Charge
America is facing a crisis unmet by any previous society. A crisis that is coming to fruition across the globe in many of the most highly developed nations. However, we as Americans are seemingly doing all that we can to make matters worse, whereas other nations have recognized the issue and are moving towards viable solutions. I’m coining this problem: the geriatric crisis. We as a society need to find pragmatic solutions to this appending bombshell of negative ethical consequence. In this post I highlight my ideas and propose both short term and long term solutions.
This topic has been at the forefront of my thought since arriving at my parents house. Both my maternal grandmother and paternal grandparents are apart of the original baby boom. They are struggling, and the support system we as a society have in place for them is grossly ill-equipped to deal with the majority of problems they face. It saddens me beyond comprehension the scale of suffering being felt by our elderly populous. We must do something about it.
Evidence of Crisis
As with every issue, research is important to understand and familiarize with the data. Along with statistics, I researched important microcosms of American society to appreciate the magnitude of the appending crisis. Below are stats and stories that damn our society and showcase unintentional cruelty.
Birth Rates, Death Rates, Life Expectancy, and Average Age
There are a few statistics America keeps on its citizens that are vital to understanding the state of our aging nation. These statistics are birth rates, death rates, life expectancy, and average age. There are many different names for these statistics, such as natality, crude birth/date rate, mortality rate, and other combination metrics such as rate of natural increase. Since throwing too many numbers at your face is not my intention, I will stick to speaking in generality and link the true statistics for further personal investigation. But trust me, the numbers aren’t pleasing.
Google has an awesome tool to visualize trends in each of these metrics and more, I highly recommend you check it out here. You can also compare nation and world populations.
The big picture is this: birth rates are going down, death rates are going down, average life expectancy is slightly going up, and average age is going up. This has tremendous implications on the effectiveness of the social welfare programs we have in place. More on this below.
The causes are many, but it’s obvious that better medicine and technology has given us a better capability to live longer, healthier lives. On the other side of the spectrum, birth rates could be decreasing due to a more steady involvement of women in the workplace. (thanks capitalism) Other things such as reliable birth control and economic highs and lows affect birth rates as well.
My main point for this subsection is that in the past we have had difficulties handling the aging populous, but never before has it been this big to be called a crisis. For an example look to the trends of imprisoned Americans.
Imprisoned Elderly
It is said that living a life behind bars ages you faster. By many approximations, those who have served considerable time in a state or federal penitentiary are mentally and physically ten years older than their birth date reads. This has caused a considerable amount of unforeseen difficulties that prisons have had to work around. If you’re down to ball your eyes out, I have a report or video you can check out.
As much as I’d like to critique the rotten judicial and criminal system/structure that often perpetrates racist ideologies, I’ll save that for another post. This problem of a growing elderly population in prison is a direct result of the movement in the 70’s towards a strong “tough on crime” stance. That coupled with insane sentencing minimums and a budding idiotic war on drugs placed America in the number one spot for percentage of citizens incarcerated amongst developed nations. Not to mention the ever present “for-profit” prisons.
This microcosm of American society can shed light on the crisis we are starting to face because it is supposedly ten years ahead. If you skipped out on the video or report let me fill you in on the conditions that these elderly are facing: they are abhorrent. Not only are many of them suffering from multiple ailments, most have no hope of ever being free. They will die behind bars, alone, afraid, and in incredible pain. Sadly, even if they are allowed back into society, many have no one to pick them up. They are doomed.
Many prisons have started to implement an inmate sourced support system where inmaes are paid measly amounts to care for and assist the aged through daily activities such as clothing, bathing, eating, and using the bathroom. These able individuals are their biggest advocates and many times their only friends.
But of course this isn’t just a social well-being problem, it also carries financial consequences. Taxpayers are paying for these individual’s medications and treatments, and the costs are staggering. Letting them out of prison only solves one of the problems. Unfortunately, they will be thrown into the just-as-broken welfare support system free citizens face. But how bad is it?
Lack of Support System
There are a few avenues of financial support available for the retired and aging population in America. Personal/family wealth, long-term privatized insurance, social security, and medicare. Most Americans don’t have enough saved to afford a full retirement. And not enough people are investing in long-term care insurance.
So most people are relying heavily on the government programs we have in place. Programs designed in an age where there were up to thirty workers paying taxes to cover one elderly. These systems have yet to experience nearly such an obstacle, one graph tells it all: The Population Pyramid.
This graph shows the percentage of total population per 5 year age group in 2018. To understand why these near century old programs are failing, you must examine the progression over time.
A steady shift towards an equilibrium of shared percentage is obvious, but our welfare programs are not the slightest prepared. The baby boom is the first tidal wave in the gif, and all of them are about to hit 65 and up. This will destroy the systems we have in place. There are now less than 3 workers to 1 beneficiary, social security needs extreme reform. Medicare needs a huge overhaul, for that I agree with my dude Bernie.
Even with perfect government welfare programs, there will be prolonged unnecessary suffering. Many old people at some point, whether they are terminally ill or fading fast, want to end their life. Yet their government forbids it, only 6 states and DC currently have death with dignity legislation. I believe that the laws already in place are useful, but could go a step further in the future. More on this later.
Long Term Fixes
The separation of long and short term fixes are based on the longevity of the solution. Some fixes could enable healthy and happy aging for all future generations, others simply alleviate some pressure right away. The difference does not however take into account the timeline for enacting policy of the sort. It’s safe to say that in our current state all policy decisions are going to be stifled with inaction and ignorance. As the issues become more and more pervasive the public will demand justice for their most deserving elder population. Here are the ways I see to solve this geriatric crisis.
Medicare and Social Security Re-hauls
My favorite president is Franklin Delano Roosevelt, without his leadership during a time of great instability we would be nowhere. He was one of the main reasons we exited WW2 as the top economic power, that and the fact we weren’t bombed to shit. His presidential cornerstone was the creation of social security. The Social Security Act was passed in 1935 as a main component of The New Deal. Many new deal policies failed miserably, but this one succeeded tremendously. It has been the most reliable government agency since inception, but it’s fundamental idea is only now becoming challenged beyond belief. It won’t make it to its 100th birthday.
I truly believe that it is time for a new, new deal. All these social issues I am constantly thinking about will be apart of it. But universal health coverage will be at the forefront. It’s frankly sad to see that we are the last developed nation to offer basic coverage. Just like holding on to the broken imperial unit system, we may never switch due to fear and cost concerns. America needs to go back to the days where they would take risks when it was the ethically right thing to do.
Now, there are a ton of changes that need to be made, and many more that could be changed. If I talked about them all I would bore you to death. Instead I will link you to some of the potential fixes. My grandma says young people need to pay more, I say we need to transition everyone to a single payer system that modifies benefits based on your age group. Another solution is providing a supplemental program to increase government earnings. The solution is NOT to get rid of it. But it is about time that seriously drastic changes be considered.
The agency will be continually failing on its payments in future years. So something needs to be done. Think we will ever have as progressive a congress?
Increased Incentives for Geriatricians
Medicare is strapped for cash, and they don’t pay recipients enough for good long term coverage. This is directly at odds with privatized insurance because of the doctors. Young students pursuing their M.D. don’t want to work on old people. It’s often considered unglamorous and unrewarding. Unrewarding both financially and mentally. Most people would intrinsically save a youth’s life over an elder’s if they had to chose. This is backed up with economical bias, geriatricians make less on average than any other profession requiring an M.D. Compared to a radiologist’s $473,000 average salary, a geriatrician’s $184,000 is shit. This is because Medicare is broke and private insurance is rich.
Not only are other areas of medicine far more lucrative, they are more often taught. During schooling many programs cycle the soon to be doctors through different areas of medicine to give them the opportunity to try things out and find what they like. Geriatrics is almost never a mandatory cycle. After all, schools want their students to go out and get high paying jobs so they can pay their way out of debt then pitch back earnings to their alma mater.
The need for geriatricians and geriatric nurses is outrageous.
“By 2030, the need will grow to an estimated 30,000 geriatricians. To reach this number, 1,200 geriatricians would need to be board-certified each year for the next 20 years. Twelve hundred may not seem like a huge number, but consider this: In 2010, only 75 medical residents entered geriatric fellowship programs across the United States, down from 112 in 2005, according to the American Geriatrics Society. The geriatrician is becoming an endangered specialty.”
Holy shit, we’re fucked, unless things change now. Start paying these doctors more, start mandating cycles in university, and remove the stigma of old lives being less important. Easy right? Nope, but otherwise we’re fucked. And when I say “we’re” I really mean your grandparents and parents. They will suffer insurmountable pains due to this lack of support personnel.
This is an area that needs more people sooner than we can get them. We need to incentivize retraining of doctors and recently unemployed to become geriatric doctors and nurses. This will provide the needed support for the geriatricians. Otherwise, suffering will ensue.
More Regulated Re-Population Schemes
The last long term solution is a bit more controversial in today’s social landscape. As shown earlier, the population will soon be equally spread amongst the age groups. This is a general trend towards an natural equilibrium. However, the graphs can’t predict the future. As we have seen in the past, people will have children for different reasons, and certain times have been dominated by intense breeding. These imbalances lead to ripples of population growth that challenge social welfare systems.
The best way to solve this problem is a more regulated re-population scheme. I’m not calling for eugenics, I just want the government to insure that another baby boom or baby drought doesn’t happen again. That could mean not going to war or it could mean actually regulating financial institutions to disallow another recession. I will leave eugenics and parental licensing for another post since that isn’t what this one is about. Just know that my opinion is that the government should not only track the population statistics, but actively encourage a steady re-population rate.
This steady rate will increase planning capabilities and insure the full payment of benefits to every citizen. The better we are at predicting the health of our population, the more prepared we are to support them.
Short Term Fixes
Suicide is a touchy subject. It is engulfed in negative connotations stemming mostly from religion. Nowadays it holds a direct link to mental health stability, and often drug/alcohol/gun abuse. After contemplating it myself and saving others from ledges I’ve developed a philosophy that is: Humans should have the right to choose how, when, and where they die. This post will talk primarily about the terminally ill and near death individuals whose deserve this option, but I firmly believe in availability to all citizens within reason.
Assisted Suicide
Assisted suicide, or more aptly called medically assisted dying, is currently legal in 6 states and D.C. The idea is simple, if a person is terminally ill or near death, they have the capability to sign a few papers and be prescribed a lethal dose of some barbiturate. Now, this is an obvious oversimplification. In reality there are waiting periods, multiple doctor approvals, and consent statements and requests. Needless to say, it’s not easy or quick. And only a few illnesses qualify per state.
I’ve already linked a few testimonials as to why this is morally righteous, but I have also experienced this first hand. These laws need to be widened to allow for more people to qualify. Too many people have to wait for their death when their body and mind have already given out. No person should have to face weeks, months, or years of pain because their government doesn’t think they qualify for a dignified death. We need to get over this “life at all costs” mentality, it’s often life-insensitive.
The will of humanity is great, if a person wants something badly enough, they will do whatever it takes to get it. One reason why Planned Parenthood is worth funding. This idea is also at play when it comes to the ending of one’s life. Whats worse, medically assisted death or suicide by cop? Pretty obvious answer I’d say. But what about the other major ways? Shooting yourself in the head? Drinking yourself to death? Or overdosing on some other drug? I think you’d be an idiot to say that anything other than assisted suicide is best or more moral. It surely is the least messy.
With all this being said, the requirements for request and verification are a gray area. And we haven’t had these laws around long enough for there to be conclusive evidence for the best practice. For now, not even enough people know about them, so education on options is more necessary.
Euthanasia
One major problem with assisted suicide is that it doesn’t cover individuals who are unable to grant consent. Say for instance your grandmother has dementia, perhaps caused by Alzheimer’s. She is unable to recognize you, and doesn’t even know her own name. With the current assisted suicide laws she can’t consent, therefore must lay to waste away until her time is up. This has enormous consequences for your family and most importantly her. She is gone, her life consists of waking up confused about where she is, forced feeding, then often medically induced sleep. Does that sound fun to you? It’s not. The only thing she wants is peace, but can’t express it because her mental capabilities have deteriorated so much. You want her to be at peace as well, but chances are, you have to let her suffer until natural death.
Pretty fucked up right? This is happening everywhere, and the moral repugnance is a stench that clouds America’s ethics. When your dog is 21, blind, and unable to stand, you put it down. It’s lived a great life and the last thing you want to do is force it to endure any further suffering. Why the fuck are humans any different? If anything, it’s more immoral for humans because they have lives of even greater value, and deserve more rights than the dog.
One way to offer these benefits without forcing loved-ones to make the hard decision is something like a do not resuscitate contract. As one gets older, it becomes more important to have a will drafted. If an individual wants to be cut short of life in the case they become unresponsive or terminally ill, they should have the capability to consent to a doctor beforehand in the will. This gives the power back to the individual and ensures the following of their wishes.
Potential Abuse
Most of the arguments against these treatment options focus on the potential abuse of insurance agencies or doctors. I’m less worried about doctors because they are almost always looking out for the best interests in their patients. What is definitely more scary is insurance companies pushing for a certain treatment or not. It’s important to keep in mind, that as long as we are a capitalist society, insurance companies are making money off of people’s faults and imperfections. If they stand to earn from a certain treatment and not others, they will coerce the buyer into choosing the more cost effective option.
This could mean a number of horrible things. First, these companies might attempt to withhold information on all treatment options and their timelines. (which is already happening) This means that they may put pressure on a person to start a treatment option without fully understanding all of the options. Second, they may limit coverage for certain treatments forcing poorer people to choose the option that would least negatively affect their family members. Thirdly, as seen with the explosion of opioid addiction in recent years, we can’t trust that pharmaceutical companies will not bribe doctors into over prescribing.
All this means that the government would have to eliminate edge cases and truly crack down on offenders. This should be coupled with a FDA overhaul in my opinion, but I’ll save that for another post. Most of the already existing policies have elements stating the pressure of an individual to make a decision of treatment vs. death be a felony. Regardless, the government needs to ensure the rights of the patient are not taken advantage of.
Closing
As I’m finishing writing this piece my grandfather has just passed away. His kidney’s were failing, he was entering dementia, and he decided to decline treatment. He was uncomfortable for weeks as he waited for his death. His wife, now alone, has lost nearly all her motor functions and memory. She also has declined treatment and is waiting for her turn to die. This is sad, not because death is scary or unfortunate. This is sad because they are forced to suffer until their bodies finally give up. They are citizens of Florida, a state without any dying with dignity policy.
If you haven’t experienced this sadness yet, you will. Death awaits all of us. We have no say in how we’re born, but we should at least have a say in how we die. We need to reform our social welfare landscape before the crisis financially cripples us.
Finally, I hope you consider how you want your end of life experience to be. Your perspective grants you empathy. And your empathy saves lives.
“Funny, the day you’re born, that’s really your death sentence.” – Donald Glover