Aging and growing health care costs: the political pathway

There is an ongoing debate concerning the effect of population ageing on health care cost growth. On the one hand, since per capita health care costs tend to rise exponentially in old age, total health care costs grow mechanistically with the rising the share of the elderly in the population. Moreover, ageing decreases GDP growth, which favours an expansion of the share of health care spending relative to the economy. On the other hand, older individuals today are in much better health than previous generations were, thereby reducing their impact on health care costs. Additionally, other factors, such as the inflation of the costs of health technology, have a significantly larger effect on health care costs than ageing. However, this debate has not considered a crucial political channel. We contend that aging relates to health care cost growth via a political prioritization of health care over other priorities. We argue that older voters prioritize health care over other social policies and, in turn, vote for parties that prioritize health care. Our paper fills a significant gap in the literature regarding individuals and political parties’ preferences for health care. Previous studies on public opinion towards health care expenditures rely on unconstrained questions about health care and are unable to measure the trade-offs between health care and other policies. Hence, previous studies have not found that age is related to preferences for health care spending (Jordan 2010; Naumann 2018; Vallée-Dubois 2022). Moreover, very few studies have analyzed parties’ positioning on health care (e.g. Green-Pedersen and Jensen 2019) and which groups of voters react to parties’ proposals about health care. We rely on three levels of analysis to test our argument. Firstly, we rely on original survey experimental techniques to measure priorities between health care and other social policies. We conducted this survey in June 2024 with representative samples in four countries (Canada, Germany, Switzerland and the United Kingdom), among 8000 respondents. Using this survey, we show that older respondents are likely to prioritize health care when facing a situation of trade-offs between health care and other priorities and are more likely to vote for the parties that they perceive as the best to manage the health care system, that is, parties with issue ownership of health care. Next, we rely on the Comparative Agendas Project to extract parties’ positions on health care in seven countries over several decades, of which Germany and the United Kingdom are also part. We analyze if an aging population correlates with more attention paid to health care. As a third step, we pair this dataset with national election polls to analyze if older respondents are more likely to vote for parties that give more attention to health care. Our study has important political implications. Validating our argument would involve that as the population gets older, parties are more likely to prioritize health care over other public expenditures, thereby contributing to a politically driven mechanism of growing health care costs.