By Larry Minnix

It all started with the New Deal, which knitted the safety net for the Great Society. The former laid the foundation for income security during retirement and in the event of job loss. The latter added healthcare for elders, people with disabilities and the poor. These programs’ existence reflected the values-based policy decision that vulnerable Americans are entitled to our collective support.

Successive developments have included the Older Americans Act, the White House Conference on Aging and a proliferation of associations that advance the cause of healthy aging.

Now, there is a stark new reality. The assumptions upon which these programs were based have changed. The retirement age of the New Deal was an arbitrary age 65. But current patterns of longevity, economics and workforce have unfolded differently. The structure of these important entitlements can no longer handle the weight of today’s new demands.

Fast forward to a post 9/11 reality—an era inflamed by a global economic crisis, unpaid-for wars and catastrophes, and a metastatic growth in healthcare spending resulting from antiquated assumptions, systems and incentives. Many experts and pundits now believe our entitlement programs as structured are unaffordable.

Add to this mix America’s unhappy populace and the acrid political hype that screams at us 24/7—vitriol that has frozen political decision-making. Political deals regarding the debt ceiling and the Super Committee have put senior programs in every community at risk. “It’s all on the table,” as they say. Public confusion about entitlement programs just compounds the predicament. 

Tales of Ignorance and Confusion

Let me offer a few vignettes to illustrate.

During the health reform debate, I was on a public television call-in show, talking about longterm care—including the need for a plan like CLASS (Community Living Assistance Services and Supports). A woman called in, self-identifying as a Medicare and former Medicaid recipient—but she didn’t believe in government-run healthcare.

One of our LeadingAge nursing home members wrote to me about his dissatisfaction with our organization’s advocacy agenda to not cut Medicaid. He said America is going broke because of entitlement programs like Medicaid. But, his nursing home residents depend on Medicaid, which is inadequate in his state, and he faced further cuts.

This member said he had a new congressman who seemed to like him. That congressman favored a proposal that would block grant Medicaid, which would further reduce reimbursement. I asked this fellow if he could stay in business with those cuts. “No,” he answered, “but I don’t want to make my new congressman mad.” I asked him how mad he wanted to make his residents, families and employees when he told them his organization must close. “I never thought of it like that,” he said. I suggested he invite his new congressman to a meeting with his board, his employees and his clientele to talk about how to responsibly rein in Medicaid.

I remember a stunning meeting with a former HUD Secretary about the importance of the HUD 202 program for elders. After listening to the discussion he said, “I know what the solution to these housing projects is: Make people get jobs. Then, they wouldn’t need all this subsidized housing.” One of my membership constituents, a leading proponent of low-income housing, asked, “So, where does an 85-year-old-woman living below poverty in a HUD-financed project find a job?” Silence.

One of our members was to introduce a United States senator at a large gathering of elders. Before they went on stage, the senator leaned over to my colleague and asked, “Now, what is the difference between Medicare and Medicaid, in case I get a question about that?”

A final vignette. As CLASS was vetted in Congress, two other advocacy organization leaders and I visited a House conservative leader to discuss CLASS. We told him we were there to ask the impossible: Could he support a provision in the health reform law championed by Sen. Ted Kennedy? 

We expected to be laughed out of his office, but he said, “I am open to it. My mother had Alzheimer’s disease. Senator Kennedy and I have found common ground on a couple of major bills. I understand the issues involved in a very personal way.” He spoke openly in favor of CLASS in his committee.

An Advocate’s Responsibility

What do these stories tell us about our responsibility as advocates? First, there are politicians who understand the need for the right policy if they have experienced issues personally. We have a responsibility to find those people and work with them on policy solutions.

Second, we must educate those who do not know the issues. Getting these people in a room with your constituents is vital. Once I invited a member of Congress to a patient care conference for a complex individual, a man whose coverage was running out and who had few options after discharge. The congressman said, “I thought I knew a lot about healthcare, but I have never experienced anything like this.” In future years, we had no trouble getting his attention.

Third, we must be willing to challenge political leaders; we cannot allow them to pontificate recklessly with ignorant rhetoric or distorted ideology. 

Finally, we have a massive public education challenge to face: our messages must be about real people, with real problems, and policy and programs that can help.

We must engage in a new advocacy, and make the case for creating the right policy for the right reasons—policy based on our experience and the evidence that what we do is effective, efficient and good for the economy. Policy based on longstanding values.

The New Deal and the Great Society laid foundations for a healthy, ethical and affordable network of services. Let’s create the next era, call it “The Era of Responsibility”—and then advocate for it.

Larry Minnix is president and CEO of LeadingAge in Washington, D.C. Visit their website at www.
leadingage.org.

Editor’s Note: This article appears in the January/February, 2012, issue of Aging Today, ASA’s bi-monthly newspaper covering issues in aging research, practice and policy nationwide. ASA members receive Aging Today as a member benefit; non-members may purchase subscriptions at our online store.

Photo: iStockphoto/Traceybc