May 17, 2024 - Health

America is hurtling toward a gray trap

Illustration of a walker on the edge of a cliff.

Illustration: Lindsey Bailey/Axios

It's little surprise that America is rapidly getting older — but now that we're at the brink of that demographic shift's major consequences, we're still completely unprepared.

Why it matters: It's not just that seniors are an increasing share of the population, which is a huge challenge in itself. The seniors of the future may also require care for longer, and aging inequalities are becoming more stark.

The big picture: Americans 65 and older will make up more than 20% of the population by 2030, according to Census Bureau projections, up from 17% in 2022. By 2050, they're projected to make up 23%.

  • One of the most obvious impacts of the aging population is on the federal budget, as spending on health programs — namely Medicare — is expected to swell.
  • But the change will be felt economy-wide: A smaller share of the population will be working age and, without drastic course correction, more may drop out of the labor force for caregiving responsibilities.

Between the lines: The economic effects won't be as drastic if seniors stay healthy longer and, as a result, work later into life. Not only would they use less health care overall, but they'd also continue to contribute to the economy.

  • But things don't seem to be trending that way.
  • "There's always been in the background an assumption that with increasing technical capacity in health care, that the older generation would be healthier than the preceding older generation," said John Rowe, a professor of health policy and aging at Columbia University.
  • "What's becoming clear is that that optimistic scenario may not be playing out, and for whatever reason, older people in the next generation may enter late life more disabled than their previous counterparts," he said.

The U.S. is also woefully underprepared for the burden that aging seniors are expected to place on the health care system — particularly in terms of workforce demands — and support systems, whether formal or informal.

  • There are already health care worker shortages, which worsened during the pandemic and are particularly acute in long-term care.
  • "As we start thinking about these broader trends in aging and how we deal with it, there are a lot of things that aren't structured or ready for the growing demand," said Tim Lash, president of the West Health Institute, which is dedicated to improving aging. "In health care in particular, it's a dark spot."
  • "Addressing it isn't just more bodies. Addressing it is fundamentally shifting what we're doing," he added.

The consequences of being unprepared for this gray tsunami are predictable but dire.

  • Beyond the caregiving strain placed on family members, aging would likely become an even more deeply unequal experience.
  • "People with resources and money and the best insurance will be able to get care, and as usual, the people without won't," Rowe said. "We're going to end up with a two-tier health system for older persons. And we don't want that."

The bottom line: The health of tomorrow's seniors will be shaped by how healthy they are now.

  • There are signs that Americans now in their 40s and 50s will be even less healthy than today's seniors when they hit retirement age, and among this group there are widening disparities that will likely keep growing.
  • "People don't get to 65 naive, as if they are now going to experience healthy aging or unhealthy aging," said Lisa Berkman, director of the Harvard Center for Population and Development Studies.
  • "If we want to think about healthy aging in America 10 or 20 years from now … we need to totally focus on the people who will be in those cohorts."
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