“It has been a long time comin”, as Sam Cooke wrote in his iconic 1960’s protest song, “A Change Is Gonna Come”. There are just a few hurdles left, but the prize is in sight for creating a true safety net for American elders.

On Friday, November 19, 2021, the House of Representatives voted to pass President Biden’s “Build Back Better” bill. It now goes to the Senate where it will undergo further wrangling until it is called for a vote. Democrats plan to use the reconciliation process as a strategy to permit the bill to be passed with a simple majority (51 votes) rather than the two-thirds majority that appears to be an impossible bar given the Republican opposition. Assuming it passes out of the Senate, it will be sent to the President for his signature. This will mark completion of the journey that started back on August 14, 1935.

The Problem is an Old One

Taking care of old people is not a new problem. Every culture and every society have encountered the challenges of determining who is eligible for being cared for, who responsible for providing that care, and what kinds of care are needed.

This is a values-centered question. Specifically, does the culture/society value elders sufficiently to accept the premise that care should be provided to them?   If yes, then who is responsible and how is it paid for?  If no, then what do we do with elders who are unable to care for themselves?  Most often these responses are framed in terms of economic impact.

“Entitlement Mentality”

Perhaps you are more familiar with this argument in how it has been presented politically:  that these benefits are “entitlements” rather than “earned”?  If so, you are not alone. There were any number of plans and programs put into place or promoted since colonial times here in the United States to address the problem of ensuring economic security for all members of the community. (For a well-written and fascinating history about social security, click here).

When Franklin Delano Roosevelt proposed his solution in 1934, it was seen as a boondoggle by Republicans. They opposed what they saw as government interference in individual’s lives. They remain consistent in this belief, in spite of overwhelming evidence demonstrating how lives have improved without giving away any individual freedom.

Lyndon Baines Johnson and the 1965 Medicare Act

It took 30 years for Congress to provide medical insurance as part of the social security net for aging adults. This oversight was addressed with the amendment to the Social Security Act signed by LBJ in August of 1965, and known to us as Medicare.

At least the Republicans are consistent. They fought tooth and nail to limit benefits under this Act, making the case that such a program would lead to socialism and loss of freedom of choice for Americans. Again, they were proved wrong. Medicare has resulted in more aging Americans living longer, healthier lives than at any time in our history.

Joe Biden and Build Back Better

We are closer than ever before in achieving the goal of meeting the changing needs of aging adults in a changing society. With Joe Biden’s Build Back Better legislation, eligible adults will have access to housing benefits, including rental assistance and funds for public housing, as well as tax credits for home repair. Expansions to existing healthcare programs, including home health, coverage for hearing aids, nursing home oversight, and caps on pharmacy costs for essential medications such as insulin, are provided. Additionally, increased funds are allocated to aid agencies involved in investigating and addressing elder abuse.

It just needs to get through the Senate, where (no surprise here) it is fiercely opposed by Republicans. Once again, they are suggesting by caring for one another, we are somehow moving into dangerous territory where the potential loss of freedom will bankrupt us and turn us into automatons. Based on results, this argument is misleading at best.

We Need to Speak in Terms of Values

We need to take this conversation out of the political realm and place it squarely in the center of a values conversation. Values include attitudes, beliefs, and behaviors that we use in making decisions. We get our values from our family and culture. They are not set in stone, but do tend to be relatively stable. They can be influenced through exposure to different ideas, actual experiences, and by formal study.

Categories of values inherent in this conversation include personal and family, social, political, religious, and economic. Your attitudes about aging, your experience with aging adults, and what you have been taught about what old age is will influence whether you agree that it is a good idea to see that aging adults have a safe place to live, adequate nutrition, access to good medical care, and a chance to remain active and contribute to the community they live in.

When Values Conflict

It is not easy to discuss conflicting values. For example, you may value fiscal responsibility and individual freedom. Yet, you may experience conflict or distress when you realize your mother does not have sufficient income to pay for the long-term care facility she needs.

It is much easier to discuss the merits of a particular piece of legislation and stand in the House of Representatives or Senate and speak of socialism and threats to freedom.

Change is Comin

In his Message of the President to Congress, on June 8, 1934, Franklin D. Roosevelt wrote:

Security was attained in the earlier days through the interdependence of members of families upon each other and of the families within a small community upon each other. The complexities of great communities and of organized industry make less real these simple means of security. Therefore, we are compelled to employ the active interest of the Nation as a whole through government in order to encourage a greater security for each individual who composes it . . . This seeking for a greater measure of welfare and happiness does not indicate a change in values. It is rather a return to values lost in the course of our economic development and expansion . . .

We are on the cusp of realizing the vision originally conceptualized by FDR back in 1935. What began then reflects the shared cultural values of caring for one another, compassion, tolerance, and respect for aging adults. These values have been sustained over the generations.

With passage of the Biden legislation, we can live up to our aspirational values of preserving the dignity of all citizens. Once and for all, we will commit our collective resources in service of those who no longer have the capacity to care for themselves. We will provide them with true social security; economically, in receiving quality healthcare, and in meeting their needs in their final days.

God willing, the Build Back Better legislation will become law.

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