The idea of growing old in America today is becoming more uncertain and even scary, and it shouldn’t be. This is one of the wealthiest nations on earth. While many seniors are fortunate to have adequate retirement income, affordable health care, and the means to live independently after decades of working, millions of others do not. They live on fixed incomes – some near or below poverty level – and struggle to maintain basic retirement and health security.  Many find themselves contending with chronic illnesses and need help with the tasks of daily living, but can’t afford proper care.  Or they are housed in nursing homes which recent history has proven can be substandard, if not outright dangerous.  Instead of being able to thrive in their elder years by volunteering, staying physically active, or traveling – life becomes a daily struggle. Family members may step in to help, but can become quickly overwhelmed.

Some of the causes of this crisis in aging are straightforward. Stagnant wages and growing income inequality have impaired workers’ ability to save for retirement. At the same time, seniors’ living costs have been escalating – especially for medical and long-term care. The prices of prescription drugs have skyrocketed to the point where many seniors are forced to cut pills in half or skip vital medications altogether. The availability of employer-provided pensions is limited, and 401(k) plans, if workers have the money to invest, are not without risk. (Remember the millions of investors whose retirement accounts were wiped out in the crash of 2008?)

The two bedrock social insurance programs of the 20th century – Social Security and Medicare – have not been sufficiently updated to reflect seniors’ 21st century needs (though serious efforts finally are underway in Congress to do so). The United States has no federal long-term care insurance program, leaving seniors to pay out-of-pocket for assisted living costs averaging more than $4,000 per month and skilled nursing care costs ranging from $5,000 to $25,000 per month. (The average monthly Social Security benefit is only $1,543.) Seniors must impoverish themselves in order to qualify for Medicaid, which covers the lion’s share of long-term institutional care.

Though these problems are significantly worse for lower income seniors and disadvantaged communities, the crisis of aging ensnares middle-class Americans, too. “I don’t want to be a burden to my children” and “I am afraid I’ll end up in a nursing home or homeless” are common refrains among older people who may have earned a decent living but are overwhelmed by insurmountable costs in retirement.

While some societies revere their eldest, the word “old” is a put-down in America. Too many Americans see older people as “in the way” or irrelevant. A 2020 AARP survey found that “78 percent of older workers saw or experienced age discrimination in the workplace.” Former U.S. Sen. Alan Simpson (R-Wyo.) used the term “greedy geezers” in defending his agenda to cut Social Security benefits.

At no time has this indifference to seniors been more obvious than during the pandemic.  Seniors represent a staggering 80 percent of all COVID deaths while representing only 16.5 percent of the total population. Millions of families mourned the loss of older loved ones. But the attitude of many Americans seemed to be, “I don’t have to worry about COVID. It’s mainly affecting older people.”

Writer Nina Kohn observed in the Washington Post, “Inequalities rooted in ageism caused the coronavirus to spread, and many policy responses take for granted that older lives are worth less than younger ones.” Kohn’s column, entitled, ‘The Painful Truth the Pandemic Revealed: America Doesn’t Care About Old People,’ concludes that “these moral blind spots… diminish us all.”

America’s apparent apathy toward seniors is somewhat paradoxical, as the nation is becoming an older and older. Ten thousand Baby Boomers turn 65 every day. By 2030, seniors will make up more than 20 percent of the U.S. population.  For the first time in our history, there will be more seniors than young people.  Yet, we are ill-prepared to take care of our aging population.

Little wonder, then, that so many Americans are scared of aging – not just because of the glorification of youth and the stigma of growing old, but because they are terrified of not having enough money for housing, food, medicine, transportation and proper medical care if they get sick.  This is a distinctly American phenomenon.

2017 study by the Commonwealth Fund ranked the U.S. at the bottom of a list of wealthy, Western countries in terms of elder care. The study found that “a disproportionate share of U.S. elderly face economic challenges.  One-quarter reported that they often worry about not having enough money for nutritious meals or necessities like housing.”  The study also concluded that American seniors are “more likely to be sick and have trouble affording care than those in peer nations.”

It wasn’t always this way. America took huge leaps forward in caring for seniors during the New Deal (Social Security) and the Great Society (Medicare, Medicaid, and the Older Americans Act). But the consensus of the mid-20th century that we can – and should – ensure basic retirement and health security for seniors has become corroded. In fact, it has been decades since Congress passed major legislation on behalf of the elderly.

We could do a lot for seniors by strengthening and expanding those two landmark 20th century programs, Social Security and Medicare – effectively bringing them into the 21st century. Social Security benefits must be boosted to help seniors meet ever-rising living costs, and the COLA formula must be adjusted to reflect the impact of inflation on the goods and services seniors consume today. Medicare must be expanded to include dental, vision, and hearing care, which millions of seniors cannot currently afford. Prescription drug prices must be tamed so that older people don’t have to ration lifesaving medications or choose between groceries and medicine. Funding for home and community-based services (HCBS) must be increased so that more seniors can receive care outside of nursing homes. Currently, more than 800,000 seniors are on waiting lists for this crucial service.  What’s more, the caregivers who work in nursing homes, assisted living facilities, and HCBS care are woefully underpaid – and should be able to earn a living wage.

After decades of stasis, Congress is finally confronting some of these needs. Rep. John Larson (D-Conn.) has introduced legislation to boost Social Security benefits, adopt a new COLA formula, and extend the solvency of the program’s trust fund. The House passed the president’s Build Back Better plan, which would finally expand Medicare to include hearing coverage, cap seniors’ out-of-pocket costs for prescription drugs, and allow the program to negotiate the prices of some life-saving drugs. The package includes new funding for HCBS care (though, unfortunately, that funding has been cut to about one third of the originally proposed amount).  These are important and historic steps – but they have encountered strong headwinds from powerful special interests and must now confront roadblocks in a divided Senate.

Whenever seniors’ champions in Congress propose to adjust Social Security and Medicare to reflect people’s current needs, opponents cry “Socialism!” – or warn that the government is “taking over” Americans’ lives or health care.  Often, they falsely claim that seniors’ earned benefits are driving the federal debt. Conservatives try to divide and conquer by arguing that younger adults shouldn’t be forced to contribute to Social Security and Medicare – and shouldn’t have to “support” the older generations. The truth is that these same programs provide workers of all ages with disability coverage, plus financial and health security for their own retirement.

Expanding Medicare and Social Security and allowing prescription price negotiation have overwhelming support from majorities of Americans across party lines. We should not have to fight to enact commonsense improvements for our most vulnerable citizens.  And we’ve had to expend too much energy opposing proposals that would actually hurt seniors, such as raising the retirement age for Social Security, means testing Medicare benefits, or privatizing both programs.

Aging in America should never be an intimidating prospect for anyone. Whatever it takes – a shift in societal attitudes, a political re-alignment, or the swelling senior population exercising its own power and voting in its own interests – we must rise to a higher standard for elder care.  President Lyndon B. Johnson said it best when he signed Medicare and Medicaid into law:  “No longer will this nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this country.” Our country should strive to live up to those words.

Max Richtman is President and CEO of the National Committee to Preserve Social Security and Medicare.