638. Are You Ready for the Elder Swell?
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Let's start today with some numbers, some demographic statistics that I think you'll find surprising. Here's the first one. Within 10 years, there will likely be more people in the U.S. 65 and older than there are people 18 and younger.

This is a brand new state of affairs, and the rest of the world is following the same path. Let's call it the elder swell. How can this elder swell be explained? It's been driven by two big trends, lower fertility, which we talked about in part one of this series, and a massive increase in life expectancy, especially over the past century and a quarter.

That is thanks to, among other things, more abundant food, cleaner air and water, less war, and vastly better public health and medical care, especially the treatment and prevention of diseases that used to kill so many children. But the real headline of the elders' swell is not just that more people will be living more years. It's that those years are expected to be better. This is what researchers call healthspan versus lifespan.

Let me give you another set of surprising statistics. The International Monetary Fund recently conducted a study of older people in 41 countries. It included both physical and cognitive testing. The researchers found that on average, the physical condition of a modern 70-year-old corresponds to that of a 56-year-old in the year 2000. And a 70-year-old person today has the same cognitive ability as a 53-year-old person in 2000.

Now, much of that gain comes from lower income countries, which had more catching up to do. Still, it is a remarkable gain in health span over just a couple of decades. So...

Today on Freakonomics Radio, how can we prepare for the elder swell? One of the great achievements of the 20th century is to produce an aging society. It's so weird we see it so negative. We'll look at whether our infrastructure is ready for the elder swell. One of the great promises that the American state makes to its citizens in the 20th century is you will be cared for in your old age.

We talked to some longevity scientists. I hope that we can shift the average lifespan of the population by 10 to 20 years. I think that's doable with modern science. We'll hear why innovating in the elder space is still really hard. If the winds go against you, money can dry up really, really quickly. And what's it like to think about living to 100 when you're just 27?

I don't think about things that way. I will live however long I live. Have you done much thinking about how long you'll live? Even if you have, it's probably time to give it a rethink. This is Freakonomics Radio, the podcast that explores the hidden side of everything with your host, Stephen Dubner.

How old are you, Kyla? I just turned 27. Do you think about yourself being old or not yet? Well, everybody thinks about death. That's kind of our unconscious all of the time is processing that, I think. Hey, I wasn't taking you all the way to death. I was just asking about the being old part. It's definitely something I think about in terms of retirement. Like, will I have Social Security? What will the health care system look like then? What will the economy look like?

But I think for most people, you just focus on the day to day and you're like, OK, no, I'll be older one day. I'm speaking with Kyla Scanlon. I am an economic commentator, so I do social media videos about the economy. My first book in this economy came out in May 2024. I do a lot of research around the attention economy, specifically focusing on sentiment and how that impacts the real economy. Do you want to talk about

The phrase you coined? The vibe session. Yeah. The vibe session is that study of why sentiment is diverging from what you could suppose to be economic reality. Tell me a little bit about how you became interested in econ in the first place. I studied economics and finance and data analytics at university. And then I went out to Capital Group in Los Angeles to work for them. What is Capital Group? Capital Group is an asset management firm. So they're on the buy side.

I was in a rotational program there. And for me, like I grew up in Kentucky. I didn't even know you could major in economics until I got to college. And I just was so stunned that we pretend that people don't need to know about economics. They live in the economy. They should understand it. And when we came to you and asked you to

do some reporting for us on aging and longevity science and so on. What was your first thought? I'm very interested in the demographic crisis. We have a bunch of people who are aging and the fertility rate is below the replacement rate. What are we going to do with an aging population that is clearly having a bunch of health problems? How do you take care of a population when there might not be enough younger people to take care of them? So yeah, it was a very exciting issue.

So Kyla Scanlon, a young economics educator who is excited by the elder swell, did some interviews for this episode. Hi, my name is Celine Hollywood. I am the founder and CEO of Loyal. Loyal is a Silicon Valley startup that wants to extend the lifespan and health span of dogs. Yes. Well, Save the Dog, Save the World was my attempt at branding and marketing. It's a romantic summary of the Loyal thesis.

which is save the dogs by helping them live longer, healthier lives. We aren't working on developing drugs for any specific disease per se. It's really more about taking your currently relatively healthy, albeit aged dog and

and having them live longer and healthier. I have an 85-pound senior Rottweiler at home who I would have brought, but you would have heard her drooling everywhere. And this fact of nature is the bigger a dog is, the shorter their average lifespan is.

When Scanlon spoke with Hollywa, Loyal had already raised over $125 million in funding, mostly from venture capital firms. On the biology, we have two categories of drugs. One for a senior dog, lifespan extension. That's more broadly around improving the metabolic fitness of your dog, which is thought to potentially drive their healthy or unhealthy aging, specifically translating the biology of caloric restriction.

caloric restriction being the most OG way, so to speak, to extend lifespan. It was first shown in the 1920s. So we're trying to basically emulate and target the downstream pathways that we believe are activated by caloric restriction that lead to this lifespan extension. Importantly, without you, A, having to give your dog less food, and B, without your dog not wanting to eat, every

Everyone always asks me why not just do a Zen pick for dogs. And it's because the whole treat feeding relationship is actually super important to the dog human relationship. Nobody wants a dog that doesn't care about treats anymore. Because it's the reward mechanism. Exactly. It's super important for bonding, for training. And honestly, I think a lot of what we interpret as our dogs loving us is our dogs begging us for food. Oh, no.

Speaking as somebody who owns a dog who is a big food monster, like I am extremely guilty of this. I have a dog too, and she's the same. And the second category is around big dog, short lifespan, specifically trying to compensate for what we think are the genetic changes that people inadvertently bred for when they were selectively breeding dogs to be very, very large dogs.

The thought being that growth hormone drives the dogs to grow really, really fast in puberty, which is great. If you're a big dog person, you don't have a medium Dane or a small Dane. You want a great Dane. But unfortunately, in dogs, this process doesn't turn off sufficiently once they're fully grown, which we hypothesize causes them to age faster and die sooner.

So the drug, what it does is dampens down the levels of this growth hormone that's circulating in these dogs' blood to a level that's seen in healthy, smaller breed dogs. You could imagine there are people who hear Loyal's slogan, save the dogs, save the world, and think, well, sure, because dogs are great and the average dog is maybe more likable than the average person.

But Celine Hollywa is really focused on the save the world part of the equation. This was something I thought about a lot, especially when I was starting Loyal, which was how do you have impact on societal norms, public policy, etc., when you don't really have a lot of money and influence? I was 23 or 24 when I started Loyal. I think the way...

the way Loyal will have its impact is by normalizing it culturally. If you can go to your vet and get your dog prescribed a drug to keep him healthier longer, it's

You're inevitably going to ask, well, why can't I do this for my grandma? The reason I started the company was to get the first drug FDA approved for lifespan and healthspan extension. It'll help us, quote unquote, save the world, a.k.a. help work on human longevity and human quality of life, too. How do you think about the ethical considerations of longevity work? I'm definitely not an immortalist. I'm not trying to make people live to 150, 100.

or a thousand. I just think longevity and lifespan extension drugs are a kind of sexy way to talk about preventative medicine for age-related diseases, which I think is actually one of the most important things that we could do for society.

Obviously, acute care for age-related diseases is extremely important. We'll always do it. But the most efficient way, so to speak, to treat these really complex diseases is prevention. So that's really what I'm trying to work on. I'm hoping we can prove our point in dogs and help a lot of dogs along the way. But I think this could be one of the most valuable things in human medicine, too.

How did we get here to a world where firms with backing from venture capitalists are chasing FDA approval for longevity drugs for dogs in order to get the same for people? American society today has an age pyramid that was not imagined before.

That is James Chappell. He is a history professor at Duke University. In the 17th, 18th, 19th centuries, it's not like there were no older people, but it was two or three or 4%. We're looking at 20%. We're looking at a massive growth. Despite a setback during COVID, the average life expectancy at birth in the U.S. is roughly 78 and a half years. For females, lifespan is around 81 years, and it's around 75 for men.

If you go back to 1950, the average was 68.2, a full 10 years less. And if you go all the way back to 1900, life expectancy was 47%.

James Chappell is only 42 years old. So how did he get interested in the elder swell? I'm from Florida. I grew up surrounded by older people. And it just struck me as bizarre that there was so little historical writing about this. The gap I'm trying to fill is a narrative about how

how American society as a whole has grappled with old age, not only as an economic problem, but also as an issue of expanded leisure time and the environment and things like that.

So Chappell wrote a book to fill in that narrative. It's called Golden Years, How Americans Invented and Reinvented Old Age. Compared to the other problems that America faces, like child poverty or racial inequality, older people are doing reasonably well. There have been massive expansions of the state in the 1930s and 1960s to care for older people. And

They've worked. I mean, old age poverty is relatively low. In his book, Chappell writes about earlier ideas for elder care schemes, including a 1933 proposal called the Townsend Plan, which was promoted by a California physician named Francis Townsend.

Some people think it was a crackpot carnival barker scheme. Some people think it was a beautiful utopian dream. The idea was that as soon as you turn 60, no matter what job you had, if you're a man or woman, black or white, whatever it is, you would get a certain pension from the government every month. And it was going to be large. The money was coming from where? Basically from the general tax revenues. It was not from contributions from your paycheck. And there was another stipulation that you had to

to spend all the money that month. So it's sort of a wacky scheme. They tried it out. They found some older people and just gave them all this money to see what they would do. They got haircuts and fur coats and things like that. The idea was this is a way to spur consumption and that would help the American economy. Also like a universal basic income for old people. Absolutely. So it's maybe a crackpot scheme. What made it a beautiful one is the egalitarianism of it.

it. It truly was for everyone. It had millions and millions of older people energized around this movement. Franklin Roosevelt didn't like it, though, did he? No, this was very much not Franklin Roosevelt's kind of policymaking. It was enormously expensive. Of

course. It was very untested. Roosevelt and his team preferred to do versions of things they had seen done before, especially in Europe. Roosevelt creates a team, the Committee on Economic Security, and he gets people like Francis Perkins, a very serious, respected reformer,

A female secretary of labor. That's right. The first female cabinet secretary, period, yes? It's got to be, yes. And they put together a plan which looks like what we now call Social Security. It does not bear any resemblance to either what the socialists wanted or what the Townsendites wanted. It was a much more conservative vision where it's not for everyone. It is for people who have worked in certain sectors of the economy and have...

paid these contributions to the state, taken out of their paycheck. And then when they turn 65, the amount they got back would be indexed to how much they put in. You praise Social Security generally in the book and say it's worked and it helped create the entire state of modern retirement. But

But if you think about just the basic economic setup of it, it's so inefficient in so many ways that no economist would ever dream up a plan like that today, would they? It's got too much lag in it. It's got too much variance. Do you still embrace the construct of the program?

Well, yes, it depends on what you think the alternative would be. If I could design a system from scratch, is this what I or most economists now, or to be honest, even in the 1930s, would have designed? Probably not. There are, I think, systems even in Europe today that are more egalitarian, much simpler to administer. I mean, Social Security is so complicated. But given what we know about American history, was the alternative...

So how does all this dovetail with our healthcare system and the creation of Medicare? Right.

very high healthcare costs. This is sinking older people who are largely on fixed incomes. So the Social Security Administration starts arguing for something like Medicare. What a lot of people wanted was simply universal healthcare. What we did instead was we linked health insurance mainly with our employers. It makes a smidgen of sense in this moment in the late 1940s. Does it make sense in 2024? Of course not. One of the

externalities of linking healthcare with employers is that what about people who are unemployed? So people who are middle-aged and unemployed in general in American history, no one cares about them. What about all these millions of older people who worked good jobs? They did their best. They're on social security. They are left out of this new system of health insurance. And so Medicare emerges to fill this gap. It is passed in 1965. It's part of Johnson's Great Society legislation. So

So here's something you wrote. Between 1935 and 1975, old age security was arguably next to military might, the central preoccupation of American policy. You write about the passage of the Social Security Act, Medicare and Medicaid Act. But additionally, you write that every year legislation streamed from Washington that addressed problems in housing, nutrition and care for older people.

It just astonishes me that so much effort was put into a policy framework that was forward-looking in a way that we don't think of policymaking often these days. Can you explain why that happened? It's a little hard to explain, to be honest. I would say, first, coming out of World War II, America is gearing up to fight the Cold War.

And they have to show that the American system has something to offer, that the Soviets are wrong. This is not simply a dog-eat-dog world where the poor go to die and the rich tycoons drive over their bones. We have to offer something. One thing that makes old age an interesting bipartisan area of concern is that it's not really very socialist.

most reforms you can imagine and that people were proposing have some kind of link with the socialist tradition or with trade unions or the working class or economic inequality. To pursue them is to criticize the system of American capitalism. Old age isn't like that. You can be in favor of serious old age benefits without making any claims at all about the justice or injustice of American capitalism. It's also not a special interest group, really, because it's

it is of all the categories of need, one that barring catastrophe, all of us one day inhabit. American policymakers knew they had to be doing something. And this seemed like the safest area to pour really tremendous levels of resources. I think we need another period of

of innovation in this space because social security and Medicare have not really been touched and they are old. I mean, Medicare is 60 years old now. Think how much the healthcare space has changed.

What sort of innovations would you like to see? Well, I, like most people, like polls show 80 or 90% of people would like to see modest reforms to, at the very least, save Social Security. It's one of the astonishing parts of the American political system that a very popular program is about to hit financial trouble in 12 or 13 years. And the political will to address this is just non-existent. The bills are in Congress. They're relatively...

Increased taxes on higher earners move around the Social Security earnings limit. And this problem can be resolved. This is the biggest poverty reduction program in the country. It's eminently fixable and it gets harder to fix every year. We settle into what is now the very familiar dynamic where Democrats, all they want to do is, quote unquote, defend Social Security and Medicare. And the

the right either doesn't talk about it at all or has these fantastical dreams of privatization. That creates a dynamic where the right is trying to attack, the left is trying to defend, and no one is trying to improve these systems, which is what is actually required. Well, some people do say that older voters have too much leverage and that it's often exercised at the expense of chivalry.

children and others. That's a pretty common argument that people trot out. I think that there's been a lot of unfortunate discourse about gerontocracy and the power of older voters, because I really do not think that that's true. Social Security and Medicare were not passed by older voters. The AARP was not pushing for these things. The Congress that passes Medicare is one of the youngest Congresses in American history. It

It had less Republican than Democratic support, but it did have significant Republican support. And I would say support by people in numerous age brackets. In fact, political scientists have shown that it's really middle-aged people who are pushing for these things and young Congress members. The reason is that these were understood at the time, not as sops to the special interest old age lobby, but as a way to secure and stabilize the families of middle-aged people. Yeah.

Because who's actually in danger if, you know, if grandma falls, it's unfortunate for grandma, but it's really unfortunate for grandma's four kids who have to leave their jobs and things like that. So keeping in mind the advances of Social Security and Medicare and other policy that aim to help older people, talk about how modern retirement can

came to be a thing. It's easy to take for granted that this is the way it's always been, but it was shocking to me reading your book how recent the phenomenon that we now see as normal wasn't at all normal for most people. The fact that we have an expectation that I like my job, but at some point I'm going to stop doing it and I would like to hang out with my kids and do some hobbies and service work for 10 or 15 years before I die. This is a very recent expectation.

For most of human history, there is no such thing as a formal exit from the labor force into retirement, let alone one where you could rely on some kind of payments, either from your employer or from the state. The basic timeline is that in the 50s,

about 60, 65% of older men are working. By the 80s, it's more like 20, 25%. Wow. It more or less has stayed stable since then. And it's not just that you stop working and hang out in your house. There is a huge infrastructure of retirement that's created. Senior centers and senior citizens discounts and AARP cruises, all that stuff emerges really quickly over this period. Wow.

One thing that's very interesting about the emergence of retirement after World War II is that a lot of workers did not want it. It was not really a demand of labor unions or the working class. Many workers, even in jobs that seem to us exploitative or dangerous, workers want to stay in those jobs. And so there's a lot of resistance in the 50s and 60s to the creation of retirement, especially in this country, to mandatory retirement.

Mandatory retirement was actually a pretty big part of the American economy in the 60s and 70s. Lots of workers in lots of fields were forced to retire when they turned 65. Americans hated that. That was one of the AARP's first big causes. It becomes illegal in the 80s in most fields.

So your main argument is that we had this massive boom in life expectancy, mostly over the 20th century, which resulted in a lot more older people and that the boom is not just continuing but accelerating now.

And you argue that we've adapted generally pretty well with policies, including Social Security and Medicare and so on. In other words, if you just want to look at the 20th century in total, you could say, wow, those were some really significant, positive solutions to this growing issue.

That brings us to now, though, 21st century. Where do you think we stand? What are the headwinds? Has progress stalled? And what do you see as proposed solutions? The issue of the booming population of 80 plus older people who need care has been persistently viewed as a kind of

afterthought, like something that can be solved with very precarious sectors of the economy and by squeezing as much labor out of middle-aged women as possible. And I think there is a possible world where we say, actually, no, this is going to be a

and dignified part of our economy. It's going to be well-regulated. It does seem to me that progress in this area has stalled. What I would say more specifically is that progress has shifted to the private sector. So to take, for example, assisted living facilities. These are an innovation in America in the 1980s

like so much of what America does with old age policy, it's something that European socialists came up with that was meant to be government funded. And then Americans copied it and made it private. Insofar as there has been serious government action in the last two decades, it's often been to empower private industry even further. Something like Medicare Part C and the introduction of Medicare Advantage plans. It's basically about giving private insurers

a bigger role to play in healthcare for older people. It's looking at the older population essentially as a market that can be divided up among private players, yes? That's right. And not as a category of need that we all share and that therefore the government should be involved in.

One of the great promises that the American state makes to its citizens in the 20th century is you will be cared for in your old age. This is a capitalist country. You're going to work hard in middle age. But once you hit 65 or 67, you can relax a little bit. You've earned it. I think in the 21st century, our business should not be to roll back promises that were made a century ago. We should be thinking about how to secure them for the future.

James Chappell brings a historian's toolkit to the Elder Swell. Coming up after the break, how does an economist think about it? I'm Stephen Dubner. This is Freakonomics Radio. We'll be right back.

Thank you.

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Before the break, we heard about the economic scaffolding that was erected decades ago for older Americans. But there are a lot more older Americans today than there used to be. So it's natural to wonder just how sturdy that scaffolding is. Here's one indicator. In 1965, there were four workers for every beneficiary of Social Security. That number is now less than three, and it continues to shrink.

Meanwhile, the Trump administration has made major staffing cuts at the Social Security Administration, even as more people than ever are filing for benefits. And with Trump's big, beautiful bill taking aim at Medicare and Medicaid.

It's fair to say that the sturdiness of the scaffolding going forward is at best uncertain. And it's not just here. Many countries around the world are dealing with the same problem. So it's time to bring on an economist to help us sort this out. His name is Andrew Scott.

I'm an economics professor at London Business School, and these days I'm somewhat obsessed with the topic of longevity. Scott began his career in various advisory roles for the UK government, including in the House of Commons, the Bank of England, and the Treasury. I do all the things you think a macroeconomist should focus on, the monetary policy, fiscal policy, financial stuff. And then I got a little bit bored. There's only so many times you can talk about interest rates going up or going down. And so he became a professor.

One of the joys of working in a business school, you're always talking about those big trends that are going to change the world. And so you're not just talking about interest rates, you're talking about globalization and artificial intelligence. I used to give this lecture on an aging society and

it was pretty miserable. You just project for these endless numbers of old people. Old people are seen as a problem. They get ill. They need a pension. And then halfway through this lecture on aging society, there was a slide that said, hey, on average, we're living longer and we're healthier for longer. And I thought, that sounds quite good. How do we turn that into a bad news story? This led to Scott writing a book called The Longevity Imperative, How to Build a Healthier and More Productive Society to Support Our Longer Lives.

The book opens with the story of Scott's identical twin brother, David, who died a few days after they were born in 1965 in London. That year, the most common age of death in the UK, what's called the modal age, was between zero and one. Today, the modal age is 87. You did not mishear me. The most common age of death in the UK today is 87. It's the same in the US.

One of the great achievements of the 20th century is to produce an aging society. It's so weird we see it so negative. It's mourning the loss of fewer children. It's fewer parents snatched away in midlife. It's more grandparents meeting grandchildren. And all we can do is turn around and say, oh my goodness, we have an aging society. I mean, it's quite extraordinary. So I have a feeling I know how you will answer the following question, but I'm going to ask it anyway. Is aging a privilege or a curse? Well, it's a privilege. I

I'll come at it from a very simple economic point of view, which is that an increase in life expectancy means we have more time.

And for most people, that's a good thing. So what do we fear about it? We fear outliving our health, our wealth, our skills, our purpose, and our relationships. Those are a lot of things to fear. It sounds like you're about to help us supersede that fear somehow. Are you a magician? Well, no. We fear getting old. So what are you going to do now to age better? That's never been an imperative before. When there's only a 10% chance of making it to 90, you don't think, I'm going to spend my 30s, 40s, and 50s preparing for a long life.

No, we have to. That's a radical moment in human history because we've never had to support such a length of life.

You write in your book about what you call an evergreen economy. I was thinking about that recently because I was in Florida, where you see an awful lot of businesses devoted to the aging. There's all kinds of medical facilities, classic car treatments. There's golf. You know, it's a lot of things that we associate with aging, longevity, retirement, and so on. So that's, you know, an obvious tip of the iceberg. But when you take a step back and look at the bigger evergreen economy, everything from

labor forces, pension, health care, etc. How do you expect it to be substantially different from

My big thing is to focus on a longevity society rather than an aging society. And I know immediately what happens when I see a consultant talking about an aging society. They start talking about the burden and then they start talking about cruise ships and care homes and the market potential, what I call the silver economy. All of which is valid. All of which is true. There are a lot more older people. And the baby boomers mean there's even more older people because that was such a large cohort.

For me, the evergreen economy is about how to remain fit and healthy throughout my life. So we should see a shift towards people eating more healthily, which we're not seeing everywhere, but we're beginning to see. It's going to be about how you do lifelong learning. It's going to be about how you can support working for longer. I think that's a really, really big change because in the 20th century, we invented a three-stage life, education, work, retirement.

As we're living longer and longer and longer, we can't just stretch out that three-stage life. Let's take the case of retirement. Retirement, to be honest, is already gone. The notion that there is a single age where everyone comes to a hard stop of work has already disappeared.

Some people retire at 60, some people retire at 70. Some people go part-time, then they retire, then they're going to un-retire. We're seeing a much more complicated pattern. One barrier to a lot of older people working longer is that they're not wanted. Their skills are considered outdated, whether that's accurate or not. A lot of younger people honestly just don't want to be around older people in the workplace and elsewhere.

How ageist would you say we are as a modern society? And assuming the answer is at least a little bit, what are your suggestions for shifting that? There's clearly all sorts of ageism around. And one of the ironies is that the more old people there are and the more likely the young are to become old, the more ageist we seem to be. Ageism is that weird prejudice against your future self. It's very strange. I get a little trouble here because I think, you know, if I tell you that over

over the last 10 years in high-income countries, the majority of employment growth has come from older workers. I read this in your book. I was shocked. Everyone is. And the share in the UK is absurdly high, yes? And Europe even higher. So in the US, it's about 60%. UK, it's about 75%. And in Europe, it's over 100%. Just to be clear, this is the growth of labor among age cohorts, yes? Yeah. So if you look at the increase in total employment and say which age groups have seen an increase,

It's older workers. It's a mixture of more likely to work and more of them. Let me just push on that data a little bit. How low of a base were we working off of there? It's not like I'm playing around with people aged over 80 where, of course, you've got a very low base. This is from 50 plus. We underestimate the capacity of old people. That's the ageism part.

And of course, if we underestimate the capacity of old people and more and more of our life is going to come at later years and more and more of the population is going to be older people, we've got a real problem if we then underinvest and cut them out because we get the very bad aging society story that we worry about.

So we have to adapt to living longer by being healthier and productive for longer. Mick Jagger's the one everyone points out. He's 80, performing on stage. You're seeing age stereotypes being challenged and some people adapting. But there's another issue, which is that most people, excluding you and me and some people we know, because we happen to toil in fields that we chose and that we enjoy. At least I do. You seem to as well. Most people around the world don't enjoy their work.

So for those who don't, how do you think about that balance? The problem we've got is that we do, as we're living longer, need to get people to work for longer. So how do we redesign work to give people opportunities to carry on working? I'm very keen on the notion of age-friendly jobs. Can you give me a for instance? Well, they've got the following characteristics. They're less physical, they're more flexible, and they give you more autonomy. So professor's great, tour guide's another one. Everyone likes jobs that are more flexible, have more autonomy, aren't very physical.

But older people really like it in the sense they're prepared to take a bigger cut in salary to do those jobs. So really important we create those because you've got to make sure that you ease the competition between older workers and younger workers. You don't create institutional blockages. Now, there's been a huge increase in the number of these age-friendly jobs, just the way the labor market is going. But of course, if you're a construction worker, you do not work in an age-friendly job.

So how at 50 do you help someone who's been a construction worker shift into an age-friendly job? That to me has to be a really important labor market policy because there's loads of skills that people have. My father-in-law was American. He was a truck driver. He stopped work too early. There are lots of things he could have done. He'd have been brilliant. He's got great people skills. We've got to help people with these shifts.

So in your book, you propose three major policy ideas for countries to achieve this longevity dividend that you call it, including raising the proportion of people working in the years running up to retirement, boosting productivity of older workers, and increasing the retirement age. So

Let's talk politics. How do you see reconciling the needs you're prescribing with the realities of our political discourse at the moment? On the politics, I wouldn't start with raising the state pension age. It actually quite annoys me at the moment that that's what governments are trying to do because not everyone can work for longer.

That's why I absolutely focus on 50 to 65. There's a huge economic gain to be had to that. In the US, if you could slow half that rate of decline, 80% of people age 50 are working a third by 65. If you could half that, that gives you 4% of GDP every single year. That's a huge uplift in terms of resources. Then you can start worrying about how I actually sort of raise the state pension age later.

But what we've got to do is not make people work for longer, but support them working longer. That has to be about health. It has to be about skills and providing the age-friendly jobs. And if you don't do that, you cannot raise a state pension age. There is this community of relatively small but quite prominent longevity hackers or scientists who are trying to really push the boundaries.

What do you think of that movement? Do you think there are useful things that will come out of it, or is it a kind of strange fantasy land or somewhere in between? Yeah, it's a broad church, isn't it? What's really interesting about that group is that they've picked up on the malleability of age. Maybe they take it to extremes, but we're so wedded to thinking about chronological age. And about chronological age, it's

It's backward looking, not forward looking. So it misses the fact that actually a 65-year-old today is different from a 65-year-old 30 years ago because they have more years to go. The other great thing I think they are focusing on is that, you know, we've got a disease approach to health at the moment. But just as in psychology, you had the positive psychology movement that said, look, let's focus on what keeps people mentally well and happy.

As we're living longer, it is an aging process that is this biggest risk factor behind multiple diseases. The key thing about prevention is focusing on a biomarker. It could be these obesity drugs, it could be your sugar levels, it could be some biological process of aging.

If you can slow that down, you postpone getting diseases. In other words, you stay healthier for longer. If you had the authority to remake a big, wealthy country's health care system, maybe it's the U.S., maybe it's the U.K., with the same amount of spending currently, what are the first few things you'd do? The first thing is about the same amount of spending, because unfortunately, I think you've still got to deal with the current disease burden, because you can't just say to people, I'm not going to treat you.

All right. Do you want me to give you an extra trillion dollars? And I mean, the U.S. spends about four trillion on health care. Let's say I install you in the U.S. despite your citizenship and say, I'm going to give you an extra 25 percent of total health care spending. What are a few things that you think would address the issues that you see down the road? Well, by the way, let me do the politician's trick and say, I'm sure I can find efficiency gains to give you.

That's what they said about the NHS and that didn't work out so well. I do think you've got to ring fence prevention. And we talk about the NHS. The NHS is set up to do intervention. There are lots of treatable things like heart disease, for instance. Diabetes looks increasingly like another one where if you intervene early enough, you can actually prevent or postpone certain diseases. So I would go for two or three key vaccines. What would you most want those vaccines to cover if

Cardiovascular disease, because cardiovascular disease links in diabetes, it links into dementia. So let me have those as the three that I would go for. There's a whole bunch of screening, genetic testing, all of which I think should be feasible with AI and big data. That's what the next few years are going to bring. Do any or many governments have a target for healthy life expectancy? And if not, should they?

I'm so glad you asked that. I think it's crazy. I mean, in my country, the biggest health target is the waiting list of operations, which is barely any relationship with health whatsoever. Health systems have to try and focus on a measure of healthy life expectancy. I mean, we've got to construct it. It's difficult. But, hey, we focus on GDP. That's difficult to measure. So I think we can do it.

I would make the social security age dependent upon that measure of healthy life expectancy. I do not think it is socially fair to demand people to work for longer if they're not healthier for longer. That gives ministries a financed incentive to invest in health because right now most ministries look at the health budget as a cost and say, I don't care how you spend the money, I'm just going to minimize how much I give you.

We've got to recognize that actually if we can invest in health and we spend money in prevention, we get good outcomes. Every economist will say we know health is one of the most important things in our life. We also know that interventions that keep us healthy but also enable us to create resources that we can use over our life are particularly valuable. I think we've got to bring much more in that health and economic perspective in how we allocate money.

Most governments are not yet focused on allocating resources to longevity, as Andrew Scott would like to see. But the private sector is. Coming up after the break, Kyla Scanlon talks to some innovators who are going right past dog longevity and straight to the humans. I'm Stephen Dubner. This is Freakonomics Radio. We'll be right back.

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There is a growing body of research showing that some pharmaceuticals, including GLP-1 treatments like Ozempic and Wegovy, may have longevity benefits beyond their intended use. But the FDA has not approved any drugs that specifically target longevity.

It's hard to imagine that won't change eventually, but the FDA may have to change first. The agency doesn't currently classify aging as a disease, which means the regulatory path to drug approval is not smooth. That's why loyal CEO Celine Hollywa, who Kyla Scanlon spoke with earlier, is trying to get FDA approval for her dog drugs as a first step. But there are plenty of other startups out there that are going straight for the humans. I

My name is Katie Fike, and I am the co-founder of Aging 2.0 and a managing partner of Generator Ventures. Fike's venture capital firm is focused on investments in aging, and Aging 2.0 is a networking and founders program for startups in that space.

Kyla Scanlon interviewed Katie Fike and asked how she got into the longevity business. I was working for Lehman Brothers on the morning of September 11th in the World Financial Center. I'd actually been there until about three in the morning the night before working on stuff that was, quote, very important. I came in that morning around eight. It was kind of a normal morning. And then obviously things quickly became very abnormal.

We stayed in the building after the first plane had hit, and then we were told to evacuate after the second one. Obviously, it was a really traumatic experience. I was 21 years old.

I had this kind of pit of my stomach feeling that I wanted the work that I did to matter more, not less. When real life happened, all this stuff that I'd been pulling all-nighters for just really didn't seem to matter anymore. And a few months after September 11th, my mom sent me an article and then a book by an MD geriatrician named Bill Thomas. That book changed my life.

Fike went back to school and wound up getting a PhD in gerontology from the University of Southern California. I had started my life in the tech and finance world, and then I moved over into gerontology, and I realized that these worlds were just so separated. The people in aging care services, the ones who really understood the needs, didn't know the people who were creating the apps or creating the business models. The people who were launching new startup companies didn't

didn't even know about some of the opportunities that were hiding in plain sight in the aging space. And so what we did with Aging 2.0 to start was getting those same people in the room. Sometimes people would want to put us in a little box, you know, and think like, oh, that's pretty niche. We would say, well, if it's more comfortable for you, you could just think about aging as the fastest growing, highest utilizing, most expensive consumers of our healthcare system.

I remember one doctor used to say, if you're not a pediatrician or an OBGYN, you're effectively a gerontologist. It's interesting how many people don't consider this market. But you've also talked about the technology, you know, tweaking existing services like Uber and Tinder and helping those be useful tools for seniors. Could you talk through how you think about these mainstream tech platforms and how we could adapt some of this technology for older adults?

the Uber for seniors or the Tinder for seniors, it starts to get a little similar to what traditional VCs often ask entrepreneurs, which is, well, what if Google decides to do that tomorrow? Or what if Amazon decides to enter this market? That's a worthwhile question for entrepreneurs to think about when they're trying to think about, should I leverage an existing technology or an existing model?

and bring it over into the senior care space because you're often competing against really well-funded incumbents. What's often tricky about mentioning what are some of the most successful companies with aging, some of the most successful ones have done it so discreetly that it's kind of hard to point out who they are. And the exact reason they're having success is because they're doing it discreetly and not so overtly. I think Apple is actually a fantastic example of that.

where Apple has really focused on, you know, good design, really good customer service. If you walk by an Apple store, you will often see who's at the genius bar might skew a little bit older, but they haven't made this, you know, the help bar for seniors. It's just Apple.

Frankly, even being able to walk into a store in the first place is a very ageless and age-friendly tactic. Could you talk through what you look for in a pitch and how you balance this commercial aspect of how do you make money and the social impact of a potential investment? In terms of the commercial side, we look at a lot of the same things that traditional investors would look at around any pitch. A strong team, a large total available market,

Good product market fit, depending on what stage you're at, ideally some early customers. It's really important to see an entrepreneur who's humble, who has high EQ, who has strong empathy, and who's willing to listen. We saw a lot of money get wasted and time get wasted by entrepreneurs who had their blinders on, thought they understood the solution, and really were not hearing the feedback they were getting from the market or from the customer. ♪

Scanlon also interviewed Kristen Fortney, co-founder and CEO of a biopharma company called BioAge. We're focused on aging biology and therapies that can ultimately help aging. That's not by itself an investable prospect, partly because there are no medicines that are approved for that right now. What would the FDA regulatory path even look like? What would reimbursement even look like? Still, BioAge raised hundreds of millions of dollars from venture capital firms, and

Could you just talk through why you chose to focus on aging and your path toward co-founding BioAge? I do.

I deliberately went into the field because I was so excited by what it could mean for human health. There's all these different ways now that we can make, for example, a mouse live 30% longer, 40% longer. What's exciting is that it's not just living longer, it's living healthier longer. So in these animals, you're delaying cancer, you're delaying cardiovascular disease. What would that mean if we could do something similar for people? It could potentially have a much larger impact than going after diseases one at a time.

Can you talk about the industry at large, you know, just it being like a volatile space and how you think about the longevity of longevity companies? The funding environment in biotech has been especially challenging the past couple years. That's in contrast to 2021, for example, when a lot of companies were going public, a lot of big rounds were being done.

There's pros and cons, right? Everybody today will be like, well, we're only investing in the good companies and everyone was crazy back then. I think what's suffering right now is the more innovative approaches, which are riskier. There's still a lot of good science being funded, but a lot of it is building another truck for the same target. Very de-risked science. Can you talk about the de-risking? What's relevant for BioAge is that there's still a few therapeutic areas where people are willing to take big swings. And

And one of those is obesity. With the incretin drugs, you know, Zepbound, Wegavie, these are really unprecedented markets in biotech. And these medicines, they're really Gen 1, right? They're these first injectable drugs that are having dramatic effects, not just on weight loss, but on incidence of disease.

So everyone is very willing to finance additional exploration of this exciting new space. For example, our drug, which mimics the effects of apolin, it's a pill that you can take once a day that should improve weight loss and also can potentially improve body composition. Everyone in the obesity space would love to have a pill version of one of these injectable drugs. There are several of them being developed right now.

I went back to Kyla Scanlon after she did these interviews to ask her how much investing momentum there is in the longevity space. What's challenging for investors about the longevity space is that it takes a lot of time and it takes a lot of money, two things that venture capitalists don't really like. They like to allocate as little money as possible and have things go as quickly as possible. And

The CEOs of these more traditional longevity companies are like, "We don't like how sparkly the space has gotten because it distracts from what anti-aging really is, which is just preventative. It's not about turning into a superhuman." I think investors like the sparkle aspect of it, but once they realize how hard it is to actually do good science, it might not be as interesting. And just how hard is it to do good science?

BioAge recently halted clinical trials of their drug, Azeloprag. When we reached out for an explanation, they said, BioAge made the decision to discontinue the Azeloprag trial after observing unexpected liver enzyme elevations in some patients receiving the drug. While these elevations were not accompanied by any clinically significant symptoms, the safety profile of the drug was no longer suitable for obesity treatment.

Another of their drugs targeting neuroinflammation will have clinical results later this year. And BioAge recently announced collaborations with Novartis and Eli Lilly. Still, at one point, BioAge had a market capitalization of more than $600 million. Now it's down to around $150 million. And how about Loyal, the dog longevity company founded by Celine Haliwa?

They've raised another $22 million since Kyla Scanlon spoke with Holly Wah, and they've got 1,000 dogs enrolled in a study to test their drug that is intended to help older dogs live longer. A few months ago, that drug got its preliminary efficacy approval from the FDA, the first of three steps needed for FDA conditional approval. I asked Kyla Scanlon if she would want to give her dog Loyal's new life-extending drug.

Oh, my goodness. My dog was just diagnosed with cancer. So I would do anything in the world to give my dog a longer life. It is interesting, like how I think about her life relative to my life. I'm like, you have to live until you're 100. But, you know, my dog is a pit boxer mix. She's on the larger side. And this is what Celine talked about in the interviews. Larger dogs are just

They're prone to dying a bit earlier. And so I'm seeing Celine's research and the whole thesis behind her company play out in my dog. How long do you expect to live?

I don't think about things that way. I will live however long I live, yeah. Do you have a number that you would consider, I'll put this in quotes, a success? Oh, it's always a bummer about my personality is I'm too philosophical and I read too much Carl Jung. And so death is just the next transition. Whenever it happens, it happens.

Let me ask you one last question. Let's say that your generation, everybody who's 27 now ends up living to on average 103 and that the quality of life is really good, which means that everybody gets, you know, another big, big chapter of 20 or 30 or 40 years where they're able to pretty much do what they want.

I'm curious if you have ideas for other big chapters that you might want to do. Would you want to become an opera singer, a PhD philosopher, the president of some country, et cetera, et cetera? Oh, yeah. I think what could be really cool if we all of a sudden added 20 more years to everybody's lives is like how much more education we could all consume. You can keep on learning forever, but it becomes more difficult because your time becomes more constrained.

I would definitely take like 20 straight years to learn everything I could about various industries and then apply them to various ideas I would have. I hope Kyla gets her extra 20 years, maybe more. Unfortunately, she recently had to put down her dog, whose name was Moo. Thanks to Kyla for helping out with this episode. She can be found on most platforms at at KylaScan. And her book is called In This Economy.

And thanks to everyone else who shared their insights on the Elder Swell. I'd love to know what you thought of this episode and our whole Cradle to Grave series. Our email is radio at Freakonomics.com. Coming up next time on the show. Donald Trump has my colleagues in the Senate afraid of him. I think that we can beat fear. You may have heard that Cory Booker, the senior U.S. senator from New Jersey, recently took to the Senate floor for a record 25 hours straight

to sound the alarm on Trump. But his concerns go deeper than that. If the Democratic Party or leaders define themselves only by what we're against, we will be lost as a nation. We'll talk about that and we'll try to keep up with the news in real time. I'm just being told by my staff that an Israel-Iran ceasefire has been announced. That's next time on the show. Until then, take care of yourself. And if you can, someone else too.

Freakonomics Radio is produced by Stitcher and Renbud Radio. You can find our entire archive on any podcast app, also at Freakonomics.com, where we publish transcripts and show notes. This episode was produced by Augusta Chapman with help from Alina Kullman. It was mixed by Eleanor Osborne with help from Jeremy Johnston.

The Freakonomics Radio Network staff also includes Dalvin Abouaji, Ellen Frankman, Elsa Hernandez, Gabriel Roth, Greg Rippin, Morgan Levy, Jasmine Klinger, Sarah Lilly, Tao Jacobs, and Zach Lipinski. Our theme song is Mr. Fortune by the Hitchhikers, and our composer is Luis Guerra. As always, thanks for listening. Steve Wright, the American comedian, says, I want to live forever, so far, so good. That's kind of my approach. The Freakonomics Radio Network, the hidden side of everything.

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