Elders (part 1)

Every species that survives must develop strategies for protecting its youngest members from immediate dangers as well as ensuring they receive sufficient growth resources until they are able to manage for themselves (and in turn produce another generation).  But there are few such species advantages (called fitness payoffs) in caring for members past the age of breeding and juvenile-rearing.  Adults beyond reproductive age are more likely to be a burden, a drain on scarce resources.  Yet there are a few survival advantages inherent in age.  The older members of many species accrue size (hence protection), experience (knowledge about resources and survival strategies), and social shrewdness (which allows them to manipulate other group members).  But most mature members of a species do not survive much beyond their breeding years.  The most powerful males will have died defending their breeding dominance.

Many mammals, particularly elephants and primates, have elevated the senior members of their species to leadership roles.  An elephant troupe is usually led by a matriarch, who has given birth to many of its members and is grandmother to the youngest, and has the experience and wisdom to keep her dynasty safe.  Monkeys and apes are highly responsive to the presence and behavior of high-status (especially male) members.  Human beings have followed a similar strategy, devoting food and respect to the elder members who hold one of the most valuable of resources—survival experience.  Small communities of homo sapiens can significantly improve their survival chances by deliberately valuing non-reproductive elders.

But the human species may have gone a bit far in this strategy since the advent of civilization.  Larger and more stratified societies have typically advanced the narrow interests of a few elite orders, which have been dominated by powerful old men.  The Romans notably made their patriarchs—the resource-commanding male heads of powerful clans—the paramount interest group of their society.  (The words senator and senile contain the same Latin root.)  The Romans have since normalized the dominance of old men—the patriarchy—in our Western societies.  But the ancient social cultures of China, India and the Middle East have been equally complicit.  Elders (specifically old men) have been in charge of our affairs for a very long time.  They have controlled resources (and tend now to be the corporate bosses) and wielded influence far out of proportion to their numbers.  Superior wisdom has not necessarily been the determining factor.  (Otherwise professors, legal scholars and seasoned scientists would dominate the heights of political power.  The ruling ayatollahs may not be the exception that proves the rule.)

In modern societies, elders are still in charge—which is to say that they continue to dominate politics and resources—though in strikingly new ways.  We have only recently entered an era when large numbers of human beings can survive into extreme old age.  The old men of ancient Rome typically reached their 40s and 50s, sometimes their 60s.  Today the resource dominators of wealthy societies often live into their 70s, 80s or 90s.  And with the invention of publicly-funded social care, these newly-numerous elderly have been promised a basic income and extensive health-care coverage for the remainder of their lives, which may last two or three decades beyond working age.  They have become more independent of their biological descendants.  And they have, in most cases, accumulated private retirement plans, investment funds, and prime real estate.  These elders are our newest interest group.  But they have also become self-aware and coordinated, which can only happen in an interconnected world.

Elders have become an extraordinarily-privileged elite group, though usually not described as such.  These new elders no longer have the extreme social influence that the elders of traditional civilizations once exercised (though their representation in politics is far beyond their predecessors’ numbers in society at large), but they have a clearer sense of their citizenship, and are cognizant of their property, their numbers, and their votes.  They also exercise their votes more reliably than any other group.  Politicians are acutely aware of this and accordingly pay them more attention than they do almost any other interest group.  What do they get for all this power?  What does their coordinated sense of self-interest mean for the rest of society?

Like all interest groups, the members of this group have used their collective power to leverage even more resources for themselves.  It has succeeded remarkably well.  In the United States, Social Security has existed only since 1935, Medicare since 1965.  These federal programs involve massive resource-transfers to a population that has already had working lifetimes to accumulate resources for their own senescence but little prospect of offsetting the tremendous costs of these public programs.  “Baumol’s cost disease” observes that states offering public coverage of health, education and social care will inevitably face rising costs over time.  These services are labor intensive, resistant to automation and other cost-saving measures, and (unlike some private business costs) cannot be externalized.  Productivity will only improve marginally.  Unlike insurance companies, governments cannot exclude the riskiest cases.  If providers of these mandated services demand higher wages (as they surely will), they will make government promises increasingly expensive to keep.

In other words, older citizens cost much more to care for than the rest.  Old age is very expensive (that is, resource-intensive) to maintain, especially in terms of public health budgets and financial redistribution.  And any success in extending lifespans will only amplify lifetime costs.  Elder citizens consume an increasingly disproportionate quantity of public resources but pay a proportionately smaller share of taxes as they age.  Their care will generally cost much more than they will ever be able to repay.  (And it would be naïve to assume that they have already paid for their future costs with tax contributions made during their previous working lives—at the very least we would have to do the sums.)  The elderly already consume about twice as much per person in state spending as school-age children.  We can be reasonably confident that our present social investments in children will be more than repaid by their future activities and contributions.  The same is not true of the elderly.  The social programs created specifically for the elderly are not only tremendously expensive (and will only get more so) but will inevitably fail.

Should a minority of members of a citizen population enjoy privileges from which the rest are excluded but for which they are compelled to pay?  It sounds unfair when put in plain words, but it is our current practice.  America’s Medicare program is a popular policy that is both unfair and inefficient.  Unfair because most citizens at any particular moment are excluded from their benefits (whatever expectations they might have for the future), but also because being excluded early on means they may not live long enough to receive them in old age.  They are inefficient because the programs hoard resources for those who will offer the poorest return on the investment.  The more efficient use of health care resources would invest them in the young, maximizing their chances of living long and healthy lives in which to earn more taxable income.  Public health care for workers not only lets them perform at their best capacity but allows them to move with fewer hindrances to places that may have better use of their labor.  Early health care investments are more likely to prevent working-age citizens from becoming disabled by ill-health and a costly burden on the state.  But public health care for those who are retired (already one of the wealthiest demographic segments in society) will deliver the poorest economic return for the money spent.  These elderly will consume a tremendous quantity of labor-intensive health resources which may extend their lives a short while, but only long enough to consume more of the same resources before their inevitable end.  While they use the resources, others can’t.

Why do we distribute scarce and expensive resources so inefficiently?  Do we grant such privileges to our elders because they are vulnerable and not able to defend themselves?  Or because we think they shouldn’t have to to run down their scant savings for costly health care?  If the latter, we might consider means-tested health insurance, noting that this same interest group tends to have a lot of accumulated resources (though not equally).  Too cruel?  Then we should make compassion our guide, in which case medical care should be given to all citizens who are in need of it.  If so, the answer should be easy: Medicare for all.  That this is politically unthinkable in the United States (until one has passed an arbitrary birthday) reflects the brutal reality that those over 65 enjoy not only a near-monopoly of public health spending but a similar share of political influence.  This influence is damaging to the well-being of society at large, though we find surprisingly little pushback against this domineering interest group.  No other species kowtows to a segment of the population that has so little likelihood of giving back.  No other species devotes so many collective resources to battling senescence or awarding priority and preferential status to those with the least prospect of a productive future.  A fair and efficient civil society would pay much more attention to this glaring inequity and decide if it were viable or just to carry on with such a demonstrable misuse of collective resources.

You monster!  Are you saying we should abandon dear old granny?  Should we just let our vulnerable elders suffer and die?  The truth is they will anyhow.  All our present spending will only delay it, and for less time and with more pain and waste than we like to admit.  So we might also examine our reluctance to acknowledge the inevitable.  We are not obliged to commit every resource we have available to a battle that cannot be won.  We have the ability to say no to treatments that squander resources on dubious outcomes.  This is all part of a public discussion we need to have.  But we also need to talk about where best to apply our limited public resources, that is, where to direct them so as to confer the greatest benefits to the public as a whole.  These maximal benefits are not what our current resource-allocation is delivering.