Between 1935 and 1975, old-age security was arguably, next to military might, the central preoccupation of American policy. The passage of the Social Security Act (1935) and the Medicare and Medicaid Act (1965) are just the two most famous examples. Every year, legislation streamed from Washington that addressed problems in housing, nutrition and care for older people. Some of it was good, some of it was bad, but together that flood of legislation created an admirable safety net for American seniors. And throughout, this safety net benefited Americans of all ages. One of the most important aims of Social Security, after all, was to free older people from dependence on their children.
Since 1975, that flood of legislation has slowed to a trickle and the national conversation about those issues has more or less ceased. It’s not that we’ve ceased talking about old age — we talk about it constantly, as we are now. But those conversations have focused on well-off older people, like Donald Trump and Mr. Biden, and on their place in culture, society and politics. From AARP to “The Golden Girls,” the American reckoning with age has been, by and large, a reckoning with age for the relatively privileged and able-bodied. The more important issues have been largely unaddressed.
The old-age lobby is not as powerful as many believe — even the mighty AARP has supported many failed initiatives, including an effort in 1988 to provide federally subsidized long-term care insurance. Social Security has not been meaningfully reformed in my lifetime; its last major change was voted into law in March 1983, a few weeks before I was born. There have been various efforts to reform a nursing home system that is, by all accounts, in disastrous shape, and to improve labor conditions for home health care workers. Those, too, have come to little, and many of the regulations that were passed have not been enforced.
Today, as we continue to have familiar discussions about old age and the so-called gerontocracy, older people are being buffeted by new challenges. Climate change, for instance: Older people are disproportionately affected by the storms, wildfires and electricity shortages that accompany our warming planet. The Covid-19 pandemic is another painful example. More than half of those killed by Covid-19 in the first three years of the pandemic were over the age of 75; three-quarters were over the age of 65. Nursing homes especially became death traps. More than one-fifth of Covid-19 deaths took place among residents or staff of nursing homes, a group that comprises less than one percent of the population.
There is a serious conversation to be had about aging. It’s about how we can, as a country, prepare for a century of pandemics, heat waves and hurricanes, and how we can provide humane care to millions of frail older people, many of them people of color who have suffered a lifetime of disenfranchisement. Every word that we use to analyze gaffes or provide armchair diagnoses is a word that is not being used on them. We can do better. More than ever before, demographically speaking, we are a nation of grown-ups. It’s time to start acting like it.