Point/Counterpoint: The Choices We Make/The Money We Save

Point/Counterpoint: The Choices We Make/The Money We Save

The “Choices” We Make

Recently I signed up for a program at my local Y for people over 50, called “You’ve Still Got It.” The title says much about our current emphasis on “successful or optimal aging.” But it’s also a sign of how we tend to emphasize individual responsibility for behavioral choices over social responsibility—as if the broader social and economic environments in which people live have nothing to do with their health.

Marketing of consumer products and services for successful aging is directed toward relatively affluent (and healthy) aging baby boomers. Clearly, money can be made by playing to the “worried well.” But what about the vast numbers of older adults who don’t have the resources and advantages many of us take for granted? Are we willing to say they’re “unsuccessfully aging”? Research shows that individual behaviors are clearly important to our health. But so are zip codes or characteristics of the places where we live. It’s time we think collectively about our responsibility for “successful aging”—especially in the U.S., which has resources and wealth far surpassing many parts of the world.

In a 1999 article I often use in my classes, Meredith Minkler of the University of California, Berkeley, writes that “holding the individual responsible for health choices is particularly problematic in the case of the poor, since poverty itself is among the most significant risk factors for illness and premature death.” We know, too, that racial disparities in society are linked to health disparities. As the late Marshall Becker so cogently—and correctly—observed, when we redefine “being ill” as “being guilty,” we run the risk of stigmatizing “the disabled, the elders, people who are overweight, and other already devalued groups in our society.”

Much of our health-promotion work focuses on individual behavior change without a full appreciation that health “choices” are constrained by social conditions such as poverty, limited education, and access to services. So as we think about the individual health choices we’re making, let’s also examine the choices we’re making as a society. From food and health policy to zoning laws and education, there is much we can do to give all Americans—not just the affluent—a fair shot at a “successful” old age. Otherwise, if we continue on the course we’re now following, we’re not going to make it.

A psychologist and gerontologist by training, Linda Chatters is a professor in the U-M SPH Department of Health Behavior and Health Education and the U-M School of Social Work.

The Money We Save

A majority of U.S. households headed by retirees have no pension or savings. As more and more baby boomers approach retirement, and as health care costs continue to rise, we face a growing crisis—not only for individuals and their families, but for hospitals and health care delivery systems, which will increasingly be called on to subsidize the cost of retiree care.

Saving for retirement has always been a challenge for U.S. workers, especially in recent years, with the downturns in the economy and the reduction in employment-sponsored pension or retirement accounts. Recent changes in the tax law have also complicated employee decisions on how best to plan for the everyday and unexpected expenses that arise as people age. Happily, a growing number of employers, among them U-M, are actively addressing the challenges that lie ahead.

With the growth in health care costs continuing to outpace the growth in our earnings, Americans will need to save even more for retirement in order to cover out-of-pocket health costs such as co-pays and diagnostic tests not covered by Medicare or the health insurance exchanges. Most investment houses and many benefit offices estimate that those retiring in ten to 15 years will need far more than they have planned for.

Many employers require or provide the means for employees to invest a percentage of their income in retirement savings. Some “match” that investment with employer contributions. If more employers took on this vital social responsibility, retirees would be better protected against the burden of rising health care costs.

More worrisome still, of course, are the millions of employed Americans who receive no retirement benefits. In a recent report, the Institute of Medicine called for action by employers and employees to encourage savings. Mandatory rather than voluntary contributions to retirement savings accounts and provision of subsidized long-term care insurance would protect all workers—particularly low-income workers—from joining the 60 percent of retirees who rely solely on Social Security benefits and/or who lack sufficient money for expenses as they age. However one looks at it, we face grave problems, as a nation and as individuals, if we do not begin saving more now.

A member of the U-M Committee on Retirement Savings Plan and Retiree Health Benefits, Kyle L. Grazier is the Richard Carl Jelinek Professor of Health Services Management and Policy and chair, U-M SPH Department of Health Management and Policy.