Sick To Death > Chapter 1 > The Baby Boom Grows Old
The current population of thirty-five million Americans age sixty-five and older will more than double within the next thirty years (Federal Interagency Forum on Aging 2000). Indeed, the population's average age is increasing because women are having fewer babies and people are living twenty years longer than they did in 1950 (United Nations 2002). Additionally, the years after World War II saw a surge in births, and those babies are now aging (Kinsella and Velkoff 2001). The last century's baby boomers will be old enough to start having high rates of late-life disability between 2020 and 2030.
In the 1960s, when Medicare started, only 9 percent (seventeen million) of the population was sixty-five or older, and only 0.5 percent (one million) of the population was older than age eighty-five. In 2000, 12 percent (thirty-five million) of the population was sixty-five and older, and 1.5 percent (four million) was older than eighty-five. While the numbers of elderly persons will continue to rise, the major increase in serious disability will come when the baby-boom generation starts turning eighty-five in about 2030, when 22 percent of Americans (eighty million) will be over sixty-five, and 2.5 percent (nine million) will be over eighty- five (U.S. Census Bureau 2000).
The effects of the changing demographics will be stunning. Housing will need to accommodate wheelchairs and walkers, income support for retirement will have to last longer, and family and community organizations will have to make room for large numbers of persons with problems in mobility, hearing, vision, communication, and cognition. The services needed during the last few years of life are expensive. In fiscal year 2000, Medicaid paid for 45 percent of the $137 billion annual cost of institutional long-term care (U.S. Congress 2002). The Congressional Budget Office forecasts that the cost of long-term care will reach $207 billion in 2020 and $346 billion in 2040 (Congressional Budget Office 1999). These extraordinary costs risk bankrupting state budgets, which currently devote 20 percent of expenditures to Medicaid, while spending on all of health care constitutes about 30 percent of state spending (National Association of State Budget Officers 2003).
According to U.S. Senator John Breaux (D-LA, ranking member of the Senate Special Committee on Aging), "[Medicaid] has become our country's 'de facto' payer of long-term care for the elderly and disabled. Most people do not know Medicaid expenditures are now outpacing Medicare nor do they realize that Medicaid is the second largest expenditure for state budgets. The unsettling notion here is that we have no real, comprehensive long-term-care system in this country and yet we are spending billions of dollars for a system that was not designed - it just evolved. Unfortunately, the system we have is inefficient, outdated, incomplete and unable to meet the needs of current or future recipients" (Breaux 2002).
People worry that living longer will mean more disability and greater burdens on society. The jury is still out as to the actual aggregate effects. Several recent studies have documented an apparent reduction in the rate of serious disability in old age (Liao et al. 2000; Crimmins, Saito, and Reynolds 1997; Manton and Gu 2001). The studies are methodologically complex and the rate's reduction, if any, is slight (Lynn 2000; Freedman, Martin, and Schoeni 2002). Of course, some conditions, like arthritis, hearing and vision deficits, and dental decay, can often be prevented or delayed. However, if general frailty remains as the path to death in advanced old age, most people who live into advanced old age will inevitably endure substantial periods of serious disability before dying.
Fifty years ago, the United States had to build new schools, houses, hospitals, and sports facilities to accommodate a dramatic increase in the number of births: the baby boomers were here. As those boomers reach retirement, they present a similar problem: we do not have the facilities or resources to care for these aging people, especially when they are sick and dying. Five decades ago, we invested in schools and housing to meet the needs of a growing generation; today, we must invest in services to ensure appropriate and high-quality care for that generation as its members grow old and die.