Beyond Medicine by Paul V. Dutton

Author:Paul V. Dutton
Language: eng
Format: epub
Publisher: Cornell University Press
Published: 2021-01-03T00:00:00+00:00

3

After Work in the United States and Sweden

The Swedes themselves are not entirely sure what they have done right.

—Paul Krugman, The Great Unraveling

Uppsala, Sweden. I wake in an unfamiliar bedroom, flooded with sunlight. I had arrived from Paris in the wee hours, and my friend had insisted that I would be more comfortable lodging at her grandmother’s house than at her own small apartment. Chatting voices now emanate from downstairs although I was told that Grandma lived alone. I dress and descend the stairs to meet her. She is eighty years old, slim, and sharp of mind but unsteady on her feet. Attending to her breakfast and daily medicines is a nurse whom I learn comes regularly to help with the various activities of daily living, such as dressing, laundry, meals, and bathing. She also provides preventive and routine health care. These nursing services are administered by the city of Uppsala, Sweden’s fourth-largest. Local governments are the principal providers for the nation’s elderly. In-home care that allows Grandma to age in place is universally available in Sweden, a major factor in the nation’s rank as the third-best country in the world in which to grow old according the Global AgeWatch Index.

The Global Age Watch employs four criteria to rank the well-being of those over sixty years of age in ninety-six countries: 1) health outcomes, including total life expectancy and healthy life expectancy at age sixty; 2) income security, including pension coverage, the old-age poverty rate, and measures of income and consumption of elderly people relative to the rest of the population; 3) capability, including the employment rate and educational attainment of elderly people; and 4) enabling environment, including measures of social integration, physical safety, civic freedom, and access to transportation. The United States ranks ninth in the Global AgeWatch Index, a far better performance than we have seen in previous chapters on comparative indices for infant, child, and working-age adult health outcomes.1 This relatively strong US performance reflects a higher state commitment to the health of the elderly, namely through Social Security and Medicare. Medicaid, the US health coverage for low-income families, also plays a major role. In fact, one-fifth of Medicare’s forty-four million beneficiaries, a number that is growing by ten thousand per day, also qualify for Medicaid assistance. Medicaid pays the fees for 63 percent of all nursing home residents, 54 percent of adult day service centers, 15 percent of those who live in residential care communities, and 9 percent of all home health agency fees. Although Medicaid was not originally created for such a role, it has become an essential component of America’s system for providing health care to elderly people.

Despite the substantial combined efforts of Medicare, Medicaid, Social Security, and local and private programs, America’s elderly suffer from health deficits that accumulate during childhood and their working years due to harmful social determinants, gaps in health care coverage, lack of attention to prevention, and lifestyle choices. As a result, America’s elderly are sicker when compared to their counterparts in similar-income European nations.

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