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Ageism and Health Care Reform: Older Adults Deserve Straight Talk

In 1968, when Vietnam and political protest created a cultural generation gap in America, the Pulitzer Prize-winning gerontologist, psychiatrist and founding director of the National Institute on Aging, Dr. Robert Butler, identified another kind of generation gap. He dubbed it “ageism,— the tendency to dismiss older people as interchangeable, less than competent, diminished by age. Today the growing number of older people contributing in vital ways to their families and communities has challenged but not eliminated those stereotypes, and ageism is creeping into the health reform debate.

[IMGCAP(1)]It is ageist to scare older Americans with talk of death panels, cuts that will destroy Medicare or drastically reduce benefits, or make it impossible to see their doctors. It is equally ageist to pat older people on the head, essentially telling them, “Don’t worry, be happy — there are no trade-offs, and health reform will bring only good things.—

Generalizing too much about older adults is another expression of ageism. Like any other group, seniors may be healthy or sick, generous or selfish. We can even distinguish the “young old,— the “old old— and those in between. But older people do have one thing in common: They tend to regard Medicare and Social Security as the foundation of their relative independence and economic security. Almost one in three older Americans lives on an income below 200 percent of the poverty line, including 62 percent of older women living alone, and more than half of all older Hispanics and African-Americans. At this stage of their lives, they cannot realistically hope to grow their assets. For them, Medicare and Social Security are not “add ons— or perks. They may even be lifelines.

This raises the stakes in the health reform debate, in which Medicare — now 14 percent of all federal spending — is under scrutiny. Older adults rightly want, and have not been getting, straight answers about the proposed $400 billion to $500 billion in “savings— from Medicare over the next 10 years. Where are the “savings— (if you are pro-reform) or “cuts— (if you are anti-reform) coming from and how much of overall Medicare spending do they represent? How will the money be used? How will Medicare be affected? How will I be affected?

Along with an honest discussion of the savings, older adults should also be given much more information about the new proposals that would benefit them, like providing better coverage for home and community services as an alternative to nursing homes, improving coordination of care for chronic illnesses, strengthening protections against rising out-of-pocket costs for lower-income seniors and addressing the growing epidemic of elder abuse.

Many pro-reform and anti-reform groups seem to believe that the best “spin— will win older adults’ hearts and minds, and that, since their opponents are slanting or cherry-picking their facts, they must do the same. Perhaps as a result, most seniors don’t believe they are getting information that is fair and even-handed from anyone. And while older adults naturally do care about what’s in it for them, they also care deeply about their children and grandchildren, their future tax burden and access to health care, as well as our nation’s ability to remain financially strong and competitive with the rest of the world.

The danger is, unless older Americans can get all the facts, pro and con, from sources they trust, they cannot come to truly informed opinions about one of the most important domestic policy issues of their lifetimes.

Let’s start giving America’s seniors the truth, the whole truth and nothing but the truth. If we do, we have great faith that the Greatest Generation will once again do the right thing for themselves and for generations to come.

Monsignor Charles Fahey is chairman of the board of the National Council on Aging. James Firman is NCOA’s president and CEO.

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