To the Barricades!

On this weekend of the Women’s Marches—175,000 of us marched in Boston alone—it’s fitting to remember that aging is predominantly a women’s issue. Robert Butler, the founding father of contemporary geriatrics, made the point powerfully and persuasively in a short article in the New England Journal of Medicine in 1996, "On Behalf of Older Women—Another Reason to Protect Medicare and Medicaid." Sadly, the observations and concerns he raised 20 years ago are exactly the ones we face today as President Trump nominates Tom Price, foe of Medicare and Medicaid, to serve as head of the Department of Health and Human Services, and Paul Ryan, Speaker of the House, hopes to finally succeed in carrying out his long-standing goal of privatizing Medicare.

Butler begins by saying that old age is a territory populated largely by women.” Updating the data he presents: life-expectancy at age 65 is 17.9 years for men and 20.5 years for women, which means that women typically outlive men by at least 2.5 years. Since death rates are higher for men throughout much of the lifecycle, this means there are currently 25.1 million older women in the US, compared to only 19.6 older men. The ratio of men to women falls with age: in the 65-74 year old bracket, there are 86.9 men for every 100 women; among those over age 85, there are only 48.3 men for every 100 women.

Butler continues: “Proposals to curtail Medicare and Medicaid, if enacted, could leave beneficiaries, the majority of whom are women, paying more out of pocket for what may be less medical care.” He reminds us that the concern about Medicare and Medicaid have arisen “because political leaders want to balance the federal budget…while giving some Americans a tax cut,” not because of concern about quality of care. His words could have been written today instead of 20 years ago. And alas, older women are apt to live in poverty today, just as was the case when Butler wrote: the median income of older people in 2013 was $29,327 for men—but only $16,301 for women. Put differently, 6.6 percent of older men live below the poverty line, compared to 11 percent of women.

The theme of aging as a women’s issue was picked up by acerbic social commentator Susan Jacoby in her 2011 book, Never Say Die: the Myth and Marketing of Old Age. She points out that the household income of women is cut in half when their husbands die. Unequal pay for equal work has a cumulative effect: pensions are lower for women. Women who take time out of work to raise a family are rarely able to compensate for the loss of wages, seniority, and missed promotions. Because women typically live longer than men, they are more likely to become frail, to develop dementia, and to be widowed. As a result, fully two-thirds of nursing home residents are female. And the issues that affect older women in general affect older women of color in spades.

As we pressure the government to preserve reproductive health rights, to institute equal pay for equal work, and to enforce laws that prohibit discrimination based on sexual orientation, we should also pressure government to maintain and improve health care for older women. That means protecting Medicare and Medicaid, subsidizing supportive housing, and assisting family caregivers--at last report, there were 34.2 million Americans providing unpaid care for an adult over age 50 and two-thirds of these caregivers were themselves over 65. So to the barricades!

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