Transcript
UNIDENTIFIED SPEAKER 1: I'd like to introduce our fourth and final speaker in the series. And it's just a great pleasure for me to introduce tonight, Dr. Carroll Estes. She is the incoming president of The Western Gerontological Society, professor at San Francisco. She is very active in so many organizations that
I don't know how you do it; there must be three or four of you to be on all of the committees. You're also the author of The Aging Enterprise. And we look forward to hearing some very exciting things that you have to tell us about aging policies.
ESTES: First of all I would like to express my gratitude to Ann Eagan for all the work she has done for this conference and the contribution I think she's made to all of us in so doing. In terms of the aging enterprise, I owe special thanks to Maggie Coon who was a constant reminder that I was presenting papers and putting forth ideas but not aggregating them
in one place that might be utilized for purposes of advancement of the cause that we'll be talking about tonight. She and my husband, Phil Lee, were particularly helpful throughout all phases of the manuscript writing and have given me the confidence in myself to put forth the thesis that I did, which I will elaborate tonight.
And I will bring you up to date with the new developments in my thinking, which are moving toward an analysis of the class basis of aging policies. And while this is briefly alluded to in the last chapter, it has grown much in my mind, and I'm trying to develop it further. So I welcome criticisms and input when I move to the blackboard for that part of the presentation. So you're having an unveiling here
that only a small group of about 10 people will have heard, in terms of this part on the class basis of policies. Last year I was asked to serve as guest editor of a special issue of Generations magazine, which is a journal of The Western Gerontological Society which we hope is coming of age. This issue on policy and aging contained a number of statements that
raised concern or echo concern that I have. In it Jack Geiger said, "Social policy currently portends a decade of disaster for the health of older Americans." Robert Binstock proposed doing away with social security as we now know it and argued instead for a guaranteed annual minimum income because social security, as currently
operating, leaves so many millions of people in poverty. Robert Butler stated, "Austerity is an inescapable theme of contemporary government. Our choices lie in how we deal with the new conditions." Jorge Lambrino, San Fernando Torres Hill said, "Historically the plight of minority older persons has been directly related to the inattention of policy makers and service providers.
This not so benign neglect has produced inequality of treatment." These are all the voices of experienced policy makers and policy analysts. Millions of the aged are poor, the poor and near poor comprise, according to Mollie Orshansky who is the author of The Poverty Index and is a statistician in the social security administration, comprises nearly 40% of the older
population. Of those below poverty they are surviving on an income which provides approximately one dollar and 66 cents a day for food. This is a [dyad?] which the Department of Agriculture defines as adequate for a temporary emergency basis only. Nearly 15 million older persons have incomes below $5,999. Older persons constitute
23 percent of everyone in the US with an income under $4,999. Public financing covers only 43% of the health care costs of the aging, the rest essentially comes out of pocket. Our policies have encouraged a meteoric rise of health expenditures with no end in sight. Housing is inadequate; expenditures for social services are outdistanced in comparison with
health services by $30 to one. Why? Why are here 45 years since the enactment of social security? Fifty years after the enactment of Medicare and the Older Americans Act, eight years after supplemental security income, and six years after Title 20, Social Services Act. I believe fundamentally it relates to how we think about the aged and aging in our
society and how politics and economics create and maintain these perceptions in the interest of maintenance of the social order. I have become increasingly concerned about how intellectuals provide the justification, legitimation and underlying rationale for how we think about aging and for the policies that flow from this thinking, social policies which are ultimately
destructive both to the individual and to our society. So before moving to policies, let's step back and look at the theoretical and empirical emphasis of social Gerontologists in the US over the last three and a half decades. The central themes in American social gerontology have been concerned with the psychological and social psychological processes of aging. Focusing largely on individuals and their adjustment
and roles in old age. Developmental or life cycle theories concern is with personality as a pivotal dimension in the aging process. Role theory, which embraces disengagement and activity theories, is concerned with the successful adaptation and social integration of the aging. Age stratifications concern is with the rhythm of the biological succession
of generations and their implications for the allocation of and socialization to societal roles and norms. All of these theories emphasize the individual. None of these theories adequately address the influence of structural factors such as the economy and social class that account for much of society's processing of the aged as well as,
to an unknown degree, the aging process itself. Drawing from the dominant sociological paradigm of the 1940s to '60s, known as structural functionalism, most of social Gerontology has been concerned about again in so far as it creates problems for the maintenance of the social system, equilibrium is the prime value. The view, as described by Bill Gamson,
is from agents of the system concerned with maintaining system equilibrium, not the view of actors in the system. Social order and social control and the service of harmony are major concerns. This system concern is reflected in the continuous and much sought after understanding of moral, life satisfaction and adjustment of the aging. All of this has furthered the idea
that individual characteristics are more important that structural factors in aging, thus the tendency is to blame the victim for her or his aging experience. Further emphasis on individual aging independent of social structure occurs in the biological and biomedical models of aging that have gained descendancy with society's tendency to characterize an increasing array
of social problems as biomedical in origin, and to look to medicine for solution. This approach reflected in the research priorities of NIH seeks knowledge of an interventions for the immune system and other hypothesized biological sources of physical decline with age. Such biomedical problem definitions both individualize and medicalize the aging process,
and I would argue obscure an understanding of the relationship between our location in the social structure, the opportunities that that provides us, the economic conditions and ultimately our health and the seemingly physiological biological manifestations of aging, such as senility. Because of the focus on the individual, our knowledge and understanding of aging is severely limited.
We understand very little about the meaning of aging or the degree to which individuals act as autonomous agents in the continuous creation of reality. We do not understand how the experiential and behavioral outcomes of aging may be expanded or redirected, constrained or limited through the different socioeconomic treatment and processing of the aged
in our society. We know even less about the relationship of capitalism to society's treatment of the aged and the relation of both of these to the aging process itself. We don't even think about and aren't studying how the alienation of older people, from the power to control their own lives, as exemplified in their disengagement in senility, is a function of capitalism and the social relations it
produces. Why am I so concerned with the state of Gerontological theory? Because its fixation for studying the atomized individual, I believe, has been significant in developing the underlying legitimation for contemporary policies, policies which I have described in the aging enterprise as a failure. How have they done so? Well the legacy of these theories is clear in policy
in terms of the legitimation that the theories provide for the policies. Let me begin with disengagement theory. That theory which posits that there is a mutual and beneficial withdrawal of the individual from society, and society from the individual, that is natural and inherent and inevitable and universal in the aging process provides a very nice rationale for excluding the elderly from the mainstream through mandatory retirement policies.
And in fact assumes that this is a beneficent act on the part of society to assist the aged with their natural disengagement to prepare for their own ultimate death, this more than 30 years prior to their death. A policy implication of activity theory is the support for services that provide for the socialization and social integration of the agent, such as recreation programs. Because the
theory that older people successfully age if they continue or substitute social roles, they will have a successful adjustment. But this theory offers little insight into the importance of the economic sufficiency of the old person that is a precondition to the capacity for meaningful substitution of roles in old age. The developmental life cycle theory provides a nice rationalization for the continuance of the multiple and contradictory
policy approaches, or a laissez-faire approach to the problem because there's so many different patterns of aging, there can be no single policy solution. By taking the view of agents of the system, as Gamson calls it, rather than of actors in the system, our gerontological theories and knowledge base do not direct us to policies that would assure the independence, self-determination and equality of the aged
such as adequate income. Consistent with the theoretical and empirical emphasis of gerontology, US policies treat the problem of old age as resolvable largely through the provision of provision of services at the individual level. Medicare and Medicaid policies, Title 20 Social Services and the Older Americans Act all are predicated on the notion that treating individuals is the way to treat the problem of aging.
I would argue such problem conceptualizations obscure an understanding of aging as a socially generated problem and status. Because gerontology has provided so little insight or understanding of class differences in the aging process, and in the societal processing of the aged, we have been deficient as social scientists in developing an understanding of an explanation for
the differential and class-based treatment of the aged through social policies. Related to the above these individualized theories on aging have lent support to a reductionism which has formed the ideological basis of both biomedical research and service delivery strategies. The application of services at the individual level as the dominant public policy, bolsters problem
definitions that relieve us of responsibility and assist us in ignoring the larger deficiencies in the way our society works and the way it differentially rewards and punishes different classes of people. Problem definitions focused on needs for services support existing class status and power differences in the population.
Why, because the solution to the problem is so defined as to exclude the role of economics. Further, services strategies foster a dangerous dependency on two levels. We've heard a lot about the dependency it creates in the recipient of services, even given in the most meaningful way, being helped degrades. The second kind of
dependency we hear much less about, but it is truly the dependency of a society in whose institutions such as the family, the Church, the community atrophy because the professionalization of caretaking takes over, functions that they performed. Well now to return to what I have found as definitions
of aging and the problem of aging in our policies, which emanate in part and receive support from the theories I've talked about. As embodied in public policy we find first that aging is defined as a social problem, that is the elderly are defined as the problem. This misconception diverts attention from the
social and political factors in society, which in reality produce most of the problems plaguing the elderly. Second, old age is seen as somehow special and different and therefore characterized by special needs requiring special programs. This has led to a separatism of the aged via public policies. Third, as already noted, we tend to view the problem of older persons in a
very individual way. The problems of old age have been conceptualized in terms of a set of needs that are thought of as best addressed by the application of services. And in terms of our investment, largely acute care medical services, provided for a profit. The concept of need, as met through services, I believe, has justified the grossly inadequate income
and retirement policies, employment policies. Because the conception is that services, not income or employment, can solve the problem. The fourth perception is that some aged are deserving and some are undeserving. In other words, our policies delineate and reflect classes of deservingness among the aged.
I'll try to do this quickly because there's so many things I want to talk about. I have put up here I believe that there are two classes of aging, deserving and undeserving aged. And among the deserving aged there are sub groups, the upper class and upper middle class and then the middle class and then the underserving are the lower class. Policies differentiate
between these classes in significant ways I believe. And it took I would say more than 10 years to come to this and once you see it you won't understand why it took so long, I hope. But anyway, you take social security, primarily an income program which these two classes have access to. It takes
continuous covered employment for a certain number of quarters and for much casual labor and for people who have been largely unemployed, single mother families, female headed families and so forth, they're non-eligible, all sorts of other people are ineligible. But social security is available for this group, within social security there is a differentiation in
payment levels which is pegged to amount that is contributed to the system. So that in fact the highest payments in the social security system occur in this class. Second, there is a regressive tax structure, that is, and this many Europeans find laughable in our country, that when you arrive at 23, $25,000 in income you pay no social security beyond that.
For people who are earning like the president of General Motors, one million dollars a year, he is paying social security on $25,000 of that income. For someone who is earning $12,000 a year that person is paying social security on 100% of that person's income. Very simple notion. But putting it all together in terms of the respective percent of income that people contribute, there is a differential.
The upper class and upper middle class pensions are very inequitably distributed in the population. And so pensions tend to fall in this group by and large. This group also has the benefit of tax credits, one has to maintain property and have other forms of income which are not wage income. Now as many of you know, if not all of you,
social security currently has a retirement test. While this is a focus of debate with fiscal crisis I have my doubts whether Reagan's promise to abolish it will come true. The retirement test as you know currently allows you to earn $5,000 but you can make $5 million a year in terms of dividend income and continue to accept your entire social security payment of somewhere up in the $700 to $800 range.
But if you're over here you're probably making $200 in social security, and if you earn more than $5,000 you begin losing your social security. So if all you have to sell if your wage labor you are indentured to poverty because there is no way that you can get out of it. OK, for this group there is this lovely program called Supplemental Security Income.
Oh, I should tell you, and it took me a long time to realize, that social security at the bottom level is below poverty. Below poverty means this is an income that allows you $1.66 a day for food. So there's some people who have paid in all their lives into social security and you're on a below poverty income. Some of those people may get Supplemental Security Income, but Supplemental Security Income,
the important thing I'm going to tell you about all the policies over here is that they have one characteristic – well, they have several characteristics alike -- but they are state discretionary. That means that while they're federal state programs many decisions about who's eligible, how much the payments are, what else you're eligible for, whether you're eligible for Medicaid and so forth, are made at the state level.
That has implications because state budgets must be balanced every year, you cannot run a deficit. If you want to organize around an issue of social security, you go to Washington and organize in one place. This is 50 sets of programs, 50 policies, that's our policy for non-deserving, this is one policy for the deserving aged. Because you've got to go 50 localities if you want to protect Supplement Security Income.
Obviously this income is below poverty, quite a bit below poverty. And in spite of the reforms in 1974 that brought this in, Supplemental Security Income is supposed to provide automatic Medicaid eligibility which I'll get to here in just a minute. But states were permitted the grandfathering of more restrictive standards if they wished, 15 states selected
more restrictive clauses for eligibility for Medicaid. So in 15 studies we don't even know how many aged on Supplemental Security Income are eligible for Medicaid. OK, health. Medicare, of course everybody virtually -- a few minor exceptions -- is eligible for. One of the fascinating things -- Karen Davis
wrote an article, she's been working in Pat Harris's office -- some years ago about how the Medicare expenses were inequitably distributed to whites and to high income aged. Why is that when everybody's eligible? Well these groups have more access to medical care. They are more desirable clients, patients.
They are more likely to receive elective surgery that may be covered. Their doctors receive higher salaries probably in the areas in which the pay scales are derived. But the fact is, and I saw a 1978 report that verified it, that whites and high income people as far as Medicare expenditures get the lion's share of the resources. Then you have private health insurance
which pretty well covers these two groups. Obviously we all know Medicare covers and acute care model isn't meeting the needs of most of the aged anyway. But more of the chronic illness falls in this population, epidemiology will show the relation of low income to chronic long term illness. So what we have here of course is Medicaid,
which has the seven -- I think it's seven, it might be eight, maybe six -- required services under it, like hospitals, doctors. It's a replication of an acute care model with the possibility that you're going to add things like dental care and eye glasses and hearing aids, but that's an optional under Medicaid. But what this primarily does 60% of Medicaid costs go for institutionalization.
So we acute care hospitalize the well off and we institutionalize after we impoverish. We impoverish from back here over and then we institutionalize. I know I'm not telling a lot of you anything new but putting it within the context of really what's happening to the expenditures and to the different channeling of different groups, I think it's very important. The congressional budget office
has a report out which shows state by state how many people below poverty are eligible for Medicaid programs. It is estimated that 50 to 60% of the American people below poverty are not eligible for Medicaid programs, they are so restrictive on a state-by-state basis. And in fact as you may recall, those of you who are up to date on the welfare reform
enactments that were proposed and never passed in the last congressional session, I guess it was two sessions ago, one proposal was to bring all state welfare programs within 60 percent of the poverty level, and that was too dramatic to pass. So we're down at 60% of that 3,000-some-odd dollars. But at any rate again the fact is
that with fiscal prices and real or threatened tax payer revolts, and with ceilings that we anticipate, one of the things Reagan wants to do is put a ceiling on Medicaid expenditures the state -- I mean the federal share -- so that if a state overspends it will be paying for it entirely itself. Which the lesson for that of course is if a state is generous it's going to get itself into fiscal difficulty.
So it's a great social control effort for the undeserving to push these policies over into the state arena where they're so multiple, so varying, so changing, so politically visible and vulnerable that you don't even know what they are, so it's an invisibility to it. And in fact most of our research right now is devoted to trying to track what's happening in these policies with fiscal prices
and tax revolt across the states because the federal government doesn't know what's happening. OK, in social services, social services here, this group comes out ahead I would argue. The Older Americans Act, which is theoretically for all aged but it provides not life support services of income and the community based
services in large percentages because it's a pitiful little act of only $780 million. And so what it primarily does is provide accessing services, transportation information referral, outreach and an increasing support for a community based service system to try to keep these people from falling over here. Because the most mobile, most knowledgeable elderly are able to
negotiate the system. And I'm not saying this is intentional but this is ... when you have a general eligibility it means 25 million people are eligible for $780 million program and who's likely to get there first? OK, Title 20 is another one. And while Title 20 and the Social Security Act was originally Social Services for The Poor and [Aged?], with the notion of group eligibility, which many states have successfully claimed, it means
virtually all aged or eligible. Well I would argue -- I think a lot of empirical research needs to be done on this but that theoretically this group again has an opportunity for these services which in a sense is crowding out this other groups. It's not saying that it is not needed because then if you look at the tax structure the whole tax structure for these services, where's it coming from? More and more it's coming from property taxes, that's coming out of
these people right here. Corporate taxes are being significantly reduced at all levels of government. So we have an individual tax burden instead of a corporate tax burden, which is going to keep the lid on and reductions increasing in these kinds of programs. That's the class basis of policies as I see it.
So the lesson is clear, states which are generous in terms of eligibility and scope of benefits must pay for it in large part themselves. It isn't federal policy to formally address the needs of the most disadvantaged with a national policy that is uniform for all low income aged across the country. OK. Last,
in terms of perceptions, given the former perceptions the perception is that it is impossible to redistribute resources to older persons in order to improve their status. Rather the perception is that it is only possible, and it is implied with great sacrifice of other generations, to hold them in place. Such definitions
of reality are very important in constraining our views, our ideas, our notions of what is possible and our action. The idea that we could provide older people a decent living is not in the realm of what many think is possible. I would argue as long as we permit ourselves and our society to adopt such a confining view, we fail as aging advocates.
An important aspect of these definitions of the problems of the aged and the policies flowing from them is that they are not derived by a consensus of the population, nor did they emanate from those most affected by aging. Rather problems are defined; public policies are created according to the relative power of vested interest. And the resources that groups and individuals bring to the process of creating
the definitions and the social policies that flow therefrom. Further, all of these perceptions combined obscure an understanding that our own policies, such as retirement or as some call it forced unemployment, and the reimbursement incentives under Medicare that create inflationary hospital and physician expenditures, these policies have created a new dependency for the middle-class old
and exacerbated the dependency of the old who were poor prior to old age. The formulation of the problem of aging in America, is such that the policy prescriptions tend to fall largely in the service strategies with a highly medical character and with power largely in the hands of providers through reimbursement of services. The problem formulations do not address the root
economic inequality of the aged, nor do they seek to directly alter the dependency status of the aged through policies that would provide continued employment or adequate retirement income. The policies which emerge also have the core characteristic of being largely separatist in nature. That is separating the aged from other groups in society on the basis of their special need. As a consequence, an aging enterprise
, as I have called it, has been created. It includes the many programs, professionals, interest groups, trade associations, even congressional committees, the American Medical Association, the America Hospital Association, medical equipment, drug companies, nursing home and insurance industries. In using this term, I want to call attention to how the aged and their needs are often processed and treated as a commodity
in our society and to the fact that age segregated policies which fuel the aging enterprise are socially divisive solutions in contrast to those policies which do not single out, stigmatize and isolate the aged from the rest of society. Furthermore, the very politics and policies which have fostered the necessity of creating an aging enterprise have generated
the necessity for representatives of that enterprise to continually reaffirm the outgroup status and the marginality of the aged in order to maintain and expand their own activities, as well as to justify their existence. Such policies and political processes engender competition between disadvantaged groups, and between generations and in doing so foster terribly dangerous dichotomies.
The belief becomes firm that no equity is possible, just tradeoffs. Such policies do not advance the cause of social justice, but instead perpetuate acceptance of the status quo of inequity and of the inevitability or perceived notion that it is inevitable to have both scarcity and inner group rivalries. Further, such separatist solutions are extremely dangerous in a time of
economic retrenchment. For it is the aged who may be used as the scape goats to explain the origin of the presumed fiscal crisis. And it is the programs of the aged that are already vulnerable targets of cost cutting. OK, I'm getting close to finishing here. In terms of what I think is likely for the '80s, the context of policies for the '80s includes
this policy structure and the perceptions that I've talked about and the theories that assist in their development. In addition, I think there are four societal conditions that are important. First is both a threat and an opportunity. It is the new uncertainty about our societal capacity, both economic and technical, to meet national needs;
the energy crisis, the oil crisis, the defense crisis. There's a growing sense of threat and uncertainty such as we have never experienced before. It has a more immediate and direct impact in our daily lives than we've ever experienced. Even for large scale problems that affects millions of people like poverty, it didn't affect us. Our lives appear increasingly interdependent
and uncertain. And under such conditions old assumptions break down. Many previously accepted ideas and beliefs become the focus of active debate and power struggle. Under such conditions intense power struggles ensue as different structural interests attempt to forward their perspectives of the problem and the solution. But this is an opportunity too for those of us
who would join the battle to reconstruct reality. Of most concern for advocates of the aging are the shifting definitions and power struggles involved in different ideas or definitions of what the needs of the aged are, their rights and responsibilities, their contribution to the current fiscal conditions and the extent to which elders will be asked to sacrifice their hard won gains in cut backs engendered
under fiscal crisis. The second condition is decentralization employed in the Nixon administration, which was a mechanism to curtail the growth of federal programs. But it transferred large fiscal pressures on the states to underwrite programs and therefore neutralized the capacity and interest in generosity in the states
to the needy. Important for the 1980s, the poorest of the aged are assisted largely through minimal and highly variable income maintenance and service policies that depend on state level actions, commitments and fiscal capacity. In a period of increasing fiscal restraint these programs face certain cutbacks, that's another challenge. The third condition is the obvious, the interest group political process by which policies are made
in this country. And particularly the influence of the most powerful interest group, such as the defense and oil industries. But I won't leave out our friends, the American Medical Association and the American Hospital Association. Not to be ignored is the political power and economic interest of the private sector in health that will benefit most from a continuing and increasing medicalization
of aging through public policy. I could give you a lecture, a whole lecture, about how that health sector is going to crowd out resources available for the other pieces, income and social services, because we currently have a Medicare and Medicaid policy which essentially provides a blank check to doctors and hospitals. The fourth condition is
that the negative effects of these other three conditions will be exacerbated by an increasing concern with productivity and favoritism to new conservatism policies that value and reward what is defined as productivity linked activities. And the aged are not socially defined as productive. OK, now to a little cheer, the positive trends
, quick. OK, in the face of all this, the positive trends that I see are three. First, we have a developing awareness of the power of individuals to take control of their own lives and to join together to attempt to change reality. The human potential movement in psychology,
in theology, the liberation theology notion, in sociology we have political economy, in economics there's a [surgence?] of political economy from such a perspective. In almost every field of social science I can think of these notions are beginning to be examined and take important significance as concepts
and paradigms. Second, there's a growing awareness of the inextricable link between large scale problems such as sexism, racism, ageism and capitalism, and I think that understanding is important for social change. Third, there is an increasing awareness -- and I'll give the Gray Panthers great kudos for this one -- of the link between young and old
and that is the tradeoffs are highly destructive and accomplish nothing for the society or for either young or old. And the common problems of income must be met by a full employment policy, for example, mutual solutions which do not pit jobs for youth against economic security for the aged. So opportunities
exist in the uncertainty and the power struggles around how the problems will be defined. They exist in the opportunity to create new definitions of reality and to reconstruct reality with an understanding of our capacity to empower ourselves and others. What do we need to do? Well first on my agenda for change would be abandoning age segregated approaches.
Second would be a guaranteed annual minimum income or else preferably, and I think essentially a full employment policy so that the economic security of one generation isn't taken at the expense of another generation. In a sense to do aging for all of us here, and for the church as well, is more than
elaborating a new social ethic based on notions of social justice. Doing aging in this decade involved challenging some very important and powerful interests in society. It involves a political process, it has to, to undertake the commitment of protecting and preserving human life. It means challenging embedded and structural values of dominant interest that won't yield without a struggle. And challenging, for example, the medical and
technological dominance would be a step to reclaiming health as a public concern and an issue of social justice. Challenging centers of power also requires a supporting power base. It involves the abandonment of the constraining and self-serving limits of professionalism. Aging policies should not be the soul preserve of social workers, physicians, schools of gerontology, or any special interest
group, rather, it should be a fundamental human concern of our community. This should be the foundation of our social movement. Thank you.
UNIDENTIFIED SPEAKER 1: It's hard to say anything after hearing that report. I thank you very much. I'm wondering if before we discuss, Maggie would you like to say a few words?
MAGGIE: Well Carroll cited her comment about the divisiveness that age segregation and the rigid stratification by chronological age has provided. And I think we're both rejoicing that the White House Conference on Aging has begun to recognize that and attempt in its planning for the 1981 White House conference to correct it. There's
a technical committee, as some of you probably know, and that technical committee has subcommittees under it, and seven of those subcommittees are directed to finding approaches to an age integrated society. With regard to societal structures, the media, economics, education and spiritual life, the churches come in on that.
It's going to be very interesting to see what comes out of the work those committees are doing, the physician papers and the recommendations that are coming to the delegates to the White House conference. And it will be very interesting to see how those, to what degree those papers and recommendations are going to challenge and shake up the aging enterprise.
I will be fascinated to see that. But if any of you have a chance to see any of those papers or to provide any input into the preparatory meetings that are now scheduled between now and, what is it spring, summer 1981, it would be well worth your while to investigate those.
I think Carroll, I'm just very, very in a sense overwhelmed and enormously challenged by what you put before us today. And I think you have made it so crystal clear the class stratification and the cruel and tragic division in a so-called classless
society. And nothing but this kind of very rigorous disciplined look at it can persuade us that this is so. Carrol and I have said in different settings and to different groups that the rich are never deemed old, and
indeed there are all kinds of very specific evidences of that. Are you sobered by this as I am? It's an enormous -- but I think we're not over -- we ought not to be overwhelmed by it, we ought to find ways in which each of these salient points can be tackled.
UNIDENTIFIED SPEAKER 1: One thing I'd like to mention and then I'd like for all us to share and talk, one of the most sobering things that hit me as I saw you develop this and watched just much more than anybody could say is coincidence, just one, two, three, four. As a social worker, I've worked with a number of people who are single parents
with children. And the social welfare system encourages you to be spouseless to qualify for benefits. That hurts your total family structure, your ability to maintain economically. So you have a woman and maybe two or three children -- I think 70-some-odd percent of the people that are on Aid to Families with Dependent Children are woman, single parents,
and that means you're not paying into the social security system. Because if you work then you can't qualify for your AFDC payments, you can only get food stamps. So that means you live -- you're encouraged to be dependent throughout your time. Maybe your children will help support you when they start earning money, maybe they'll be so mad at the tough kind of life they had to live they go off and
you know, there have been so many family struggles that the relationship is so bruised you're left alone and by the time you're old you have nothing. Well, what can we do about this?
UNIDENTIFIED SPEAKER 2: (inaudible) so much of what you said (inaudible). Well I find myself [inundated?] from being (inaudible) and if we're to abandon the age segregated approach don't we start by saying there's no need for (inaudible) on aging, to go public and say that that's only reinforcing
the aging as a group separate and apart from society. Then we also try and get rid of bureaucratic structures that reinforce the aged as a separate group, the National Institute on -- I mean, right on to the Administration on Aging. I'm caught in sort of this tension between what I'm doing professionally and the whole notion
that I agree with you that we do have to make a start somewhere and where do we start?
ESTES: It's a tough question. I think it's a matter of strategy. One of my visions of an Administration of Aging I would like to see would be one whose job was to see that the health system and the mental health system and the social service system was responsive and created a fair share of resources to meet the needs of the aged population within those sectors, and that we
didn't have to build with the Administration on Aging a parallel service system which could only be a second class citizen among service agencies.
UNIDENTIFIED SPEAKER 3: I'd like to say one of the fascinating and awesome parts of Carroll's book is the documentations of fragmentation. And the duplication of the aging network was set in place without reference to all of the other planning structures that were already there. Isn't that right? And nobody's
really working at that, except if we talk about a local community and how you organize a community that is comprehensive and cohesive. You've got all of these different mechanisms, all of these different funding sources, all of these different public authorities and accountabilities to deal with. You've got a mess.
UNIDENTIFIED SPEAKER 4: I don't look at it as a mess, I look at it as an opportunity.
UNIDENTIFIED SPEAKER 3: OK.
UNIDENTIFIED SPEAKER 4: If you had one agency, they couldn't say no. If you have a number of agencies, you have an opportunity to sensitize some one person. Because I'm sure each of us in the group agree that if we want to make it a better world we can't get a dime for that. But if we say
we want to immunize a person against to prevent and to save a buck, there is a possibility.
UNIDENTIFIED SPEAKER 1: You were going to say some more, right?
UNIDENTIFIED SPEAKER 5: May I make a remark which became in hearing you more and more urgent from my own European background? In seeing how in the scheme more and more the Medicare problematic became central and acute.
You made a picture, kind of suggestion, of being old means being taken care of. Well I'm afraid that this is a kind of suggestion which is in our civilization very much central, but which perhaps is one of the most dangerous suggestions which we have in
connection with the problem of aging. I was reminded in seeing this coming so on this blackboard of what Simona de Beauvoir is saying in her book about, I think it's about research in India somewhere. But you would imagine that older people have a certain central place in society as the more wise and experienced people. And she says, "Well that's only true
for the rich people. The poor people are simply killed, they are destroyed. So what we have as a kind of admiration for older people is a kind of class phenomenon," she says. Well what we have experienced in the war in Europe and have experiences quite near to my own life in Holland was
that at a certain time the Nazi said, well, these are people in homes and so on -- are so old they have no use any more for them in our production process, they have to be annihilated and they were annihilated. It was not only the gas chambers for the Jews but also for the older people and for people in mental homes. So this was the suggestion,
people whom we are taking of are useless people. And this is the suggestion which is somewhere deep in our civilization. And when you are poor and you are useless, well why not at a certain moment if we have to make more missiles and more nuclear weapons because the Russians have invaded
Poland and we have to increase our armament, well then of course the temptation to scrap in this kind of programs will be I think great. And in a certain moment our civilization will go over the brink and say why not destroy these people? It's a kind of horrifying sort of course but I've experienced so near that
I think it came to my mind and I have to talk about it. Well, I think we have to -- you have been asking that the last three questions, the positive trends, I have the feeling that we have to make our stand still somewhat deeper. That we have to propagate, we have to express a belief in old age as something of a human right.
I think it's a kind of human rights program that we have to defend in asking people to be concerned about aging people. Old people have a right to be old and to be taken seriously as older people, to have an opportunity of not only working but then of course of earning their own livelihood, but also of experience all the opportunities which old age brings with it. And I think this is one of the tasks of churches and a symposia like this to say that old people are not people whom we are obliged to
take care of, but older people are people who have a right not only to live but to be old and to give perhaps in their old age a kind of contribution to society. And if this contribution would not be there then still they have a right to be old. This was
something which came to my mind that you were touching somewhere in the background of your lecture on very important issues for the development of our program. And this suggestion that it all depends whether we are able and willing to take care of old people is somehow a suggestion which we should fight. I hope you don't mind too much what I've been saying, but it was somehow on my mind.
UNIDENTIFIED SPEAKER 1: Thank you. I think too in hearing what you just said about Germany and Hitler makes us realize that we need to take very, very seriously your paradigm. And when I look at this and see that we've got the deserving who get all of these things, and the undeserving, you wonder tying in with what you just said. I think of Campbell in Hero's Way
I believe it is in Frazier, I believe it was Frazier who talked about the whole development of myth and culture and the king of the mountain kind of thing, which is found in so many cultures and so many stories that are found in a variety of cultures where there are those who protect their turf and against others who are
dispossessed.
UNIDENTIFIED SPEAKER 6: Just two comments and a question of clarification for Carroll. The second thing you pointed to as being optimistic, I think you referred to a realization across the pressed marginal lines that sexism and racism, ages and etc. are, folks in those movements are seeing the interconnectedness. Was that what you were getting at and you saw that as a hopeful sign?
ESTES: Mm-hmm.
UNIDENTIFIED SPEAKER 6: Would you spend (inaudible) just [a little bit more on that?].
ESTES: I think more I was saying that in the community in which I am located, which is academic community, and in the development of thinking an analysis around oppressed groups, there is an increasing understanding of that. But I hear it in the Gray Panthers, I hear it in the feminist movement. And I think
it's something that should be built upon and is one of the primary strategies, the joining together of the dispossessed across all types of dispossession that is important.
DENNIS: Just a comment on that. I would like to think that would be the case but I guess I'm not so optimistic about that happening because I see certain people within those groups recognizing that must happen in order to survive. But everything that I see from the power structure side militates against that, including policies, including as we've talked before in pitting group against group. And just a -- I don't know if anyone here -- I wasn't there, but perhaps
some of you women were in New York a couple weeks ago, sort of the founding convention, the Feminist Institute, Theological Institute. And the reports that I got from various people that were there was that there was a great deal of division among gays and straights and blacks and Puerto Ricans and whites and rich and poor. Each of them again, of those women, each of those within the feminist struggle
, theological struggle, lifting up their own causes and that becoming very discouraging for a lot of the women that were there. I wonder if that's portending of what might be happening again, a resurgent subdivision. Especially when the '80s begin to point to us of a tightening of the economic grip on dispossessed people. And the people who are in control, the middle class and the
upper-middle class people who are in control of those power structures are damn well going to fight to keep privilege and to keep power right where it is. And then my second comment is on what Dr. Harper was saying and that is perhaps what might happen in the '80s, and what is being suggested already, is a type of genocide among the old by allowing
as you were beginning to point out, just cutting off politics, cutting off the programs that will support quality of life among lower undeserving classes of people. So it's a social sort of genocide that's already happening. We're saying that there is a class of people who are aged who are dispensable because they're undeserving and we just cut the funds off (inaudible) [describe?] themselves. So I guess I'm saying I don't feel quite that optimistic on the second point.
ANN: Dennis, that was one of the concern areas that was discussed at the National Inner Faith Coalition on Aging mini conference at the White House.
ESTES: Can't hear you, Ann.
ANN: I'm sorry. That was one of the areas of concern that was talked about in the National Interfaith Coalition on Aging mini conference on spiritual values for the White House Conference. It said this is a real problem area for the future. The possibility of some type of institutionally based, policy based genocide for the undeserving. And this
needs to be dealt with. Dick, I don't know how much that was further discussed after I left, if you would like to ... We had a couple of hands up.
UNIDENTIFIED SPEAKER 7: Carroll, I saw your book around the symposium and just looking at the title I thought, I'm not going to buy that book and I'm sure not going to read it. Because it was already producing anxiety and my anxiety level had just permeated the ceiling I think. Now I'm serious about that. But I certainly commend you if your book is anything like the presentation tonight I think it's a superior analysis and interpretation, though very frightening and so I commend you on that.
UNIDENTIFIED SPEAKER 8: It's impossible to get a copy.
UNIDENTIFIED SPEAKER 7: Some of the other questions that have been stated tonight [placed me?] that dialectic also, in terms of the caution against age separatist, [philosophers?], policies, etc. At the same time, we meet with older people who ask for a separate Department of Aging, for example, and to try to cooperate and accommodate in that kind of dialectic is difficult for those of us who are evil service providers, and I say that facetiously. I
guess I feel somewhat anxious in that kind of situation, I think I hear this from others in the audience. And I think somehow we'll have to -- that will be a problem in itself to solve that so that we can effectively work. I think the thing that is most frightening to me is I wonder if this can be accomplished in an evolutionary manner, and I'm wondering if [revolution?]. Because we're dealing with intrinsic, powerful, all pervasive, permeating, economic, governmental structures
that are basic to democracy or to what we call democracy in this country. So we're almost [at half hen?] to attack that which is the strength of our economy and our government, and so this is not a harmless kind of issue. And I don't know if any of the rest of you feel as uncomfortable as I do about this and I'm going to keep asking my theological questions.
I don't look to theology to solve all kinds of problems, but I'm still looking for theological constructs to instruct us about moral conduct and moral responsibility and a better life for all of us, aging, youth, the oppressed, the dispossessed, all of that. And quite frankly I'm not getting theological answers from [our?] denomination. I've asked to meet with the person to
[the level of the?] General Assembly and I've been told that our staff person does that. I don't know the policies of the task force on aging. I don't know the policies of the staff of the General Assembly. I have been fortunate to meet with this group, which I understand is a renegade group, Maggie, and I hope you do lots of renegading. But I do believe that theological perspectives and biblical perspectives of aging is very much lacking
and I'm going to continue to ask for that element in our discussions.
UNIDENTIFIED SPEAKER 9: I can give her a partial answer. I don't think you throw the whole bushel of apples because a couple rotten ones are around, although maybe you and I don't see the same thing. You see mostly rotten apples so you're going to throw the good ones away with it, and I guess you feel it's a lot worse than I do.
ESTES: You made a facetious remark about evil service providers. This is one of the things that I think I have been most misunderstood and unfairly maligned for, so I'd like to clarify. My concern about the Older Americans Act has been that it was in my mind the way to provide for indirect services and bureaucracy building that is planning and coordination and needs assessment, and
now geriatric screening, case management possibly in the future, as opposed to funds for direct services. Direct services are needed; I do not believe however they should be the centerpiece of our policy. Inadequate income, the independence and autonomy ought to be the centerpiece but of course services are needed. And I would be the last person to argue again them and I think this is something
I just wanted to clarify. I share the tension that you feel, or that I hear you expressing if I understand you correctly, about being opposed to an aging enterprise yet working in the aging field as such. And part of the way I make peace with it personally is that -- and this is in part an answer to your question about research on aging and training on aging --
is that the work that I do I hope will lead to the empowerment or to a critical understanding of what prevents the empowerment of myself and others of us in society and most particularly the aged. And that without doing research in this area I don't think we can understand the oppression that's
ongoing. I'm not saying research is the answer, it certainly isn't, income is the answer I think. But and in addition trying to make others aware of how our society views aging issues and how our society processes the aging in ways that keep the social order the way it is. I think it's a very important thing to do.
And we each attempt with a good heart to make the life better given the structure that we have and the fact that revolution is not likely in the immediate future. So in that sense I have no apologies for working in this field, but I will be an honest critic
and have to be tolerated as such.
UNIDENTIFIED SPEAKER 1: The questions that you have raised and others are very vexing, disturbing questions. And I have hope that just as Carroll has been the responsible disturber within her discipline. She has been the conscience and has
provided a kind of judgment and ethical analysis of what is going on within her profession. And I say in loving tribute to her she risked an awful lot, a hell of a lot, to write that book. And I think that are working in this field have a great deal of personal stake in it. Our future, however long that may be, is there, right there.
And I would hope that there could be as a result of this symposium and other conversations that we're going to have as a result of our being here, that there could be responsible insiders who could be a part of consistent continuous, even revolutionary change. And linked with the people who are the dispossessed, whether there isn't some new kind of social change
opportunity.
UNIDENTIFIED SPEAKER 10: May I speak for the evil providers; I think most of us evil pro-- I think Carroll's book is marvelous. I think it's great, doesn't threaten me a bit. Most of us evil providers are working away in our own little place with our little agenda of crisis and pseudo crisis and mini crisis and [hung?] crisis and papers to file to Washington and all that, and work very hard but with blinders, with very narrow vision. And I think it's only by looking at something
which looks at the thing overall systems wide that we can start to see what's going on and what it's all about. And I think this is the beginning of being able for everybody to get a handle on something which however well-intentioned or evil intentioned, has come about but which can be changed and modified. And getting back to the Church, I think that the Church is that body which has an office in every core place in
the country, where the Church can be an agency for helping to get that done, especially if there's one little Panther in the belfry ringing the bell. (inaudible). I really think it's a combination of a little nation, such as like Carroll's done in her book, and (inaudible) from the belfries by Panther type activism at the grassroots level. Not by the professionals
but by the people who are there to make these things happen. And I don't think it's as hard as it looks.
UNIDENTIFIED SPEAKER 11: Another factor I think somewhere somebody says nothing can stop an idea whose time has come. So we got to get the right idea. [Evidently?] these thoughts and the decisions that were behind the legislation and all the actions was taken a long time ago. Things have changed a lot since then, so all we're doing is updating and renewing which is what our Christian religion is all about. So let's get on with the job,
there's no better way of doing things, so let's go because we're wasting money and everybody seems to understand the pocketbook, you know what I mean, more people do than some of these other things. So just hit them in the pocketbook and somebody will holler, because you'll be on his toes. And we're talking about taxpayer's money here, I think we've got -- and the misuse of it.
And so we've got a powerful idea then let's clean up -- take off the chap, let the muscle show through, take off the fat, and let's roll.
UNIDENTIFIED SPEAKER 12: I think that sounds nice but seems to me we have a number of questions as to how anything develops which has a solid foundation in terms of political impact, and has also the inner resources to sustain itself. See I'm
... seems to me a couple of things are clear in listening to what Carroll has to say and some of our reactions thus far. One is that there are a growing number, maybe growing very slowly and still very small, of people like Carroll in all sorts of disciplines and places who
are sort of fighting their lonely battles with a little support here and there. And that can go on and it is going to go on. I think that more important than the question of how coalitions are built right now is how alienation augments. See I'm not too worried about the fact that when a group of women get together in New York from all the different feminist backgrounds
that they can't talk to each other. I'm not too worried about the fact that I spend a lot of time in north Philadelphia in the black community in the hopes of beginning to find some basis for interaction and mutual support. If that happens it's a miracle, it's not something I expect. You could site other examples of that, but I think that it's important for us to realize that in terms of how change comes about that the building of coalitions really
is a -- occurs in a relatively short period of time at the right moment to bring about change. And now what is much more important is the increasing awareness, experience of alienation and the transformation of people's values and perceptions that go with that. Now the thing that bugs me though is where does the next step occur
in terms of community building which has become a sort of center for the ongoing emergents [sic] of trial and error experience of all kinds, political activities of all kinds. And what I was trying to get at, and Carroll has mentioned this evening, this business of finding ways to take
control of our lives in one area or another. So it seems to me that where the activism of the '60s failed in at least one point was that it did not take seriously enough the fact that when a fundamental change is going to come about. It's called for, the pain that people go through is so great and the risks that they're taking are so great, and
the demands of the struggle are so great that only if something is happening that provides a new life for people that is more compelling then what they're going through with the breakdown of the old order, you don't have a political movement for change. And that's where I think the real question arises now, both in terms of political actions on the part of Gray Panther groups, and where does the Church go next.
Because I think that – see, there are a lot of interesting things to me, historical examples of this. If you think about the English revolution, if you don't mind my going into a couple of examples of this, but I'd like Carroll to comment. I'm really raising a question for you (inaudible).
ESTES: No, no, please.
UNIDENTIFIED SPEAKER 12: If you look at the English Revolution of 1684 it didn't happen because at a certain point there was a group of people came together politically out of nothing. It was built on a 100 years of the Puritan Conventicles, these little groups of religious people that got together because they couldn't fit in to the established Church. And somehow or other in the course of 100 years they moved from Calvinistic sovereignty of God
in completely religious terms to politics. The same thing that happened in the French Revolution, it took 100 years of [Salons?] to produce the French Revolution. Or you can go inside [Neagzembulus?] right now in Korea, the struggle is going on there is completely impossible without the existence of these small Christian communities that have developed over a period of five years
. But in all of these cases the thing that makes the difference is that people have found a new quality of life. And out of that discovery you have not just a few political activities, but a matrix for political creativity that is much more important than any one political strategy or tactic.
Now I don't know, Carroll, you present so many down to earth, concrete pictures of what's going on, but I'd be interested in your comment on this. Well, how do you see something beginning to emerge which gets at this? Because my experience with the Gray Panthers is a very limited one but just in the last few months the problem
I see is (inaudible) --
ESTES: I'm thinking about first of all how in the conservative era that we are entering I believe we're going to see a general de-legitimation of the aged that is a devaluing of all the aged, deserving and underserving, to the extent that they're defined as unproductive. And on the other hand because the deserving aged, even though de-legitimized in certain ways, have so
many more benefits there on the left side of that chart that they do not see the poverty of the benefit structure for other aged classes. And they therefore think everything is fine and they're making $700 off of social security and have a pension check and also have dividend income
, tax credits and so forth. So that their likelihood of joining such a struggle is limited, even though they are devalued as a broad group and made senile earlier than necessary and other things like that in that devaluation. So I think you're very astute in your
observation that to organize around a specific issue is much easier, much more likely. And I suppose unless we have an economic cataclysm or a nuclear cataclysm or something that is sufficiently dramatic in the next four years the basis for
organizing and creating the broad movement that will sustain the desire to endure the sacrifice and the potential threat of the destruction of the social order just is not possible. I don't see how I could possibly envision a strategy independent of something that would affect the life condition of so many people
with such consciousness of how that life condition was affected. And this is the thing about the class basis of policies. What I think was so important to me once it became clearer and clearer, is how invisible this is to most of us who work in the field and to most of the people who receive pieces of the quote/unquote benefits in the general public.