[The tightening economic connection to longevity has profound
implications for the simmering debate about trimming the nation’s entitlement
programs. Citing rising life expectancy, influential voices including the
Simpson-Bowles deficit reduction commission, the Business Roundtable and
lawmakers on both sides of the aisle have argued that it makes sense to raise
the eligibility age for Social Security and Medicare.]
By Michael A. Fletcher
ST. JOHNS COUNTY, Fla. — This prosperous community is the picture of the
good and ever longer life — just what policymakers have in mind when they say
that raising the eligibility age for Social Security and Medicare is a fair way
to rein in the nation’s troublesome debt.
The county’s plentiful and well-tended golf courses teem with
youthful-looking retirees. The same is true on the county’s 41 miles of
Atlantic Ocean beaches, abundant tennis courts and extensive network of biking
and hiking trails.
The healthy lifestyles pay off. Women here can expect to live to
be nearly 83, four years longer than they did just two decades earlier,
according to research at the University
of Washington. Male life expectancy is more than 78 years, six years
longer than two decades ago.
But in neighboring Putnam County, life is neither as idyllic nor
as long.
Incomes and housing values are about half what they are in St.
Johns. And life expectancy in Putnam has barely budged since 1989, rising less
than a year for women to just over 78. Meanwhile, it has crept up by a year and
a half for men, who can expect to live to be just over 71, seven years less
than the men living a few miles away in St. Johns.
The widening gap in life expectancy between these two adjacent
Florida counties reflects perhaps the starkest outcome of the nation’s growing
economic inequality: Even as the nation’s life expectancy has marched steadily
upward, reaching 78.5 years in 2009, a growing body of research shows that
those gains are going mostly to those at the upper end of the income ladder.
The tightening economic connection to longevity has profound
implications for the simmering debate about trimming the nation’s entitlement
programs. Citing rising life expectancy, influential voices including the
Simpson-Bowles deficit reduction commission, the Business Roundtable and
lawmakers on both sides of the aisle have argued that it makes sense to raise
the eligibility age for Social Security and Medicare.
But raising the eligibility ages — currently 65 for Medicare and
moving toward 67 for full Social Security benefits — would mean fewer benefits
for lower-income workers, who typically die younger than those who make more.
“People who are shorter-lived tend to make less, which means that
if you raise the retirement age, low-income populations would be subsidizing
the lives of higher-income people,” said Maya Rockeymoore, president and chief
executive of Global Policy Solutions, a public policy consultancy. “Whenever I
hear a policymaker say people are living longer as a justification for raising
the retirement age, I immediately think they don’t understand the research or,
worse, they are willfully ignoring what the data say.”
A Social Security Administration study several
years ago found that the life expectancy of male workers retiring at 65 had
risen six years in the top half of the income distribution but only 1.3 years
in the bottom half over the previous three decades.
In 1980, life expectancy at birth was 2.8 years longer for the
highest socioeconomic group defined in a research study than the lowest,
according to a report by the Congressional Budget Office.
By 2000, the gap had grown to 4.5 years.
“Life expectancy has increased mainly among the privileged class,”
said Monique Morrissey, an economist who focuses on retirement issues at the
Economic Policy Institute, a liberal-leaning research organization. “For many
people, raising the retirement age would amount to a significant benefit cut.”
Advocates of raising the retirement age say only a relative handful
of older workers would be harmed and that the vulnerable could be protected by
enacting hardship exemptions. Meanwhile, they say, with a wave of baby boomers
moving toward retirement and health-care costs always on the rise, the
retirement programs are sustainable only if people are willing to pay higher
taxes or accept fewer benefits.
Overall, life expectancy has improved substantially since the
first Social Security payments were issued in 1940. Then, a man who made it to
65 could expect to live 12.7 years, compared with 18.6 years in 2010. A woman
who turned 65 in 2010 could expect to live 20.7 more years, compared with 14.7
in 1940.
That trend helped persuade lawmakers in 1983 to slowly move the
age people could receive full Social Security benefits from 65 to 67, a change
that will be complete in 2027. Now, as the cost of providing old-age benefits
has emerged as the key driver of the nation’s long-term budget deficit, there
is increasing pressure to again raise the retirement age — this time for both
Medicare and Social Security.
But given the widening differences in life expectancy for people
on opposite ends of the income scale, “that would mean a benefit cut that falls
heaviest on people who generally are most reliant on Social Security for their
retirement income. It is totally class-based,” said Eric Kingson, a Syracuse
University professor and co-chair of Social Security Works, a coalition opposed
to reducing old-age benefits.
The gap in life expectancy has widened as the country’s economic
life has grown more bifurcated. The high-income Washington region includes two
counties with some of the nation’s longest life expectancies. In Montgomery
County, life expectancy was 81.4 years for men and 85 years for women in 2009.
In Fairfax County, it was slightly lower — 81.3 years for men and 84.1 years
for women.
In the District, where 18.7 percent of the population lives
in poverty, life expectancy was 72.6 years for men and 79.6 for women in 2009.
Not only is life expectancy diverging by income level, but now
some demographic groups — particularly low-income white women — are losing
ground.
A study published last week in the journal
Health Affairs said that in almost half of the nation’s counties, women younger
than 75 are dying at rates higher than before. The counties where women’s life
expectancy is declining typically are in the rural South and West, the report
said.
Putnam County shares many of those characteristics. Forests,
picturesque lakes and the beautiful St. Johns River, the longest in Florida,
dot the area. But amid that rural splendor there are few good jobs and,
officials said, little access to medical care.
Even people who have health insurance often struggle to make it to
doctor appointments, complicating efforts to manage chronic diseases.
“I see a lot of people with uncontrolled diabetes or who haven’t
had their high blood pressure treated in a year or more,” said Terrence Soldo,
medical director for St. Vincent’s Mobile Health, which runs regular medical
clinics in Putnam. “There are health-care deserts out here.. . . There is
a lack of access because there are not enough doctors around.”
County health rankings by the Robert
Wood Johnson Foundation show that there is one primary care
physician for every 2,623 residents in the county. One county east in St.
Johns, there are more than double the ratio of family doctors, one for every
1,067.
The problem goes beyond access. In St. Johns, residents are more
likely to seek out information to bolster their health. Even when St. Johns
residents do not search for health information, medical professionals say they
are at minimum more likely to follow doctors’ orders.
“Being more affluent and educated, you are likely to have better
access to information and you are also more likely to want it,” said Joe Gordy,
chief executive of Flagler Hospital, which is in St. Johns County.
Jeff Feller, chief executive of WellFlorida Council, a
state-designated regional health-care nonprofit organization, described Putnam
as part of “the Southern disease belt.”
With 38 percent of its children in poverty and just
31 percent of its population with even some college education, there is
little wonder why more than a fifth of Putnam residents are in poor or fair
health, double the rate in St. Johns.
Adults also smoke at nearly double the rate they do in St. Johns,
and they are far more likely to be obese and far less likely to be physically
active, according to rankings developed by the Robert Wood Johnson Foundation.
“It doesn’t take a rocket scientist to figure this out,” Feller
said. “You just have to look at the socioeconomic and demographic differences —
unemployment, education levels, income between the two counties — to understand
what is going on. This is fueled by poor economics and a lack of access to
health insurance and health coverage.”
Those differences are compounded by the resource gap separating
the two counties. With a healthy tax base that is recovering from the
recession, St. Johns officials are in a better position than those in Putnam to
address problems as they arise. When St. Johns officials learned of a change in
the infant mortality rate, they quickly joined forces with local nonprofit
groups to get information out encouraging prenatal care.
Cyndi Stevenson, a member of the St. Johns County commission, said
the county has formed similar partnerships to tackle a wide range of problems.
The result is a county ranked as one of the healthiest places in Florida.
Putnam, meanwhile, is ranked near the bottom.
She added that the county’s relative wealth helps make life not
only better for its residents, but also longer. “A good economy does a lot for
a family,” Stevenson said.
