2015 | 2(10)/2015 Social Policy and Models of Services for the Elderly International Perspective | 53-70
Four pillars of aging policy in the United States
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To understand aging policy in the United States, it is critical to understand the federal budget, which along with national defense is dominated by Social Security, the publicly funded pay-as-you-go universal retirement program, and health care programs largely targeting the elderly (Medicare) and the poor, including the poor elderly (Medicaid). Not only is a large portion of the U.S. federal budget spent on elders, spending under these categories is mandatory: in other words, Social Security, Medicare, and Medicaid are entitlements, guaranteed by law. Politicians therefore have limited ability to allocate funds elsewhere. Discretion is further limited by the fact that currently, the U.S. budget is operating under a defi cit. Th ese budgetary pressures have evoked a variety of policy responses, which vary according to political affi liation. No matter the ideological vantage point, however, the spiraling cost of existing commitments has prevented serious consideration of other, emerging public policy issues in aging, such as the perilous state of systems for providing long-term services and supports (LTSS). Still, one bright spot is increasing attention to end-of-life issues – most likely because this is viewed as a cost-saver. It is because of Social Security, health care, LTSS, and end-of-life care that aging policy is central to the current budgetary and political debate in the U.S., a position that will only grow with time with the aging of the unprecedentedly large “baby boom” cohort born between 1946 and 1964. Th e irony is that these programs are in fact hugely popular among recipients and potential recipients. Th at is not to say that Social Security and programs providing health care to the poor and the elderly do not need reforming: there is enormous waste in the system. Yet sensible proposals for reform are oft en stymied by political obstructionism. So, too, are attempts to plan more systematically and thoughtfully about the growing aging population in the U.S. An advantage of the U.S. federal system of government is that in some cases progress can be made at the state-level such as with LTSS and end-of-life care; the downside is that this creates enormous cross-national disparities and that it fails to utilize the tools and the power that central government alone can provide.
- PhD, BPhil. Associate Professor of Gerontology and Fellow, Gerontology Institute, McCormack Graduate of Policy and Global Studies, University of Massachusetts Boston, 100 Morrissey Blvd., Wheatley Hall, 3rd Floor, Room 104,Boston, MA 02125-3393, Tele: 617-287-7342, Fax: 617-287-7080, firstname.lastname@example.org
- PhD, MPA. Professor of Gerontology & Public Policy, and Fellow, Gerontology Institute, McCormack Graduate of Policy and Global Studies, University of Massachusetts Boston, 100 Morrissey Blvd., Wheatley Hall, 3rd Floor, Room 104, Boston, MA 02125-3393, Tele: 617-287- 7313, Fax: 617-287-7080, email@example.com
- American Medical Association. (1999-2015). H-140.952 Physician Assisted Suicide. Retrieved July3, 2012, from https://www.ama-assn.org/ssl3/ecomm/PolicyFinderForm.pl?site=www.ama--assn.org&uri=%2fresources%2fh tml%2fPolicyFinder%2fpolicyfi les%2fHnE%2fH-140.952.HTM.
- Berwick, D.M., & Hackbarth, A.D. (2012). Eliminating Waste in US Health Care. Journal of theAmerican Medical Association, 307(14), 1513–1516.
- Biles, B., Casillas, G., Arnold, G., & Guterman, S. (2012, October). Realizing Health Reform’sPotential: Th e Impact of Health Reform on the Medicare Advantage Program: RealigningPayment with Performance. New York: Commonwealth Fund. Retrieved July 28, 2015, fromhttp://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Oct/1637_Biles_impact_hlt_reform_Medicare_Advantage_rb.pdf.
- Blahous, C. (2015, June 1). Th e Social Security Trustees’ Respectable Projection Record (Part 1).New York: Manhattan Institute. Retrieved July 26, 2015, from http://economics21.org/commentary/social-security-trustees%E2%80%99-respectable-projection-record-part-1.
- Bureau of Labor Statistics. (2015). CPI Infl ation Calculator. Washington, D.C.: Author. RetrievedJuly 27, 2015, from http://www.bls.gov/data/infl ation_calculator.htm.
- Carter, A. (2011). Fighting an Unexpected Th reat to Hospice Care: Medicare Fraud and Abuse.Home Healthcare Nurse, 29(3), 197–198.
- Catholic News Agency. (2012, May 4). How Many U.S. Catholics Don’t Belong to a Parish. NationalCatholic Register. Retrieved July 26, 2015, from http://www.ncregister.com/daily-news/how-many-u.s.-catholics-dont-belong-to-a-parish.
- Center for Budget & Policy Priorities. (2012, November 6). Top Ten Facts About Social Security.Washington, D.C.: Author. Retrieved July 26, 2015, from http://www.cbpp.org/sites/default/fi les/atoms/fi les/PolicyBasics_SocSec-TopTen.pdf
- Center for Budget & Policy Priorities. (2015, March 11). Policy Basics: Where Do Our Federal TaxDollars Go? Washington, D.C.: Author. Retrieved July 26, 2015, from http://www.cbpp.org/research/policy-basics-where-do-our-federal-tax-dollars-go
- Centers for Medicare & Medicaid Services. (2015, July 28). NHE Fact sheet. Baltimore, Maryland.Retrieved July 28, 2015, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html.
- CNN Opinion Research Corporation. (2009, September 11–13). CNN Opinion Research Poll; September11-13, 2009. Retrieved July 26, 2015, from http://i2.cdn.turner.com/cnn/2009/images/09/14/rel14b2.pdf.
- Coleman, D. (2015, May 11). Why disability rights advocates oppose assisted suicide (Commentary).Syracuse.com. Retrieved July 26, 2015, from http://www.syracuse.com/opinion/index.ssf/2015/05/why_disability_rights_advocates_oppose_assisted_suicide_commentary.html.
- Commission on Long-Term Care. (2013, September 30). Report to the Congress. Washington,D.C.: Author. Retrieved July 26, 2015, from: http://www.gpo.gov/fdsys/pkg/GPO-LTCCOMMISSION/pdf/GPO-LTCCOMMISSION.pdf.
- Congressional Budget Offi ce. (2015, January). Th e Budget and Economic Outlook: 2015 to 2025.Washington, D.C.: Author. Retrieved July 26, 2015, from https://www.cbo.gov/publication/49892.
- Cubanski, J., Swoope, C., Damico, A., & Neuman, T. (2014, July 21). How Much Is Enough? Out--of-Pocket Spending Among Medicare Benefi ciaries: A Chartbook. Washington, D.C.: Th eHenry J. Kaiser Family Foundation. Retrieved July 28, 2015, from http://kff .org/health-costs/report/how-much-is-enough-out-of-pocket-spending-among-medicare-benefi ciariesa-chartbook/.
- Davis, M.P., Strasser, F., & Cherny, N. (2015). How Well Is Palliative Care Integrated Into CancerCare? A MASCC, ESMO, and EAPC Project. Supportive Care in Cancer. [Epub ahead ofprint, February 14].
- Death with Dignity National Center. (2015, July 10). Portland, Oregon: Author. Retrieved July 26,2015, from http://www.deathwithdignity.org/advocates/national.
- DeSilver, D. (2013, December 5). U.S. income inequality on the rise for Decades, is now highest since1928. Washington, D.C.: Pew Research Center. Retrieved July 26, 2015, from http://www.pewresearch.org/fact-tank/2013/12/05/u-s-income-inequality-on-rise-for-decades-is-nowhighest-since-1928/.
- Dugan, A. (2015, May 6–10). In U.S., Support Up for Doctor-Assisted Suicide. Princeton, NewJersey: Gallup. Retrieved July 26, 2015, from http://www.gallup.com/poll/183425/support--doctor-assisted-suicide.aspx.
- Feder, J., & Komisar, H.L. (2012, February). Th e Importance of Federal Financing to the Nation’sLong-Term Care Safety Net. Washington, D.C.: Georgetown University. Retrieved July 27,2015, from http://www.thescanfoundation.org/sites/default/fi les/georgetown_importance_federal_fi nancing_ltc_2.pdf.
- Federal Interagency Forum on Aging-Related Statistics. (2012, June). Older Americans, 2012: KeyIndicators of Wellbeing. Washington, D.C.: Author. Retrieved July 27, 2015, from http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/2012_Documents/Docs/EntireChartbook.pdf.
- Feinberg, L. Reinhard, S. C., Houser, A., & Choula, R. (2011). Valuing the Invaluable: 2011 Update.Th e Growing Contributions and Costs of Family Caregiving. Washington, D.C.: AARP PublicPolicy Institute. Received May 1, 2013, from http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf.
- FindLaw. (2015). “‘Death With Dignity’ Laws by State” New York: Th ompson Reuters. RetrievedJuly 26, 2015, from http://healthcare.fi ndlaw.com/patient-rights/death-with-dignity-laws--by-state.html.
- Fromme, E.K., Zive, D., Schmidt, T.A., Cook, J.N., & Tolle, S.W. (2014). Association between PhysicianOrders for Life-Sustaining Treatment for Scope of Treatment and in-hospital death inOregon. Journal of the American Geriatrics Society, 62(7), 1246–51.
- Genworth Financial, Inc. (2014). Genworth 2014 Cost of Care Survey: Home Care Providers,Adult Day Health Care Facilities, Assisted Living Facilities and Nursing Homes. RetrievedApril 14, 2014, from https://www.genworth.com/dam/Americas/US/PDFs/Consumer/corporate/130568_032514_CostofCare_FINAL_nonsecure.pdf.
- Greer, D.S., Mor, V., Morris, J.N., Sherwood, S., Kidder, D., & Birnbaum, H. (1986). An Alternativein Terminal Care: Results of the National Hospice Study. Journal of Chronic Disease, 39(1), 9–26.
- Harrington, C., Ng, T., LaPlante, M., & Kaye, H.S. (2012). Medicaid Home- and Community-BasedServices: Impact of the Aff ordable Care Act. Journal of Aging and Social Policy, 24(2), 169–187.
- Th e Henry J. Kaiser Family Foundation. (2011, April 1). Kaiser Health Tracking Poll – April 2011.Washington, D.C.: Author. Retrieved July 28, 2015, from http://kff .org/health-reform/poll-finding/kaiser-health-tracking-poll-april-2011/.
- Th e Henry J. Kaiser Family Foundation. (2015a). Hospitals by Ownership Type. Washington, D.C.:Author. Retrieved July 28, 2015, from http://kff .org/other/state-indicator/hospitals-by-ownership/.
- Th e Henry J. Kaiser Family Foundation. (2015b, July). Th e Facts on Medicare Spending and Financing.Washington, D.C.: Author. Retrieved July 26, 2016, from http://fi les.kff .org/attachment/fact-sheet-the-facts-on-medicare-spending-and-fi nancing.
- Institute of Medicine. (2014, September). Dying in America: Improving Quality and HonoringIndividual Preferences Near the End of Life. Washington, D.C.: Author. Retrieved July 26,2015, from http://iom.nationalacademies.org/~/media/Files/Report%20Files/2014/EOL/Report%20Brief.pdf.
- Jacobson, G., Huang, J., Neuman, T., & Smith, K.E. (2014, January). Income and Assets of MedicareBenefi ciaries, 2013 – 2030. Washington, D.C.: Th e Henry J. Kaiser Family Foundation.Retrieved July 27, 2015, from http://kff .org/medicare/issue-brief/income-and-assets-of-medicare-benefi ciaries-2013-2030/.
- Jacobson, G., Damico, A., Neuman, T., & Gold, M. (2015, June 30). Medicare Advantage 2015Spotlight: Enrollment Market Update. Washington, D.C.: Th e Henry J. Kaiser Family Foundation.Retrieved July 28, 2015, from http://kff .org/medicare/issue-brief/medicareadvantage-2015-spotlight-enrollment-market-update/.
- Kaye, H. S., Harrington, C., & LaPlante, M. P. (2010). Long-Term Care: Who Gets It, Who ProvidesIt, Who Pays, and How Much? Health Aff airs, 29(1),11–21.
- Kohut, A. (2012, June 14). Debt and Defi cit: A Public Opinion Dilemma. Washington, D.C.: PewResearch Center. Retrieved July 26, 2015, from http://www.people-press.org/2012/06/14/debt-and-defi cit-a-public-opinion-dilemma/.
- Krueger, A.B. (2012, January 12). Th e Rise and Consequences of Inequality in the United States. Washington,D.C. Council of Economic Advisors. Retrieved July 26, 2015, from https://www.whitehouse.gov/sites/default/fi les/krueger_cap_speech_fi nal_remarks.pdf.
- Marmor, T. (2000). Th e Politics of Medicare. Hawthorne, NY: Aldine de Gruyter.
- Miller, E.A. (2011). Flying Beneath the Radar of Health Reform: Th e Community Living AssistanceServices and Supports (CLASS) Act. Th e Gerontologist, 51(2), 145-155.
- Miller, E.A, Doherty, J., & Nadash, P. (2013). Pay-for-Performance in Nursing Homes: Lessonsfor the Nursing Home Sector. Public Administration Review, 73(September/October), S153-S163.
- Miller, E. A., & Nadash, P. (2014). Th e Aff ordable Care Act and Long-Term Care: Marginal Advancementon the Status Quo. Home Health Care Services Quarterly, 33(4), 194-210.
- Mor, V. (2005). Improving Long Term Care Quality with Better Information. Milbank Quarterly,83(3), 333-64.
- Munnell, A.H. (2014, August). Social Security’s Financial Outlook: Th e 2014 Update in Perspective.Chestnut Hill, Massachusetts: Center for Retirement Research, Boston College. RetrievedJuly 26, 2015, from http://crr.bc.edu/wp-content/uploads/2014/07/IB_14-12_508rev.pdf.
- Melnyk, A. (2005). Long-Term Care Insurance or Medicaid: Who Will Pay for Baby Boomers’ Long--Term Care? Retrieved June 2, 2009, from: http://www.acli.com/NR/rdonlyres/FEB87D8A--9E2F-45B6-B08A-CBED882A66C6/0/LTCBabyBoomers05.pdf.
- National POLST Paradigm. (2012-2015). Programs in Your State. Portland, Oregon: Author. RetrievedJuly 26, 2015, from http://www.polst.org/programs-in-your-state/.
- Ng, T, Harrington, C., Muscumeci, M., & Reaves, E. (2014, December 22). Medicaid Home andCommunity-Based Service Programs: 2011 Data Update. Washington, D.C.: Th e Henry J.Kaiser Family Foundation. Retrieved July 26, 2015, from http://kff .org/medicaid/report/medicaid-home-and-community-based-services-programs-2011-data-update/.
- OpenSecrets. (2015). Lobbying: Top Industries. Washington, D.C.: Th e Center for ResponsivePolitics. Retrieved July 28, 2015, from https://www.opensecrets.org/lobby/top.php?showYear=2014&indexType=i.
- Ornstein, K.A., DeCherrie, L., Gluzman, R., Scott, E.S., Kansal, J., Shah, T., Katz, R., Soriano,T.A.(2015). Signifi cant unmet oral health needs of homebound elderly adults. Journal of theAmerican Geriatrics Society, 63(10), 151-7.
- O’Shaughnessy, C.V. (2014, March 27). National Spending for Long-Term Services and Supports(LTSS), 2012. Retrieved July 26, 2015, from https://www.nhpf.org/library/the-basics/Basics_LTSS_03-27-14.pdf.
- Ostrow, L., & Manderscheid, R. (2010). Medicare mental health parity: A high potential Changethat is long overdue. Journal of Behavioral Health Services & Research, 37(3), 285-90.
- Pew Research Center. (2014, January 23). Most See Inequality Growing, But Partisans Diff Oversolutions. Washington, D.C.: Author. Retrieved July 26, 2015, from http://www.people-press.org/2014/01/23/most-see-inequality-growing-but-partisans-diff er-over-solutions/.
- Pew Research Center. (2014, June 26). Compare Political Typology Groups. Washington, D.C.: Author.Retrieved July 26, 2015, from http://www.people-press.org/2014/06/26/typology-comparison/social-security/.
- PollingReport.com. (2015). CBS News Poll. Jan. 17–21, 2014. Retrieved July 28, 2015, from http://www.pollingreport.com/health.htm.
- Ruffi ng, K., & Van de Water, P.N. (2015, May 4). Social Security Benefi ts Are Modest. Washington,D.C.: Center on Budget & Policy Priorities. Retrieved July 26, 2015, from http://www.cbpp.org/research/social-security/social-security-benefi ts-are-modest.
- Saez, E., & Zucman, G. (2014, October).”Wealth Inequality in the United States since 1913: Evidencefrom Capitalized Income Tax Data,” NBER Working Paper 20625. Cambridge, MA:National Bureau of Economics Research. Retrieved July 26, 2015, from http://eml.berkeley.edu/~saez/saez-zucmanNBER14wealth.pdf.
- Selvam, A. (2012, March 3). For-profi ts rising: Investor-owned hospitals add market share, alongwith growing numbers of ventures with not-for-profi t counterparts. Modern Healthcare.Chicago, Illinois: Author. Retrieved July 28, 2015, from http://www.modernhealthcare.com/article/20120303/MAGAZINE/303039958
- Social Security Administration. (2014, April). Income of the Population 55 or Older, 2012. Washington,D.C.: Author. Retrieved July 26, 2015, from http://www.ssa.gov/policy/docs/statcomps/income_pop55/2012/incpop12.pdf.
- Social Security Administration. (2015, July 22). Th e 2015 Annual Report of the Board of Trusteesof the Federal Old-Age and Survivors Insurance and Federal Disability Insurance TrustFunds. Washington, D.C.: Author. Retrieved July 26, 2015, from http://www.ssa.gov/OACT/tr/2015/tr2015.pdf.
- Stone, C., Trisi, D., Sherman, A., & DeBot, B. (2015, July 14). A Guide to Statistics on HistoricalTrends in Income Inequality. Retrieved from July 26, 2015, from http://www.cbpp.org/research/poverty-and-inequality/a-guide-to-statistics-on-historical-trends-in-incomeinequality.
- Teno, J.M., Gozalo, P.L., Bynum, J.P.W., Leland, N.E., Miller, S.C., Morden, N.E., Scupp, T., Goodman,D.C., & Mor, V. (2013). Change in End-of-Life Care for Medicare Benefi ciaries: Siteof Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009. Journal of theAmerican Medical Association. 309(5):470-477.
- Tucker, J.V., Reno, V.P., & Bethell, T.N. (2013), January. Strengthening Social Security: What DoAmericans Want? Washington, D.C.: National Academy of Social Insurance. Retrieved fromJuly 26, 2015, from https://www.nasi.org/sites/default/fi les/research/What_Do_Americans_Want.pdf.
- Th e White House. (2015, July 13). FACT SHEET: Th e White House Conference on Aging, EmpoweringAll Americans as We Age. Washington, D.C. Offi ce of the Press Secretary, Th eWhite House. Retrieved July 26, 2015, from https://www.whitehouse.gov/the-press-offi -ce/2015/07/13/fact-sheet-white-house-conference-aging.
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