Baby boomers, 78 million strong, are turning 65 at a rate of 4 million per year in the United States.
The press, the government, and the medical community claim, often and loudly, that these numbers augur a mass dependency crisis. Such spokesmen envision a world of decrepit elders afflicted with chronic disease devouring the country’s resources.
Still, amidst the alarmists, a few commentators acknowledge that aging itself has changed. Many boomers are working well into their 70s and 80s, staying in remarkably good health, and reinventing this final stage of life. In short, they are proving that chronological age is not biologically uniform.
In the United States the so-called “geriatric crisis” is less related to age itself than to the relationship between old age and government support—such as the unequal distribution of health care dollars, via Medicare, across the age spectrum.
Such policies assume that people over 65 are by definition in worse health, dependent, and in need of government support. Yet this is not always the case. A financially independent, healthy 70-year-old costs society less than an ill 40-year-old.
Throughout the first half of the twentieth century, Americans argued over the proper relationship between the state and its elderly citizens. They tried to define “old age” and its problems, while questioning the federal government’s obligation to offer a solution.
In different measures, the Social Security Act in 1935 and the passage of Medicare in 1965 offered policy conclusions to these debates. The elderly would be defined as individuals over 65 years of age and the problem of old age would be characterized as illness and its related expenses.
Neither of these conclusions was foregone; both were expedient answers to social and political pressures. Indeed, many analysts over the century did not believe that old age necessarily meant ill health or dependency if approached correctly. They opposed plans and policies to separate the elderly from the rest of the population, and advocated for preventative health spending throughout the lifespan.
This article will return to the middle of the twentieth century to explore how 65 became a federal marker of old age and why health insurance came to be seen, in the years following the first National Conference on Aging (1950), as the best solution to the problems afflicting America’s elders.
The “Problem” of Old Age
On July 30, 1965, Lyndon Johnson, the 57-year-old President of the United States, honored 81-year-old former president Harry Truman by traveling to Independence, Missouri, to sign into law a bill that would give America’s elders federally funded health insurance.
The passage of Medicare—a policy that Truman had reluctantly supported in the early 1950s—became Johnson’s political windfall. Johnson could now claim to have solved the “problem of old age.”
The problem of old age started to attract public and political attention in the 1930s, when industrialization, urbanization, mass unemployment, and the Depression combined to leave many of the aged without jobs or support from their extended families.
As a result, during this decade, the problem of old age was largely characterized as impoverishment due to unemployment.
At the same time, the elderly were a group whose numbers were on the rise. Advances in public health had transformed life expectancy in America: from 1860 to 1930 the percentage of the American population over 65 had more than doubled. In ten years, from 1930 to 1940, there would be an additional 36.5 percent increase in this group, at a time when the entire population increased by only 7.2 percent.
Within the decade, spokesmen across the United States pressed the government to enact more pension programs. By the time Franklin Roosevelt became president, some thirty states delivered pension programs, albeit unevenly; only 3% of those deemed aged were receiving state funds in 1935.
The fight for pensions, or just cash, continued through the thirties in the popular Townsend Old Age Revolving Pension Plan, Upton Sinclair’s End Poverty in California (EPIC) plan, and Robert Noble’s Ham & Eggs movement. All of these groups argued that the government should give a stipend to those deemed too old to work, whether 50, 60, or 65.
At its base, the philosophy of social insurance, or the social welfare tradition, maintained that governments should provide some measure of economic security. First enacted in 1889 by Otto Von Bismarck in Germany, social insurance programs spread quickly across Europe.
American yearnings for such programs emerged with Theodore Roosevelt in 1912 and reached an apex during the Great Depression. In 1927, Abraham Epstein, a weathered state pension advocate, announced: “It’s time for a group that will do nothing but work to create old-age pensions.”
Mindful of the sullied public reputation of the word pension, Epstein titled his organization the American Association for Old Age Security, later to be renamed the American Association for Social Security.
Epstein’s rechristening worked. Quickly backed by such activist luminaries as Jane Addams and Florence Kelley, Epstein and his intellectual mentor, I.M. Rubinow, helped create a federal social security program. Ad campaigns exposing the horrors of the poorhouse bolstered the numbers of Epstein’s supporters and focused further attention on the plight of unemployed elders.
By 1934, Epstein had succeeded in nurturing American empathy for the aged if not for his particular pension plan. In his proposal, the unemployed would receive money from a central pool funded by employee and employer alike. Conservatives skewered him and his supporters for advocating a redistributive scheme that reeked of communism.
In 1934, President Roosevelt issued an executive order to create the Committee on Economic Security with the goal of studying and solving the problem of economic insecurity in America. Epstein along with other social insurance experts advocating redistributive programs were strategically left out of almost every planning meeting.
Still, asserts historian Michael Katz, through Epstein and his cronies, “old-age security broke loose from its earlier association with poor-relief; forged ahead of every other kind of social insurance; and earned its privileged place as the only irreversible and untouchable welfare program in American history.”
On August 14th, 1935, President Roosevelt signed into law the monumental Social Security Act. The Act failed, Epstein protested, to redistribute wealth or actually alleviate economic insecurity for the most needy (since it offered relatively equivalent support to all older Americans). Nonetheless, it fundamentally changed the relationship between the government and its older citizens, setting apart the elderly as a distinct social and political group that the government now took responsibility to assist and protect.
How 65 came to be “Old”
In 1935, the aged—or “oldsters,” as they were often called—were not exclusively defined chronologically. In fact, numerous doctors and scientists working in the 1930s pushed for a biological, rather than chronological definition of old age, claiming that physical markers and not simply the passing of years best defined old age.
They looked at the correlations between poverty, chronic disease, family history, and psychology to determine that the onset of senescence or old age was relative rather than uniform. These early gerontologists believed that employment and usefulness would stave off the markers of old age. Still, they had little control over industry policies that pushed workers out of jobs at the early age of 40. Some factories even retired women at 35.
The Committee on Economic Security understood both the harsh economic reality of forced retirement and the absolute social necessity to keep the young employed. The Committee settled on 65 as the marker of old age for its economic feasibility.
At the time, life expectancy at birth was 58. Taking their cues from existing state pension systems and the recently passed Railroad Retirement System, the committee recognized that 65 was a number that could be sustainably financed through payroll taxation.
As historian Andrew Achenbaum reports, “As a result of the Social Security Act, old age—defined for administrative purposes as the attainment of age sixty-five—for the first time became a criterion for participation in several important programs at the federal level.”
From 1935 on, the U.S. federal government committed itself to the well-being of its senior citizens, who hereby would be defined as individuals over 65 years of age.
Wards of a Biomedical State
By the 1940s, the pension movement of the 1920s and 1930s had largely collapsed. Having achieved the Social Security Act, popular participation in pension-oriented lobbying groups diminished and political organizers focused attention elsewhere. Then, just as the pension movement slowed to a halt, the field of biomedical research exploded.
Science and war proved productive partners. The utilization of penicillin, skin grafts, and blood transfusions, writes historian Victoria Harden, “enhanced public belief that scientific research offered an endless frontier on which a happier, healthier life could be built.”
After the War, Congress went to work, sponsoring a spate of legislation to update American health care. According to Medicare expert Theodore Marmor, federal spending after WWII focused on three areas, “medical research, hospital construction, and federal health insurance programs.”
While scientists and doctors in the 1930s sought to ameliorate the social and physical stigmas of old age by discovering the parameters of what healthy aging could look like, scientists and doctors of the forties and fifties came to believe that chronic diseases could be reversed in laboratories and cured in hospitals. The federal government agreed.
While the federal government got into the bio-medical business, older Americans, reeling from the unintended consequences of the Social Security Act—such as forced retirement whether a person could or wanted to work longer—joined together in community halls and religious institutions to figure out where they stood in the post-war order.
“By setting an arbitrary retirement age,” the co-authors of The Senior Rights Movement argue, “the Social Security Act had inadvertently circumscribed the problems of persons over 65 as a distinct set of social problems. As such it provided a coherent basis for their solidarity and common identity and gave a newfound sense of legitimacy to elderly demands for social justice.”
In 1950, this nascent group of politically conscious elderly collided with an energized bio-medical industry and fair-deal policy wonks at the Federal Security Agency (FSA)’s National Conference on Aging.
Old Age Insurance and the First National Conference on Aging
In 1949 Oscar Ewing had problems. Since taking over the Federal Security Agency (FSA) in 1947 he had become a maligned figure in Washington. Branded by the American Medical Association as “Mr. Socialized Medicine,” Ewing opened his political life with a more modest nickname, Jack.
The straight-laced technocrat started his career in high school as the secretary of the Decatur County, Indiana, Democratic Committee, and pursued his political ambition at Indiana University, becoming first president of his junior and senior classes and then valedictorian. From there, he went to Harvard Law School, edited the Harvard Law Review, and eventually started his own law firm in Indianapolis. After enlisting as a first lieutenant in World War I, Ewing returned as a captain, primed to take on high profile legal cases and enter national politics.
In 1944, he publicly supported Truman’s run for the vice presidency, thereby securing a position as one of Truman’s key political strategists. When Truman became President, he urged Ewing to head the FSA and help him pass national health insurance.
In 1942, Fortune magazine announced the American public’s support for national health insurance as a whopping 74%. It seemed just a matter of time until the United States followed in Europe’s path and offered every citizen the right of health care.