Following on from my last post on the attitudes of pro-longevity bioethicists, here's an open-access piece by Tom Koch. It opens with these questions:

Why has longevity become a source of dismay rather than a cause for celebration? How did we turn the greatest triumph of 20th century public health and medicine into a problem for the 21st century?

This is the view from inside the paradigm of state-regulated, state-controlled medicine. Centralized systems of privilege, cut loose from price signals, inevitably devolve to rationing and crumble beneath increased demand. That increased demand is feared even when it is a great good, such as medical technology. This state of affairs stands in stark opposition to the free market, in which increased demand is a sign of great success - it is the opportunity to create progress through trade, research, and competition. A monolithic system crumbles under growth, while the competitive market thrives. Looking back at the SAGE Crossroads podcasts on (political) economics and engineered longevity, we have this:

Again I say if this were a privatized system, we would all say "gee it’s wonderful. All these people want more health care, this industry is thriving". Let me put one other analogy. Suppose we made cars a government entitlement. Instead of cheering when auto production went up, we’d say, "Oh my God, we can’t afford this!". How you finance it may greatly affect the psychology and actually the freedom of the economy to take advantage of these new opportunities.

Koch concludes in his article:

much of what we think of as geriatric [medicine] is in fact medicine for fragile persons. Geriatric expertise in the maintenance of people with multiple conditions can serve the critically ill of every age. Blaming people who are over the age of 65 for the rising costs of our publicly funded health care systems permits us to focus on one class of patients. In truth, health care is expensive at every age and not something to be begrudged anyone because of age. The alternative is that we should all die young, at the first hint of illness, or figure out how to live healthily and forever.

If we lived in a world in which government had nothing to do with the provision of medicine, there would be no begrudging, no need for battles over centrally planned resource assignment, no rationing by fiat of the uncaring and distant. There would instead be a ferociously competitive marketplace, responsive to needs, and there would be generous medical charity for the unfortunate; we would do very well by that. It is a great pity that we stand very far indeed from such an ideal.