The sheer magnitude and scale of public and private income and health care programs under social security that have become an indispensable aspect of public policy captured the attention of researchers and policy makers, resulting in an overwhelming body of literature and wide range of disputable perspectives.
In recent decades, the scholarly and public literature has focused on perceived and real threats to the viability of income and health care programs for the elderly, especially social security systems. Much of the discussion has been related to analysis of the impact of aging populations and a shrinking dependency ratio of people who are working and contributing money through payroll taxes to finance those who are not. Research has also been conducted on the impact of diminishing government resources and the ongoing attempts to shift some, or even most, of the government burden for income support and health care from the public to the private sector, including transferring responsibility for managing programs from national to local governments. The findings of this research are inconclusive, leaving many unanswered questions, especially as to the sustainability of the public systems, and the presence of political power sufficient to dramatically alter such entrenched and popular programs.
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The edited text under review adds to our knowledge of two important but less frequently examined aspects of the debates about support systems for income and health in old age. The text is the ninth in a series of volumes on the economics of aging. The first five chapters of this volume discuss how the elderly accumulate, or fail to accumulate, wealth. The second six chapters examine how wealth is related to health, including mortality. Four chapters give an international perspective with two making comparisons between the United States and Britain. One examines experiences in South Africa and another discusses health in Russia. Several chapters are followed by commentary from an expert in the field that greatly enriches the content.
The authors draw on various sources of macro and micro secondary socioeconomic status (SES) data, as well as data on mortality rates from the Centers for Medicare and Medicaid Services, the Asset and Health Dynamics among the Oldest Old (AHEAD) panel study, and the Survey of Income and Program Participation (SIPP), among other data sources. The data are subjected to descriptive, analytical, and econometric evaluation. Many readers may not be totally familiar with the nuances and methods of econometric analysis, but there is ample discussion of the data presented in each chapter to make this an informative and interesting book to a wide audience.
Each chapter raises intriguing questions that are pertinent to both practice with the elderly and the development of social policies. This includes, for example, detailed discussion on what has contributed to the reduction of mortality rates of the elderly. Has it been public health? Better nutrition? Improved medications? Modified behavior? What, if any, is the significance of home equity on income and age? What is the source of household wealth? Does household pooled income provide more health protection for elderly members? What is the relationship between mortality, income, and income inequality? Is there a difference in the geographic utilization of medical care and mortality among the elderly in the United States? What has been the impact of the transition from employer managed defined benefit pensions to defined contribution programs?
The text addresses these and related questions using strong methodological approaches. The discussions are thoughtful and thought provoking. The authors of the book's chapters range over many topics of importance to understanding the needs of elderly people. Anyone interested in how the elderly are impacted by income and health care support policies and programs will find this book to be of considerable value.
Martin B. Tracy
University of Kentucky
