There’s a wistful story noised about among gerontologists that everyone should live in good health to a ripe old age, well into their nineties, and then have life end with a quick bullet—fired by a jealous lover. But we all know that is not the way most people in America head off into the Great Beyond. Too much of the time, in our current American culture, dying can be protracted and especially painful, isolating, and costly.
The exciting news is that people living to age 65 in the United States will have an average life expectancy of an additional twenty years (Administration for Community Living, 2013). Less exciting is that even if remaining independent and living at home, seven out of ten of us will likely need assistance for three of those years (Redfoot, Feinberg, and Houser, 2013; Lynn, 2013). This assistance would include help with everyday activities such as bathing, dressing, preparing meals, or paying bills.
Private plans have been part of the Medicare program, and an alternative to traditional Medicare, since the program’s inception. A hallmark of the Medicare program has always been that enrollment in private Medicare plans is voluntary. When people become eligible for Medicare, the default is enrollment in traditional Medicare.
Medicare, the healthcare program long relied upon by older adults, also covers 9 million people who are younger than age 65 living with disabilities, and who comprise 17 percent of the Medicare population (Kaiser Family Foundation, 2010). While the disability population has always existed in the shadow of older adults—at least in the public’s conception of the program—Medicare has long been critical to supporting the health of people with disabilities.
Initially established in 1935, the field of geriatrics has grown considerably and has made important contributions to understanding the nature of older adults and issues related to health service delivery for them. As Medicare turns fifty, this is an opportune moment to consider how principles of geriatrics care can be leveraged to inform Medicare policies and improve the care of older Americans.
Generations Guest Editors John Rother and Tricia Neuman moderated this conversation with three leading beneficiary advocates to review program shortfalls and strengths, and address strategies to strengthen Medicare for the future. The roundtable discussion included Joe Baker, president of the Medicare Rights Center in New York City; Judith Stein, executive director of the Center for Medicare Advocacy in Willimantic, Connecticut; and, Kevin Prindiville, executive director of Justice in Aging, headquartered in Washington, D.C.