Round Table: Grey Matters
One of the biggest changes taking place in the developed world today is its aging. Here in B.C., those aged 65 and older make up about 15 per cent of the population, up from 10 per cent in 1979; that portion is expected to reach 23 per cent by 2030, according to BC Stats. And similar shifts are being seen in wealthy nations around the globe.
The baby boom generation is like the biggest ship in the bay: its giant wake influences the course of all others. And as that generation slides out of its current wealth-churning place in the workforce and into traditionally high-maintenance old age, leaders everywhere – both in politics and in business – struggle to imagine and prepare for the consequences. And that’s where things get tricky.
Does the greying of our population constitute a crisis to our health-care and finance systems that will compel us to make serious sacrifices to our standard of living? Or is that just fearmongering? Are we in fact better prepared for the shift than we realize – already making the subtle changes in our economy that we’ll need to adapt?
To help sort out where B.C.’s economy and public policies stand relative to this slow and predictable evolution, we’re joined by Andrew Ramlo, executive director of the population research institute Urban Futures; Gloria Gutman, professor emeritus and founder of SFU’s gerontology research centre and co-leader of the B.C. Network for Aging Research; and Adrian Dix, health critic for the BC NDP and former chief of staff to premier Glen Clark.
What is B.C.’s demographic situation today?
ANDREW RAMLO (left): There is a lot of talk about an aging population, and that’s quite simply manifested itself in the post-World War II baby boom generation. Right now the leading edge of that generation is over the age of 60, approaching 65. And the most typical person in B.C. is in their late 40s. Under a lot of common projections, the population over the age of 65 is going to grow almost five times more rapidly than the working-age population, those aged 25 to 64.
GLORIA GUTMAN (centre): Population aging occurs for two reasons: because you have more and more people living to be old and because there is a drop in the birth rate. People are not getting married and not making babies, and the birth rate has dropped around the world like a rock. We are down to 1.5. In Korea, they are down to 1.2. Around the world in various countries they’ve tried paying money to women, but that doesn’t do it. The Scandinavians have gotten themselves back to the replacement level, 2.1, basically by beefing up child care.
What is it about our aging population that has people so concerned?
GUTMAN: Well, it depends on whether you want the doom-and-gloom or the good-news scenario. Because the doom-and-gloom scenario is that all those old people are going to overwhelm the health-care and pension system. But it really depends on how you do your projections. If you project from a static situation, then you see some increases in health-care costs, but there are changes in practice and changes in the health of the population that need to be taken into consideration. When my father-in-law had his cataracts out, he was in the hospital for two weeks lying there with tea bags on his eyes. Today a cataract operation takes 20 minutes. You are in there for maybe two hours, total. And there are a number of other kinds of health-care practices where it’s been the same kind of thing.
So what does this look like from Victoria’s perspective? Surely this situation presents a challenge for future governments.
ADRIAN DIX (right): We’ve seen this dramatic increase in life expectancy in the 20th century, and this is all good news for us as human beings. The bad news, I’d argue, is that the way the baby boom generation has engaged in politics is problematic for its own self-interest. The development of the welfare state really benefited the baby boom generation when we got education. The advance in post-secondary education, K-to-12 education, all those things, were built up over those times and paid for by the generation who are currently seniors. And when the generation that benefited from that welfare state got to its highest earning years, there were dramatic cuts in marginal tax rates. Baby boom politicians and baby boom voters have engaged in these kinds of policies – things that will not benefit them perhaps when they move to become seniors. If we continue to limit the capacity of the state to support us when we need those services – which are important for the quality of life of seniors – it’s going to really come back to haunt us.
GUTMAN: With the last recession, much of the blame was put on the seniors population, and that was an excuse to cut services 10 years ago. If you look at the continuing-care system in B.C., it was a model for the rest of the world when it began in 1978; literally, people came from afar to study our system. But over time it has been eroded. Now to get into a bed in a care facility, you have to be very, very frail. The average entry age is 85. At the same time, there were cuts in the home-care side. So the preventive side got cut too. We’re now trying to maintain what we’ve got and trying to regain a little bit of what was here before. In terms of future cuts to senior services, I don’t see what they’re going to cut, because they already did it.
DIX: But they are going to cut. The health authorities are dealing with a shortfall of $319 million.
RAMLO: These cuts are economically driven, in the short term, and we’ve certainly seen other challenging times where there have been cuts to the general system. But these demographics change like a glacier: very, very slowly. And we can look and see what these longer-term changes are within some of the economic cycles.
The reality is, the cost of providing quality care to everyone is going to be falling on the shoulders of the working-age population, which is rapidly decreasing relative to the seniors population. Over the last decade, we’ve seen about a 35 per cent increase in per-capita health-care spending, once adjusted for inflation – well in excess of what the population has grown. And the rule of thumb is that as you get into those older stages of the life cycle, for every 10 years, your health-care costs on a per-capita basis just about double, and the last couple years of life are the most expensive. That demographic pattern of increasing costs with age plus increasing cost generally has the potential to pose some real challenges to the system.
DIX: But it’s not correct to say that the growing seniors population is a primary driver of that increase in health-care cost; it has been the per-patient cost. There is a tendency to discuss these issues in terms of seniors being some sort of burden on society, which isn’t true.
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