(How) Is Aging a Health Policy Problem?

During the 1990s, the claim that an aging population constituted a long-term “crisis” became a policy cliché. This assertion became particularly popular among elite journalists and academics in the United States. For example, Washington Post columnist David Broder wrote of “the fiscal calamity that the retirement of the baby-boom generation poses for the early years of the next century.” ¹ Former Director of the Congressional Budget Office (and current President of the Urban Institute) Robert Reischauer referred to “the demographic tsunami of the baby boom’s retirement.” ² Moreover, the Congressional Budget Office and U.S. General Accounting Office began issuing reports projecting the date of economic doomsday caused by spiraling deficits that would be caused, in turn, by burgeoning pension and health care costs. ³ Because Medicare costs have grown far more quickly than Social Security obligations—though the latter will still remain larger than the former for many years—and because a significant portion of Medicaid spending also covers the elderly, much of this commentary has focused on health care costs in particular. Eminent health economist Victor Fuchs wrote that health care costs for the elderly “could plunge the nation into a severe economic and social crisis within two decades.” ⁴ Former Colorado Governor Richard D. Lamm wrote of “the 448moral imperative of limiting elderly health entitlements,” claiming that program costs would otherwise impoverish the young. ⁵