Demography and Retirement: The Twenty-First Century

By Anna M. Rappaport; Sylvester J. Schieber | Go to book overview

cannot make the marginal adjustments needed to maintain the program pretty much along the lines now configured. We should make those marginal adjustments to prevent long-term imbalance in the program as far in advance as possible.

The long-term prospect for Medicare is decidedly pessimistic. It would appear that current projections suggest a future level of benefits that may not be politically sustainable. Putting this conclusion in the larger context of the U.S. health system's inflation and access problems suggests that fundamental issues about the organization and provision of health care services will have to be addressed long before the baby boom reaches retirement age.


This paper attempts to answer the question of whether Social Security can survive the expected demographic changes in our society after the turn of the century as the baby boom generation passes from their working careers into retirement. That this is an issue may be startling to the casual observer of our social insurance system. Just eight years ago, we completed the big overhaul of Social Security that resolved its short-term financial crisis and set it on a course that was hailed as being actuarially sound for the next 75 years. With just one-tenth of that period elapsed and with the system's experience being almost exactly what was predicted, and with the unprecedented accumulations now occurring in the trust funds, it may seem an odd time to be overly concerned about the system's survival.

The prospects for Medicare have not been as bright, at least in recent years, as those for the cash benefits program we call Social Security. But, each time we seem to approach the cusp of crisis in Medicare, the program is amended to push the day of reckoning further into the future. Maybe the continued careful course adjustments can keep Medicare afloat, for who can think of the alternative? And if the financing of Medicare becomes dangerously precarious, we do have the cash benefits trust funds just sitting there.

Yet as we begin to move through the 1990s, the prospects for future problems are beginning to unveil themselves in a fashion that legitimizes questions about the long-term viability of these social insurance programs. After the release of the 1989 Trustees Report, at least one authority declared that the picture on Social Security's financial health was a rosy one for the elderly, but a dim one for the young. 1 Increasingly, there is a feeling in the business community that the federal government's Medicare policies are nothing more than the government promising benefits to the elderly on the one hand, and making employersponsored plans pay the bill on the other. There is a growing concern that the shifting of costs from governmentally sponsored health plans to private ones is making the sponsorship of employer plans an untenable proposition. Thus we face the prospect that Medicare is choking its one existing safety valve. Given the general problems of cost inflation, concerns about the quality of care provided, and the limited access that some citizens have to the U.S. health care system, it is important to understand the interrelationship of Medicare to the larger system.


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Demography and Retirement: The Twenty-First Century
Table of contents

Table of contents

  • Title Page iii
  • Purpose of the Council vii
  • Contents ix
  • 1: Overview 1
  • Introduction 1
  • 2: Demographic Change in the United States, 1970-2050 19
  • Stephen C. Goss 53
  • Barry Edmonston 57
  • Introduction 57
  • 3: Expected Changes in the Workforce and Implications for Labor Markets 73
  • Introduction 73
  • Joseph F. Quinn 105
  • 4: Can Our Social Insurance Systems Survive the Demographic Shifts of the Twenty-First Century? 111
  • Introduction 112
  • ENDNOTES 148
  • 5: The Impact of the Demographic Transition on Capital Formation 163
  • Introduction 163
  • ENDNOTES 180
  • Alicia H. Munnell 183
  • 6: Implications of Demographic Change for Design of Retirement Programs 189
  • 7: Trends in Health Among the American Population 225
  • Introduction 225
  • ENDNOTES 242
  • Discussions 243
  • 8: Population Aging and Retirement Policy: An International Perspective 255
  • Introduction 255
  • ENDNOTES 284
  • Robert J. Myers 293
  • Bibliography 297
  • Index 315
  • Contributors 323


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