• The current debate over the economic consequences of population aging is waging in the United States of America.

• Some argue that the number of older adults will bankrupt the social system and bleed the economy dry.

• Others argue that older adults should not be targeted and victimized in this debate.

• The older American population contains a large number of healthy, ambitious and entrepreneurial individuals.

• Innovative older adults are well-positioned to fill in gaps in industry and senior healthcare.

• Pitting older adults against younger individuals creates a zerosum fallacy, and may further marginalize vulnerable older adults.

• Policies based on equity should be explored.

Societies wrought by angst over an uncertain future often look towards specific populations as the cause of their woes, leading to a phenomenon described as ‘alarmist demography’ [1] or ‘apocalyptic demography’ [2,3]. In eras of rapid change, officials may enact public policies based on demography (comforted by the ‘scientific’ basis) in an effort to preserve the status quo [4]. Examples of such reactionary policies are abundant in United States history. In the early 1900’s, as American society faced enormous social and economic upheaval, the American people railed against the perceived threats of fertility and migration in ‘undesirable’ populations [4,5]. Between the 1900’s and the 1970’s, the United States forcibly sterilized approximately 64,000 citizens through a variety of public programs aimed at stemming births among individuals deemed unfit to reproduce [4,6]. Similar programs focused on damming the flow of immigrants - most notable are the Chinese Exclusion Act (1882-1943) and the Immigration Act of 1924 (aimed at Southern and Eastern Europeans) [4,5]. As American society again faces turbulent socio-economic changes, once again demography is in the spotlight with a growing unease over the ever-increasing older population [7]. An unease that has plagued the United States for at least the last twenty years [1] and surfaces with force during economic crises [8]. The United States, it seems, is returning to the theme of ‘the aged as scapegoat’ [8,9]. The Malthusian Catastrophe, as penned by Thomas Malthus in his 1798 An Essay on the Principle of Population, described a world in which unchecked population growth outstrips the resources needed for survival, eventually imploding society [10]. Malthus’ theory reverberates in the current debate over the consequences of population aging. The Malthusian Catastrophe has become a Methusian Catastrophe.

Over the next thirty years the number of older adults is expected to double [11,12]. The United States, once characterized by substantial birth rates, is now considered a long life society [13]. The post-World War II baby boom gave way to declining fertility rates, with increases in family planning and contraceptive use [11,14]. Advances in medical technology and public health, once focused on infectious disease, now concentrate on chronic conditions associated with the aged, decreasing mortality rates among older adults [15,16]. Life expectancy is on the rise - from 47 years in 1900, to 68 in 1950, and to 78 years in 2008 [16-18]. Life expectancy for American men (which is typically lower than American women) has already increased over 10 years since 1950 - from 66 to 80 - developing the medical means to address heart disease, stroke, cancer, diabetes and other debilitating conditions could increase longevity by upwards of 15 years [14,18,19]. As fertility and mortality rates drop and longevity increases, the ratio of young to old begins to skew in favor of the old, with the proportion aged 65 and over at 12.3 percent in 2005 and expected to reach 19.3 percent by 2030 [11,17,20]. Although still a small percentage of the total population, the number of centenarians (aged 100 and over) is thought to have increased from 2,300 in 1950 to 50, 000 in 2000 [16]. Estimates have 40 million people reaching aged 65 and over, with 5.5 million individuals reaching age 85 and over in 2010 [20]. The United States population is steadily aging.

An aging population carries with it economic implications. Older individuals utilize more health care than those under age 65 [21]. As it stands, 40% of federal government spending goes to programs targeting older adults - such as Medicare, Social Security, Medicaid, and veterans’ benefits [12]. At current rates, individuals aged 65 and older (13 percent of the population) consume 30% of health care monies [19]. In other words, 2.5 of the U.S. gross domestic product and 5 percent of the U.S. gross national product is spent on health care for older adults [15,21]. Furthermore, a combination of decreasing youth and increasing older adults may work together to create an impending shift in the dependency ratio (the ratio of those capable of production-either goods or services - to those unable to work) [22,12]. This ratio is predicted to shift from 100 workers supporting 29 non-workers (in 2000) to 100 workers supporting between 43-52 non-workers (in 2030) [22].

Twenty years ago, fiscal conservatism and the fear of a growing older population [8] led to calls for age-based rationing of medical care [23] and ‘generational equity’ [24]. Since that time, some have foretold the eventual bankruptcy of social systems as older adults, with their expensive disabilities and long, drawn out deaths, disrupt the dependency ratio and bleed the economy dry while destroying public pension plans and other payroll supported services [19]. At the outset of a new age in health care for the United States, with the Supreme Court upholding the Affordable Care Act, older Americans are still characterized as an expensive, disability-ridden, looming threat in popular media [25]. Labels like “silver tsunami” imply an impending, destructive crash of older adults [25]. Older Americans are characterized as causing enormous increases in health care costs, outliving their own financial resources, breaking the Social Security system, and bringing socio-economic burdens upon younger generations [19]. As a result, societal resources are expected to shift from education to long-term care and medical costs [22]. Tax rates may increase to compensate for a rise in public spending due to the growing proportion of elderly with major disabilities, and health care coverage might shrink as a result [17]. We are warned that The Elderly, like the “undesirable” immigrants of the past, will cause wage deflation and compete with younger workers in the labor market [26]. This may bring about an ‘entitlement crisis,’ where a work-force minority must financially support an elderly majority, creating a support system akin to an unstable inverse triangle [12]. Bankruptcy will follow as older adults strain whatever government-supported system they interact with, be it the prison system or social safety nets [27,28], due, in some part, to ‘aging polities’ [29]. As the Baby Boomers age into Medicare and Social Security, and draw down their retirement, media pundits predict a “coming generation war” between older adults (with the “moneygrubbing demagogues at the American Association of Retired Persons” on their side) and the younger workforce [30]. If left unchecked, this crisis was predicted to endanger all accomplishments of western culture [31].

Addressing the demographic shift without scapegoating older adults is vital. Marginalizing an already vulnerable older population effectively further disempowers older Americans, and minimizes their agency and voice in society. Formulating an economic crisis as a zerosum game between older adults and children or younger, working adults deceives us into focusing on the characteristics of the vulnerable populations rather than the unequal power distributions [32], and does a great disservice to all. This zero-sum game removes the possibility that the underlying theories behind the entitlement crisis predictions, based on conjectures concerning dependency ratios, fertility, mortality, immigration, disabilities, and long-term care utilization, could prove false [4,15,22,33-35]. Also, it ignores that American society, due to its diversity in opinions and talents, and its economic structure and innovation - as can be seen from America’s track record of national achievements - is well positioned to overcome difficulties such as changes in demographics related to the baby boom population [36]. Perhaps most importantly, it reinforces the concept that older adults are only valued when they produce for society (the ideal of the ‘career self ’), trapping us all on a linear life course focused on productivity and efficiency to the detriment of self-development [37]. Policies based on equity, such as the ‘equal regard for all persons’ model proposed by Martinson and Halpern [38] should therefore be explored.

Finally, in regarding all persons equally, the possibility of older adults contributing to the health and well-being of others in their own age cohort should be expanded. While we must be cautious not to focus solely on productivity and efficiency, we cannot ignore that the older American population contains a large number of healthy, ambitious and entrepreneurial individuals. The recent rapid growth of start-up businesses spearheaded by older adults speaks to this [39]. Innovative older adults are well-positioned to fill in gaps in industry and senior healthcare, and stand as a reminder that the future is not as grey as the alarmists lead us to believe.

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