But the severity of afflictions increases and the cost of preventing further deterioration increases with age: "Five years before the year of death, annual health cost is virtually the same as all annual Medicare costs per capita. By the second year before death the cost has risen by about 60 percent, and in the year of death the annual cost exceeds the average by more than four times. Indeed, expenditures on persons during their last two years of life account for 40 percent of all Medicare expenditures."
The 20th century radically reduced deaths due to acute infectious diseases, which were concentrated in infancy and early childhood. In 1900, more than 33 percent of all deaths were of children under 5; today they are less than 2 percent. In 1900, deaths of persons 65 and older were only 18 percent of all deaths; today they are 75 percent.
This demographic destiny might entail starving every other sector of society -- including national defense, at great cost to America's international standing. It had better not, given what Fogel argues in another essay, this one in the current issue of Foreign Policy. It is titled "$123,000,000,000,000." Fogel's subtitle is: "China's estimated economy by the year 2040. Be warned."
He expects that by 2040 China's GDP will be $123 trillion, or three times the entire world's economic output in 2000. He says China's per capita income will be more than double what is forecast for the European Union. China's 40 percent share of global GDP will be almost triple that of the United States' 14 percent.
Fogel finds many reasons for this, including the increased productivity of the 700 million (55 percent) rural Chinese. But he especially stresses "the enormous investment China is making in education."
While China increasingly invests in its future, America increasingly invests in its past, the elderly. China's ascent to global economic hegemony could be slowed or derailed by unforeseen scarcities or social fissures. America's destiny is demographic, and therefore is inexorable and predictable, which makes the nation's fiscal mismanagement, by both parties, especially shocking.