© 2008 delmar cengage learning. chapter 18 the elderly: health politics beyond aging? william p....

© 2008 Delmar Cengage Learning.

Chapter 18

The Elderly: Health Politics Beyond Aging?William P. Brandon and

Patricia Maloney Alt


2

“Senior Life” as Social Construction

• Through the end of the 19th century– There was little conception of the aging

members of the workforce ceasing productive work


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• 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


• Nursing home phenomenon in the U.S. – Largely spawned by conscious policy decisions

• Including Kerr-Mills Act and the shaping of Medicaid


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“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


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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


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• Medicaid, for instance, covers costs for elderly nursing care– Was originally designed to assist the poor


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• 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

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

Senior Institutional Landscape:Interest Groups

• Mass-membership groups and ideological organizations – Proven interest groups with the greatest

staying power and potency


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Senior Institutional Landscape:Interest Groups

• AARP (once the American Association for Retired Persons) – Largest and best-endowed organization

representing the interests of seniors


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• Sponsors research– Sells insurance and other benefits to members,

lobbies federal government on behalf of a steadily-broadening “senior” population


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• Has generally held moderate political positions in recent years– Though fought hard for the Medicare

Modernization Act (MMA) in 2003


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• 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


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• Often opposes AARP, other organizations in taking positions on the political left

• Offered resistance to AARP in its support for MMA


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• United Seniors Association/USA– Next presents conservative alternative to

NCPSSM

• Initially focused on seniors– Worked to broaden its constituency in recent

years


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• Attacked AARP for its opposition to Personal Savings Accounts (PSAs) in Social Security, 2005


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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


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Senior Institutional Landscape: Other Groups

• American Public Health Association (APHA) – Become increasingly engaged when it comes

to the treatment/representation of seniors


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Senior Institutional Landscape:The Media

• Media tends to focus on controversies involving seniors– Such as the abortive battle over Social

Security reform


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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

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


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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


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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


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• Broad agreement exists:– Social Security will EVENTUALLY run through

its resources• Disagreement as to WHEN


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• 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


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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


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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

© 2008 delmar cengage learning. chapter 18 the elderly: health politics beyond aging? william p....

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