correlates seem to be income and behavior (e.g. smoking, obesity).


Behavior has to be the biggest. If we look outside the US and populations known for longevity we see exercise and lower caloric correlations.

Looking at studies surrounding exercise, even simply walking 30 minutes every day leads to better quality life in terms of health including preventing cognitive decline. Exercise is also associated with preventing the shortening of telomeres which scientist believe are connected with aging.


Could be. Richer regions would have better health care, emergency services, sanitation, etc


beyond basic healthcare, better healthcare has surprisingly low effect on life spans.


do you have a citation? This seems like an incredible result, and I would love to hear more!


I've seen it established too, though I don't have the citation either.

But doesn't seem too "incredible", it's mostly the typical notion of "diminishing returns" we see everywhere.


Obviously rich could afford fresh, non-junk food, less toxic environments, better ecology (less polluted, less crowded areas with better water sources - less infections, less hazards, etc).

Mere environment matters a lot.

Update: What is wrong with that? Look how rich segregate themselves and where they used to live.

Also ask any sociologist or comparative historian.


My argument (currently) is that money can buy a housing location next to your office. Completely removing a commute is a pretty big happiness booster.


Or, perhaps, people who have health issues make less money?

Correlation is not causation.


Or something else contributes to both income and health (intelligence seems like a good candidate, there's a similar multi year life expectancy difference between the high and low ends).

I wonder how much simply controlling for parents' money and health would make this go away, although that doesn't separate effects from monetary inheritance.


Although poverty might affect intelligence (I'm not sure the current state of research. Definitely there's a correlation, but I don't know whether genetics fully explains it or whether we can point a causal arrow from poverty to lower IQ.)


Common sense would appear to suggest that, on the whole, lower IQ could be a cause for poverty.


Sure, but some have suggested the reverse as well.


Why do we need to study anything at all when we can just rely on our self-serving intuitions?


So you think having an IQ below 100 wouldn't hamper you in the job market?


Depends on the work; not all work requires you to be a genius. But simply saying it's "obvious" that that must be one of the prime drivers of poverty strikes me as 1) not that obvious at all 2) self-serving


When it goes both ways it can be called a "spiral" or "trap". Poverty does that on a wide range of issues.


People with weak immune system, autoimmune diseases, bad habits related disorders (almost everything, including depressions) etc, would be outperformed by top achievers (outliers), but they would be in the "average" region. It is the same model as IQ, where wast majority are average.


Having money is strictly better than not having money. This is not something that is in question.

Money doesn't solve all problems in life. However, nearly every problem that exists without money will be no worse with money. The reverse is not true.


I think the conclusion can also be read like this:

A social system were everything is for money is deadly for some.

I wonder if the same conclusion can be replicated in countries with more social protections (Scandinavia for example).


It is useful to look at the comparison between countries:

- just static graphics: http://static.gapminder.org/files/vector-graphics/gapminder-...

- interactive, new data: http://www.gapminder.org/tools/bubbles#_state_marker_size%2F...

- text: http://www.gapminder.org/posters/gapminder-world-2013/

To be honest, since there is variation between countries (for Russia vs Japan it is ~20 years!) it would be really surprising if there were no variation within countries (especially as uneven economically as US).


It would be interesting to correlate this with IQ.

It's well known that higher IQ correlates with greater income. I wonder if higher IQ also correlates with better health.

Even more interesting is if being around people with (on average) higher IQ, correlates with better health by osmosis of sorts, by people picking up good habits from those around them.


Yep. And both of those correlations have plausible causations in both directions.

* Higher income -> less likelihood of lead poisoning -> higher intelligence

* Higher intelligence -> more success in job market -> higher income

* Better health as a child -> better brain development -> higher intelligence

* Higher intelligence -> more likely to exercise, eat healthy -> better health


There is tons of research on this. Higher IQ at young ages, independent of social class, strongly predicts health outcomes. Since it also predicts income, and since a big part of IQ can be predicted before birth, IQ seems to be the real driver here.

From here: https://en.wikipedia.org/wiki/Cognitive_epidemiology

A strong inverse correlation between early life intelligence and mortality has been shown across different populations, in different countries, and in different epochs."[3][4][5]

A study of one million Swedish men found showed "a strong link between cognitive ability and the risk of death."[6][7][8][9]

A similar study of 4,289 former US soldiers showed a similar relationship between IQ and mortality.[7][8][10]

The strong correlation between intelligence and mortality has raised questions as to how better public education could delay mortality.[11]

There is a known inverse correlation between socioeconomic position and health. A 2006 study found that controlling for IQ caused a marked reduction in this association.[12]

Research in Scotland has shown that a 15-point lower IQ meant people had a fifth less chance of seeing their 76th birthday, while those with a 30-point disadvantage were 37% less likely than those with a higher IQ to live that long.[13]


This is pretty interesting, given the article about NY's poor being healthier than other poor Americans that was on the front page of HN yesterday [1]. I wonder how much of this can be attributed to environmental factors (long commutes to work, few quality grocery stores, violent crime, etc.) I'm glad there seems to be a fair bit of interest in figuring this mess out.

[1] http://www.nytimes.com/2016/04/11/upshot/poor-new-yorkers-te...


Everybody works hard to make money so they can live longer and better then they realize they forgot to live.


People fixate over these tiny things, little differences in the arrangement of deck chairs, as they are dying of a medical condition called aging, that might be controlled and prevented entirely if enough of them stopped fixating on tiny things and started helping to fund rejuvenation therapies.

There are startup companies now, today, working on the first rejuvenation treatments that address one of the actual root causes of aging. Oisin Biotechnologies and UNITY Biotechnology. Look them up, look up the senescent cell clearance methodologies they are turning from labwork to clinical treatment. These therapies will not cost very much when ready, simple mass-produced infusions.

Yet what is in the news and the thing that people pay attention to? Tiny differences in the status quo, who has a better deck chair as the ship is going down.

It is a frustrating thing to be living in the human condition.


Didn't you post this exact thing last night?


It is an important thing to say.

Among the less attractive aspects of human nature are a fixation with what is rather than what can be, the tendency to limit the definition of success and desired outcomes to whatever the best of the present options might be, and a burning desire to tear down those who have more than you rather than work to create more for everyone. Even in an age of rapid, radical change driven by advancing technology, the vast majority of people focus entirely on the distribution of present assets and opportunities, giving little to no thought to the much larger set of assets and opportunities that we could create for tomorrow.

You see this in the vastly greater attention given to any evidence for distributions and correlations in life expectancy between populations today, and the tiny amount of attention and support given to the production of rejuvenation therapies to greatly increase life for everyone at a modest cost. Given the realization of SENS rejuvenation treatments, the first of which are already under development in startup companies, and most of which will take the form of comparatively low-cost, mass-produced infusions, ten year variations in longevity due to lifestyle choices or access to medicine will be swamped, made irrelevant and small.


Note that the centenarian populations of various blue zones are not typically high income - in fact, many of them are members of rural, agrarian communities.

Eat good food, get plenty of exercise, and try to relax and be gracious.


This does not surprise me anyone. Richer people can afford better life in general, better healthcare, better spouses etc. etc. It would be a surprise if they dont live longer than others.



It looks like Universal Income will not drastically improve life expectancy.


Is this news to anyone?


While it is an obvious truth, it's nice to have some statistics to back up the notion.


Fair enough.


The numbers are.


Come to Europe. We have cookies.


I wonder whether they accounted for suicide. I'd expect the rates to be higher in the rust belt.


Correlation doesn't equal causation. I'd bet that an alcoholic millionaire would have a shorter life expectancy than a healthy street sweeper. It isn't money that matters, it's the cultural norms.


Indirect causation is still causation.

Two people have heart-attacks in middle age after eating cheeseburgers their whole lives. One of them doesn't have health-insurance, and dies, perhaps having never even received good health advice from a yearly check-up. The other is well-off, and so gets stabilized in the hospital and eventually provided with heart surgery (and a whole load of admonishments regarding lifestyle).


As I said before, it's about the cultural norms, which is exactly what you've just described.

For an example showing that money and cultural norms are not necessarily linked, take a look at Ikaria:

http://www.nytimes.com/2012/10/28/magazine/the-island-where-...


What cultural norms? We're talking about two men who made exactly the same bad lifestyle choices. And I know a number of living candidates to be both these guys!


An alcoholic millionaire having a shorter life expectancy than a healthy street sweeper doesn't mean there isn't a correlation between wealth and life expectancy.


I never denied that correlations could exist, but correlation is not the same as causation. In other words, you can have overlap, but one doesn't cause the other.

In terms of causation, stress can influence life expectancy, and lack of wealth can affect stress (which is especially exacerbated if a country doesn't have public healthcare). Quality of food and water can also be an issue in a society with stark inequality. That's basically as far as it goes.

Poor people can be healthier than rich people. If wealth was a dominant cause of better health then that outcome would be unlikely.


It's just an empty statement. A dead millionaire has a lower life expectancy than a living welfare recipient. True, but irrelevant - the fact that you choose to add details to even things out means that you had some cause in your perception of their relative baselines to decide on the direction of your adjustments.

> Poor people can be healthier than rich people. If wealth was a dominant cause of better health then that outcome would be unlikely.

You're mixing possibility and probability, and the entire point is that it is unlikely.

edit: I feel like I have to be very explicit here, because this is very basic: A particular result of a comparison being unlikely to be true for any pair of individuals does not mean that if you find a single example of a comparison going the other way, you've proved something. People are very unlikely to be on an airplane at any particular time. That doesn't mean that no one is on an airplane, or that anyone anywhere being on an airplane is an uncommon event.


> "It's just an empty statement. A dead millionaire has a lower life expectancy than a living welfare recipient. True, but irrelevant - the fact that you choose to add details to even things out means that you had some cause in your perception of their relative baselines to decide on the direction of your adjustments."

I'm making that extra distinction to make it clear that it's about the lifestyle, not the money per se. The perception is that wealthier people in the US have a healthier lifestyle on average than poor people in the US. However, by looking at the issue globally you can see that people who live in cultures that are healthier than the US do not necessarily have more money than the US, nor is there such a pronounced difference between the health of the richest and the health of the poorest in those healthier cultures. With that in mind, you can see that it's not the money making the difference, but rather the cultural norms. If you want to get more specific, compare the diets of the various countries with the best life expectancy, and look at the affordability to the locals for such a diet.

> "You're mixing possibility and probability, and the entire point is that it is unlikely.

edit: I feel like I have to be very explicit here, because this is very basic: A particular result of a comparison being unlikely to be true for any pair of individuals does not mean that if you find a single example of a comparison going the other way, you've proved something. People are very unlikely to be on an airplane at any particular time. That doesn't mean that no one is on an airplane, or that anyone anywhere being on an airplane is an uncommon event."

Look at what the countries with the longest life expectancy do to achieve that. Now ask yourself how much it would cost other countries to achieve similar results.


Call me a heretic, but a 10-15 years discrepancy at a baseline of 70+ years life expectancy does not sound that scary or problematic to me.


As a comparison, if a containment in the water supply caused 10-15 year reduction in life expectancy, that would be considered a crisis, and there would be outrage.


With a median yearly household income of $51,939, that's up to $779,085 you only get if you're rich.


I think his argument is that you've already retired at that age and it's to be expected that your live will end in a few years.


Unfortunately ageing doesn't tend to be 'some years tacked on the end', it tends to be literally getting older at a different rate.

So some 40 year-olds are physically 30, and other 40 year-olds are physically 55. (going by length of telomeres, physical fitness, etc etc). So these people that die earlier have a shorted 'prime of their life' as well.


Really? You wouldn't be concerned about your life being shortened by a decade and a half, then?




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