The Third Third

Targeting the Aging

Do you feel it, too – that target that’s been drawn on your chest, centered between your wrinkle-creamed neck and exercised-but-nevertheless-slightly-bulging waistline, stretching from the ache in your right shoulder to the creakiness on your left?  It’s a bulls-eye, alright, and they’re taking aim, it seems, very directly at us – people about our age who are, as we know, legion.

 Who’s “they”?  Depends who you ask – and where you’re coming from, politically – but, believe me, it’s not just the folks the screamers say want to pull the plug on Granny. In this particular case, I think “they” are the rest of society, everyone under 60 who is frightened and overwhelmed by the prospect of change and all the demagoguery associated with that prospect of change to health care and health care insurance in this country.  They seem able to think about what they need in terms only of what someone else is getting, and they have failed to recognize, even in the abundance we Americans have known, the possibility that health care reform is not a zero-sum game.  (It’s not a game at all, actually.)  What “they” have grasped instead are the two facts they think they  understand:  people aged 65 and over have a public health insurance plan called Medicare; and a third of all Medicare money is expended during one’s last two years of life.  And that makes all of us approaching 65 into moving targets, conveniently slow-moving targets, at that.

This is not a new phenomenon. Old, it turns out, is a demographic construct defined relatively recently by our government.  Societies do this.  Adolescence, for example, was not a recognized stage of development in early American life:  instead you were a child and then you went to work.  Adolescence is a product of leisure in an industrialized nation, the time between childhood and work, the time now dedicated to growing up.  With the enactment of Social Security in 1935, the nation’s elderly likewise became a demographic caste, one looked upon far more benevolently than most teenagers, to be sure, but one, like adolescence, defined initially in relation to external social exigencies rather than mere chronology.

Suddenly, as society advanced, and health improved and cures were found for disease, more people who had not planned on it, or for it, began living longer.  At the same time, family structures shifted dramatically.  The aging and aged showed up more alone and in greater numbers than ever before. . . and no one knew what to do with them.  A sympathetic group, they’d lived through tough times and paid their dues, so the country voted to honor thy grandmother and thy grandfather with, initially, social security, and then with a panoply of age-centered welfare programs to address most, if not all, of their perceived needs.  These generous policies and the government’s explicit assumption of responsibility for “taking care of” the elderly had a profound collateral effect on our perception of old:  if you were old, you were deserving. . . but also poor, frail, dependent and vulnerable.   To most, it seemed a small price to pay for Medicare, public housing, energy assistance, and income tax breaks, among other benefits.

Beginning in the late 1970’s, however, Congress began to refine its requirements for all this compassionate aid to the elderly, chiefly because of competing calls for government spending, especially on education and health care for younger constituencies.  Even then, expenses supporting the elderly represented a quarter of the entire federal budget. Today it has grown to fully one-third.

These economic pressures began to change society’s perception of older people.  No longer the deserving, frail, poor, the aged began to be seen as more selfish “greedy geezers,” and in many ways, a burden.  Just think how many of us are going to be really, really old over the course of the next 40 years!  And how much we’ll need!  The backlash begins.

What’s frightening about this to me is the gross over-simplification about age.  Like all monolithic stereotypes (racism, sexism), ageism erases very real differences in the name of one easily codified unifying factor, in this case, chronological age.  The perception ignores, if not denies, all reality of physical condition, expected lifespan, economic security, political affiliation, religious involvement, work background, job status, educational level, participation in family life, involvement in the community, and/or interests – and invites prejudicial treatment.  Too, it intensifies the struggle for control over our lives at a time when we may be most vulnerable, most terrified of having none.

 This is not a “Don’t pull the plug on Granny” piece.  I have already signed my medical directives and I believe they pretty much say if my mind is not working there’s no reason for my body to; if my body has worn out, it should not be artificially sustained.  And I fully comprehend the bloat and misuse of Medicare funds.  What I object to is feeling like there’s this target on my body and the bodies of my peers:  that simply by aging, our health care needs become more or less important than anyone else’s; that, if we’re lucky, having taken good care of ourselves, we will live beyond what might statistically be our last two years of life and lose access to appropriate care.  Smart policy may, in fact, limit medical intervention upon the normal exigencies of aging.  I can go along with that.  But it has to be smart policy – and not just political winds blowing harshly against the economic power and burdens of an aging population.  Shifting resources from one vulnerable population (the poor and uninsured) to another (the aging because there are so many of us and we represent one of the few pots of money visible in any federal budget) is not health care reform.  Everyone – of every age -- in this country deserves better.






























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