Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-28T07:43:54.257Z Has data issue: false hasContentIssue false
  • English
  • Français

The Politics of Ageing in America†

Published online by Cambridge University Press:  14 November 2008

Carroll L. Estes
Carroll L. Estes
Affiliation:
Professor and Chair, Department of Social and Behavioral Sciences, School of Nursing, and Director, Institute for Health and Aging, University of California, San Francisco, CA 94143.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This paper discusses the politics of ageing in the US within a political economy framework. Four forces are shaping US policy: austerity, federalism, deregulation, and the medical-industrial complex. Two major trends in the development of policy are the commodification of the aged and their needs and a class basis for the distribution of benefits, differentiating the deserving elderly from the undeserving elderly. Ideologies of individualism, self-help, privatisation, and procompetition are being used to delegitimate public programmes and to reduce expectations about what government can and should do to ameliorate social problems.

Recent policy is characterised not only by a reduction of federal funds for domestic social spending, but also a restructuring of the community care delivery system as it operates in the private, non-profit sector of the economy. The emergent processes of this restructuring, e.g., targeting of services based on ability to pay and individual characteristics, medicalisation, and absorption of non-profit agencies by for-profits are discussed. These policies and the consequences that flow from them are viewed in light of the search for new sources of capital investment in the domestic markets. This analysis raises important political questions concerning the transformation of relations between the state and the non-profit sector.

Type
Research Article
Information
Ageing & Society , Volume 6 , Issue 2 , June 1986 , pp. 121 - 134
Copyright
Copyright © Cambridge University Press 1986

References

NOTES

1 Estes, C. L., Swan, J. and Gerard, L., Dominant and competing paradigms in gerontology: toward a political economy of ageing. Ageing and Society, 2, 2 (1982), 151–164.CrossRefGoogle Scholar

2 Myles, J. F., The Political Economy of Public Pensions. Little, Brown, Boston, 1984.Google Scholar

3 Estes, C. L., Swan, J. and Gerard, L. 1982, op. cit.Google Scholar

4 Myles, J. F., 1984, op. cit.Google Scholar

5 O'Connor, J., The Fiscal Crisis of the State. St Martin's Press, New York, 1973.CrossRefGoogle Scholar

6 O'Connor, J.Accumulation Crisis. Basil Blackwell, New York, 1984.Google Scholar

7 Edelman, M., Political Language: Words That Succeed and Policies That Fail. Academic Press, New York, 1977.Google Scholar

8 Estes, C. L., The Aging Enterprise. Jossey-Bass, San Francisco, CA., 1979.Google Scholar

9 Estes, C. L. and Gerard, L., ‘Governmental responsibility: issues of reform and federalism’, in Estes, C. L. and Newcomer, R. J. (eds). Fiscal Austerity and Aging. Sage, Beverly Hills, CA, 1983.Google Scholar

10 Relman, A. S., The new medical-industrial complex. The New England Journal of Medicine, 303, no. 17 (23 10 1973), 963–970.CrossRefGoogle Scholar

11 Wohl, S.The Medical-Industrial Complex. Harmony, New York, 1984.Google Scholar

12 Estes, C. L., Gerard, L. E., Zones, J. and Swan, J., Political Economy, Health, and Aging. Little, Brown & Sons, Boston, 1984.Google Scholar

13 Estes, C. L., 1979, op. cit.Google Scholar

14 Walker, A., Towards a political economy of old age. Ageing and Society, 1, 1 (1981) 73–94.CrossRefGoogle Scholar

15 Estes, C. L., 1979, op. cit.Google Scholar

16 Tussing, A., ‘The dual welfare system’, in Horowitz, L. and Levey, C.Social Realities, Harper and Row, New York, 1971.Google Scholar

17 Walker, A., 1981, op. cit.Google Scholar

18 Nelson, G., Social class and public policy for the elderly. Social Service Review, 56, 1 (03 1982), 85–107.CrossRefGoogle Scholar

19 Nelson, G., Tax expenditures for the elderly. Gerontologist, 23, 5 (10 1983), 471–478.CrossRefGoogle Scholar

20 U.S. Senate, Special Committee on Aging. Developments in Aging: 1984, Vol. 1. Government Printing Office, Washington, D.C., 1985.

21 Since some estimated three million beneficiaries receive a higher monthly payment than would be payable under the regular benefit formula, critics have pointed to the alleged welfare character of the minimum social security benefit.

22 Ruther, and Dobson, , 1981 (missing)Google Scholar

23 Measures already implemented to reduce Medicare costs are: (1) significant increases in patient costs for hospital care through Medicare Part A hospital deductibles (up 96% since 1981), for medical treatment by doctors throughout Part B annual deductibles for physician services (up 25% since 1981) and the annual Part B premiums (up 62% since 1981), as well as new co-payments on certain equipment.

24 Davis, K., ‘Health implications of aging in America’. Unpublished manuscript. Johns Hopkins University, Baltimore, 1983.Google Scholar

25 U.S. Congressional Budget Office. Changing the Structure of Medicare Benefits: Issues and Options. Washington, D.C., 1983.

26 Friedland, R., Alford, R. R. and Piven, F. F., ‘The political management of the urban fiscal crises’. Paper presented at the annual meeting of the American Sociological Association, Chicago, September 1977.Google Scholar

27 For every one million unemployed workers, Social Security loses $100 million in contributions per month, and each 1% of inflation is estimated to cost Social Security $1.5 billion annually.

28 Estes, C. L., Social security: the social construction of a crisis. Milbank Memorial Fund Quarterly/Health and Society, 61, 3 (1983), 445–461.CrossRefGoogle ScholarPubMed

29 Myles, J. F., ‘Population aging and the elderly’, in Forcese, D. and Richer, S. (eds). Social Issues: Sociological Views of Canada. Prentice-Hall, Ontario 1982.Google Scholar

30 Rahn, R. W. and Simonson, K. D., ‘Tax policy for retirement programmes’. In Retirement Income: Who Gets How Much and Who Pays? (National Journal Issues Book). Government Research Corporation, Washington, D.C., 1980.Google Scholar

31 Ball, Robert R., ‘Health and social policy for an aging society’. Unpublished paper. University of Texas Health Science Center, Houston TX., 1985.Google Scholar ‘Medicare's success in reducing its own costs. The date for Medicare bankruptcy keeps being postponed. The Congressional Budget Office now says ten years as compared to 1989 or 1990 a short time ago, and if one takes seriously the optimistic economic projections of the 1986 budget estimates, the date would move to sometime in the next century’ (Ball, 1985).

32 Wood, J. B., Estes, C. L., Lee, P. R. and Fox, P. J., Public Policy, the Privale Nonprofit Sector and the Delivery of Community-Based Long Term Care Services for the Elderly. Final Report, 1983; Year 02 Report, 1984. Aging Health Policy Center, University of California, San Francisco CA., 1983; 1984.Google Scholar

33 Salamon, L. M. and Abramson, A. J., Nonprofits and the Federal budget: deeper cuts ahead. Foundations News (03/04 1985). 48–54.Google Scholar

34 Starr, P., The Social Transformation of American Medicine. Basic, New York 1982.Google Scholar

35 O'Connor, J., 1984, op. cit.Google Scholar

36 Kuttner, R., The Economic Illusion: False Choices Between Prosperity and Social Justice. Houghton Mifflin, Boston, 1984.Google Scholar

37 Miller, S. M., Welfare State Revisited. Social Problems (1985), p. 64.Google Scholar

38 Olson, L. K., The Political Economy of Aging. Columbia University Press, New York 1982.Google Scholar