In an aging society, health care is bound to be an increasingly dominant political concern. And everybody knows American society is aging. The portion of our population over the age of 65 has nearly doubled in the last half century, and will just about double again in the next half century. The oldest of the old, Americans over the age of 85, are now the fastest growing portion of the population. Older people have more health problems, so a society with more older members will naturally be more concerned about medicine and health care.
But beyond the simple demographics, there is a more profound and understated cultural force compelling our coming obsession with aging, decline, and health care. In the coming decades, American society is likely to age in another way, more subtle but no less crucial. Our self-image, which for more than five decades now has been a baby-boomer self-image, will likely grow old as the boomers do.
In countless ways large and small, America’s understanding of its recent history is a baby-boomer biography. There are of course many crucial exceptions, but the broad pattern is striking.
In the 1950s, the baby boomers were too young to actually control events, but — as young children — they did perceive them. That perception, more than the reality of the 50s, has stayed with us as the lasting impression of that decade. We still view that time through the eyes of a five-year-old. In the young child’s world, all is warm and fuzzy, the family is perfect, problems are simple, and solutions are easy. In reality, of course, the Fifties were anything but a tranquil paradise. In 1955, the teenage birthrate was far higher than today. Divorce was increasing as the nation settled back into a peacetime way of life. The decade was politically tumultuous as well — the 1960s did not come out of nowhere, after all. But all we hear about are simple lives and model families. Everything is simple in the toddler’s world, and ours is a toddler’s perception of the 1950s.
By the mid-1960s, the baby boomers were beginning to control the agenda. By its sheer size and insolence, that generation came to dominate the national conversation. A bit spoiled and convinced they had all the answers, a substantial portion of the teens of the 60s (though by no means all) threw a temper-tantrum. Under their influence, the decade was characterized by misguided idealism and misdirected anger, all wrapped up in a blanket of arrogance: a world of late-teens. But we view those years through the eyes of those very teens, and so we see them as days of blissful idealism. We remember only the left-wing attitudes of some teen-aged baby boomers, and forget that the Sixties were in many ways a profoundly conservative decade (the way our culture often imagines 1968, for instance, leaves little room for the fact that Richard Nixon won that year’s presidential election).
Most of the college-aged activists of that period no longer subscribe to the attitudes they held as young students, but some never lost them, and many of those went on to government, journalism, and the academic world. Starting in the 1960s, the nation’s self perception became one with that of the baby-boomers. America’s image of itself has since aged as they have.
In the 1970s, the nation was twenty-something and on drugs. A nation of graduate students, we were inanely introspective, overly self-critical, and always tired — or at least that’s how that decade now seems in our collective memory. As the 70s neared a close, and the baby boomers entered their late twenties, the nation looked back on the dreams of its teenage years and got the horrible feeling that its life was going nowhere. Soon enough, though, it would get beyond that and settle into a suburban middle-class lifestyle.
In the 1980s, the activists of the 60s turned 35. They had a mortgage and some kids, and thus needed tax cuts and a station wagon. Settling into adulthood, the nation turned capitalist and serious. We got much of our confidence back, and took on a more sober countenance as age 40 approached. Now more directly dominated by the baby boomers than ever before, the nation headed towards middle age.
And indeed, the 1990s were a decade of forty-somethings going on 50. The prevailing national mores were those of the parents of teens. The hippies of the 60s started calling their kids slackers (the gall!) and taking an active interest in spreading good family values. For themselves, they began to be very concerned about health-care and physical fitness. As the 90′s progressed, we fell deeper and deeper into a geriatric mind-set. The baby-boomers were only 50, but they began to worry about old age. A drug to fight male impotence was for a time hailed as the medical advance of the era. Even NASA, which once provided us with young fearless explorers and heroes, took great pride in sending John Glenn, a septuagenarian, into orbit in 1998 — just to show that even old folks have the right stuff.
September 11, 2001, was in some respects a powerful break in the pattern; and the events that followed began to shine a light on the younger generation by shining a light on America’s military. But the intense pressure to cast the global war against radical Islam in the mold of Vietnam has taken its toll, and in some key respects the baby boomer self-image is again America’s self-understanding.
Getting Old from the Inside
Obviously, this gross generalization suffers from the usual maladies of its kind. It is painted with an extra-broad brush, and there are a many exceptions to the pattern. But it is hard to deny that the story of America’s last five decades is a story largely told through the eyes of the baby boomers, and that this huge, assertive, self-reflective generation dominates every scene of which it is a part.
It is also hard to overstate, therefore, the cultural significance of the aging of the baby boomers. The first of them will turn 65 in 2011, the last in 2029, and a great many of them (we hope) can look forward to long and active senior citizenship. The cultural dominance of the baby boomers will surely wane as more of them retire, but it will by no means end, and their aging is sure to cast a giant shadow over America’s self-image in the coming decades.
For the health-care debates, this means our concern may well shift from working families and the uninsured to an increasing focus on geriatrics, Medicare, and long-term care. This is not all bad. There are complex problems to be thought through regarding health care and the elderly, and Medicare, more than any other federal program, is in desperate need of serious reform. But seeing these problems from the point of view of the baby boomers themselves — seeing ourselves as a nation in its 70s — will probably make entitlement reforms and other crucial policy innovations far less likely, not more.
Above all, we are likely to become obsessed with long-term care and dementia. Roughly 40 percent of deaths in the United States are now preceded by a period of enfeeblement, debility, and in many cases dementia lasting years, and that percentage will increase as more Americans reach old age in good physical health. This is a cost of our medical successes, and a cost well worth paying. But we have not yet begun to fathom just how high a cost it will be. Far from belt-tightening in Medicare, in a nation in its 70s we are likely to see immense pressure to have Medicare begin to pay for long-term care (as Medicaid now does).
The effect of the aging of the baby-boomers — that shaping generation — will surely also be felt in our attitudes about the nation’s vitality, and its ability to contend with these large problems. We can only hope that the rising generations of children and grandchildren of the baby-boomers will supply the energy to offset the geriatric mindset somewhat — but that frankly remains to be seen.
Pressed by a growing obsession with the dilemmas of the elderly, the nation will need to strike a balance that addresses with compassion and attention the genuine public problems confronting our aging society, but that does not forget about our responsibilities to younger generations, and to those not yet here. These duties to the future — cultural, economic, social, and political — risk being trampled under the sheer weight of the baby boomers, and conservatives in particular will need to be alert to them.
But if you want to be president in 2020, learn all you can now about long-term care.
— Yuval Levin is a fellow at the Ethics and Public Policy Center and senior editor of the The New Atlantis magazine.