Mr. President, almost nobody wants to think clearly about aging in our society. It is much easier to push some single idea: an aging society will bankrupt the federal budget and leave our children an unsupportable debt; aging baby boomers will work long into old age and will volunteer their time and expertise on behalf of the common good; aging brings disease, dependency, and dementia; aging is a curable condition; old people are a burden; old people are wise. And so on.
The new longevity is a stunning achievement. The key question is this: what do we do with it? Today almost 15 percent of our population is 65 and over; one-third of Americans will live to 85 or above-and that percentage will continue to increase. And the epidemiology is unprecedented. As the President's Council on Bioethics puts it: "The defining situation of our time seems to be that we are both younger longer and older longer. We are more likely to be vigorous at ages that once seemed very old and we are far more likely to suffer protracted periods of age-related disability and dependency because we live to ages few people reached in the past."
But demography is not destiny. The first thing to recognize is that we are aged by culture, as Margaret Gullette puts it. Hatred of dependency and fear of impotence, wrinkles, weakness, disease, frailty, and dementia become transformed into negative stereotypes and prejudice toward "them" (as Bernard Berenson once said, old age is always ten years older than I am). These internalized stereotypes create spoiled identities and encourage us to live out cultural scripts of decline.
But living long and good lives is the great promise and goal of our era.
Social policies should aim at protecting the vulnerable, providing basic health care coverage, and strengthening the capacity of all elders to grow and contribute to solving our common problems.
In the current crisis, alarmist demographers and fiscal conservatives will reiterate their gloomy scenarios and argue that we cannot afford the cost of current Social Security and Medicare programs, which must be slashed to avoid mortgaging our children's future. It is true that elders, like all of us, will have to make sacrifices, but we must protect the poor and the vulnerable. Social Security is the cornerstone of our welfare state and clearly its most successful program. Fully half of all older people would be impoverished without it. It is essentially an intergenerational compact in which each working generation supports its parent's generation, with the understanding that it in turn will be supported by the next working generation.
Your advisors know that there is no real crisis in Social Security and that relatively minor adjustments, such as those made in 1983, will keep the system solvent throughout the most difficult years of baby boomers' retirement. Medicare, on the other hand, is more difficult because of the rising cost of health care and the rapidly increasing use of high-tech interventions among 80- and 90-year-olds. You will have to resist discriminatory calls to ration expensive life-saving technology by age yet not allow support for hospital and long-term care to crowd out priorities of education and job creation. One significant way of reducing costs is to require people above a certain income threshold to purchase long-term care, though this would obviously be politically difficult. Investing in health promotion, disease prevention, and biomedical research to delay the onset of frailty and dementia is also a way to reduce costs.
But equally important is the need to transform how we view our elders and our aging selves. Aging is not a problem to be solved but an experience to be lived in community. We want to promote health. But what is health for? The issue here is to recognize lifelong needs for learning, creativity, spiritual growth, and civic engagement. Older people are a rapidly growing natural resource. Promoting the civic engagement and spiritual growth of elders should be a primary goal of aging policy. Those older voters in Florida don't just need welfare state benefits. Just like younger voters, they need publicly sanctioned avenues of engagement and contribution, best done in public/private collaboration. This could be accomplished, for example, by revisioning the vast aging services network funded and organized by the Administration on Aging. Elders are not primarily a burden and a problem-they should be part of the solution.
Thomas R. Cole is a historian and medical humanist who specializes in the ethics and cultures of aging. His books include The Journey of Life, No Color Is My Kind, and the forthcoming Guide to Humanistic Studies in Aging.
