The Promise of a New America

By Mae Elise Cannon


Great movements of social reform were born out of the civil upheaval of the 1960s in the United States. Fighting the injustices of race toward people of color, the Civil Rights Movement challenged laws and social practice particularly toward the menacing treatment of African Americans. The Women’s Movement was a response to women’s lack of access to jobs, equivalent pay, and demeaning treatment compared to their male counterparts. Political and social leaders were cut down as one by one leaders of movements were assassinated from President John F. Kennedy, followed later in the decade by Martin Luther King, and Bobby Kennedy. The Vietnam War raged with strife and disagreement about US involvement. The 60s was also a time of political reform. When Johnson assumed the presidency after the assassination of Kennedy, he proposed a set of domestic programs identified as the Great Society. These programs intended to create social reform for the elimination of poverty and racial injustice. The Great Society legislated spending and reform toward education, health care, urban issues, and transportation. Medical care for the elderly was at a crisis point as early as the days of Truman’s presidency. Those moving into retiring age worried that their lifelong commitment to work and save would be depleted with increasing healthcare costs. The burden for care fell largely upon young families who often were not economically stable or independent in their own rite, let alone with additional resources to care for ailing parents, aunts and uncles, or other family. Society had no perception that long-term medical care was needed, except for those who were poor. The health care changes introduced by Harry Truman were made law under Johnson’s Great Society program. Many of the reforms of the Great Society have been excised or eliminated, but the medical aid programs are among the few that prevail: Medicare and Medicaid. 

Prism Magazine is Evangelical’s for Social Action’s premier bi-monthly magazine that encourages a vision of relevant, compassionate Christian witness in our culture. The following excerpt from Who Will Defend the Widows: The Growing Cost of Health Care in the United States and Why Women Are Bearing the Biggest Burden was published in Prism Magazine (November/December 2007) and can be found in it’s entirety here.

“No longer will older Americans be denied the healing miracle of modern medicine.  No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.  No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles and their aunts. And no longer will this Nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive country.”

A vision for the Great Society had been declared. Medicare would respond to the needs of the those 65 years and older to ensure that they had affordable access to medical services. On July 30, 1965, President Harry Truman was the first Medicare beneficiary. Medicaid, established with less intentionality and forethought, was in response to the healthcare needs of the under-resourced. Although access to healthcare for the impoverished was prevalent in the 1960s, the Medicaid program was not largely perceived as a need by the general public. The program is jointly funded by both the federal and state governments and serves low income parents, children, seniors, and people with disabilities. Medicaid is the largest source of funding for medical and health-related services to those with limited access to resources.

When Johnson declared his vision for the Great Society in the United States in 1965, he perceived a culture where men and women nearing the end of their lives would need access to affordable healthcare. It was never considered that the elderly would need access to long-term care in a way that is commonplace four decades later. During the mid-twentieth century, men were the primary providers and it was not commonplace for women to work outside of the home. As the generation of World War II veterans and their counterparts near the end of life, more often than not the pension, retirement, social security, and other fiscal resources are provided by the man of the household. In the 1960s, approximately 40 percent of women worked outside the home. This number has steadily increased to over 70 percent of women in the past several decades. This is significant because many of the women today who are over 65 years of age have never had to worry about working outside of the home or managing their family resources.

Men and women in the 1960s were dying at younger ages, so the working generation did not necessarily have the foreknowledge to financially prepare and plan for the health needs that they would have later on in life. With increasing technology and medical services, as the decades past, people began to live longer and longer. According to the Centers for Disease Control and Prevention and the National Center for Health Statistics, the average life expectancy for a man (of all races) in the United States in the 1960s was 67 years old compared to 73 years old for women. Forty years later, the average expected age increased to 75 years old for men and 80 years old for women. Men and women today are consistently living five to ten years longer than proceeding generations. It is important to note as well, that the life expectancy varies according to race with whites living longer than people of other races. For example, white men in 2004 were expected to live 76 years compared to 70 years for their African American counterparts. As life expectancy has increased, more and more people are living longer. Medicare programs were not designed with the thought that millions and millions of Americans would live to be nearly a century old. Today, the fastest growing segment of the population is those over the age of 85 years old. As increasingly more people are reaching there 70s, 80s, 90s, and even a century old, the long-term care crisis facing the healthcare system has become proportionately alarming.

Medicare was developed as an acute care model where more benefits are extended the more curable the illness or malady. If someone is not able to get better because he can’t bathe himself, dress himself, or he has dementia, Medicare services are not readily available. Today, almost half of those over the age of 80 years old who live in the United States have some type of dementia. About 80% of those age 65 and older have one chronic condition and two-thirds have two or more. The health care ailments of these individuals are not considered treatable by the acute care provided by Medicare. According to a study at the Population Studies Center (PSC) at the Institute for Social Research at the University of Michigan, Medicare has sizable gaps; most notably it fails to cover extended hospital stays or most long-term care. By 2020, over 80% of all health care expenditures will be spent for people with chronic conditions; direct health care for chronic conditions will exceed one trillion dollars in expenditures. This means a neglect of care for people who fall through the gaps and are in need of extended hospital stays or long-term care. The result is an increasing number of elderly who are living below the poverty level and an extreme burden on families caring for their elderly loved ones. 

In today’s Medicare system, if an individual has a long-term care need that is not able to be responded to by acute care, it is the individual’s responsibility to cover health care costs until the point that he or she is impoverished. Once that individual only has two thousand dollars in assets remaining, when their income is low enough, only then will they be eligible for health care services through Medicaid. The elderly are increasingly concerned that their limited social security benefits and pension will cover the costs of their long-term care needs that are continually being abandoned by Medicare.

One of the main predicaments facing our society today is the lack of financial stability for elderly widows. Because our current healthcare system favors care for those who are in need of acute care, elderly women are burdened by spending their family retirement on meeting their partners long-term care needs. Men may or may not be eligible for Medicare based on their physical situation. If their illness is not attended to by Medicare, Medicaid only kicks in once most of the families investments and other securities are already diminished – leaving women with limited resources to sustain their own care once their husbands have passed away.

Lyndon Johnson’s promise of the reforms of the Great Society to support and provide health care to the elderly while alleviating the burden of younger generations as they carry out the noble act of carrying for their relatives has been broken. Throughout the Scriptures we see God’s call to his people to respond to the needs of the poor and the oppressed, including the elderly. Leviticus 19:32 states, “Rise in the presence of the aged, show respect for the elderly and revere your God. I am the LORD.” What is the role of the church in understanding and responding to the healthcare crisis facing elderly in America today? Scripture also says to “give proper recognition to those widows who are really in need” (1 Timothy 5:3). Certainly God cares about the plight of the widows and would have His followers engage in advocating on their behalf. We may be a long way away from the Great Society that President Johnson described in 1965, but as Christians we are called to be aware, engage, and advocate on behalf of the elderly, particularly as it pertains to the plight of the elderly in crisis of long-term care.

Mae Elise Cannon is executive pastor at Hillside Covenant Church in Walnut Creek, California. She formerly led the social justice ministry at Willow Creek Community Church in Barrington, Illinois.