Is Our Government Really Supporting Us as We Get Old?

A couple of weeks ago I attended the USAging conference in Chicago, one of several events I attend each year. I go to these conferences to understand and learn about the many programs that support seniors, as well as the ways that our federal, state, and local governments work to aid us as we grow older. It helps me understand the impact of the laws and regulations that our government has passed that affect you and me.

While Medicare and Medicaid have the biggest impact, there are other programs that also support us as we grow older. One example is The Older Americans Act (OAA), which has many areas of support for seniors, the most visible being meals on wheels. This law has been reauthorized for multiple years in a cooperative, bi-partisan manner since its inception in 1965 but it has languished in the Senate this year and it continues to function now in kind of a continuing resolution manner. Most of the conference attendees work as part of state or local programs that are funded, at least partially, by the OAA. As you can imagine there was major concern expressed in many of the conference sessions due to the funding cuts scheduled for Medicaid, the changes to Medicare that have been done or are proposed and the lack of a reauthorized OAA.

Before I go any further, I want to talk about my observations and discussions with the people that lead and work in these programs. They are motivated and dedicated to the work they do for America’s seniors. They see the good that these programs do, but they also see the inefficiencies and waste that exists, and they would like to see a refocus of how the money is spent. I did hear, multiple times, the expression, “we shouldn’t throw the baby out with the bath water”. It seemed to me to be another instance where the government’s effort to eliminate waste, fraud and abuse didn’t always get rid of all the dirty bath water and often lost some of the babies. They almost universally said that each state and local area agency on aging and other senior programs had the best information on where to eliminate waste in their area and there had to be way to incentivize them to be more efficient. It was very helpful to talk with these people to get there take on these important programs.

There were some great sessions that dealt with how aging is changing and how the world is looking at older people. There were many instances of ageism that were described and the resultant lack of the proper response due to these ageist views. We are aging differently now than ever before in the history of the world. The life expectancy in 1850 was around 40 years. In 2025 it is projected to have doubled to 79.4. This is even with the set back of the COVID years that lowered life expectancy by a 2.5-years. Medical and medicine discoveries, public health policies and socioeconomic factors have all worked to increase life expectancy. One thing that caused me to pause was the statistic that two-thirds of the people that have made it to 65 years old in the history of the world are alive today. That gives you some idea of the tsunami of older Americans that will have an increasing impact on our country. That’s you and me, we’re the ones that are tasked with changing how the world, and especially our country, perceives growing old.

There were many discussions that dealt with how seniors can grow old without growing frail. Once again, I heard about health span as opposed to life span (see my earlier blog on this subject). There were many discussions concerning chronic diseases and their cost to our healthcare system. One of the attendees at a session said, “if they really want to save money, keep people out of assisted living facilities”. It was pointed out that we don’t have healthcare, we have sick care. We wait for people to get sick and then we use a fee for service approach to treat the patients. The provider gets paid for each treatment, medicine, or procedure, concentrating on the immediate situation with no incentive to reduce the longer-range costs. The siloed healthcare cost centers we have give no reward to a medicine or procedure that keeps patients out of the hospital. Most of the attendees agreed that preventative care, or valued based care, would have a big impact toward lowering costs over the long run. It’s been an ongoing battle to change to value-based care, but it’s one worth fighting.

I came away from the conference fearful about the cuts and regulations that have been levied on different parts of our healthcare system but buoyed up by the caliber of people dedicated to serving older Americans and the focus on increasing our health span.

Best, Thair

p.s. Take a minute to read our statement on a recent HELP committee hearing.