Can you slow the growth of Medicare costs without hurting access or quality?

What we did in the Affordable Care Act was to say there are ways we can get better bang for our health care dollars. The reforms ensured seniors can get preventive care, which could lead to less-expensive care down the road. Routine mammograms and colonoscopies are covered, there are 50 percent discounts on brand-name prescription drugs, and ultimately there's a close in the doughnut hole.

At the same time, we've said to hospitals and doctors: "Let's do things smart." Let's make sure we're not subsidizing the insurance industry for services that Medicare provides perfectly adequately. And that's in contrast to some proposals you've seen that say, "We're going to give you this set amount of money. You go into the open marketplace to try to buy health insurance," and lo and behold, you may not be able to buy it because the insurance companies are charging a lot more than what your voucher's worth. That's a way of shifting costs onto seniors. But we actually want to reduce costs.

What about Social Security?

I think we can make progress. We're ahead of the game in the sense that we're already having a vigorous debate now, and there's no danger of Social Security going bankrupt.

The issue is, can we make these tweaks to ensure that everybody who's expecting a dollar in Social Security payments gets a dollar instead of 75 cents? And the sooner we do it, the better off we're going to be. I think that if we can make some progress first on Medicare and Medicaid, because those are the entitlement programs that are really driving the long-term debt, we'll have a framework of negotiations to actually do something on Social Security as well.

Back to your birthday: Have you asked for anything special?

A much lower unemployment rate. And lower gas prices. [Laughs.] Those would be perfect gifts for my birthday.

Let's talk about the economic recovery. You've said all along it will take time. But how long do you think you can counsel patience?

Well, keep in mind that the economy is growing and has been growing for a year and a half, two years now. We've seen enormous job growth — 2 million private-sector jobs created. The question is, can we get it moving faster so that more people feel the impact? Because if you're out of a job, the only improvement you want to hear is that you're going to have a job.

So to the unemployed, those who are underwater on their homes, folks who are supporting their adult kids and aging parents, too — what can you say to offer hope?

What I can say to them is that things are getting better. Traditionally it takes a little longer to come out of a financial crisis than out of a normal recession. The tax cut that we passed in December on a bipartisan basis — helping people with their payroll tax — is putting more money in people's pockets. Yet a lot of jobs that traditionally used to be there — not just in manufacturing, but jobs like a bank teller or a travel agent — aren't as available now as they used to be. And so we have to get not just our young people, but people who are midcareer, retrained for jobs that exist now, as opposed to the jobs that existed yesterday. And as we get a handle on our deficit, we've got to make investments in education, in basic research, in clean energy, and in infrastructure.

Those are formidable challenges. What do you do to relieve stress?

Exercise is important. But the most important thing is spending time with family. And when I think about those people who continue to thrive into their 70s and their 80s, usually what distinguishes them is that they exercise and have good habits. They laugh a lot and keep their sense of humor. They're involved with their family. And they're connected to work or causes that they care about.

I'm surprised you didn't mention music as a stress reliever. You're a big music listener.

I am a big music listener, and I can tell you that my iPod is well stocked.

Marilyn Milloy is deputy editor of AARP The Magazine.