13 - Justice, health care, and the elderly

Summary

A dominant theme in both public and policy-making discussions of health care in recent years has been the need to control relentlessly escalating health care costs. One widely perceived and important cause of this problem has been the “graying” of America – recent and anticipated increases in life expectancy and in the proportion of the population over age 65, and especially the even more rapid increase in the “old old” population. The increased numbers of elderly in turn make disproportionately large use of health care. In response to any proposals to limit the availability to the elderly of resources generally, and health care resources in particular, their advocates have added the charge of “ageism” to the more familiar charges of racism and sexism. From the other side and in the face of the daunting political power of the elderly wielded by such lobbying groups as the American Association of Retired Persons, the argument is increasingly heard that making Social Security or Medicare programs relatively immune from the budget cuts suffered by other domestic programs is creating intergenerational injustice – that the welfare of children and working-age Americans is being wrongly sacrificed for the benefit of the elderly. The intensifying policy debate over health care and other social support programs serving the elderly is forcing a rethinking of questions of intergenerational justice and the claims of the elderly on social resources.