State of the Union January/February 2008

No Country for Young Men

The Baby Boomers’ retirement will change the texture of society in ways we’ve scarcely begun to contemplate. A dispatch from America’s coming silver age

It is cliché to speak of sleepy little country towns, but my mother’s hometown goes beyond sleepy into Rip van Winkle territory. Newark, New York, has more churches than bars. Neat clapboards and stately Victorians line quiet streets wrapped tight around the Erie Canal. Drive through Newark quickly, and it looks like America’s past. Stay a little longer, and you begin to recognize it as our future.

Also see:

Roundtable: "After the Boom" (January 8, 2008)
Megan McArdle, Clive Crook, and Philip Longman debate the repercussions of looming Baby Boomer retirements.

Walk into one of those churches on a typical Sunday morning, and you will find only a few, startling islands of brown or blond hair amid a sea of gray. Almost 20 percent of the population is over the age of 65. (The town’s economic fortunes have declined along with those of the Erie, and many younger workers have left.) On the street where my mother grew up, and my aunt now lives, the only children you see are visiting their grandparents.

The former Midlakes Middle School, which sits in neighboring Phelps, has transmogrified into “Vienna Gardens,” a private independent-living facility where my grandmother now lives. The bones of the schoolhouse are still clearly visible under the carpet and overstuffed couches that line the halls; the residents take their meals in the cavernous former gymnasium. Vienna Gardens is home to 64 people, but the place has an empty feel. The rent is out of the reach of many of the area’s seniors.

Those seniors, eventually, may end up at the county nursing home. It is a new and lovely facility. But its supervisors are leery of slipping into the red; most of its residents are on Medicaid, and the program’s meager payments don’t cover costs. Any overruns would likely be made up through taxes, and the seeds of a tax revolt appear to be germinating. Local property taxes are already high: the school tax alone is 2.5 percent of assessed home value each year. Many of the town’s residents grouse about their tax bills. Local school officials are nervously eyeing nearby Monroe County, where the county executive wants to cope with budget woes by diverting school money into county coffers.

As Newark has aged, its commerce and the nature of its workforce have shifted. The Wal-Mart in town is busy, even on a weekday afternoon, and several local clothing stores have closed. While neither phenomenon is unique to Newark, the town’s aging has doubtlessly contributed to both: big-box stores appeal to the elderly not only because of lower pricing, but also because they put more goods in one place, enabling seniors who can’t walk far, or who have difficulty getting into and out of cars, to make the most of each shopping trip. At the local community college, new programs in health care are proliferating.

At a gala event held at the National Press Club in Washington, D.C., on October 15, Kathleen Casey-Kirschling— born one second after midnight on New Year’s Day 1946—became the first Baby Boomer to file for Social Security benefits. Over roughly the next 20 years, close to 80 million of her fellow Boomers will follow suit. By 2030, America will look like Newark. Almost one in five Americans will be in life’s golden years, up from about one in eight today.

A lot of op-eds have been written about what will happen when the Boomers retire. Like our policy debates, they tend to focus, somewhat remarkably, on accounting. Will the Social Security Trust Fund go bankrupt? Does the trust fund really exist? These questions are too narrow, and they don’t yield particularly useful answers. As Newark’s experience suggests, the retirement of the Boomers will transform the texture of our society. How will it change our economy, our culture, our politics? When it’s over, will America look better, worse, or just different?

Start with the stuff America makes, and the people who make it. Young people buy goods, like cars, houses, and iPods. Old people need services, like transportation, meal preparation, and health care. We have made great strides in enabling the elderly to get around—the scooters you see advertised on daytime television, for example. My grandmother, who is blind and physically frail, was able to live at home much longer than she otherwise could have because she had Meals on Wheels, a home health aide, and a Life Alert-type necklace to call for help in case she fell.

But these services require a lot of labor. According to an analysis by McKinsey Global Institute, the number of hours required to produce an automobile in North America fell by 1.7 percent annually from 1987 to 2002, to an average of about 100 hours. Meanwhile, it still takes about the same amount of time as it always did to drive a senior to a doctor’s appointment, or to help an older patient bathe and dress. Productivity growth is faster in the things that kids consume than in the things that the elderly need.

As the Boomers age, they will consume fewer of the things that we produce efficiently, and more of the things that we provide relatively inefficiently. Productivity is notoriously difficult to pro­ject, but many forces will be pushing it downward as the Baby Boomers age.

Since services are labor-intensive, and the number of service-consuming seniors will grow rapidly, we’ll need a lot more workers (that’s bad news for those who favor restrictive immigration policies, particularly the kind that keep low-skilled workers out). And, of course, the mix of service workers that we’ll need will be different from what it is today. In effect, the next 20 years will require a massive transfer of resources and people away from the care of children, who will decline in relative number, and toward the care of old people.

This rebalancing should have already started, but it hasn’t. Consider that approximately 29,000 pediatricians now work in the United States, caring for roughly 75 million children. To care for roughly half that number of patients over 65, the American Geriatrics Society reports, the country has only 7,128 board-certified geriatricians. Just 468 first-year fellowships in geriatric medicine were available in the 2006­–2007 academic year; nonetheless, almost half of them went unfilled.

It’s not just doctors: according to the John A. Hartford Foundation, which promotes (among other things) geriatric-nursing education, fewer than 20,000 registered nurses and nurse-practitioners are certified in gerontology. Lower-skilled jobs in long-term care, such as certified nursing assistant positions, should theoretically be easier to fill, but several states report that shortages exist in these areas as well.

In part, this is a reflection of pay. Medicare, which bankrolls many of these services, pays for procedures, not outcomes. So surgeons do relatively well from Medicare, while geriatricians, whom you would think Medicare would want to attract, make around $160,000 a year. That’s hardly a poverty wage, but since physicians-in-training have other, better-paid options, it’s not surprising to see a shortage. Likewise for geriatric RNs; nurses are in demand nationwide, and jobs caring for the elderly usually don’t pay especially well.

But low pay is only part of the story. Almost everyone has heard a classmate or friend say they want to “work with children” when they graduate. When was the last time you heard someone say they wanted to “work with old people”? Children represent the future, and your own happy past. The elderly represent your own mortality, and your powerlessness to do anything but manage decline. This will be a major problem for the economy as our society ages. The nursing home in Newark pays a government wage, with government benefits, and in Newark, that’s good money. But it struggles with a shortage of RNs, while the local school district has no trouble filling slots.

Of course, if you raise wages enough, you’ll find more job-takers, and the shortages will eventually disappear. But that means higher health-care costs (more on this later). It also means more people taking work that they might find emotionally difficult and psychologically unsatisfying, predominantly for the paycheck. How do you tally the social costs of that?

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