8
Summary Discussion

REACTION OF DISCUSSANTS

Five discussants offered perspectives on the grand challenges of an aging society. They were followed by a final general discussion among all panelists and members of the audience.

Robert Binstock of Case Western Reserve University criticized the “merchants of doom” who predict intergenerational conflict as old and young compete for scarce resources. He takes a different view. Because elderly people are embedded in their families, communities, and society, he argued, old-age policies are in effect family policies, affecting the whole social fabric. Social Security benefits and other retirement income allow seniors to care for grandchildren; proper health care for older people affects not only these individuals but also their families and communities in many ways. Binstock concluded, “Most of us, of all ages, have a stake in old-age policies. Social Security, Medicare, and Medicaid are not luxurious government benefits for a group of Americans who are presently depicted in public rhetoric as if they were a separate selfish tribe of the elderly. Reframing our understanding of the social contract in these terms, I think, is a major challenge for our aging society.” Binstock suggested that a relevant research initiative would be to document the extent to which so-called old-age benefits actually benefit all generations.

Robert Butler, reflecting on what he’d heard over the course of the symposium, noted that longevity is a real human achievement, and the years gained are healthy ones. Nonetheless, many of the topics discussed point to grave problems. The financial grounding of baby boomers is



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8 Summary Discussion REACTION OF DISCuSSANTS Five discussants offered perspectives on the grand challenges of an aging society. They were followed by a final general discussion among all panel- ists and members of the audience. Robert Binstock of Case Western Reserve University criticized the “merchants of doom” who predict intergenerational conflict as old and young compete for scarce resources. He takes a different view. Because elderly people are embedded in their families, communities, and society, he argued, old-age policies are in effect family policies, affecting the whole social fabric. Social Security benefits and other retirement income allow seniors to care for grandchildren; proper health care for older people affects not only these individuals but also their families and communities in many ways. Binstock concluded, “Most of us, of all ages, have a stake in old-age policies. Social Security, Medicare, and Medicaid are not luxu - rious government benefits for a group of Americans who are presently depicted in public rhetoric as if they were a separate selfish tribe of the elderly. Reframing our understanding of the social contract in these terms, I think, is a major challenge for our aging society.” Binstock suggested that a relevant research initiative would be to document the extent to which so-called old-age benefits actually benefit all generations. Robert Butler, reflecting on what he’d heard over the course of the symposium, noted that longevity is a real human achievement, and the years gained are healthy ones. Nonetheless, many of the topics discussed point to grave problems. The financial grounding of baby boomers is 

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 GRAND CHALLENGES OF OUR AGING SOCIETY inadequate; the labor market is not accommodating to older workers; obesity and lack of exercise continue to be problems; the training of doctors—whether in the gray areas of decision making, new technologies, or palliative care—is lacking; and communities are not up to provid- ing the transportation and other services that older people need. Thus, Butler summarized, the baby boomers are not prepared for aging, and society is not prepared for them. Addressing this lack of preparedness is the immediate challenge. Butler also recommended further research on the interrelationship of health and wealth. His final suggestion was much greater attention to and funding for longitudinal studies so as to ground a life-course perspective on many issues of physical and cognitive health, income and productivity, meaning and engagement, and commu- nity involvement over the entire life span. James Jackson of the University of Michigan offered several obser- vations and insights. He noted that many of the symposium presenta- tions had addressed averages, with insufficient attention to the profound heterogeneity of the aging population. He also remarked that the age grading of society will change because of both increased longevity and declining fertility. Thus, not only will people live longer, but they will live in a radically different society—a situation that merits further appre- ciation. Jackson’s third emphasis was on the myriad connections and mutual influences of global flows in trade, capital, and migration as well as intergenerational linkages. He then underscored the importance of a life-course perspective and consideration of cohort and period events that occur to different groups as they age over a particular point. Jackson also discussed the inadequacy of models that assume people behave rationally. In practice, individuals and families make decisions without full informa- tion or without using the information they do have well. That will affect how they handle the problems and challenges of an aging society. Jackson also asserted that as society has “essentialized” certain ages (such as 62 for early retirement, 65 for full retirement), this has precluded thinking in new ways about retirement and other issues. Similarly, he suggested a rethinking of retirement as a status. If only people who are economically productive are valued, where does that leave retirees? Jackson suggested further thinking about the different reasons for exiting retirement, rang- ing from economic necessity to self-actualization, since these would result in very different experiences. Finally, Jackson urged that synchrony be improved at all levels—between policies and programs, between state and federal programs, between diverse policies targeting any one age group, or between policies addressing different age groups. It is important to think about how these all go together and “impact people as they traverse their life courses, as families traverse their life courses, and indeed, as institutions change as we become an aging society.”

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 SUMMARY DISCUSSION Barbara Torrey of the Population Reference Bureau mentioned sev- eral possible theoretical avenues of policy action and research suggested by symposium presentations. Some of the suggestions would influence behavior without technology, through information and incentives. For example, noting that people generally fail to consider or prepare end- of-life directives, Torrey speculated that this could be a requirement for getting a driver’s license. Or perhaps the annual mailing from the Social Security Administration estimating an individual’s benefits at different retirement ages could also offer varying estimates of life expectancy for that individual reflecting different health behaviors, such as excessive weight gain or tobacco use. Overuse of health care at the end of life might be addressed by requiring some reimbursement from the deceased’s estate for the final six months of care. Such a controversial policy might change family attitudes toward miracles, she suggested. Torrey identified several areas meriting further research, including housing as a vital asset for the elderly and how to tap it, obesity and future disability rates, and the responses of the elderly around the world to economic upheaval. She also drew attention to the imperative of addressing the immigration of health care workers who have been trained in the developing world. Their services are essential; their countries of origin should be compensated for training. Axel Börsch-Supan also offered closing perspectives, underscoring in part the research agenda he had earlier outlined. These include the study of age and productivity: Is it economically profitable to work to age 75? What happens at age 30 or 40 to make people more productive at older ages? What is the gap between productivity and payment at older ages? What is the actual impact of part-time work on productivity, particularly at older ages? The topic of age and saving is also a major one, including how to develop more accurate models of savings behavior and how to translate those models into policies. Global aging merits attention, from modeling the effects of international spillovers to making international comparisons regarding natural demographics or institutional change. Börsch-Supan raised two further points. He highlighted the need for much greater study of aging and inequality, encompassing both how inequalities in income, health, and education interact over the individual life course and the implication of inequality for macroeconomic growth. A final essential issue, Börsch-Supan acknowledged, is the structural lag of institutions and the inability to reform them as well as the structural lag in behavior. While human beings learn some things very quickly, oth- ers things require generations to learn. Thus, “if we have three trials and then finally get it right, 100 years have passed.” This may be acceptable in some areas, but not, for example, in Social Security or health care. With population aging as with climate change, the process is occurring faster

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 GRAND CHALLENGES OF OUR AGING SOCIETY than people’s learning process. To meet the dramatic challenges posed by an aging society, Börsch-Supan observed, people are going to have to learn faster. GENERAL AuDIENCE DISCuSSION The general audience discussion that followed returned to many of the themes that had been raised over the two days of the symposium. One theme was social change, particularly the frustrations around institutional lag and the mysteries of promoting individual change across society. In discussion, presenters and participants alike drew attention to the delay in institutions in adapting to changes in social reality. Institutional lags are seen as hampering efforts to define or implement new policy. They perpetuate incentives that are no longer appropriate under conditions that have changed substantially from when the institutions were established. They limit and rigidify options for human behavior and choice. Further- more, lagging institutions become a distraction to change, as efforts are misdirected toward preserving inherited institutions rather than creating new ones to address current challenges. Promoting change in individual behavior can be equally challeng- ing. Despite substantial knowledge regarding what constitutes healthy behavior or wise economic choices, and despite carefully designed inter- ventions and programs, people often do not act rationally, do not make the necessary changes, or do not maintain positive changes once they are achieved. In the final discussion, one participant referred to this recur- ring theme and thought a cross-disciplinary study of behavior change, incorporating work from psychology, economics, medicine, engineering, and other fields, would be useful. The need for more longitudinal studies was also affirmed. Another theme was a concern with heterogeneity and inequality. This included diversity across culture, citizenship status, health, income, education, gender, technology use, transportation use, and many other factors. Many symposium participants expressed a sense that neither current research nor current policies are giving adequate attention to heterogeneity and inequality, particularly how inequalities can be exacer- bated across a life course. Many of the challenges of aging will be ampli - fied for those with fewer means, worse health, less education, or weaker social networks. Policies to deal with health care financing or labor force participation, medical approaches to disabilities, even the design of com - munication technologies will need to take social inequalities into account. Enduring inequalities also have macroeconomic and social implications for aging populations. A final theme was the importance of taking a life-course perspective.

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 SUMMARY DISCUSSION Investments in health and education in early and middle age have a con - tinuing profound effect on later life span, productivity, and physical and cognitive health. Access to health care at earlier ages influences the need for health intervention at later ages. Healthy behaviors are necessary and effective over the entire life span. Policies to promote healthy and produc- tive aging should address individuals at all points in their lives. In the final discussion, a life-course perspective was also urged as an antidote to concern over potential intergenerational conflict. When the possibility was raised that scarce resources might become the subject of a zero-sum struggle between older and younger generations, several participants and panelists advocated greater attention to the intergenerational spillover effects that result from programs and resources designed to benefit older persons. They cited broad data that intergenerational conflict over budget resources are not occurring, as well as the results of specific programs in which, for example, resources provided to grandmothers generate improved outcomes for grandchildren. In effect, these speakers advocated taking a life-course perspective to families, communities, and societies as well as to aging individuals.

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