AARP: Shades of Old Age

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A little over a year ago I went off salary at The Hastings Center, keeping a few duties but losing the formal status that gave me health insurance through private carriers. I promptly signed up for Medicare coverage and simultaneously for the AARP medigap program. Since I write on health care and aging I was naturally curious to compare Medicare coverage with the earlier private coverage, and to see if medigap was as good as advertised. I have been pleased on both counts and have felt even more economically secure than I had earlier. But I haven’t really put them to the test, deciding simply to avoid all serious illnesses, long-stays in ICUs, and rare forms of metastasizing brain cancer for which there is a $200,000 painful treatment good for three-to-four extra days of life.

What I could not avoid was paying $15 a year charge for a subscription, with accompanying membership, to AARP The Magazine, required as part of the medigap plan. I did not complain: a $15 a year charge for any magazine is a good deal. I was also curious about AARP, an enormously successful outfit with a nonprofit and a for-profit branch. It is a good example of meeting the traditional test of Washington success (where its offices are), that of starting out to do good and ending up also doing well. It has had lots of critics over the years for that mix, but that doesn’t interest me nearly as much as trying to figure out, reading the magazine, just what its take on aging is. It is well edited in modern terms, with lots of pictures, small boxes full of factoids, colorful illustrations and typefaces, and celebrity interviews.

The issues the magazine takes up are varied and cover most of the main issues of aging. What it doesn’t much cover are those in the 80-plus age group–unless of course it is someone at 85 who recently finished a marathon and was photogenically met at the finish line by his new 50-year-old wife and their two little twin IVF-procreated children. (Yes, I made that up, but it is true, in some higher sense or other).

When I first heard about the AARP, I believe the membership age was 60 or 65, but it later dropped to 50. When you think about it a bit, this seems a bit odd. The usual story is that people are now living longer and old age is starting later. The notion that the line for aging could be pushed lower, all the way down to 50, seems counterintuitive. But it kind of makes sense for an organization that mixes philanthropy and profit: enlarge the potential market both up and down in age.

Moving the age down now captures not just the young-old and the old-old, but those who might be called the geriatric pre-K group, those who will someday be old but are approaching that stage with trepidation and some anxiety. The unrelenting thrust of the magazine is to remove fear among the pre-K group about the road ahead. It is full of hope: featuring plenty of glowing, thriving, attractive 50- and 60-year olds–but you have to look just great, not a day over 50, in order to be featured as a 70-year-old. Banished from that scene is the retirement stereotype I was raised on, that of playing golf every day for the men and grandma visiting the grandchildren for the women; and not much anymore about taking cruises. Now it is social activism, good citizenship, joining up with some high-minded cause, walking 30 minutes a day, and continuing to enjoy sex. .

A political scientist friend recently contended that the American system of values has now effectively been reduced to three: safety, health, and choice. Well, it is more complicated than that but not too far off. Those three values are on regular display in the magazine: a desire to be safe from unexpected dangers, to be independent and free to make lifestyle choices, and especially to be in good health.

My most recent issue warms up with “5 Ways to Beat A Cold” and, on the same page, a paean to drinking caffeinated coffee, which can lengthen life, reduce the risk of Alzheimer’s, and help muscles relax after strenuous exercise. Three cups a day is best, but there was no mention of the likelihood that the recommended three cups also induces more daily trips to the bathroom. I guess that is a good tradeoff.  

Another section of the magazine had four “Tests That Could Save Your Life”: capacity to name a famous face in a picture (dementia), assessment of sleep quality (early clues for Parkinson’s), ability to smell peanut butter (early Alzheimer’s), and strength to open jars (disability in later life along with postoperative complications and premature death). The one about opening jars, I confess, really brought me out of the closet, and they could have added any purchased item enclosed in hard plastic. That feature was followed by touting the benefits of three red fruits (for a stronger heart).

A later section of the same issue makes use of public opinion data on “How Americans Really Feel about Aging.” Some 45% of us think others believe we look younger than our age. In my own case, I think it would be 98%, but then my friends are more perceptive than most Americans. Another feature of the survey found that as people get older they find aging easier than they expected, and that was also true with their expectations about their energy. But the surveys stop with people in their 70s. I can testify that it gets tougher after that, probably even if you are the old marathoner with twins.

Daniel Callahan, 83, is cofounder and President Emeritus of The Hastings Center and the author of the recently published “Medical Progress and Global Chronic Disease: The Need for a New Model” in the Brown Journal of World Affairs. 

 

9 Responses to “AARP: Shades of Old Age”

  1. Carol Eblen

    I see you are in good form. Your comments about AARP were entertaining, interesting and informative. I once tried to chastise the AARP for advertising “franchising” in a published article as a wonderful opportunity for the retired while failing to inform their paid readers and trusting members that 50% of all small businesses, including franchises, fail in the first five years.

    The AARP has convinced the American public who has great respect for the AARP that THEY will fight to protect Medicare for future generations of Americans. We note, however, that the AARP is also fighting to protect their own huge profits made from selling Medicare GAP and other insurance policies to the American people. Forbes, in an article in 2012, wrote “How the AARP Made 2.8 Billion by Supporting Obamacare’s Cuts to Medicare.”

    But! if we follow the money, we know that this will lead to both the Republicans and the Democrats who have both put BIG INSURANCE into the position of managing the people’s social program and safety net for the profit of Big Insurance, Big Medicine, and Big Pharma. Medicare might be in trouble but their partners are all doing very well for themselves.

    You will have to be careful now that you are in your handsome and healthy 80’s and on a Medicare GAP policy. I’m sure that you have no fear of a unilateral covert or overt(default) DNR Code status being extrapolated into YOUR hospital chart to hasten your death without your informed consent. I know that you are opposed, personally, to involuntary passive euthanasia and physician assisted suicide and are aware that covert rationing, which is involuntary euthanasia, can be accomplished by just “not paying” for the treatment. (I listened to a speech of yours on the Internet. Thank God for The University of Google.”)

    Won’t you and The Hastings Center please blow the whistle for others in their 80’s on Medicare/Medicaid who aren’t aware of the danger they may face when admitted to an Acute Care Hospital that receives public funds?

  2. John T (Jack) Garland, MD

    As a retired endocrinologist, I have seen both sides of medicine. AARP has done a service by promoting discussion of issues relating to aging, but I also have been critical of their dependence upon funds from insurance firms. I think we would all be better served by an improved MEDICARE for everyone. Physicians and other providers now must deal with hundreds of insurance carriers and thousands of plans. This non-system is perpetuated at a cost of about 31% of our health care spending. A single payer system, such as traditional Medicare, could cut that to perhaps 2 or 3%. The 400+ BILLION saved could pay to cover everyone. Paying for this via the tax system would also increase mobility for workers, who currently are often tied to their jobs to keep insurance.

    AARP would have been a good group to raise that possibility — IF they were not so dependent upon the insurance carriers.

    Best regards to Daniel Callahan, who led the way for many of us to consider ethical questions for the last 40+ years.

    JTG 06 MAR 2014

    • Carol Eblen

      So True! Dr. Garland. I am with Public Citizen who continues to work for “single pay” Medicare for All as the only realistic means of providing health care to all Americans as a human right and civil right of the citizens of our great democratic Republic.

      But, of course, Big Insurance fights against this initiative of “single pay” that would save millions in administrative costs and they have the $$$$$ to prevent this from happening.

      Because the non-system we have now has permitted much over treatment of Medicare/Medicaid patients for the profit motive, If and when Justice and HHS wins their lawsuits against the oncologists for overtreatment for profit that is a violation of the federal false claims act, this will stop a lot of over treatment for profit of Medicare/Medicaid patients, won’t it? And, for many years now CMS and Big Insurance have not been reimbursing the hospitals/physicians for non beneficial over treatment as well as mistakes, errors, etc. of Medicare/Medicaid patients ..

      it appears, however, that the autonomy of both physicians and patients will be sacrificed as Big Insurance and Big Hospital negotiate the terms of payment under Medicare/Medicaid and Big Insurance reimbursement protocols.

      The recent growing trend of hospitals purchasing the practices of physicians and the physicians becoming employees of the hospitals will mean that Big Insurance and Big Hospital will be negotiating and writing Medicare law. Will IPAB work for BIG Insurance and Big Hospital or for the people who have paid Medicare and Social Security Taxes all of their working lives?

      In the meantime, who will stop the involuntary euthanasia of the elderly/disabled Medicare/Medicaid patients who are the victims of over treatment and adverse events who are hastened unto death with unilateral covert and overt(default) hospital DNR code status?

  3. Robert Shabanowitz

    What a coincidence. Just moments ago, I admit, I joined AARP not for the Medigap program, but rather the free donut (with purchase of coffee) at Dunkin’ Donuts and, what looks like a good deal on a AARP cash-back credit card. I figured the donut would provide incentive for a 5K run and I’d earn a few cents if I used the credit card for my coffee purchase. I think I’ll advocate for a new AARP credit card that earns points for your deductibles and co-pays. Of course, that may not be necessary because, working for a large “non-profit” health system, I have the promise that if I let them into my genes and provide full access to my EMR, I will be rewarded with personalized medical care. Which brings me back to my coffee and donut.

  4. Nancy Mott

    Dan, thank you for wording so gracefully what many of us older ones also feel.

    I joined AARP as soon as I turned 50 some 27 years ago, deciding that if I were to get old anyway (which I certainly hoped to do), I might as well enjoy the advantages of aging, some of which are provided by its membership: lovely discounts; an engaging magazine with lots of tips (you sample them nicely); an informative newsletter; and a hugely effective lobbying force for an age-cohort I would soon join. I still appreciate and strongly support AARP.

    I avidly read AARP’s helpful tips, though noting from time to time how advice see-saws: example from a couple of years ago: ‘how to buy drugs safely from Canada’; two months later: ‘buying Canadians drugs isn’t safe’; (I dug out the previous issue to make sure I remembered it right: did FDA complain?), but while taking everything with some salt, I basically appreciate reminders to eat well, exercise, socialize and smile.

    Now I’ve been in the over-70 age for a few years and I’m tired of feeling invisible. I find off-putting the magazine’s unrelenting focus on celebrities the age of my son (whom you know) with but an occasional sprinkle like your hypothetical 85-year-old marathoner whose genes and good fortune give such extraordinary physical or mental stamina as to make me wonder if I’m already disabled.

    Certainly you’ve put your finger on one clear example of aspects of our culture that ill serve both us and society: 1) a determined avoidance of many important issues of aging and death, both of which should be seen as a positive part of ‘the good life’ regardless of one’s physical health; and concomitantly 2) a glorification of youth and youth culture–arguably unhealthy for folks of all ages.

    Side note: I find particularly galling how often AARP Magazine features advice on how to deal with an irascible or demented parent. What a stereotype! And if I’m irascible or demented, might I still not appreciate media help to cope?

    Again, thank you for both your writings and your example. You’re just a bit older than I and you inspire me.

  5. Li-hsia Wang, MD, FAAP

    I’m with Jack Garland–Medicare for ALL (improved, of course, to include at least teeth and ears and long-term care as needed)! Medicare’s overhead is indeed only about 3-4%. Speaking as a pediatrician, I think of how much money would be saved if we started Under 18 to over 65. And SO much better than Medicaid.

  6. Li-hsia Wang, MD, FAAP

    I meant to say “added Under 18” not “started”

  7. Lynn Simpson

    I just turned 65, receiving SS benefits and had great private insurance. Ughhhhh, I was quickly ‘cut off’ (although the insurance co still collected my premiums for 3 months!) I found out that I was automatically ‘enrolled’ in Medicare and had to sign up and pay for Part B (still trying to figure out the other parts of the alphabet. You do not address what happens to those of us that read through the ‘benefits’ of medicare, medigap, advantage that don’t apply to them — there is no alternative medicine, no acupuncture, no natropathic care, no cutting edge research. there is end of life and hospice. Double ugghhhhh.
    I paid my taxes, I am paying for part B, I am paying for advantage care. My out of pocket is now more than my private coverage and I am not covered for anything. What AARP is addressing is all the ‘feel good’ koolaid that is fed to us and says nothing to the anger and frustration we feel.
    Basically, social security, medicare and adminstration “where’s my money”?

  8. Glen

    Invaluable ideas , I learned a lot from the insight , Does someone know where I could acquire a sample NYC RPIE-2010 Instruction document to type on ?