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Reimagining America - AARPs Blueprint for the Future

How America Can Grow Older and Prosper

Endnotes


  1. Congressional Budget Office, The Long-Term Budget Outlook, Washington, DC: U.S. Government Printing Office, December, 2003.
  2. Administration on Aging (AoA), U.S. Department of Health and Human Services. A Profile of Older Americans: 2003. Washington, DC. Available online at http://www.aoa.gov/prof/statistics/profile/2003/2003profile.pdf.
  3. U.S. Department of Health and Human Services, Center for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2004, Table 27, Washington, DC.
  4. Total dependency ratios are persons 65 and older plus persons under 20 divided by persons 20 to 64 years old.
  5. Alan Greenspan, Chairman of the Federal Reserve Board, Testimony before the U.S. House of Representatives Budget Committee, Washington, DC, February 24, 2004.
  6. Comptroller General David Walker, Statement to the U.S. Special Committee on Aging, March 21, 2002, p. 6.
  7. Comptroller General David Walker, "The Debt No One Wants to Talk About," The New York Times, February 4, 2004. Available online at http://www.nytimes.com/2004/02/04/opinion/04WALK.html. A more detailed accounting of Walker's argument is available in his speech at the National Press Club, Truth & Transparency: The Federal Government's Financial Condition and Fiscal Outlook September 17, 2003. It is available online at http://www.gao.gov. See footnote 12 for a definition of "fiscal gap."
  8. Cynthia Smith, Cathy Cowan, Art Sensenig, Aaron Catlin, et.al., "Health Spending Growth Slows in 2003," Health Affairs, Vol. 24, No. 1, January/February 2005, pp. 185-194. Figures are from the Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group.
  9. Cynthia Smith, Cathy Cowan, Art Sensenig, Aaron Catlin, et.al., "Health Spending Growth Slows in 2003," Health Affairs, Vol. 24, No. 1, January/February 2005, pp. 185-194. Figures are from the Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group. After overall health expenditures are adjusted for economy-wide inflation, constant dollar growth rose 5.8 percent in 2003, compared with 6.9 percent average annual growth between 2000 and 2002.
  10. Institute of Medicine, Insuring America's Health: Principles and Recommendations, Washington, DC: IOM. January 2004. Available online at http://books.nap.edu/html/insuring_health/reportbrief.pdf.
  11. Ibid.
  12. The fiscal gap was developed by Alan J. Auerbach in 1994 as an accounting measure intended to reflect the current long-term budgetary status of the government. CBO's definition is: "The fiscal gap, which is expressed as a percent of GDP, is the size of the immediate and permanent increase in revenues or decease in outlays, expressed as a percent of GDP, that would be necessary to keep federal debt at or below its current share of GDP" for a future projection period (CBO, 2000).
  13. Previous measures of the "fiscal gap" have proven to be extremely volatile. For example, in 1996, Medicare costs were projected to reach 7.39 percent of GDP by 2030. Today Medicare spending is projected to be 4.75 percent of GDP in 2030, a 36 percent reduction in the projection in just seven years.
  14. Congressional Budget Office, Long-Term Budgetary Pressures and Policy Options, March 1997; Long-Term Budgetary Pressures and Policy Options, May, 1998; The Long-Term Budget Outlook, October 2000.
  15. Alan J. Auerbach, William G. Gale and Peter R. Orszag, "Sources of the Long-Term Fiscal Gap," Tax Notes, May 24, 2004, p. 1051.
  16. James Lubitz, Acting Chief, Aging and Chronic Diseases, Statistics Branch, National Center for Health Statitistics, Centers for Disease Control and Prevention, Testimony Before the U.S. Senate Joint Economic Committee, Washington, DC, July 22, 2004.
  17. Timothy A. Waidmann and Korbin Liu, 2000, "Disability Trends Among Elderly Persons and Implications for the Future," Journal of Gerontology, Vol. 55B, No. 5, pp. S298-S307.
  18. Kenneth G. Manton and XiLang Gu, 2001, "Changes in the Prevalence of Chronic Disability in the United States Black and Nonblack Population Above 65 from 1982 to 1999," Proceedings of the National Academy of Sciences, Vol. 98, pp. 6354-6359.
  19. A third factor, the recent increases in obesity and disability among much younger cohorts, discussed later in this Blueprint, has the potential to reverse these declines in disability in old age.
  20. AARP Public Policy Institute analysis of CMS data supplied by C. McKeen Cowles, 2004. The proportion of nursing home residents with Medicare as primary payer has been increasing, but such care is only short term and medically oriented.
  21. Darius Lakdawalla and Tomas Philipson, 2002, "The Rise in Old Age Longevity and the Market for Long-Term Care," The American Economic Review, Vol. 92, March 2002, pp. 295-306.
  22. Donald L. Redfoot and Sheel M. Pandya, "Before the Boom: Trends in Long-Term Supportive Services for Older Americans with Disabilities," Washington, DC: AARP Public Policy Institute, October 2002.
  23. AARP Public Policy Institute analysis of CMS data supplied by C. McKeen Cowles, 2004.
  24. Burton H. Singer and Kenneth G. Manton, 1998, "The Effects of Health Changes on Projections of Health Service Needs for the Elderly Population of the United States," Proceedings of the National Academy of Sciences, Vol. 95, Issue 26, pp. 15618-15622.
  25. Uwe E. Reinhardt, "Does the Aging of the Population Really Drive the Demand for Health Care?" Health Affairs, Vol. 22, No. 6, November/December 2003, pp. 27-39.
  26. Diane Rowland, Sc.D., Medicaid's Role Today, The Kaiser Commission on Medicaid and the Uninsured Briefing on What Has Caused the Growth in Medicaid in Recent Years, Washington, DC, January 26, 2005.
  27. John Holahan and Arunabh Ghosh, The Urban Institute, Understanding the Recent Growth in Medicaid Spending: 2000-2003, The Kaiser Commission on Medicaid and the Uninsured Briefing on What Has Caused the Growth in Medicaid in Recent Years, Washington, DC, January 26, 2005. Also reprinted in Health Affairs (Web Exclusive), January 26, 2005, pp. 52-62.
  28. Congressional Budget Office, The Budget and Economic Outlook, An Update, Washington, DC: U.S. Government Printing Office, September 2004.
  29. AARP, Staying Ahead of the Curve: The AARP Work and Career Study, Washington, DC: AARP, 2003.
  30. Congressional Budget Office, Disability and Retirement: The Early Exit of Baby Boomers from the Labor Force, Washington, DC: U.S. Government Printing Office, 2004.
  31. AARP, Beyond 50: A Report to the Nation on Economic Security, Washington, DC: AARP, May 2001.
  32. U.S. Bureau of Labor Statistics, Employment and Earnings, January 1986 to January 2004, Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics.
  33. Ibid.
  34. Mitra Toossi, "A Century of Change: The U.S. Labor Force, 1950-2050," Monthly Labor Review, 125 (May 2002), 15-28. Howard Fullerton and Mitra Toossi, "Labor Force Projections to 2010," Monthly Labor Review, 124, November 2001, 21-38.
  35. D. Rogers, E. Toder, and L. Jones, Economic Consequences of an Aging Population, Occasional Paper No. 6, The Retirement Project, The Urban Institute, September 2000.
  36. Op. Cit., AARP, Beyond 50: A Report to the Nation on Economic Security. The "haves" are those who have enjoyed the cumulative advantages of higher-wage jobs with employer-based pensions and health insurance coverage, allowing them to save more on their own for retirement.
  37. Op. Cit., AARP, Beyond 50: A Report to the Nation on Economic Security.
  38. These strategies are adapted from a ten-year agenda for social change, developed by AARP. It aims to help people maintain quality of life as they age, be able to afford their increased longevity, keep public programs that contribute to quality of life (e.g., Medicare, Medicaid and Social Security) affordable and viable, and accomplish this with generational fairness. The complete Agenda is on the inside back cover of this booklet.
  39. Dr. Henry E. Simmons and Joel E. Miller, A Perfect Storm: The Confluence of Forces Affecting Health Care in America, Washington, DC: National Coalition on Health Care, November 2001. Available online at http://www.nchc.org/materials/studies/A%20Perfect%20Storm.pdf.
  40. OP. Cit., CBO, The Long-Term Budget Outlook, 2003.
  41. Dr. Elias A. Zerhouni, Director, National Institutes of Health, FY 2006 Director's Budget Request Statement, House Subcommittee on Labor-HHS-Education Appropriations, March 9, 2005.
  42. Institute of Medicine, Insuring America's Health: Principles and Recommendations, Washington, DC: National Academies Press, January 2004. Aavailable online at http://www.iom.edu/report.asp?id=17632.
  43. Ibid.
  44. CBO also is wary—understandably so—of predicting savings given historical evidence that when Medicare begins covering a service, the demand for that service increases and, therefore, costs increase.
  45. See, for example, Soumerai, S.B. et al. "Payment Restrictions for Prescription Drugs Under Medicaid: Effects on Therapy, Cost and Equity," New England Journal of Medicine 317 (9) (1987): 550-56; "Effects of Medicaid Drug Payment Limits on Admissions to Hospitals and Nursing Homes," New England Journal of Medicine, October 10, 1991: 1072-1077; "Effects of Limiting Medicaid Drug Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine, September 8, 1994: 650-655. Other states also revised their prescription cap policies based on these findings.
  46. See, for example, Lichtenbert, Frank R. "The Effects of Pharmaceutical Utilization and Innovation on Hospitalization and Mortality," National Bureau of Economic Research Working Paper #5418, January 1996; "The Benefits and Costs of Newer Drugs: Evidence from the 1996 National Medical Expenditure Panel Survey," National Bureau of Economic Research Working Paper #8417, March 2001; "Benefits and Costs of Newer drugs: An Update," National Bureau of Economic Research Working Paper #8996, June 2002.
  47. Medicare Payment Advisory Commission, Report to the Congress:Variation and Innovation in Medicare, June 2003, Washington, DC.
  48. Medicare Payment Advisory Commission, Report to the Congress:Medicare Payment Policy, March 2004, Washington, DC.
  49. Ibid.
  50. See Committee on Quality Health Care in America, Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century, National Academy of Medicine, Washington, DC, 2001; L. T. Kohn, Corrigan, J. M., Donaldson, M. S., To Err Is Human: Building a Safer Health System, National Academy Press, Washington, DC, 2000. E. A. McGlynn, S. Asch, J. Adams, J. Keesey, J. Hicks, A. DeCristofaro, E. Kerr, "The Quality of Health Care Delivered to Adults in the US", New England Journal of Medicine, 348: 26, June 26, 2003.
  51. See Agency for Healthcare Research and Quality, National Healthcare Disparities Report, Rockville, MD, December 2003.
  52. National Committee for Quality Assurance, The State of Health Care Quality, 2004, Industry Trends and Analysis, p. 7, Washington, DC, 2004.
  53. National Institute of Child Health and Human Development (NICHHD), National Institutes of Health, "Calcium Crisis" Affects American Youth, Press Release, December 10, 2001, quote by Duane Alexander, Director, NICHHD. Available online at http://www.nichd.nih.gov/new/releases/calcium_crisis.cfm.
  54. Darius Lakdawalla, Jayanta Bhattacharya, and Dana Goldman, "Are the Young Becoming More Disabled? Rates of Disability Appear to be on the Rise Among People Ages Eighteen to Fifty-Nine, Fueled by a Growing Obesity Epidemic," Health Affairs, Vol. 23, No. 1, January/February 2004, pp. 168-176.
  55. RAND Health, Obesity and Disability: The Shape of Things to Come, Santa Monica:The RAND Corporation, 2004.
  56. American Diabetes Association, "Economic Costs of Diabetes in the U.S. in 2002," Diabetes Care, 26: 917-932, 2003. Available online at http://care.diabetesjournals.org/cgi/content/full/26/3/917.
  57. Jack Rowe and Robert Kahn, Successful Aging: The MacArthur Foundation Study of Aging in America, New York: Pantheon Books, 1998.
  58. Centers for Disease Control and Prevention, Healthy Aging: Preventing Disease and Improving Quality of Life Among Older Americans. Available online at http://www.cdc.gov/nccdphp/aag/aag_aging.htm.
  59. Centers for Disease Control and Prevention, Smoking Prevalence Among U.S. Adults, May 2005. Available online at http://www.cdc.gov/tobacco/research_data/adults_prev/prevali.htm.
  60. Committee on the Consequences of Uninsurance, Institute of Medicine, Care Without Coverage: Too Little, Too Late (Washington, DC: National Academy Press), 2002.
  61. Anderson, G., Robert Wood Johnson Foundation, 2002. Partnership for Solutions: Better Lives for People with Chronic Conditions. Written testimony before the Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives. 108th Cong. 1st sess. April 16. As cited in Medicare Payment Advisory Commission, Report to the Congress:Medicare Payment Policy, Washington, DC: MEDPAC, March 2004. Available online at http://www.medpac.gov.
  62. Bodenheimer, T., Wagner, E.H., and Grumbach, K., "Improving Primary Care for Patients with Chronic Illness, The Chronic Care Model, Part 2," Journal of the American Medical Association, Vol. 288, No. 14, pp. 1909-1914, October 9, 2002.
  63. AARP/Roper Public Affairs and Media Group of NOP World. Beyond 50.05, A Report to the Nation on Livable Communities: Creating Environments for Successful Aging, Washington, DC: AARP, May 2005.
  64. MacArthur Foundation Study of Successful Aging defines the term as the ability to maintain three key behaviors or characteristics: low risk of disease and diseaserelated disability; high mental and physical function; and active engagement with life.
  65. Commission on Affordable Housing and Health Facility Needs for Seniors in the 21st Century Report.
  66. Bailey, Linda. Aging Americans: Stranded Without Options. Surface Transportation Policy Project, Washington DC, 2004.
  67. AARP Public Policy Institute tabulations of March Demographic Supplement, Current Population Survey, U.S. Bureau of the Census, 2002, 2003.
  68. OASDI Board of Trustees, 2005. Three alternative sets of economic and demographic assumptions are used to show a range of possibilities for the trust funds. The intermediate assumptions (Alternative II) reflect the Trustees' best estimate of future experience. The intermediate assumptions are reflected throughout this paper unless otherwise noted. The low-cost Alternative I is more optimistic for trust fund financing; and the high-cost Alternative III is more pessimistic. These assumptions are reexamined on an annual basis.
  69. James J. Choi, David Laibson, and Brigitte Madrian, "Plan Design and 401(k) Savings Outcomes," National Tax Journal, 52(2), June, 2004: 275-98.
  70. A. Munnell and A. Sunden, A., Coming Up Short: The Challenge of 401(k) Plans. Washington, DC: The Brookings Institution, 2004.
  71. Benartzi, S., and Thaler, R., Save More Tomorrow: Using Behavioral Economics to Increase Employee Savings, Journal of Political Economy, 112:1, pp. 164-87, 2004.
  72. AARP, Staying Ahead of the Curve: The AARP Work and Career Study, Washington, DC: AARP, 2002.
  73. Employment Policy Foundation, The American Workplace 2003: Realities, Challenges and Opportunities, Washington, DC, August 27, 2003. See press release providing highlights of the report online at http://www.epf.org/news/nrelease.asp?nrid=179. Some industries are already facing this problem. See, for example, Denise Kersten, "The Grayest Generation: The Aerospace Industry Launches a Quest for Talent as its Workforce Ages and Fresh Genius Runs in Short Supply," Business Forward, November 6, 2003. Available online at http://www.bizforward.com/wdc/issues/2002-11/government/generation.
  74. AARP actively promotes this by recognizing the Best Employers for People Over 50. This annual recognition program identifies the best practices and policies implemented by employers and promotes them to encourage other employers to adopt them.
  75. Congressional Budget Office, The Long-Term Budget Outlook, Washington, DC: U.S. Government Printing Office, December, 2003.
  76. American Enterprise Institute, Public Opinion on Taxes, AEI Studies in Public Opinion (Updated June 4, 2003). Available online at http://www.aei.org/publications/pubID.16838/pub_detail.asp.
  77. National Public Radio/Kaiser Family Foundation/Kennedy School of Government, National Survey of Americans' Views on Taxes, April 2003. Available online at http://www.npr.org/news/specials/polls/taxes2003/index.html.
  78. J. Gist and S. Verma, "Entitlement Spending and the Economy: Past Trends and Future Projections," Issue Paper 2002-13, AARP Public Policy Institute, September 2002.