In the days since Donald Trump was reelected president, we’ve been subjected to news of the president-elect’s Cabinet choices, each one a harbinger of some disaster in the making: a defense secretary issuing orders to a military to attack private citizens; an attorney general weaponizing the state to go after political enemies based on grudges; a national intelligence director working in tandem with the world’s most ruthless despots.
These are just the routine nominations. President Trump is also planning to set up the new Department of Government Efficiency, to be led by his acolytes Elon Musk and Vivek Ramaswamy, with the explicit goal of slashing $2 trillion of federal spending. With close to 35 percent of the federal budget allocated to Medicare and Social Security, one would assume that these programs, which support the country’s elderly, would be on Musk and Ramaswamy’s chopping block. Yet Trump has deemed these programs untouchable, telling AARP earlier this fall, “As you know, I was there for four years and never even thought about doing it. I’m going to do nothing to Social Security.” He similarly vowed to protect Medicare, suggesting that increased economic growth under his leadership would be enough to sustain the program.
Trump’s disavowal that Social Security and Medicare would undergo cuts wasn’t enough to retain voters over 65, who favored him by seven points in 2016 and five points over the Democratic candidate in 2020 but were evenly split between him and Kamala Harris this year. This may be because seniors are far more attuned to the precarious future facing America’s rapidly aging population. Both Social Security and Medicare trust funds are heading toward exhaustion in a decade, and the long-term outlook for these programs is threatened by a precipitous decline in birth rates since contributions from workers fund the programs.
There’s also a looming cost-of-care crisis as the sizable Baby Boomer generation continues to hit old age. The number of Americans living with Alzheimer’s—just one type of dementia—is projected to double to 13.8 million by 2050, while associated costs are expected to grow to $1.5 trillion, twice the costs for individuals without dementia. Our current system of Medicare covers medications and surgeries for elders afflicted with conditions like cancer and heart disease but does not pay for help with everyday activities like eating and dressing, the type of caregiving those with dementia primarily need.
At the same time, most Americans lack enough savings to maintain their current level of living, dementia or not. This cloudy outlook for seniors is rarely mentioned by policymakers and the media. Released earlier this month, Golden Years, by the historian James Chappel, seeks to compensate for this lack of attention. Beginning with the invention of retirement in the early 20th century—before which Americans were expected to work until death—Chappel traces the history of how America’s seniors came to have a social safety net at all, before arriving at today’s uncertain future. Throughout the book, both a thorough history and a call to action, Chappel airs his frustration over the country’s failure to do more for our aging population.
Much like with universal health care, the United States is a laggard among industrialized nations when it comes to providing for its seniors. Yes, Social Security offers a basic monthly stipend, and Medicare does pay for costly acute medical care that might otherwise bankrupt a family on a fixed income, but most wealthy countries in Europe and Asia cover long-term care in the form of assisted living and nursing homes.
What does America have instead? Women. As Chappell rightly points out, it is middle-aged daughters, many of whom are already buried under their own child care responsibilities, who are called on to take over the onerous task of caring for an elderly parent. Chappel quotes a 67-year-old grandmother named Miriam Dypold, who takes care of her 90-year-old mother and describes feeling “more frazzled and tied down than she did during the years when she was raising five children.” Akin to reserve military personnel, once activated, these women are expected not to grumble but rather to view the job as one of duty and honor.
I should know—I’m one of them. When my now 86-year-old father was widowed eight years ago, I imagined a time would come when he would be unable to take care of himself; I just didn’t know when. He was able to live by himself for a few years until the pandemic took away the systems he relied on: his gym routine and the cook who came every day to prepare a home-cooked meal and tidy up.
The monotony and loneliness wrought by the pandemic sent him spiraling into a deep depression and placed my erstwhile mentally sharp father on the path of cognitive decline. (Seventy-five percent of those killed by the pandemic in the United States, or 860,000 people, were over 65, and those seniors who did manage to survive the COVID-19 virus often suffered similar fates to my father.) Irascible and beset with anxiety, he began bouncing between living with me and my family in Brooklyn and in a retirement home 7,000 miles away in New Delhi, India, the country of his birth.
My father also suffers from diabetes and a heart condition that has led to a couple of heart attacks in the last few years. As I’ve taken on his care, I’ve become intimately familiar with his pill regimen and fluctuating blood sugar and blood pressure levels. My blood pressure, likewise, has skyrocketed, and I’ve developed a frozen shoulder from the stress. As Dypold puts it, “This is just the way it is for women of my generation.”
I am ill-equipped to be taking care of my father, but paying for long-term care in the U.S. is prohibitively expensive. Unless he is prepared to hand over all of his hard-won life savings—painstakingly accrued over his 50 years as an immigrant in America—to the state and go on Medicaid, my dad is, as they say, shit out of luck.
Medicaid does pay for long-term care, but only after a person has exhausted his or her savings, with spouses also required to spend down to near-poverty levels. Even then, long-term care through Medicaid may not be attractive when only poor-quality nursing homes accept Medicaid patients. America’s failure to provide universal long-term care doesn’t just impact the elderly. Younger people with disabilities or life-threatening illnesses are also left in the lurch, not to mention female caregivers like me.
Chappel spotlights the failure of the U.S. government to provide long-term care for its aging population, instead placing an undue burden on their adult sons and daughters, many of whom are raising children of their own. Indeed, he notes, relieving aging parents’ dependence on their grown children was the very impetus behind Social Security when it was conceived and passed by President Franklin D. Roosevelt and his labor secretary, Frances Perkins, in the mid-1930s. According to a report commissioned by FDR to study the issue of social insurance for the aging, dependency was “enormously expensive not only in the cost of actual assistance” but also in the “loss of self-respect and the constant fear of insecurity.”
The passage of Social Security followed a ferment of early-20th-century social movements that lobbied the federal government to provide for aging Americans, the most popular of which was led by a physician from Southern California named Francis Townsend. Spurred by socialist ideals, Townsend envisioned a state-supported division of life into three parts. Americans would receive an education in their youth, after which they would begin working and enter what Townsend deemed the “productive years of life.” Finally, no longer able to work, they would arrive at old age, or the “age for leisure.” Under his scheme, every old person would receive a monthly payment of $200—the equivalent of $5,000 today—all of which he or she would be forced to spend every 30 days to fuel a prosperous economy.
The Townsend Plan, as it was known, gained steam precisely because its champion possessed a vision of old age distinct from the other phases of life at all. “Townsend wasn’t just promising miserly, means-tested pensions to keep older people out of poverty,” Chappel writes. “He was promising a new way of life for older people, and he was offering them a chance to participate in the salvation of the American economy.” Perhaps most importantly, Townsend was offering it to all old people, women, and former slaves among them, not just to the working white men who, until then, had long dominated the conversation on providing for retirement.
The program FDR and Perkins ultimately implemented was a far cry from the generous Townsend Plan, which ultimately foundered when Townsend was forced to admit before Congress that he had invented the revenues that would be generated to cover the scheme. FDR’s Social Security was not funded by government general revenue but by a new and separate payroll tax through which people would receive a retirement income in proportion to how much they paid in, translating into smaller payments to the less well-off. The program would be less about articulating a new phase of life for the country’s seniors and more about reducing their dependence on their children, who were still contributing to the economy.
Chappel laments how Social Security reinforced the existing hierarchies of the labor market, contrasting it with how the Townsend Plan would have “used old-age policy to attack and redress some of the most insidious injustices of American society.”
Despite this critique, Chappel is quick to acknowledge that Social Security and its handmaiden Medicare, passed three decades later and for much the same reason—“to save younger people from being on the hook for their parents’ expenses,” as he puts it—have done much to reduce poverty, particularly among older Black Americans and seniors with disabilities.
The wave of political energy that spawned these and other federal safety net programs from the 1930s to the ’60s crested in the 1970s and ’80s. Right-wing ideologues like the economist Milton Friedman, the chief architect of the era’s conservative retrenchment, began raising concerns that Social Security would soon run out of money. Other leading conservative figures, magazines, and think tanks jumped on the bandwagon, increasingly calling for market-based solutions and private investment. The drumbeat of negative attention culminated in a lengthy 1974 report in U.S. News & World Report entitled “Social Security: Promising Too Much to Too Many?”
The criticism was not entirely misplaced. In 1983, President Ronald Reagan struck a bipartisan compromise to address the program’s insolvency, ultimately raising taxes on younger Americans while cutting their future benefits.
Yet other efforts to improve the lives of the elderly ran aground. A congressman named Claude Pepper sponsored the Medicare Catastrophic Coverage Act, which would have funded long-term care by eliminating the income cap on Medicare taxes. The act, which allowed individuals to pay premiums toward long-term care, was initially passed in 1988 but was repealed the next year.
The financial world stepped into the breach left by faltering legislative activity. Financiers looking to capture a potential windfall in retirement funds helped usher in the individual-funded 401ks and IRAs that are meant to compose the bulk of our retirement income today. Friedman’s fervent desire to do away with Social Security and Medicare is hardly a moot question and could still come to pass under President Trump despite his protestations. Indeed, the conservative Project 2025 blueprint calls for making Medicare Advantage, which are Medicare-approved plans offered by insurance companies, the “default enrollment option.” This is tantamount to the privatization of Medicare.
Describing how popular culture from the Reagan era reflected the notion that aging Americans were responsible for their own basic well-being, Chappel dedicates an entire rapturous chapter to the cult classic The Golden Girls. In an episode called “Rose Fights Back,” he writes the character played by Betty White is distraught when she realizes that she will no longer receive a small pension from her late husband’s bankrupt business. As a result, she pulls herself up and gets a job as a journalist’s assistant. “Just as the show propagated a widely shared ideal of health as personal responsibility, it did the same for finances,” the author writes, adding that Golden Girls rarely depicts an older person’s reliance on the government, “almost as though Social Security doesn’t exist.”
Almost a century after its creation, Social Security has proved remarkably resistant to the slings and arrows. As described earlier, however, its reckoning is fast approaching. Golden Years is a clarion call not just to reform the fragile system that supports old age in America but also to augment it to cover the long-term care the country, including my family, so desperately needs.
Yet nearly 300 pages later I was none the wiser on what solutions Chappel proposes to get there. His lens is a progressive one, so maybe an increase in taxes would play a role in funding an improved system, but he fails to mention the easiest fix of all—raising the cap on payroll taxes, currently set at $176,100. Does he support increasing the full retirement age for Social Security from the current 67? I can’t imagine he does, but I would have wanted him to compare and contrast the various proposals being considered. What kinds of taxes would be involved in funding long-term care? How would he propose dealing with a potential public outcry over increased taxes to support the elderly, upon whom a third of the federal budget, or $2 trillion, is already spent?
As much as I believe that fully funded long-term care for my father is the answer to our own family’s crisis, I do wonder how it would be paid for in hyper-individualistic America. In any event, my father cannot wait for that to happen and is returning to India, where, to my relief, he can afford to pay for a nursing home out of pocket.
Golden Years is unlikely to get a wide reception. Had Chappel ended his encomium to America’s seniors with a set of proposals for addressing the pending Social Security crisis and expanding the framework to include long-term care, this book might have become required reading for policymakers on both sides of the aisle. Nonetheless, it is a welcome primer on the history of American aging for anyone who has a parent or is planning to get old. And yes, that means you.
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