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Four pillars of aging policy in the United States

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Nadash P. , Miller E. A.

nr 2(10)/2015 Social Policy and Models of Services for the Elderly International Perspective

53-70

To understand aging policy in the United States, it is critical to understand the federal budget, which along with national defense is dominated by Social Security, the publicly funded pay-as-you-go universal retirement program, and health care programs largely targeting the elderly (Medicare) and the poor, including the poor elderly (Medicaid). Not only is a large portion of the U.S. federal budget spent on elders, spending under these categories is mandatory: in other words, Social Security, Medicare, and Medicaid are entitlements, guaranteed by law. Politicians therefore have limited ability to allocate funds elsewhere. Discretion is further limited by the fact that currently, the U.S. budget is operating under a defi cit. Th ese budgetary pressures have evoked a variety of policy responses, which vary according to political affi liation. No matter the ideological vantage point, however, the spiraling cost of existing commitments has prevented serious consideration of other, emerging public policy issues in aging, such as the perilous state of systems for providing long-term services and supports (LTSS). Still, one bright spot is increasing attention to end-of-life issues – most likely because this is viewed as a cost-saver. It is because of Social Security, health care, LTSS, and end-of-life care that aging policy is central to the current budgetary and political debate in the U.S., a position that will only grow with time with the aging of the unprecedentedly large “baby boom” cohort born between 1946 and 1964. Th e irony is that these programs are in fact hugely popular among recipients and potential recipients. Th at is not to say that Social Security and programs providing health care to the poor and the elderly do not need reforming: there is enormous waste in the system. Yet sensible proposals for reform are oft en stymied by political obstructionism. So, too, are attempts to plan more systematically and thoughtfully about the growing aging population in the U.S. An advantage of the U.S. federal system of government is that in some cases progress can be made at the state-level such as with LTSS and end-of-life care; the downside is that this creates enormous cross-national disparities and that it fails to utilize the tools and the power that central government alone can provide.