Dealing with large and growing numbers of old and "old old" people (those above the age of 85) inevitably will change social norms. Decisions that seemed clear—when should people stop working and retire, for example—will become less clear. Attitudes toward older people will change, and this is already happening in our increasingly negative attitudes toward warehousing the elderly in nursing homes and other institutional settings. Our laws and rules will reflect emerging demographic realities as well. In fact, this is one of the first places we'd expect to see structured responses to the age wave.
[See Can Boomers Lead an Elder Revolution?] I believe most change is of the "whimper" and not "bang" variety. Others, including The Black Swan author Nassim Nicholas Taleb, can point to significant and unanticipated events as being prime movers of big changes that can swamp incremental adjustments. Think "9-11." I suppose that could be the case with aging as well. What if science develops tools to enable our cells to stay forever young, or to be regularly rejuvenated, so they happily keep on reproducing and halt, or at least greatly slow, the aging process? My 20-something son is certain this will happen in his lifetime, which he accordingly expects to be very, very long. (Of course, he also expects to soon be able to take a weight-loss, anti-cholesterol pill that will counteract 15 years of excessive pizza consumption.)
The Massachusetts Supreme Judicial Court ruled that an ex-husband's obligation to pay alimony should continue even though he had retired. As the court noted, lots of factors come into play in determining whether alimony payments should continue, including the former spouse's ability to continue earning money. Age, in other words, is not an automatic out.
Our courts and public institutions are grappling with many other tough aging issues that will not be going away. How should the judicial system factor in big gains in longevity when evaluating prison sentences and parole requests? Our jails are dealing with unprecedented healthcare challenges because inmates are living longer and longer. A recent op-ed in the New York Times said age discrimination in the workplace has long been viewed as a relatively minor form of wrongdoing compared with race and sex discrimination. "Many people also seem to agree . . . that unlike racism, which is inherently wrong, there is something natural about the old making way for the young," the piece said. "Never mind that with the Social Security retirement age rising, and pensions disappearing, many older Americans have no choice but to work."
Our healthcare system is on the front lines of age-related issues. We provide Medicare and Medicaid to our older citizens, and the costs literally are bankrupting the nation. What is the "right" level of support we should provide to the elderly? At nearly 2,000 pages in length, the House-passed healthcare reform bill says a lot about a lot of things. Not so much about this break-the-bank concern. And for generations, Social Security has been considered a political "third rail" that would fry any politician so reckless as to touch it. Can we afford such a hands-off attitude any longer?
One direct aging issue in the reform legislation involves the rates that older and younger people should pay for health insurance. Young people are much less expensive to insure than the older people who consume most of the nation's healthcare. In a workplace setting, these differences are invisible. Group rates mean that family size and household status, and not age, are the variables in setting premiums. Otherwise, young workers would pay much less or decide not to get any coverage, and older employees would face unaffordable premiums.
However, in the individual market, big age-related differences in premiums are the norm. Under both House and Senate healthcare reform measures, a lot of the people who will be added to the insurance rolls will be individuals who are not part of workplace plans. Because pre-existing conditions would no longer be grounds for denying coverage under the bills, insurers must provide coverage to a very costly group of older people. How do you make it affordable? The lawmakers' solution is to set limits on the ratio of insurance premiums charged to the youngest and oldest policyholders. But what should the ratio be? Two-to-one? Three-to-one? Whatever figure emerges from Congress will have a big impact on the generational subsidy that younger people are paying so that insurance is affordable to the elderly. Morally and economically, how large a burden can we fairly place on the shoulders of generations that are, in pure numbers, smaller than the generations they are being asked to help?