Excellus Health Plan, Inc.

Policies for an Aging Society by Stuart H. Altman; David I. Shactman Review by: Peggy A. Gallup Inquiry, Vol. 40, No. 3 (Fall 2003), pp. 306-308 Published by: Excellus Health Plan, Inc. Stable URL: http://www.jstor.org/stable/29773083 . Accessed: 24/04/2013 13:21
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Inquiry/Volume

40, Fall

2003

since 1889. Reform inmedical education is bur? William L. Kissick, M.D., Dr. P.H. dened with significant challenges. The same can Emeritus Professor ofMedicine and be said for the practice of medicine. Management, University of Pennsylvania The authors' fifth initiative deals with theunin? Adjunct Professor ofHealth Policy and sured in our society, who have been of concern Management, Yale University since the 1931 report of the Committee on the Branford, Connecticut Costs of Medical Care. Certainly Medicare and Medicaid, signed into law in 1965, provided ac? Policies for an Aging Society. Stuart H. Altaian cess for these previously uninsured population and David I. Shactman (eds.). Baltimore: The groups. Given thedeliberations of theU.S. House Johns Hopkins University Press. 2002. 400 pp. of Representatives and the U.S. Senate over $24 (softcover). the past four decades (including their current attempts at prescription coverage forMedicare Policies for an Aging Society presents a compre? recipients), I suspect we will be at it for years hensive array of writings about the economic, and, perhaps, decades to come. social and policy issues facing theUnited States Another of the authors' initiatives is to improve in maintaining a social insurance program for population health. Three decades ago, theCalifor? the elderly into the 21st century. The book con? nia Department ofHealth published a prescription sists of 17 writings prepared by renowned ex? for improved population health. They suggested related to the perts in many disciplines a low-calorie diet, seven to eight hours of sleep an of work evolved The aging society. each night, alcohol inmoderation, exercise, stop? problems from a 1999 conference of these policy experts ping smoking, and the use of seat belts. Today, given by the Council on the Economic Impact we should add safe sex.With my tongue in cheek, of Health System Change research (a group how are we doing? theRobert Wood Johnson Founda? sponsored by Improving the health care market through con? tion). Each chapter stands independently, while sumer choice and preventing anti-competitive at the same time the writings work together to practices is another of the authors' suggested ini? provide many perspectives on defining and ana? tiatives. Logic says that this strategywill require lyzing the current situation. They suggest ways an extraordinary shiftof resources from biomed of solving the problem of how to create an eco? ical research to the social sciences, including eco? nomically viable program for the future that nomics. This will be a long haul. meets the needs of the elderly, but not at the ex? The authors' call for a national health strategy of other important government programs pense must recognize thathealth policy is 10% legisla? or the nation's tion and 90% implementation. Their call for ac? economy. Most of this book ex? amines Social tion concludes with a coda, "Let's get best health Security, Medicare, and the long care term in return for our dollars." This is "value for portion ofMedicaid, but there also are discussions of the government's policies for pri? money in health," a concept that has had much vate pension programs. previous press. Each chapter addresses a different aspect of My concerns notwithstanding, I sign on. For decades, however, I have taught medical, nurs? aging policy, grouped into sections entitled "Eco? nomic and business students about Framework," "Policy Alternatives" and ing, public health, "Political Realities." Among the authors, there is the iron triangle of health care, that is, the inex? orable tension among cost containment, quality agreement that spending on programs for the el? of care, and access to care. It seems that no derly is considerable; currently 6.4% of the gross ever has domestic addressed the country product and 35% of the federal budget successfully to associated the with health older care's members of our society. And there iron tri? go challenges This book ex? from is the authors' with the growth of the elderly that angle. speaks agreement I are correct and that the these perience. hope they programs are not sustainable population, a of their call for national in current their form. Without policy changes, implementation 306

education, we've been at it for more than two the University of Pennsylvania centuries?at since 1765 and at the Johns Hopkins University

health strategy will vitiate my concerns. I wish them well.

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Book

Reviews

descriptions, early sections of the book explain the uncertainty associated with making accurate many of thekey strategies for reforming thefinan? projections about the future. As an introduction cial structure, eligibility requirements and ser? to the economics of social policy for the elderly, vices provided by social programs for the Henry Aaron warns that economic projections elderly. Mark Pauly considers taking Social have limited value, while acknowledging that Security andMedicare away from the social insur? ance model, and introducing defined contribu? they are the basis of "every study or proposal and Medicare" cost controls for tions, more market-based regarding Social Security (p. 63), and that policy analysis for the future is Medicare, and income-related eligibility. Alterna? even more uncertain. He is critical of analysts tively, Alicia Munell supports maintaining de? like himself, calling them "wannabe fined benefits, arguing that payments based "on policy makers" one's skills as an investor is not consistent with the (p. 68). This chapter provides a basis for the reader to understand the economic projec? goals of amandatory Social Security program" (p. tions presented by Eugene Steuerte and Paul Van Olivia Mitchell, and 249). John Geanakoplos, deWater in their "user's guide to long-term bud? Stephen Zeldes give a detailed explanation of the meaning of "privatizing" Social Security. get projections" (p. 81). Recent economic news clearly demonstrates They conclude that,while there are possible ben? Aaron's point about how difficult it is to make ac? efits from private accounts, the returnwill not be curate economic forecasts and, by extension, to as high as its proponents suggest. In a later chap? Norman Ornstein adds that the public appeal ter, develop clear plans for the future of social pro? of these private accounts also has faded with the grams. The size of the federal debt will affect pre? dictions about how much money is available for drop in the stock market. The age of retirement social programs. In theirdiscussion on long-term will have a major impact on the cost of programs for the elderly, and Joseph Quinn shows that since budget projections, Steuerte and Van de Water make reference to theBush administration's plan about 1985 more elderly Americans have been to pay down some portion of the federal debt over working, many in "bridge jobs" that are between the next 10 years. Yet, the White House recently full employment and retirement. Public policy announced that for 2003 the government will change is one reason for this increase, but older have a deficit of $455 billion, the largest ever. Americans today are probably healthier, andmany As would be expected when many experts in have less physically demanding jobs than their the field address such a complex issue, the book predecessors. Lynn Etheredge describes a compre? presents many differentperspectives of the sever? hensive retirement policy that integrates public and private programs to provide work incentives ity of the problem as well as the best solutions. Whether there even is a fiscal "crisis" ahead is and necessary benefits in an efficientmanner. debated. Joseph White calls it "the entitlement After examining themany policy options for crisis that never existed" (p. 140), and advocates reform, Ornstein and Robert Binstock (in sepa? rate chapters) assess the political environment making some policy changes now (such as reduc? for implementing these changes. Both authors ex? ing national debt and controlling Medicare costs) but leaving significant policy changes to those plain how the American political environment who live in the future. Theodore Marmor and can hamper making changes, but they call for de? Mashaw concur, saying thatmany of the veloping a comprehensive aging policy. Finally, Jerry claims that Social Security is facing a fiscal crisis the book ends with a chapter written by Victor are motivated by "ideologic Fuchs giving a holistic view of the situation, con? opposition" (p. 175) to social insurance. Furthermore, theybelieve the sidering the health and financial condition of the financial problems of the future can be managed elderly, and promoting policies that encourage by the "modest adjustments" (p. 176) proposed saving and paid work. 307

Social Security, Medicare, and Medicaid long term care will use 70% of the federal budget by 2030. Furthermore, there is general agreement that these programs have been beneficial, particu? larly for reducing poverty among the elderly. In addition to economic statistics and program

by the Ball Plan within the 1996 Social Security Advisory Council. In contrast,Richard Lamm de? scribes the growth in demand and sees looming a serious problem thatcould bankrupt the country unless we make considerable policy changes now to achieve "intergenerational equity" (p. 205). The book provides a critical examination of

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Inquiry/Volume

40, Fall

2003

words that have been heard by everyone but may have many definitions; this would be espe? cially helpful for students because these writings include so many disciplines. This book does not present a unified perspective on social policy re?

Policies for an Aging Society covers aging pol? icy broadly and in depth, and the text provides good explanations for the technical concepts dis? cussed in the book (which range from regression analysis to net present value). Itwould be useful to have a glossary for unfamiliar terms or for

boomers?who act really are the problem?will like "greedy geezers" who compete with the rest of society for government support, or whether will be "socially responsible" (p. 356). Hope? they will be the latter and we can, as a nation, fully, it work together to create an equitable social insur? ance program thatprovides for all who need it.

book does not intend to answer all questions. So we are left to decide for ourselves whether baby

Peggy A. Gallup, Ph.D. form, but rather educates the reader by presenting Associate Professor a wealth of information and statistics to help in Department of Public Health current the the Southern Connecticut State University, situation, understanding proposals for reform, their effects and their likelihood. The New Haven

308

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