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Elderly Americans are now protected by three major entitlements: Social Security (cash benefits), Medicare (health benefits for all elderly), and Medicaid (additional health benefits for low-income elderly). All are threatened with cuts. Medicaid is further threatened because turning it over to the states eliminates its universal entitlement status. The range of the proposed changes is unprecedented. This book does not question the need to make cuts. The authors' point is that the whole three-part structure of entitlement should be considered together. Further, looking for cuts first is the wrong way to go. Look for needed improvements in responsiveness and efficiency first, say the authors. Then add up how much these changes would save and decide how these savings should best be used. Pursuing this strategy, the authors identity many changes that are worth serious consideration.
The U.S. population is aging. Social Security projections suggest that between 2013 and 2050, the population aged 65 and over will almost double, from 45 million to 86 million. One key driver of population aging is ongoing increases in life expectancy. Average U.S. life expectancy was 67 years for males and 73 years for females five decades ago; the averages are now 76 and 81, respectively. It has long been the case that better-educated, higher-income people enjoy longer life expectancies than less-educated, lower-income people. The causes include early life conditions, behavioral factors (such as nutrition, exercise, and smoking behaviors), stress, and access to health care services, all of which can vary across education and income. Our major entitlement programs - Medicare, Medicaid, Social Security, and Supplemental Security Income - have come to deliver disproportionately larger lifetime benefits to higher-income people because, on average, they are increasingly collecting those benefits over more years than others. This report studies the impact the growing gap in life expectancy has on the present value of lifetime benefits that people with higher or lower earnings will receive from major entitlement programs. The analysis presented in The Growing Gap in Life Expectancy by Income goes beyond an examination of the existing literature by providing the first comprehensive estimates of how lifetime benefits are affected by the changing distribution of life expectancy. The report also explores, from a lifetime benefit perspective, how the growing gap in longevity affects traditional policy analyses of reforms to the nation's leading entitlement programs. This in-depth analysis of the economic impacts of the longevity gap will inform debate and assist decision makers, economists, and researchers.
The United States is in the midst of a major demographic shift. In the coming decades, people aged 65 and over will make up an increasingly large percentage of the population: The ratio of people aged 65+ to people aged 20-64 will rise by 80%. This shift is happening for two reasons: people are living longer, and many couples are choosing to have fewer children and to have those children somewhat later in life. The resulting demographic shift will present the nation with economic challenges, both to absorb the costs and to leverage the benefits of an aging population. Aging and the Macroeconomy: Long-Term Implications of an Older Population presents the fundamental factors driving the aging of the U.S. population, as well as its societal implications and likely long-term macroeconomic effects in a global context. The report finds that, while population aging does not pose an insurmountable challenge to the nation, it is imperative that sensible policies are implemented soon to allow companies and households to respond. It offers four practical approaches for preparing resources to support the future consumption of households and for adapting to the new economic landscape.
Mirroring a worldwide phenomenon in industrialized nations, the U.S. is experiencing a change in its demographic structure known as population aging. Concern about the aging population tends to focus on the adequacy of Medicare and Social Security, retirement of older Americans, and the need to identify policies, programs, and strategies that address the health and safety needs of older workers. Older workers differ from their younger counterparts in a variety of physical, psychological, and social factors. Evaluating the extent, causes, and effects of these factors and improving the research and data systems necessary to address the health and safety needs of older workers may significantly impact both their ability to remain in the workforce and their well being in retirement. Health and Safety Needs of Older Workers provides an image of what is currently known about the health and safety needs of older workers and the research needed to encourage social polices that guarantee older workers a meaningful share of the nation's work opportunities.
For fifty years, Medicare and Medicaid have stood at the center of a contentious debate surrounding American government, citizenship, and health care entitlement. In Medicare and Medicaid at 50, leading scholars in politics, government, economics, health policy, and history offer a comprehensive assessment of the evolution of these programs and their impact on society -- from their origins in the Great Society era to the current battles over the Affordable Care Act ("Obamacare"). These highly accessible essays examine Medicare and Medicaid from their origins as programs for the elderly and poor to their later role as a safety net for the middle class. Along the way, they have served as touchstones for heated debates about economics, social welfare, and the role of government. Medicare and Medicaid at 50 addresses key questions for understanding the past and future of health policy in America, including: · What were the origins for these initiatives, and how were they transformed over time? · What marks have Medicare and Medicaid left on society? · In what ways have these programs produced innovation, even in eras of retrenchment? · How did Medicaid, once regarded as a poor person's program, expand its benefits and coverage over the decades to become the platform for the ACA's future expansion? The volume's contributors go on to examine the powerful role of courts in these transformations, along with the shifting roles of Congress, public opinion, and state governors in the programs' ongoing evolution. From Lyndon Johnson to Barack Obama on the left, and from Ronald Reagan to George W. Bush on the right, American political leaders have tied their political fortunes to the fate of America's entitlement programs; Medicare and Medicaid at 50 helps explain why, and how those ongoing debates are likely to shape the future of the Affordable Care Act.
Family caregiving affects millions of Americans every day, in all walks of life. At least 17.7 million individuals in the United States are caregivers of an older adult with a health or functional limitation. The nation's family caregivers provide the lion's share of long-term care for our older adult population. They are also central to older adults' access to and receipt of health care and community-based social services. Yet the need to recognize and support caregivers is among the least appreciated challenges facing the aging U.S. population. Families Caring for an Aging America examines the prevalence and nature of family caregiving of older adults and the available evidence on the effectiveness of programs, supports, and other interventions designed to support family caregivers. This report also assesses and recommends policies to address the needs of family caregivers and to minimize the barriers that they encounter in trying to meet the needs of older adults.
The population of Asia is growing both larger and older. Demographically the most important continent on the world, Asia's population, currently estimated to be 4.2 billion, is expected to increase to about 5.9 billion by 2050. Rapid declines in fertility, together with rising life expectancy, are altering the age structure of the population so that in 2050, for the first time in history, there will be roughly as many people in Asia over the age of 65 as under the age of 15. It is against this backdrop that the Division of Behavioral and Social Research at the U.S. National Institute on Aging (NIA) asked the National Research Council (NRC), through the Committee on Population, to undertake a project on advancing behavioral and social research on aging in Asia. Aging in Asia: Findings from New and Emerging Data Initiatives is a peer-reviewed collection of papers from China, India, Indonesia, Japan, and Thailand that were presented at two conferences organized in conjunction with the Chinese Academy of Sciences, Indian National Science Academy, Indonesian Academy of Sciences, and Science Council of Japan; the first conference was hosted by the Chinese Academy of Social Sciences in Beijing, and the second conference was hosted by the Indian National Science Academy in New Delhi. The papers in the volume highlight the contributions from new and emerging data initiatives in the region and cover subject areas such as economic growth, labor markets, and consumption; family roles and responsibilities; and labor markets and consumption.
Open up Dignity and Old Age, and you’ll find a wealth of thoughtful suggestions for how you and others can gain more respect and admiration for your relatives, neighbors, and patients who are in the latter stages of life. You’ll examine the word “dignity” as it relates to the world’s elderly population to the fullest and most challenging extent, taking into account cross-cultural, religious, and even literary influences. Throughout this provoking and thorough examination, you’ll tackle some tough questions, all of which will equip you with the theoretical and practical know-how needed to evoke change and preserve honorable relations with the elderly persons in your professional and personal relationships. The manner in which Dignity and Old Age will help you grow in your relationships with elderly people is twofold--ideally and practically. You’ll begin with a revitalizing discussion of concepts that revolve around dignity and the elderly, and from there you’ll move into the sphere of active practice, gleaning a wide variety of ways you can enhance your affairs with the elderly in health care, social services, government, and retirement entitlements and benefits. Specifically, you’ll find positive approaches in these and other areas: the dignity in old age the true meaning of “Quality of Life” in old age achieving respect for ethnic elders as a health care provider bringing spirituality and community together in the last stage of life forming a philanthropic, caring partnership between government and the elderly In this insightful volume, you’ll take an important step forward in creating a more dignified quality of life for the world’s elderly--today’s and tomorrow’s. Overall, you’ll gain the variety of perspectives necessary to ensure that everyone you come in contact with in casual, legal, leisure, and professional spheres will see you care enough to be concerned with the ideas and practices contained in Dignity and Old Age.
Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.
No developed nation relies exclusively on the private sector to finance health care for citizens. This book begins by exploring the deficiencies in private health insurance that account for this. It then recounts the history and examines the legal character of America's public health care entitlements - Medicare, Medicaid, and tax subsidies for employment-related health benefits. These programs are increasingly embattled, attacked by those advocating privatization (replacing public with private insurance); individualization (replacing group and community-based insurance with approaches based on individual choice within markets); and devolution (devolving authority over entitlements to state governments and to private entities). Jost critically analyzes this movement toward disentitlement. He also examines the primary models for structuring health care entitlements in other countries - general taxation-funded national health insurance and social insurance - and considers what we can learn from these models. The book concludes by describing what an American entitlement-based health care system could look like, and in particular how the legal characteristics of our entitlement programs could be structured to support the long-term sustainability of these vital programs.