Generational Equity and Public Health Policy: A Critique of "Age/Race War" Thinking

Abstract

A potent new tool in the politics of fiscal retrenchment lies in the creation of a framework for policy analysis which implicitly or explicitly "blames" the old for poverty and economic hardships in the young. This paper examines the recent efforts to promulgate this generational equity or "age/race wars" perspective and demonstrates that opinion poll data fail to support the rhetoric of growing age/race group antagonisms over entitlement programs for the old. The assumptions underlying the generational equity framework are critiqued, and the race and ethnic issues embedded within this framework are examined. In particular, we explore spurious assumptions concerning the relative financial wellbeing of the elderly, escalating Social Security and Medicare costs as a primary cause of poverty in the young, and growing resentment of programs for the old among minorities and youth. Attempts to deligitimate the claims of the elderly through the advancement of the ideology of age/race wars are seen to have significant implications for public health policy, with the country's recent experience with the Medicare Catastrophic Coverage Act serving as an important case in point. The need for an alternative policy framework stressing the interdependence of generations is suggested, and some guiding principles put forward toward the development of such an alternative framework.