America Growing Old
Peter G. Peterson ("Will America Grow Up Before It Grows Old?" May Atlantic), to correct his vision of future "Social Insecurity," would have us all, and the elderly in particular, start sacrificing now. The sacrifices he demands, largely cuts in Social Security and health care and a general reduction of consumption, are based on the false premise that the aging of our population makes them necessary.
By the year 2030 -- when, proclaimers of the apocalypse tell us, the Old Age and Survivors Trust Fund will "go bankrupt" -- we will have only about three people of working age (from twenty to sixty-four) for every one who is sixty-five or older, as against five now. The program could be kept solvent all the way to 2069, according to the fund's trustees, by adding less than 2.2 percent to payroll taxes. Many other allocations of revenue could set this right without draconian payroll-tax increases from the current 12.4 percent to 17 or 22 percent, or "about 35 to 55 percent of every worker's paycheck" if we include Medicare, which Peterson indicates will be necessary if we do not tighten our belts now.
The increase in the proportion of the elderly is a real issue, but it has to be balanced against a decline in the proportion of dependent young. The total ratio of dependency, including young and old, will by the fund's "intermediate" projections have risen only six percent by 2030. That leads to the important and relevant question not of what is in trust funds but of how much output will be available to share among the population. What Peterson and many others seem to forget is that the bread the elderly or anyone else eats must be produced by those who are working; we can't eat money or savings accounts, no matter how much they are increased now or in the future.
Fortunately, though, even the modest rate of growth of one percent a year in output per worker -- no more than our slow growth over the past twenty-two years -- would increase total output per worker by 42 percent in thirty-five years. That would be enough to provide for a 33 percent increase in goods and services for every man, woman, and child, regardless of age, even after allowing for a six percent increase in nonworking dependents.
Peterson is right in urging measures to increase growth -- a growth in output of two percent per worker would give us 90 percent more for everybody in thirty-five years. But many of his proposals are counterproductive. Forcing us to consume less will not necessarily increase investment; if we don't buy that new car, a form of investment in itself, GM is likely to invest less, not more. And economists increasingly recognize that the path to growth lies in investment in human capital -- in education, in health, in research, and in providing a safe environment in inner cities and in suburbia where we can all realize our full potential.
Peter G. Peterson's suggestions concerning living wills lack the thoughtful argument of the rest of his article. Peterson asserts that an increase in the use of living wills would reduce the 30 percent of the Medicare budget that is spent in a patient's last year of life. Although beforehand knowledge of our death might be useful, living wills are popular not because they hasten death and reduce medical bills but because they provide unconscious patients with a measure of autonomy. This ranges from taking all means necessary to prolong life to ruling out certain interventions in certain situations. Increasing the number of living wills may not have the effect Peterson desires in the absence of incentives to persuade people to opt for less costly intervention.
Recognizing this, Peterson makes an egregious suggestion: that we "perhaps even provide financial incentives to maintain [living wills]." If the purpose of such incentives is to persuade people to forgo costly intervention, little would remain of autonomy. Many people already agonize over the burden they present to their families, which influences their decisions about treatment at the end of life. We should not further encourage people to accept an earlier death because of the cost of medical intervention.
Peter Peterson's latest version of "the sky is falling" reflects our impressive proclivity for treating what should by any standard be a national triumph -- a longer-lived, healthier, more financially secure elderly population -- as an unmitigated disaster. Some of his points are indeed well taken, but his statistical overkill should be a red flag warning the reader to beware of the intermingled ad hominems, personal predilections proffered as revealed truth, and subtle detours around less-supportive evidence.
Consider the Medicare-Medicaid flap, which is less a matter of ill-advised Entitlements than a symptom of our continuing fundamental health-care distress. That distress could easily be alleviated by a move to some variation of the widely misunderstood -- and often deliberately misrepresented -- "single-payer" format, with universal coverage based on universal rating, without the distortions created by the appallingly inappropriate promotion of health care as "an attractive investment opportunity."
Few know that the Congressional Budget Office confirmed that such a program would cover more people for more conditions at lower cost than any alternative.
Edward Marshall Nielsen
Peter Peterson continues his campaign of many years to cut Social Security and Medicare benefits for seniors already in retirement and to portray seniors as a greedy bunch who are living off the next generation.