As the nation rapidly grays and income disparities widen by the day, a sizable number of Americans — a group that built the nation to greatness and has been its economic bedrock — is headed to yet another ugly indignity: More than half of middle-income seniors won’t be able to afford their medical expenses and the cost of assisted housing they will need at age 75 and older.
New research published in the journal “Health Affairs” has projected what already soaring medical and housing costs will mean to those whose incomes fall between $25,001 to $74,298 per year and are ages 75 to 84. These middle-income elders will increase in number from 7.9 million now to 14.4 million by 2029 and soon will be 43% or the biggest share of American seniors.
But the picture for them and their finances, housing, and medical expenses may be glum. Projections show they will lack the money, even if experts calculate in their home equity, to afford assisted living they may need in their late years.
As matters stand now, increasing numbers of older Americans can’t rely on spouses or children — especially daughters — to provide elder care. They may grow sicker and less able as they age. They may not be able to stay in their homes, as they lose mobility and find that they can’t get needed services, such as food delivery or help with basic needs like bathing and transport to medical appointments. They are unlikely to have set aside the time and resources to fix their homes, so they truly can age in place.
They also will be caught in the grip of unhappy changes in U.S. society, as was explained to Kaiser Health News service by Beth Burnham Mace, chief economist at the National Investment Center for Seniors Housing: “The low-income cohort has been taken care of by tax subsidies” and programs like Medicaid for assisted living costs, “while the high-income cohort is largely self-sufficient. But the middle-income seniors have been ignored.”
Mace and colleagues offer potential options and ways to help middle-income seniors. These do not appear to be cheap or easy. They also note that they may have underestimated the scope of the problem, because they used a relatively low figure ($5,000 annually) when examining seniors’ out-of-pocket medical costs.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the soaring cost, complexity, and uncertainty of therapies and prescription medications, including all too many drugs that prove dangerous.
Our nation long has been gripped by a quiet but formidable caregiving crisis, with women bearing unfair burdens in tending to ailing spouses and other loved ones, doing so at great professional and personal costs and when their own health may be problematic or failing. Caregivers contribute huge time and energy that the current economic system does not recognize or support. Proponents at the state level argue that this benefit to the health care system merits tax credits and other tangible assistance.
Long-term care, of course, represents yet another looming and large nightmare for us all, not only ensuring the affordability and access but also the safety and quality of facilities so no frail, ailing, and vulnerable senior is subjected to nursing home neglect and abuse.
In case anyone missed it, the 2020 presidential campaign is burning up already, with at least 20 declared Democratic aspirants and two on the Republican side. It is early, of course, but lots of ambitious notions are flying, for example, about changing Medicare and creating a single-payer system. Voters, for now, are telling politicians they need to be persuaded about the benefits of yet another overhaul of the U.S. health system.
The Affordable Care Act, particularly its protections against insurer discrimination based on preexisting conditions, has become more popular than ever — and respondents to a recent Kaiser Foundation poll want Obamacare supported and fixed, not repealed and replaced. They also say they want protections from surprise medical expenses and relief from sky-high prescription drug costs. In brief, respondents pleaded for less politician bickering and better help for their significant and daily medical concerns.
That all makes sense. We also, however, can’t stick our heads in the sand about the major problems that demographics and income inequities will impose on us all. We all would be well served to dig into the details of candidates’ health care ideas and plans. We also can’t let them gull us with pretty words and promises that aren’t backed up by actions.
At a time when more of us will need collective help, notably through safety net programs like Social Security, Medicare, and Medicaid, we can’t forget that Republicans gave a $1 trillion-plus tax cut to the wealthy corporations and the richest among us — and they now want to savage programs we’ve all paid into to deal with a burgeoning national debt. This is fodder to consider, along with worrying about how we’ll live as we grow old.
