People are having knee and hip joint replacements at younger ages. In the past, doctors usually recommended putting off joint replacement surgery until patients were in their  sixties or seventies, but that seems to be changing.

Alex Janin, writing in The Wall Street Journal, tells us the average life expectancy is ticking up and the average age of joint replacement surgery is going down. He says many Americans are no longer willing to sacrifice decades doing their favorite activities, such as skiing, hiking or playing pickleball, to sit in pain, according to doctors.

Certain intense, high-impact fitness activities can increase the chances of injury and arthritis—leading to more procedures. “In the past, people would just say, ‘I don’t run, I have bad knees,’” says Dr. Ran Schwarzkopf, an orthopedic surgeon at NYU Langone. Now, he says, “they’re not willing to accept limitations that arthritis gives.”

The other reason younger people are getting replacements is the growing prevalence of obesity in the U.S. More than 40% of U.S. adults have obesity, the Centers for Disease Control and Prevention says, up from roughly 30% in 1999. Excess weight puts more pressure on the joints—roughly 4 pounds for each additional pound of body weight—leading more patients to need replacements earlier in life.

For patients ages 45 to 64, there was a 211% increase in inpatient hip replacements and a 240% increase in inpatient knee replacements between 2000 and 2017, according to data from the U.S. Department of Health and Human Services’s Agency for Healthcare Research and Quality. (Records after 2017 are less accurate due to changes in Medicare coding.) There was also an increase in joint replacements for patients ages 65 to 84, but the rise wasn’t as steep.

This tracking doesn’t include the growing share of replacements that are outpatient surgeries, which allow patients to go home the same day as their procedure. More than a million hip and knee replacement surgeries are performed in the U.S. every year.

“Back in the day, patients were told they had to wait until they were 70 or 80 to undergo this procedure because implants did not last long enough,” says Dr. Antonia Chen, an orthopedic surgeon at Brigham and Women’s Hospital. “Now, implants last 20, 25 or 30 years, and quality of life means a lot more.” Chen estimates that patients under 65 account for roughly 50% of her practice now, up from roughly 30% in 2014.

All this sounds great but there is another side to this story. Many surgeons still recommend minimizing or altogether avoiding running and other high-impact exercises after surgery, because it can put extra pressure on the prosthetics. Our joints are like tires; the more weight the tire carries, the quicker it wears out. These procedures are largely elective, and surgeons caution they still shouldn’t be considered preventive. They carry risks including infection, dislocation or joint instability.

As an orthopedic surgeon myself, I can tell you it’s more complicated than it seems. I once performed a total knee replacement on a 33-year-old man, but he would have been in a wheelchair otherwise. I wasn’t trying to get him back to running marathons! Anyone can undergo a total joint replacement at an early age and improve their level of function. But the real test is how long before you have to repeat that procedure because the artificial joint has worn out, or more commonly, has become loose.

If a person in their forties has a knee or hip replacement, and lives a normal life expectancy, it is almost guaranteed they will have to have that joint replaced a second, or even a third time. And if obesity is their problem, those repeat joint replacements will happen even more frequently. While this is certainly possible, the incidence of complications with repeat replacements goes up significantly. I doubt the surgeons doing many procedures in patients under the age of sixty-five are being fully candid about the drawbacks of repeat total joint replacements. No improvements in the materials used or the surgical techniques employed can change that reality.

The latest news in the financial world is “price controls.” This approach to economics was put forth by the Biden Administration two years ago with the Inflation Reduction Act (IRA), a misnomer for legislation that only added to our inflation problem. The intent of this legislation was to reduce prices on prescription drugs.

It makes good political sense to tell seniors you’re going to lower the price of their prescription drugs. What you won’t tell them, however, is this same move will reduce the development of new medicines.

The Wall Street Journal editorial board tells us Charles River Laboratories, a top research contractor that helps drug makers with clinical trials, warned in its quarterly earnings report that pharmaceutical companies are slashing research and development owing to the IRA’s drug price controls.

“There are profound cuts” at pharmaceutical companies that reflect a “rapid deterioration” of their business, CEO James Foster said. He added: “A lot of these decisions have been taken relatively recently and probably more to come and haven’t been taken yet.” Might drug makers be hedging their investments because Democrats look more likely to hold the White House?

WSJ explains: “The IRA let Medicare “negotiate” prices for 10 to 20 drugs a year and a total of 60 by 2029. Negotiate is a euphemism for extortion: Drug makers that don’t participate or reject the government’s price face a daily excise tax that starts at 186% and climbs to 1,900% of a drug’s daily revenue.”

The law also requires manufacturers to pay the government rebates on medicines sold to Medicare if they raise prices more than the rate of inflation, and puts them on the hook for more of the entitlement’s Part D costs. Democrats used the resulting estimated “savings” of some $160 billion to pay for the green new deal.

WSJ says, “But subsidized solar panels won’t help if you get sick. The inevitable, albeit invisible, result of Democrats’ raid on pharmaceutical companies will be fewer new medicines.”

Roche CEO Thomas Schinecker said last summer that “we have decided that we are not going to do certain trials, or that we are not going to do a merger or acquisition or licensing [deal] because it is becoming financially not viable.” Astra-Zeneca also warned that it might delay launching some cancer medicines because of the IRA.

Some 90% of drug candidates fail in clinical trials, and manufacturers sometimes never recoup their investment on even those that are approved. They use profits from their few commercial successes to finance research and development into new medicines and to compensate investors. The IRA threatens this risk-reward model.

Despite these obvious drawbacks of price controls on the manufacture of prescription drugs, Democratic presidential nominee Kamala Harris has just announced she will pursue price controls on food and groceries as a “solution” to our inflation problem. Just as it has reduced the supply of new medicines when used in the IRA, this use of price controls will inevitably lead to fewer supplies of food and groceries.

Here is what the WSJ editors have to say about that:

“Fixing prices is a recipe for shortages, as controls would discourage grocery suppliers. Voilà, empty store shelves. Price controls have led to shortages everywhere they’ve been tried, from Moscow to Caracas. The last American President to impose wage and price controls was Richard Nixon in the early 1970s. He had to stage a humiliating retreat amid shortages and market dislocations, and prices immediately soared when controls were lifted. If Ms. Harris really believes in this price-fixing, she lacks the most basic understanding of economics. If she is merely floating it to be able to get “price gouging” into a speech, her cynicism is also telling.”

Today’s post is a history lesson for all those paying attention. In 2010 the Democrats passed the Affordable Care Act, better known as ObamaCare, without a single Republican vote. It was implemented in 2014 and people quickly came to realize it was not what it was cracked up to be. Rather than a panacea for rising healthcare costs, it drove them even higher.

President Obama made several promises then including the famous “If you like your healthcare plan you can keep your healthcare plan” which turned out to be lies. He promised ObamaCare would reduce healthcare premiums by $2500 per person per year but in fact they only increased. Less than five years later in 2018 insurance premiums doubled for individuals and rose 140% for families, even while deductibles increased substantially.

Democrats said the solution was to convert ObamaCare into single-payer healthcare; a government guarantee for all medical care they insisted would be “free.” The British have such a system called The National Health Service, which was established by the constitution, and says: “You have the right to receive NHS services free of charge.” But they ignore the fact that the U.K. funds the program by taxing citizens some $160 billion a year, even with its severe limits on access to specialists, drugs and technology.

Dr. Scott Atlas wrote of the problems of such a system in 2018 in The Wall Street Journal. Here is what he said then: “In the past half-century, nationalized programs have consistently failed to provide timely, high-quality medical care compared with the U.S. system. That failure has countless consequences for citizens: pain, suffering and death, permanent disability, and foregone wages.”

“Single-payer programs usually impose long waiting lists and delays unheard of in the U.S. Last year, a record 4.2 million patients were on England’s NHS waiting lists; 362,600 patients waited longer than four months for hospital treatment as of that March, and 95,252 waited longer than six months. By this July, 4,300 people had been on the wait list more than a year—all after receiving their diagnosis and referral—according to NHS England’s “Referral to Treatment” waiting-times data.”

The same was true in Canada. In 2018, the median wait time between seeing a general practitioner and following up with a specialist was 10.2 weeks, while the wait between seeing a doctor and beginning treatment was about five months. According to the Fraser Institute study, the average Canadian waited three months to see an ophthalmologist, four months for an orthopedist, and five months for a neurosurgeon.

This issue came up in the mid-term elections of 2018 and was promoted by socialist Vermont Senator Bernie Sanders in a slick campaign called “Medicare for All.” Then Senator Kamala Harris jumped on the bandwagon, endorsing Sanders’ socialized medicine plan. It is doubtful you’ll hear her say the same thing now, but her record is clear.

The Wall Street Journal editorial board wants you to remember this important history since Democrats are trying to re-write history. Here’s what the editors say: “Harris campaign aides are whispering that she no longer supports single-payer healthcare, but travel back to Ms. Harris’s Senate tenure. She co-sponsored a bill from Vermont Sen. Bernie Sanders that would set up a single-payer system in the U.S. in four years. That would toss 150 million Americans who receive health insurance at work into a new government plan, inevitably financed by ferocious tax increases across every income level.

At a Democratic debate in 2019, a moderator put this question to the primary contenders: ‘Many people watching at home have health insurance through their employer. Who here would abolish their private health insurance in favor of a government-run plan?’ Ms. Harris raised her hand.”

The WSJ editors say the Harris plan from 2019 could cost $44 trillion over a decade, according to a forthcoming analysis from health economist Stephen Parente and Theo Merkel at the American Action Forum. That includes some $1.8 trillion to cover some 11 million illegal immigrants. America can’t afford this and doesn’t want this even if it could.