"Though Much is Taken" -- Reflections on Aging, Health, and Medical Care

The Medicare trust funds face huge prospective deficits by the end of this decade.This paper discusses trends in six areas that bear on the Medicare problem: the number of the elderly, their health status, use of medical care, labor force participation, income, and living arrangements. Among the most important findings are: 1) a very large increase since 1965 in life expectancy at age 65; 2) a very large increase since 1976 in real per capita health care expenditures on the elderly relative to expenditures on persons under age 65; 3) a cross-sectional increase with age in per capita health care expenditures that is primarily attributable to very large expenditures in the last year of life; 4) a sharp decrease in labor force participation and a sharp increase in relative income of the elderly since 1965.The paper concludes by raising questions about the need to reconsider the definition of the elderly, the need for more flexible labor market arrangements for older workers, and a need for a social consensus concerning appropriate care of dying patients.