Political Science Perspectives on Aging Policy: A Policy Oriented Curriculum
Robert B. Hudson, Boston University
Professor and Chair, Social Welfare Policy
Introduction
This syllabus ties materials largely, but not exclusively, from political science to the field of gerontology and in particular to the needs and presence of older Americans in political life. There is both "distal" or contextual material and "proximate" policy-relevant material included. While all of the material included here is "political," not all such material comes from the pens of political scientists. Thus, items from economists, sociologists, demographers, and others are included where the contribution is of overtly political/policy relevance.
Seven curriculum modules are presented below. They are:
I. The Development of Aging Policy in the United States
- A. Theoretical Perspectives on Social and Aging Policy
Development
- B. Historical Development of Public Policies on Aging
II. The Aging in Politics
III. The Interaction of Politics and Policy
IV. Age, Generation, and Public Policy
V. The Normative Bases for Benefits
VI. Assessing Public Policies on Aging
VII. Assumption of Risks and Responsibilities for People in Old Age
As organized, the material moves generally from the past to the present, to the future, and from the contextual to the general to the specific. Materials included are descriptive, explanatory, and prescriptive. Among other things, the increasing politicization of aging policy in recent years is demonstrating how "the normative shapes the empirical." Because "the normative" centers on such political hot topics as privatizing Social Security and means-testing Medicare, this curriculum includes both balanced analyses and specific policy proposals.
I. The Development of Aging Policy in the United States
Factors contributing to and impeding development of social welfare policies in the United States have long been grist for the theoretician's mill. In part, such interest is ideologically-based, with different observers favoring or opposing an expanded government role in assuring individual well-being. In part, it has been academic, with different theories--most notably, logic of industrialism, prevailing political culture, social democratic presence, and interest group salience--seeking to explain varying patterns of policy adoption and expansion. The United States has been both an integral and unique presence in most of these analyses. Under the rubric of "American exceptionalism" or "welfare state laggard," the United States was deemed by many to be late, low, and slow when it came to social welfare policy growth.
It is in this context that the aged have been important in American social policy developments. Acknowledging that the United States never possessed a feudal heritage or strong class pressures, analysts have noted how we began many of our policies with vulnerable rather than established populations (i.e., those in need of immediate assistance). And the needs of older people resonated most clearly in these discussions. Thus, older people were featured in both Title I and II of the original Social Security Act, were the sole beneficiaries of the original Medicare legislation, and became the principal beneficiaries of the Supplemental Security Income program, originally intended to benefit AFDC recipients. Depending on their broader theoretical perspective, analysts may differ on why the aged were so prominently featured, but no one disputes that--both absolutely and in cross-national perspective--the aged, historically, were a very favored population.
Readings
A. Theoretical Perspectives on Social Policy and Aging Policy Development
Brown, J. Douglas. 1956. "The American Philosophy of Social Insurance," Social Science Review, 30: 1-8.
Gordon, Linda. 1992. "Social Insurance and Public Assistance: The Influence of Gender in Welfare Thought in the United States, 1890-1935," American Historical Review Vol. 97, No. 1 (Feb): 19-54.
Graebner, William. 1980. A History of Retirement: The Meaning and Function of an American Institution, 1885-1978. New Haven, CT: Yale University Press.
Heclo, Hugh. 1974. Modern Social Politics in Britain and Sweden: From Relief to Income Maintenance. New Haven, CT: Yale University Press.
Heidenheimer, Arnold. 1973. "The Politics of Public Education, Health and Welfare in the U.S.A. and Western Europe," British Journal of Political Science, 3: 315-340.
Hudson, Robert B. 1978. "The 'Graying' of the Federal Budget and Its Consequences for Old-Age Policy," The Gerontologist, 14: 428-440.
Hudson, Robert B. 1999. "Conflict in Aging Politics: New Population Encounters Old Ideology." Social Service Review, 73(3), 358-379.
Huntington, Samuel. 1968. "Political Modernization: America vs. Europe." In S.P. Huntington (ed.), Political Order in Changing Societies. New Haven, CT: Yale University Press.
Minkler, Meredith and Estes Carroll (Eds.). 1999. Critical Gerontology: Perspectives from Political and Moral Economy. Amityville, NY: Baywood Publishing Co.
Myles, John. 1984. Old Age in the Welfare State: The Political Economy of Public Pensions. Boston, MA: Little Brown.
Rimlinger, Gaston. 1971. Welfare Policy and Industrialization in Europe, America, and Russia. New York: John Wiley & Son, Inc..
Skocpol, Theda. 1992. Protecting Soldiers and Mothers. Cambridge: Belknap Press.
Walker, Alan and Naegele, G. (Eds.). 1999. The Politics of Old Age in Europe. Buckingham, PA: Open University Press.
Williamson, John and Fred Pampel. 1993. Old Age Security in Comparative Perspective. New York: Oxford University Press.
B. Historical Development of Public Policies on Aging
Altmeyer, Arthur. 1966. The Formative Years of Social Security. Madison, WI: University of Wisconsin Press.
Benjamin, A.E. 1993. "An Historical Perspective on Home Care Policy," Milbank Quarterly, 71: 129-156.
Burke, Vincent and Vee Burke. 1974. Nixon's Good Deed. New York: Columbia University Press.
Cates, Jerry. 1983. Administrative Leadership in Social Security, 1935-1954. Ann Arbor, MI: University of Michigan Press.
Derthick, Martha. 1979. Policymaking for Social Security. Washington, DC: The Brookings Institution.
Fox, Peter. 1989. "From Senility to Alzheimer's Disease: The Rise of the Alzheimer's Disease Movement," Milbank Quarterly, 67(1): 58-102.
Himmelfarb, Richard. 1995. Catastrophic Politics: The Rise and Fall of the Medicare Catastrophic Coverage Act of 1988. University Park, PA: Pennsylvania State University Press.
Hudson, Robert B. 1994. "The Older Americans Act and the Defederalization of Community-Based Care." In P. Kim (ed.), Services to the Aging and Aged: Public Policies and Programs. New York: Garland Publishing.
Light, Paul. 1985. Artful Work: The Politics of Social Security Reform. New York: Random House.
Lubove, Roy. 1968. The Struggle for Social Security. Cambridge, MA: Harvard University Press.
Marmor, Theodore. 1973. The Politics of Medicare. Chicago: Aldine.
Steckenrider, Jamie and Parrott, Tanya (Eds.). 1998. New Perspective on Old Age Policies. Albany: State University of New York Press.
Vladeck, Bruce. 1980. Unloving Care. New York: Basic Books.
II. The Aging in Politics
As the older population has grown in size in recent decades, great interest has developed in their role in the political and policymaking process. It is well established that older people are more politically active than younger ones, with older persons' levels of activity only slackening in their very advanced years. As to the singular impact of older persons' political activism, there is more question. While they do display a high rate of formal political participation, there is much evidence that the particular position older people take on a variety of candidates and issues generally mirrors that of the population as a whole. It may be, however, that where issues are very sharply focused and/or where decisions are being made at the local level, older and younger citizens may vary. Local school bond referenda are the most salient example here.
Readings
Alwin, Duane F. 1998. "The Political Impact of the Baby Boom: Are There Persistent Generational Differences in Political Beliefs and Behavior?" Generations 22(1), 46-54.
Binstock, Robert H. 2000. "Older People and Voting Participation: Past and Future." Gerontologist 40(1), 18-31.
Binstock, Robert H. and Christine L. Day. 1995. "Politics and Aging." In R.H. Binstock and L. George (eds.), Handbook of Aging and the Social Sciences (4th edition). San Diego, CA: Academic Press.
Button, James W. 1992. "A Sign of Generational Conflict: The Impact of Florida's Aging Voters on Local School and Tax Referenda," Social Science Quarterly, 73: 786-797.
Cook, Fay Lomax and Edith Barrett. 1992. Support for the American Welfare State. New York: Columbia University Press.
Holtzman, Abraham. 1963. The Townsend Movement. New York: Bookman.
Peterson, Steven A. and Albert Somit. 1994. The Political Behavior of Older Americans. New York: Garland Publishing.
Powell, Lawrence A., Kenneth Branco, and John B. Williamson. 1996. The Senior Rights Movement: Framing the Policy Debate in America. New York: Twayne Publishers.
Pratt, Henry J. 1976. The Gray Lobby. Chicago: University of Chicago Press.
Rosenbaum, Walter A. and James W. Button. 1992. "Perceptions of Intergenerational Conflict: The Politics of Young and Old in Florida," Journal of Aging Studies 6(4): 385-396.
Strate, John, Charles J. Parrish, Charles D. Elder, and Coit Ford III. 1989. "Life Span Civic Development and Voting Participation," American Political Science Review, 83(2): 443-464.
Wolfinger, Raymond and Steven Rosenstone. 1980. Who Votes? New Haven, CT: Yale University Press.
III. The Interaction of Politics and Policy
In its discussions of public policy, political science concerns itself with processes, structures, and outcomes. In its earliest years, dating to the time of Woodrow Wilson, concern has focused very much on structures, principally constitutional ones. Policy was no more than secondary concern because prior to the Depression and New Deal, the volume and scope of American domestic policy was much more circumscribed than would later be the case. In the post-World War II period, new attention was placed on political processes (voting patterns, interest group formation, political party activity) and how they shaped the growing volume of government policy. Following group or pluralist theory, these processes were held to very much shape governmental outputs, to the point where government was held to be a relatively passive force, perhaps only a "scorekeeper" of the outcomes of demands and pressures emanating from actors in the overall political process.
More recently, structures (social, economic, political) have been reintroduced into the policy debate. In the first instance, such forces are held to very much shape and constrain the agendas, activities, and successes of individuals and groups engaged in politics. In the second instance, one of the major structures is public policy itself. In many analyses, the place of policy has been elevated to the point where the traditional causal arrows have been reversed, viz., policies shape politics, not the other way around.
Aging policy has proven to be perhaps the showcase arena of this new emphasis. This has meant that earlier (and frequent) statements to the effect that "the elderly are the most potent political constituency in America" and that "AARP is the most powerful interest group in America" have been amended or nearly supplanted. Instead, often heard today is that public policy (namely, Social Security and Medicare) that have transformed the elderly into a political constituency and that AARP and other groups have organized and institutionalized that presence. This view is reinforced by most analyses of particular aging policy cases which find that the organized elderly did not play a central role in the policy formation. More recently, they are seen as a presence in defending the policies and the interests of older people in those policies.
Readings
Berry, Jeffrey M. 1997. The Interest Group Society (3rd ed.). New York: Longman.
Binstock, Robert H. 1972. "Interest Group Liberalism and the Politics of Aging," The Gerontologist, 12: 265-280.
Hudson, Robert B. 1998. "Privatizing Old-Age Benefits: Re-Emergent Ideology Encounters Organized Interest." In J.G. Gonyea (ed.), Resecuring Social Security and Medicare: Understanding Privatization and Risk. Washington, DC: Gerontological Society of America.
Lowi, Theodore. 1994. The End of the Republican Era. Norman, OK: University of Oklahoma Press.
Olson, Mancur. 1965. The Logic of Collective Action. Cambridge, MA: Harvard University Press.
Pierson, Paul. 1993. "When Effect Becomes Cause: 'Policy Feedback' and Political Change," World Politics, 595-628.
Pratt, Henry. 1993. Gray Agendas. Ann Arbor, MI: University of Michigan Press.
Street, Debra. 1993. "Maintaining the Status Quo: The Impact of Old-Age Interest Groups on the Medicare Catastrophic Care Act of 1988," Social Problems, 40: 431-464.
Walker, Jack. 1983. "The Origins and Maintenance of Interest Groups in America," American Political Science Review, 77: 390-406.
IV. Age, Generation, and Public Policy
The growth both of the older population and of public policies on behalf of the old has not only elevated the standing of chronological age in political debates but has introduced, as well, the heretofore arcane construct of generations and cohorts. Until the early 1970s, the common political concern of gerontologists was to alert America to the growing number of elderly and the generally perilous state they found themselves in. As program enactments of the mid-1960s to mid-1970s kicked in, gerontological analysis turned to the diversity of the older population, attention being drawn to the very different life histories and prospects introduced by variations in race, gender, and class.
Dating to the early 1980s, the likely or unknown fates of different generations entered the political stage. There is much debate about the meaning and motives behind "generational equity" arguments, but there is no question they have helped shape contemporary debate about the future of age-based and age-related policy. The heart of the contemporary argument lies in the very generous (and expensive) policy returns that individuals born early in the 20th Century have enjoyed compared to those born later (and whose contributions and taxes will support those born earlier). Those skeptical of this argument focus on the certain inevitability of those members of relatively small cohorts entering an "immature" system early in life to enjoy disproportionate benefits. However, whether and how to even tax burdens between generations is very much part of the debate.
There is, as well, an important confusion that often crops up in these discussions, namely, the difference between generation and age. Thus, it is important to distinguish between the life-course prospects of people born at a certain point in time from the fate (and presumptive costs) associated with people who are old at different points in time. The need for this distinction arises especially in discussions of whether benefits for the elderly are "impoverishing children." If older people are assumed always to be a net cost to society, that is an aging, not a generational argument. If, however, as David Thompson suggests, there is a group of people born roughly between the two World Wars who have done well throughout their lives (due largely to the welfare state), that is a generational argument.
Finally, and to some, the "intergenerational equity" debate is about neither generation nor age. Rather, these analysts see the talk of generations denied as a "stalking horse" used by conservatives to rein in the scope and reach of the federal government. If old age "is where the money is" in government spending, then one goes after age-related programs. But, critics contend, the truth of the matter is the attack on the aging programs is really designed to reduce government's role or, in the strongest statements, to "delegitimize" government's standing in promoting domestic welfare.
Readings
Binstock, Robert H. 1983. "The Aged as Scapegoat," The Gerontologist, 23: 136-143.
Cook, Fay Lomax, Victor Marshall, J. Marshall, and J. Kaufman. 1994. "The Salience of Intergenerational Equity." In T. Marmor, T. Smeeding, and V. Greene (eds.), Economic Security and Intergenerational Justice: A Look at North America. Washington, DC: The Urban Institute Press, pp. 91-127.
Heclo, Hugh. 1988. "Generational Politics." In J. Palmer, T. Smeeding, and B. Torrey (eds.), The Vulnerable. Washington, DC: The Urban Institute Press.
Kingson, Eric R., Barbara Hirshorn, and Jack Cornman. 1986. Ties That Bind: The Interdependence of Generations. Washington, DC: Seven Locks Press.
Longman, Phillip. 1985. "Justice Between Generations," Atlantic Monthly, June: 73-85.
Public Policy and Aging Report. 1996. Fall.
Marmor, Theodore, Jerry Mashaw, and Phillip Harvey. 1990. America's Misunderstood Welfare State. New York: Basic Books.
Preston, Samuel. 1984. "Children and the Elderly in the U.S.," Scientific American, 251 (6): 44-49.
Quadagno, Jill. 1989. "Generational Equity and the Politics of the Welfare State," Politics and Society, 17: 353-376.
Riley, Matilda White and John W. Riley, Jr. 1994. "Structural Lag: Past and Future." In R.L. Kahn and A. Foner (eds.), Age and Structural Lag. New York: John Wiley.
Thomson, David. 1989. "The Welfare State and Generation Conflict." In P. Johnson, C. Conrad, and D. Thomson (eds.), Workers and Pensioners. New York: St. Martins.
V. The Normative Bases for Benefits
As the politics of aging heats up, it call on us, as well, to rethink or at least re-examine the formal rationales for benefit provision in the United States. In the Titmuss and Wilensky/Lebeaux formulation, our benefit structure for a long time was a "residual" one, i.e., government should only step in when the normal workings of the market and the family had failed (and then only local government should step in). Over time, many of our programs moved in an "institutional" direction, i.e., benefits were made available on an ongoing normative basis to persons who had been active in the labor force but were forced to withdraw for reasons of unemployment, old age, disability, or survivorship. The United States has never approached a third stage, social citizenship, that is associated with programs in some of the Scandinavian countries. Here, eligibility is based on citizenship status at least partially independent of work history and usually totally independent of absolute need.
While we have never approached the social citizenship ethos (with the interesting exception of public education), American policy may now be moving back toward a residual and away from the institutional movement associated with much of the post-World War II period. Older people were beneficiaries of our early forays into residual welfare (soldiers and mothers pensions) and later entry into institutional social welfare (Social Security, Medicare). They may also be disproportionately affected as movement now turns toward the opposite direction.
Readings
Fraser, Nancy and Linda Gordon. 1992. "Contract vs. Charity: Why is There No Social Citizenship in the Untied States?" Socialist Review, 22: 45-67.
Holstein, Martha. 1997. "Ethics and Public Policy: A Normative Defense of Age-Based Entitlements." In R.B. Hudson (ed.), The Future of Age-Based Public Policy. Baltimore, MD: Johns Hopkins University Press.
Lamm, Richard D. and Heather E. Lamm. 1996. "The Challenge of an Aging Society," Public Policy and Aging Report, Fall (7)(4): 1ff.
Moon, Marilyn and Janemarie Mulvey. 1995. Entitlements and the Elderly. Washington, DC: The Urban Institute.
Myles, John. 1997. "Neither Rights Nor Contracts: The New Means-Testing in the U.S. Aging Policy." In R.B. Hudson (ed.), The Future of Age-Based Public Policy. Baltimore, MD: Johns Hopkins University Press.
Street, Debra 1999. "Special Interest of Citizens' Rights? "Senior Power," Social Security and Medicare." In M. Minkler and C. Estes (Eds.)., Critical Gerontology.
Thompson, Lawrence H. 1994. "The Roles of Social Insurance, Tax Expenditures, Mandates, and Means-Testing." In R.B. Friedland, L.M. Ethridge, and B.C. Vladeck (eds.), Social Welfare at the Crossroads. Washington, DC: National Academy of Social Insurance.
Wilensky, Harold and Charles Lebeaux. 1958. "Conceptions of Social Welfare." In H. Wilensky and C. Lebeaux (eds.), Industrial Society and Social Welfare. New York: The Russell Sage Foundation.
VI. Assessing Public Policies on Aging
Over the decades, there have been many accomplishments in public policies on aging. In the aggregate, the older population is better off than has ever historically been the case, and public policies lie at the heart of that progress. Despite this progress, three important cautionary comments are needed. First, well-being among the aged continues to be highly uneven, perhaps the most dramatic comparison being that of the 4 percent poverty rate of young-old white men, in contrast to the greater than 40 percent poverty rate among the very old African-American women. Old age policies have helped most of the old, but they have helped them unevenly and, contrary to some popular wisdom, they have done very little to reduce inequality among the old. Second, it is important to keep the growing contrast between young and old in mind in discussion centered on old age policy and politics. Because the politics are very different, it is not accurate to locate a causal connection between improved well-being of the old and growing poverty and insecurity among the young. But to have such notably divergent paths in well-being unfolding among two vulnerable populations deserves concerted attention.
Third, the uneven effect of our policies within the older population and between young and old introduces the broader question of the appropriateness of fit between what our policies intend (and accomplish) and what different populations require (and may or may not receive). The question here focuses on the severity and likelihood of different risks selected populations face. In the case of aging, we have done well in helping meet the income needs of many, but much less well in meeting their health-care related needs, especially those centered in long-term care. For a variety of reasons, and with the exception of education, children have enjoyed far fewer public policy benefits than have the aged, but the same kind of "risk/response" analysis could be applied to them as well. For cultural and political reasons, the responses might still remain divergent, but a dispassionate analysis of population risk and policy response to vulnerable populations remains very much in order in the United States.
Readings
Aaron, Henry. 2000. "The Centenarian Boom: Providing for Retirement in a Long-Lived America." The Brookings Review. 18(2), 22-25.
Gould, Stephanie G. and John L. Palmer. 1988. "Outcomes, Interpretations, and Policy Implications." In J.L. Palmer, T. Smeeding, and B. Torrey (eds.), The Vulnerable. Washington, DC: Urban Institute.
Holden, Karen C. and Timothy M. Smeeding. 1990. "The Poor, the Rich, and the Insecure Elderly Caught in Between," Milbank Quarterly, 68: 383-411.
Hudson, Robert B. 1993. "Social Contingencies, the Aged, and Public Policy," Milbank Quarterly, 71(3): 253-277.
Kingson, Eric R. and Schulta, James H. (Eds.). 1997. Social Security in the 21st Century. New York: Oxford University Press.
Neuman, Patricia, Diane Rowlan, Michelle Kitchman, and Drew Altman. 1999. "Understanding the Diverse Needs of the Medicare Population: Implications for Medicare Reform." Journal of Aging and Social Policy 10(4), 25-50.
Starobin, Paul. 1998 (March 28). "The Daddy State." National Journal, 678-683.
VII. Assumption of Risks and Responsibilities for People in Old Age
Nothing better captures the transformation of old age policy in recent years than E.E. Schattschneider's dictum about "the scope of conflict." More than perhaps any other domestic policy arena, there has been a marked and sequential expansion of aging politics over this time period. From getting the needs of older people on the political agenda, to sorting out the needs within this diverse population, to assessing the standing of today's old against people of different generations or born at different times, the debate today is now couched in ideological terms that extend well beyond the standing, relations, and prospects of different populations.
Aging policy today is caught up in broad political and economic discourse about what are appropriate roles of different institutions in American life. Three axes to this debate can be singled out:
- public and private sector
- formal and informal
- centralized and decentralized
Pressures abound everywhere, including in aging policy, to move responsibilities for well-being from public to private sectors. Proposals to partially privatize Social Security, to expand Medicare HMO risk contracting, to create Medical Savings Accounts, and to rely on largely privately financed assisted living providers to address the housing problems of frail older Americans have privatization at their root. Demands and evidence that families provide more care for frail elders (and others) points in the direction of "informalization." Hastened hospital discharges, the transformation of nursing homes into sub-acute hospitals, the introduction of prospective payment into long-term care, the provision of traditionally acute care services in the home, and the expansion of cost-sharing in community programs in the home all translate into increased pressures on and responsibilities for family members and other informal caregivers. Devolution of public responsibility from national to state and local jurisdictions has also been a marked trend of recent years. Political philosophy and state administrative capacity have combined to make very real the old saw that the United States "really has 50 Medicaid programs." The evolution in scope and variation of home and community-based care is one consequence of this combination: more flexibility in spending federal Medicaid monies and the introduction of new state-level monies have expanded services in this area. Among other effects, new "Medicare+Choice" options will also lead to move diverse and potentially fragmented service delivery mechanisms around the country.
Much more than can be included here has been written about these interwoven trends. The salient point remains, however, that shifting the locus of responsibility for assuring well-being among the old in a "private/informal/localized" direction is a major shift from the initiatives which marked political initiatives in this century's third-quarter, which moved matters in a "public/formal/nationalized" direction.
Readings
Dreyfus, R. 1996. "The Biggest Deal: Lobbying to Make Social Security Private," American Prospect, May-June: 72-75.
Foster, Susan E. and Jack A. Brizius. 1993. "Caring Too Much? American Women and the Nation's Caregiving Crisis." In J. Allen and A. Pifer (eds.), Women on the Front Lines: Meeting the Challenge of an Aging America. Washington, DC: The Urban Institute Press.
Gonyea, Judith. 1994. "Making Gender Visible in Public Policy." In E.H. Thompson (ed.), Older Men's Lives. Thousand Oaks, CA: Sage Publications, pp. 237-255.
Gonyea, Judith G. (ed.). 1998. Resecuring Social Security and Medicare: Understanding Privatization and Risk. Washington, DC: Gerontological Society of America.
Hayes-Bautista, David, Werner Schnik, and Joge Chapa. 1988. The Burden of Support: Young Latinos in an Aging Society. Stanford, CA: Stanford University Press.
Kane, Rosalie. 1995. "Expanding the Home Care Concept: Blurring Distinctions Among Home Care, Institutional Care, and Other Long-Term Care Services," Milbank Quarterly, 73(2): 161-181.
Quinn, Joseph F. 1997. "Retirement Trends and Patterns in the 1990s: The End of an Era?" Public Policy and Aging Report, 8(3).
Tennstedt, Sharon L., Sybil L. Crawford, and John B. McKinlay. 1993. "Is Family Care on the Decline?" Milbank Quarterly, 71(4): 601-624.
