1. © 2008 Delmar Cengage Learning. Chapter 18 The Elderly: Health Politics Beyond Aging? William P. Brandon and Patricia Maloney Alt

2. © 2008 Delmar Cengage Learning. 2 “Senior Life” as Social Construction Through the end of the 19 th century –There was little conception of the aging members of the workforce ceasing productive work

3. © 2008 Delmar Cengage Learning. 3 “Senior Life” as Social Construction No conception of “retirement” as such –Only arose as a result in the shift toward certain types of employment, and increases in natural lifespans

4. © 2008 Delmar Cengage Learning. 4 “Senior Life” as Social Construction Nursing home phenomenon in the U.S. –Largely spawned by conscious policy decisions Including Kerr-Mills Act and the shaping of Medicaid

5. © 2008 Delmar Cengage Learning. 5 “ Senior Life” as Social Construction Other industrial nations tend to focus on caring for seniors in the home Recent trends in the U.S. away from institutionalization –Toward home/community care of seniors

6. © 2008 Delmar Cengage Learning. 6 Senior Institutional Landscape: Government As of 1978: –Eighty federal programs for the elderly could be identified –Senior policy quite decentralized/fragmented “Senior” government institutions actually serve broad constituencies

7. © 2008 Delmar Cengage Learning. 7 Senior Institutional Landscape: Government Medicaid, for instance, covers costs for elderly nursing care –Was originally designed to assist the poor

8. © 2008 Delmar Cengage Learning. 8 Senior Institutional Landscape: Government Funding of programs under the Old Age Assistance Act (1965) –Has not kept pace with the rise in the number of seniors in recent years –Crunch will be faced with aging of baby boomers

9. © 2008 Delmar Cengage Learning. 9 Senior Institutional Landscape: Interest Groups Up until the early 1970s –Seniors as a group were disorganized –Politically weak With senior legislation in the late1960s: –Interest groups serving the elderly swiftly arose and proliferated

10. © 2008 Delmar Cengage Learning. 10 Senior Institutional Landscape: Interest Groups Mass-membership groups and ideological organizations –Proven interest groups with the greatest staying power and potency

11. © 2008 Delmar Cengage Learning. 11 Senior Institutional Landscape: Interest Groups AARP (once the American Association for Retired Persons) –Largest and best-endowed organization representing the interests of seniors

12. © 2008 Delmar Cengage Learning. 12 Senior Institutional Landscape: Interest Groups Sponsors research –Sells insurance and other benefits to members, lobbies federal government on behalf of a steadily-broadening “senior” population

13. © 2008 Delmar Cengage Learning. 13 Senior Institutional Landscape: Interest Groups Has generally held moderate political positions in recent years –Though fought hard for the Medicare Modernization Act (MMA) in 2003

14. © 2008 Delmar Cengage Learning. 14 Senior Institutional Landscape: Interest Groups Other major interest group: –Overtly political National Committee for the Preservation of Social Security and Medicare (NCPSSM) –Founded by James Roosevelt, son of FDR, in 1982 Infused with liberal policy vision

15. © 2008 Delmar Cengage Learning. 15 Senior Institutional Landscape: Interest Groups Often opposes AARP, other organizations in taking positions on the political left Offered resistance to AARP in its support for MMA

16. © 2008 Delmar Cengage Learning. 16 Senior Institutional Landscape: Interest Groups United Seniors Association/USA –Next presents conservative alternative to NCPSSM Initially focused on seniors –Worked to broaden its constituency in recent years

17. © 2008 Delmar Cengage Learning. 17 Senior Institutional Landscape: Interest Groups Attacked AARP for its opposition to Personal Savings Accounts (PSAs) in Social Security, 2005

18. © 2008 Delmar Cengage Learning. 18 Senior Institutional Landscape: Other Groups Professional societies also work on behalf of the senior population Gerontological Society of America (GSA) and National Council on Aging (NCOA) –Examples of groups that reflect the liberal perspective of most social service workers

19. © 2008 Delmar Cengage Learning. 19 Senior Institutional Landscape: Other Groups American Public Health Association (APHA) –Become increasingly engaged when it comes to the treatment/representation of seniors

20. © 2008 Delmar Cengage Learning. 20 Senior Institutional Landscape: The Media Media tends to focus on controversies involving seniors –Such as the abortive battle over Social Security reform

21. © 2008 Delmar Cengage Learning. 21 Senior Institutional Landscape: The Media Many senior advocacy groups have taken to the web –Also express concern about the “digital divide” excluding many seniors from this (relatively) new medium

22. © 2008 Delmar Cengage Learning. 22 Seniors in American Politics: Medicare “Modernization” Balanced Budget Act of 1997 (BBA) –Designed to increase the enrollment of Medicare beneficiaries in managed care plans In ironic twist: –Policy actually caused contraction in profitable markets of managed care –Number of Medicare beneficiaries covered under such plans dropped

23. © 2008 Delmar Cengage Learning. 23 Seniors in American Politics: Medicare “Modernization” MMA of 2003 –Represents the first time Medicare beneficiaries are divided by income groups on basis of benefits offered AND payments Long-term health of Medicare –Threatened because it has become relatively more valuable to lower-income groups

24. © 2008 Delmar Cengage Learning. 24 Seniors in American Politics: Social Security Reform Debate over the precise future form Social Security is to take arise not from any fiscal “crisis” –From continued philosophical differences over the basic goals of the program

25. © 2008 Delmar Cengage Learning. 25 Seniors in American Politics: Social Security Reform Broad agreement exists: –Social Security will EVENTUALLY run through its resources Disagreement as to WHEN

26. © 2008 Delmar Cengage Learning. 26 Seniors in American Politics: Social Security Reform Possible remedies include: –Raising retirement age –Requiring state and local employees to enter system –Removing taxable income cap –Most controversially, privatizing elements of the system

27. © 2008 Delmar Cengage Learning. 27 Chapter 18 Summary Conception of “the elderly” constitutes a social construction –Which has changed over time Four institutional venues hold particular relevance to seniors: –Government, interest groups, private service organizations, and the media

28. © 2008 Delmar Cengage Learning. 28 Chapter 18 Summary Interest groups representing seniors: –Mass membership organizations, ideological outfits, and professional societies Medicare and Social Security Reform –Recent/ongoing issues of particular import for seniors