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AGING IN AMERICA: FUTURE CHALLENGES, 

PROMISES, AND POTENTIAL 

FORUM 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

WASHINGTON, DC 

DECEMBER 14, 2011 

Serial No. 112–12 

Printed for the use of the Special Committee on Aging 

( 

Available via the World Wide Web: http://www.fdsys.gov 

(II) 

SPECIAL COMMITTEE ON AGING 

HERB KOHL, Wisconsin, Chairman 

RON WYDEN, Oregon 

BILL NELSON, Florida 

BOB CASEY, Pennsylvania 

CLAIRE MCCASKILL, Missouri 

SHELDON WHITEHOUSE, Rhode Island 

MARK UDALL, Colorado 

MICHAEL BENNET, Colorado 

KRISTEN GILLIBRAND, New York 

JOE MANCHIN III, West Virginia 

RICHARD BLUMENTHAL, Connecticut 

BOB CORKER, Tennessee 

SUSAN COLLINS, Maine 

ORRIN HATCH, Utah 

MARK KIRK III, Illnois 

DEAN HELLER, Nevada 

JERRY MORAN, Kansas 

RONALD H. JOHNSON, Wisconsin 

RICHARD SHELBY, Alabama 

LINDSEY GRAHAM, South Carolina 

SAXBY CHAMBLISS, Georgia 

DEBRA WHITMAN, Majority Staff Director 

MICHAEL BASSETT, Ranking Member Staff Director 

(III) 

CONTENTS 

Page 

Opening Statement of Senator Herb Kohl ............................................................. 1 

Statement of Senator Chuck Grassley ................................................................... 10 

Statement of: 

Rob Hudson, Professor of Social Policy at Boston University .............................. 2 

John Rother, President and CEO, National Coalition of Health Care and 

NCHC Action Fund .............................................................................................. 4 

Kathy Greenlee, Assistant Secretary for The Administration on Aging ............. 12 

Richard J. Hodes, Director of the National Institute of Aging ............................ 16 

Michael Harsh, Chief Technology Officer, GE Healthcare ................................... 18 

Jack Rowe, Director, MacArthur Foundation Research Network on Successful 

Aging and Professor at the Columbia University Mailman School of Public 

Health ................................................................................................................... 20 

Robyn Stone, Executive Director, LeadingAge Center for Applied Research ..... 22 

Henry Aaron, Bruce and Virginia MacLaury Senior Fellow, The Brookings 

Institution ............................................................................................................. 26 

Laura Carstensen, Professor of Psychology and the Fairleigh S. Dickinson, 

Jr., Professor of Public Policy at Stanford University ...................................... 32 

APPENDIX

PANELISTS STATEMENTS FOR THE RECORD

Rob Hudson, Professor of Social Policy at Boston University, Boston, MA ........ 38 

John Rother, President and CEO, National Coalition on Health Care and 

NCHC Action Fund, Washington, DC ................................................................ 57 

Kathy Greenlee, Assistant Secretary for Aging, Administration on Aging, 

U.S. Department of Health and Human Services, Washington, DC ............... 61 

Richard J. Hodes, Director of the National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services .................. 72 

Jack Rowe, Director, MacArthur Foundation Research Network on Successful 

Aging and Professor at the Columbia University Mailman School of Public 

Health, New York, NY ......................................................................................... 76 

Michael Harsh, Chief Technology Officer, GE Healthcare, Waukesha, WI ........ 79 

Robyn Stone, Executive Director, LeadingAge Center for Applied Research, 

Washington, DC ................................................................................................... 87 

Henry Aaron, Bruce and Virginia MacLaury Senior Fellow, The Brookings 

Institution, Washington, DC ............................................................................... 101 

Laura Carstensen, Professor of Psychology and the Fairleigh S. Dickinson 

Jr., Professor in Public Policy at Stanford University, Stanford, CA .............. 106 

(1) 

AGING IN AMERICA: FUTURE CHALLENGES, 

PROMISES, AND POTENTIAL 

WEDNESDAY, DECEMBER 14, 2011 

U.S. SENATE, SPECIAL COMMITTEE ON AGING, Washington, DC. 

The committee met, pursuant to notice, at 2:35 p.m. in room SD– 

G50, Dirksen Senate Office Building, Hon. Herb Kohl (chairman of 

the committee) presiding. 

Present: Senators Kohl and Grassley. 

Also present: Debra Whitman, Staff Director. 

OPENING STATEMENT OF SENATOR HERB KOHL 

The CHAIRMAN. Good afternoon to everybody. We thank you all 

for being here, and we thank you for joining us at this event this 

afternoon. 

Over the past 50 years, the Senate Special Committee on Aging 

has been in the thick of the debate on issues of concern to older 

Americans. With more than 10,000 baby boomers turning 65 every 

day, the issues affecting older Americans are only becoming more 

urgent. 

Throughout its history, this committee has continuously called 

attention and offered concrete solutions to a wide variety of problems affecting older Americans. From the cost of health care to retirement security to long-term care coverage options to employment 

opportunities for older Americans, and very much more, this committee has debated some of our country’s most difficult issues over 

the past half century. 

We are also proud of the Aging Committee’s long-standing tradition of bipartisanship. This kind of cooperation and the hard work 

of talented leaders, including Senator Grassley, who will be joining 

us today, has helped to further our country’s commitment to caring 

for some of our most vulnerable citizens. But we cannot rest on 

what we have accomplished thus far. Much more needs to be done. 

And to get there, we need the help of experts, people like many of 

you who are here today. 

We need to put Social Security back on a long-term path to solvency and strengthen our nation’s pension systems so that Americans can plan for a secure retirement after a lifetime of work. We 

must reign in rising health care costs and grapple with how to finance long-term care so that seniors can live independently for as 

long as possible. 

More than most, older adults are feeling the effects of the struggling economy and local service cuts. Now is not the time to let 

2 

home- and community-based programs, such as those funded by the 

Older American Act, languish. As our nation ages, policies that improve the lives of older Americans will become even more critical 

to helping the entire economy. 

By 2030, when the last of the baby boom generation reaches retirement age, nearly 20 percent of Americans will be over age 65 

compared with 13 percent today. 

I am hopeful that we will find the courage to craft an innovative 

and effective path forward for the greater good of our nation’s seniors and our country as a whole. 

I have been chairman of this committee for nearly five years, and 

we are all proud of everything that we have accomplished. But 

today we are here to learn from you, the real experts, and we look 

forward to this discussion. 

I also want to take a moment to recognize and thank the former 

staff of this committee, some of whom are with us here today. 

Please know that your hard work has made a difference in the lives 

of older Americans. 

With that, I will turn things over to the Aging Committee’s staff 

director, Deb Whitman, who has been with me for the entire five 

years that I have been chairman, and she will be moderating this 

forum. As all of you who know Deb are very much aware, I will 

be putting you in very capable hands. We thank you again, and we 

thank all of our distinguished panelists for being with us today. 

Deb. 

[Applause.] 

Ms. WHITMAN. Thank you, Chairman Kohl. It has been an honor 

to serve under you for the last five years. We have done a lot together and looked at a lot of issues, but there is more that needs 

to be done. And the purpose of this forum today is both to look 

back at our history and look forward to our future. 

Our first panel is a distinguished group, who will be able to talk 

about the historical importance of the committee, as well as its impact on aging policy. I would like to introduce Rob Hudson, who is 

a professor and chair of the department of social policy at Boston 

University School of Social Work. He has written widely on the politics of aging, and he currently serves as editor of the ‘‘Public Policy 

and Aging Report.’’ Then we will have John Rother, who is the 

president and CEO of the National Coalition on Healthcare. Prior 

to joining the coalition, John served as executive vice president for 

policy, strategy, and international affairs at AARP. Mr. Rother also 

served as staff director and chief counsel at the Senate Special 

Committee on Aging under Chairman John Heinz. 

Rob. 

STATEMENT OF ROB HUDSON, PROFESSOR OF SOCIAL POLICY 

AT BOSTON UNIVERSITY 

Dr. HUDSON. Thank you very much. Senator Kohl, Ms. Whitman, 

thank you for inviting me here. I feel like I am bringing gold to 

Newcastle in some ways. Many of the people in this room are closer 

to the events of the past 50 years or 20 years perhaps than I am. 

But I have been an observer of the committee and aging policy for 

several decades, and I am pleased to be able to, however briefly, 

share a couple of thoughts with you. 

3 

The first thing I would like to mention is that I also serve as editor of the ‘‘Public Policy and Aging Report,’’ which is the quarterly 

publication of the Gerontological Society of America, and we have 

an issue that has just come out which is associated with this event 

honoring the celebration of the committee’s 50 years. And we would 

be happy to make that issue available to anybody who would like 

to see it. 

As you know, the committee began as a subcommittee back in 

1959. It became a full committee in 1961. It was brought very 

much into existence by the issues around rising costs in health care 

of the early 1960s, and had a central role in the band wagon effect 

that led to be an advancement of Medicare in 1965. And, in the 

spirit of bipartisanship, it is always good to remember that Part A 

is Democratic Medicare, and Part B is Republican Medicare. And 

there is a whole history on how that took place in the early 1960s. 

There have been a number of legislative successes that the committee has been associated with around the Older Americans Act 

and events that brought it into being, and the expansions in the 

1970s, many associated with Arthur Fleming and the creation of 

the Aging Network. It also played a central role in the decades-long 

battle to try to elevate the Commission on Aging’s office higher into 

the officialdom of HEW, and later as HHS. And, in fact, the first 

paper I wrote years ago had an assistant secretary of the Department of HEW testifying before this committee, saying, ‘‘Senator, I 

don’t believe that the AOA should report to the Secretary’s office. 

We are the Department of Health, Education, and Welfare. If we’d 

wanted to call it the Department of the Young, the Middle Aged, 

and the Elderly, we would have done that, but we chose not to.’’ 

In any event, as we know, today there is an assistant secretary for 

aging, and the committee helped create that reality. 

A number of additional successes in the 1980s, many associated 

with the late Senator John Heinz, were very important. There were 

also, in addition to legislative accomplishments, the committee has 

been actively involved in oversight activity, which has been extremely important over the years. Some of the early efforts associated with Senators Smathers, Chiles, and Moss involved investigation of nursing home fraud and abuse, with the developments in 

aging publication of the committee, putting out reports with titles 

like, ‘‘The Litany of Nursing Home Abuses,’’ ‘‘Drugs in Nursing 

Homes: Misuse, High Costs, Kickbacks,’’ ‘‘Doctors in Nursing 

Homes: The Shunned Responsibility,’’ ‘‘Access to Nursing Homes 

By Poor Minorities.’’ These were very, very powerful reports when 

they came out, and have had an enduring effect. 

Senator Heinz and Chiles worked together in the 1980s around 

DRGs and eligibility recertification issues associated with the DI 

and SSI programs, and Senator Grassley has continued to be actively involved in oversight of issues, many associated with longterm care in nursing homes. And today under Senator Kohl’s direction, the committee is very interested in issues around prescription 

drug costs and the idea of trying to indeed increase the availability 

of generic equivalents. 

In conclusion, let me just say that in its early years, the committee brought the needs of the aged to the country’s attention, and 

played a role in the passage of a major decade’s worth of legislation 

4 

from the mid-60s to the mid-70s. Much attention turned to oversight in the following years, with the committee pressing to assure 

that benefits associated with those legislative enactments were accessible, affordable, and of high quality. And working with authorizing committees, both elected members and staff members of those 

committees, the Special Committee on Aging has been able to combine resources and efforts to keep a close watch on the workings 

of executive branch agencies. 

Finally, the committee, especially under its most active chairmen, could pick its battles, devote its resources, mobilize its allies 

in a timely and needed way, what I would call sort of a SWAT 

team for elderly. Thank you very much. 

[Applause.] 

STATEMENT OF JOHN ROTHER, PRESIDENT AND CEO, NATIONAL COALITION ON HEALTH CARE AND NCHC ACTION 

FUND 

Mr. ROTHER. Good afternoon, Mr. Chairman. Thank you for holding this event. It gave me a chance to look back a ways at the Committee’s impact on older Americans, and I think it is a remarkable 

story what has happened to the life situation of older people. Truly, 

their lives have been transformed in part because of the work of 

this committee. 

Fifty years ago, the situation of Americans 65 and older was very 

different than it is today. Economic security in retirement was limited to a relatively small part of the population. Health insurance 

was either unavailable or unaffordable for most. And there were 

few social services or housing alternatives to support those who became frail or disabled. Most seniors in the 1960s were dependent 

on family, neighbors, or charity when faced with adverse events, 

and many died prematurely due to poor social and physical living 

conditions or lack of good medical care. 

The changes have been profound, and, of course, there are still 

issues that need to be addressed. But I think we should take a second just to recognize some of the impact of this committee’s work 

on the lives of older Americans. 

As Rob pointed out, I think the first thing you have to point to 

is the committee’s work on health care, which certainly contributed 

to the enactment of Medicare. Medicare is just not a health insurance program; it has transformed our health insurance system. It 

has transformed health care in America, and it has certainly become a major pillar of economic security for seniors and the disabled. So, it is much more than just a health insurance program. 

The committee investigated many problems associated with 

health care, including pharmaceutical pricing and marketing. It did 

a lot of work that eventually led to the enactment of the drug benefit in Medicare in 2003, and, more recently, to the expansion of 

that benefit as part of the Affordable Care Act. And, as a result, 

millions of seniors each year can now take advantage of the very 

important benefits that prescription drugs provide without having 

to choose between food or the medicine they need. 

The committee’s work also resulted in the adoption of a hospice 

benefit in Medicare. That’s significant, because it supports the 

quality of life at the end of life. This is something that I know from 

5 

personal experience, and I am sure others do, too. It is important 

not only to the person who is facing the end of life, but especially 

to the family who is there with them. 

Perhaps no aspect of health care has received more attention 

from the committee over the years than problems in long-term 

care, and, as Rob mentioned, the Committee has undertaken a long 

series of investigations into problems in nursing homes. After 

DRGs were enacted, the phrase ‘‘quicker and sicker’’ was a way of 

focusing attention on the problems in post-acute care, which had 

not been looked at very seriously until then. And as a result, now 

I think there is a much greater commitment to the whole continuum of care. So health care policy is no longer about just what 

goes on in the hospital, but it includes community-based care, the 

follow-up care in the home, and ambulatory care. 

Again, we still have work to do, but Medicare has been transformative in the way that health care today is organized. The benefit goes not just to people who are receiving that care, but to the 

family members as well, who are no longer faced with the total disruption in their lives when a parent or spouse becomes ill. 

The committee led efforts to support research in aging that resulted in the establishment of the National Institute of Aging at 

NIH. It also, as Rob mentioned, was a leading advocate for a strong 

Administration on Aging within the executive branch, which has 

been key to support of the whole network of aging services now 

vital in every county across the country. 

Housing programs are now much more responsive to the needs 

of older people, whether it is the 202 Program or a wide range of 

other housing programs. The committee’s theme was the integration of needed services, along with the bricks and mortar, and putting those together. As a result, we are seeing much more responsive housing programs and housing options for people as they get 

older. 

A wide range of consumer protections are now in place through 

the committee’s work, whether in financial products like reverse 

equity mortgages or living trusts and guardianship arrangements. 

I think the committee has had a leading role in giving life to consumer protections that really benefit all Americans, not just older 

Americans, but where the problems were easily dramatized with 

older people. 

Today, we still have problems with elder abuse. The committee 

has had, throughout its tenure, a focus on elder abuse, and the 

public exposure, I think, has had a tremendous impact in the lessening of those problems. But, again, we have continuing needs 

there. 

The committee has long championed productive aging, promoting 

employment and volunteer service options for those who want or 

need to work. And we are starting to see a change in the behavior 

of people with regards to the retirement age, and we are seeing a 

big change in the role of women in the workforce, in part because 

of the committee’s advocacy to eliminate the mandatory retirement 

provisions that were in place until the mid-1980s. Many low income seniors have also been helped by their special inclusion in 

various job programs, particularly Title V, that would not exist but 

for the committee’s advocacy. 

6 

And, finally, I will just mention that income security today is 

much stronger, in part due to the committee’s long focus on this 

area, whether it is the social security solvency amendments that 

were adopted in 1983, and the enactment of ERISA before that. 

The Committee also played a leading role in blocking what could 

have been very negative changes in social security in 1981 and 

again in 2004. 

The committee has focused on disability insurance, a very important, often overlooked issue, and it has resulted in changes in disability that have benefitted many of our most vulnerable workingage Americans. 

In conclusion, I would say that the Senate Special Committee on 

Aging continues to play a vital role in improving the lives of older 

Americans. Its work over the past 50 years has had a major impact 

on the lives of most seniors and their families. The chairs and 

ranking members, in particular, have used their positions on legislative committees, such as Finance, HELP, Budget, and Appropriations, to achieve legislative changes that were developed in the context of the Aging Committee. The committee continues to be the 

only place in the legislative branch where the situation of the 

whole person can be reviewed, where in-depth investigations can be 

launched, and where the members and staff have the time to delve 

into issues that other committees simply cannot take the time to 

consider. 

Looking forward, the committee faces the twin challenges of the 

retirement of the large boomer generation, and the ever-increasing 

costs of health care. The committee’s success in addressing these 

future challenges will, therefore, be critical to the quality of life for 

all Americans in generations to come. 

Thank you very much. 

[Applause.] 

Ms. WHITMAN. I would like to ask both John and Rob to think 

about the past and the future and how we can use the lessons that 

we have learned. And I want to remind everybody when they respond, to please turn on their microphones. 

So, John, I have found that the Aging Committee’s lack of specific jurisdiction legislatively is an advantage because of the range 

of issues that we can address. I think you just referred to it as the 

ability to review the situation of the whole person, but it also 

makes it harder to actually move legislation through Congress. 

So, how has the design of a special committee then, having broad 

jurisdiction, but lack of legislative authority, been both a benefit 

and a curse over the years? 

Mr. ROTHER. Well, the benefit is that it’s very broad mission allows it to be entrepreneurial—to package ideas and build support 

for those ideas that then the member, or the chairman, or the 

ranking member can take to the committee with legislative jurisdiction. And that is extremely powerful. Most of the accomplishments that I have reviewed today were developed in the committee. 

Political support was developed with the committee. And then, 

sometimes through cooperation with the legislative committee, but 

sometimes over the objections of the legislative committee, something was enacted into law. 

7 

Of course, the downside of not having direct jurisdiction is that 

other people have to be persuaded in order to move, and other people have other priorities. And today, I think we face a particular 

challenge because the needs of older people are not often seen as 

a top priority, and so there is real competition in the public debate. 

And that gets reflected in the ability to work with other committees. 

Ms. WHITMAN. Rob, your testimony ended with a reference to the 

Aging Committee as being sort of a SWAT team for elders, and I 

kind of like that, especially because we have had Jack Mitchell, the 

Committee’s Chief of Oversight and Investigations, as our private 

cop for several years. 

I found the committee’s investigative and oversight authorities to 

be a useful way to gather information and highlight abuses on a 

wide variety of issues, including conflicts of interest in medicine, 

medical device recalls, nursing home abuses, and products that are 

aimed to elderly consumers. 

Can you reflect on the oversight work of the committee through 

the last 50 years, and how important has that oversight authority 

been to its mission? 

Dr. HUDSON. Okay. Indeed, the oversight function has been very 

interesting, because even in reviewing the history of the committee, 

but social policy more generally, is, in the wake of the Great Society programs, a whole subfield in policy studies emerged under the 

rubric of policy implementation and oversight. There had not been 

enough domestic policy, apart from checks coming out of the Social 

Security Administration, to really worry about implementation. 

And I think there has been sort of an evolution in the committee, 

not 100 percent of course, moving toward the oversight checking on 

the implementation of various policies, including heavy duty issues 

such as fraud and abuse, but also around efficiency, and effectiveness, and all sorts of things from the Aging Network through 

health and disability programs across the board. 

So, I think this function is enormously important, because the 

heyday of new legislation, the new authorization, sort of petered 

out after the late 70s. And whether it is this committee or something else, there has been an enormous need to keep an eye on 

what providers have been doing and what agencies have been doing 

to follow up on their legal obligations to run programs in a compassionate and effective way. 

So, I think, A, it is critically important, and, B, just emphasizing 

what John said, that I think the committee is extremely well suited, both in terms of the breadth of the things it can examine, but 

also in some ways being free from some of the more immediate authorization appropriation issues that would impede a broad oversight function. 

Ms. WHITMAN. Anything to add? 

Mr. ROTHER. Well, I think, as you well know, Deb, being staff director of this committee is a complete luxury and a very unusual 

role, because you have the ability to look across a very broad spectrum of the population, of the economy, of needs, and you can go 

where you want to go. You can help set the agenda, lift up problems or the public to see, and promote broad policy solutions. And 

8 

there are not too many other places in Congress where that ability 

exists. 

And, as a result, I think that the Aging Committee can be much 

more responsive to some of the social and economic developments, 

not just within the older population, but more broadly, compared 

to the committees that have to be concerned with reauthorizations 

and meeting deadlines. 

So, I really value that flexibility and breadth of vision for the 

committee, and I hope that that continues. 

Ms. WHITMAN. Whenever I get together with former staffers or 

former staff directors and tell them the issues that we are working 

on in the committee or thinking about working on, I am usually 

met with, oh, yeah, we did that back in 1972, or, we held a hearing 

almost exactly like that, you should see the report that I wrote. 

There are obviously perennial issues that both of you raised. 

But what are the issues that maybe have not gotten enough attention over the years, or that were touched on in the early years 

that we should pick back up based on all of the reviews you have 

done, and, John, your years of watching us work? 

Dr. HUDSON. Is that directed to me? 

Ms. WHITMAN. Both of you. 

Dr. HUDSON. Go ahead. 

Mr. ROTHER. Well, there is no shortage of problems that still 

need to be addressed, despite whatever attention we gave them. 

Today, there are more and more older people who want to continue 

to be productive, and the economy is not supporting that. And 

there are more and more people who need to continue to be productive and continue to earn. So, that is an area that certainly requires more and more attention. 

I also think that as we have put off for many people the age at 

which disability or frailty happens, we have this huge reservoir of 

productive capacity, if you will, that we still have not figured out 

how to tap in terms of our volunteer programs, in terms of helping 

to meet the community needs, in terms of how to meet the needs 

of younger generations. So, those are areas that all seem to be worthy of continuing. 

Dr. HUDSON. I would just build on that. I have a concern about 

the future, having studied aging politics for a long time, that there 

has been sort of a bifurcation, and John alludes to it. We obviously 

have successful aging, productive aging, a lot of things that Jack 

Rowe has written to. 

We also have obviously a whole series of issues associated with 

chronic illness and long-term care. And politically, much of the success older people have enjoyed over the years is based on a reality 

and partial stereotype of being in need, being frail, being poor, and 

all the conditions we know of. 

Now, in the face of successful and productive aging, and volunteerism, and civic engagement, we are getting something of a 

split, which is sort of a good news/bad news situation. And, in 

short, the politics I worry about are we could end up sort of recreating sort of a residualized, very old population who gets benefits 

because they are just monsterably down and out and we feel sorry 

for the poor souls. And much more conflict and political concern 

about an able, productive, old population that basically if they do 

9 

not need it, why are we giving it to them? And how do we address 

that? Do we simply raise retirement ages? Do we introduce new 

functional tests of one kind or another? 

And there is an ethical issue of really is the aging population a 

single beneficiary group, or is it not? And I think people like us 

need to address that question because it is behind a lot of the 

issues that we hear about today. 

Ms. WHITMAN. Thank you. The two agencies that are fundamental to the Federal government’s work on aging, the National 

Institute of Aging and the Administration on Aging, exist today in 

large part to the Aging Committee’s advocacy and drive to establish. We are fortunate to have the two heads of these agencies with 

us here today, who you will hear from shortly. 

But how do we get the rest of government, including the Labor 

Department, the Environmental Protection Agency, the Justice Department, and others to look at their own work through an agefriendly lens and champion the cause of older Americans? 

Dr. HUDSON. That has been the central challenge of the Older 

Americans Act and aging policy for 40 years. It is the central challenge of the Aging Network, whether it should be a vertically integrated series of community and social services largely within its 

own purview, or should it do advocacy and what my late colleague, 

Bob Mitsock, and I call leadership planning in order to get mental 

health departments, transportation departments to do better by 

older people in the larger population. 

It is a very serious discussion to have about resource allocation. 

Can you do better sort of staying within the parameters of your 

world, however defined, or do you have the resources and the will 

and the ability to move and shake outside that relatively narrow 

structure and make bigger things happen? And I am certainly in 

favor of the latter, but getting it done is a very, very tall order. 

Mr. ROTHER. If I could just add to Rob’s answer, one of the 

things that we used to do was to require every executive agency to 

write an annual report as to what it was doing with regard to the 

challenges facing the older part of the population. And that can 

then become the basis for follow-up, for investigations. And it a report seems innocuous, when actually it is just the opening wedge 

to get more responsive behavior out of the executive branch. 

Ms. WHITMAN. Thank you both. I am going to move to our next 

panel, who we will hear from the country’s leading experts in 

health, research, retirement security, technology, long-term care, 

and aging services. 

We have asked these speakers to not only describe how far we 

have come over the last several decades, but also to play the role 

of fortune tellers and predict where we are headed as a society 

with a rapidly aging population. 

I also gave them the ability to wave a magic wand and create 

a new future by changing the trajectory of the path that we are 

currently traveling. And to make the challenge truly difficult, I 

have only given them each five minutes to speak. [Laughter.] 

Ms. WHITMAN. So, before they bring out their crystal balls and 

magic wands, let me briefly introduce each speaker. 

Kathy Greenlee is the Assistant Secretary for Aging at the U.S. 

Department of Health and Human Services, where she works to 

10 

advance the health and independence of older Americans and their 

families. Previously, she served as the Secretary of Aging for the 

State of Kansas, as well as the Kansas State long-term care ombudsman. 

Dr. Richard Hodes is the director of the National Institute of 

Aging at the National Institute of Health. A leading immunologist, 

Dr. Hodes was named director of the NIA in 1993, and oversees research into the clinical, epidemiological, and social aspects of aging. 

Michael Harsh is vice president and chief technology officer of 

General Electric Health Care. In his role, Mr. Harsh oversees the 

diverse businesses, including medical imaging and information 

technologies, medical diagnostics, patient monitoring systems, and 

drug discovery. 

I have just been informed we have Senator Grassley here, so I 

am going to break the introductions and give him a chance to say 

a few words. 

STATEMENT OF SENATOR CHUCK GRASSLEY 

Senator GRASSLEY. I had to look over to see who is up here, distinguished people performing already. I am sorry I missed everything you have said so far, and I will probably miss everything else 

you say. [Laughter.] 

First of all, let me thank Chairman Kohl for his work as chairman of the committee. It seems like he and I have worked together 

on many issues, and he has been an extremely good chairman of 

this committee. And thank you for your hard work. 

Since Senator Kohl is going to retire, I am going to miss him in 

his retirement. But like I tell a lot of former senators, any time you 

want to come to my office, you are welcome to come to my office. 

[Laughter.] 

Senator GRASSLEY. And, of course, with the 50th anniversary of 

this committee, and particularly since I was one of the charter 

members, in 1975 with the beginning of the House Committee on 

Aging, and serving there the six years I served there, obviously I 

wanted to serve on this Committee when I come to the United 

States. And I had the privilege of being on this committee probably 

for, I believe, about 23 or 24 years, I believe. 

Anyway, it is a tremendous opportunity to serve as chairman of 

the Special Committee on Aging, and I did that from 1997 until 

2001. I had the good fortune of following another good chairman, 

Senator Bill Cohen of Maine. And my successor was John Breaux, 

who was my partner on the committee as ranking member then. 

And I know I am biased, but the Aging Committee offers one of the 

greatest opportunities for service on Capitol Hill, and serving on 

the Aging Committee got me very much working very closely with 

a loyal staff member for so many years, both prior to my being 

chairman and after being chairman. And that is one of the people 

that is here in the audience by the name of Ted Totman. There is 

Ted Totman there. 

And, yeah, as I think Senator Kohl will tell you, it takes a pretty 

darn good staff for any senator to be effective, either as an individual senator or as chairman of a committee, and probably more 

important, chairman of the committee. And I think if I had anyVerDate Nov 24 2008 14:44 Mar 19, 2012 Jkt 072923 PO 00000 Frm 00015 Fmt 6633 Sfmt 6633 C:\DOCS\72923.TXT DPROCT
11 

thing to do with any progress on this committee, I would give Ted 

Totman the credit for that. 

This is, as I said, a great opportunity to serve as chairman, and 

even to serve on the committee. The committee has such a broad 

mandate to improve the quality of life of older Americans. Within 

that framework, there are endless opportunities. The Aging Committee is part consumer advocate, part policy work, part gumshoe 

detective, as I like to think most of my work was, and part bully 

pulpit. No other committee in the Senate can claim such broad 

platforms. Each chairman appreciates the possibilities of the committee. 

During my tenure, we had a former employee of a predatory 

lender testify with his identity hidden about how the lender preyed 

on older Americans. Katie Couric testified about the importance of 

colon cancer screening. The family members of victims of nursing 

home abuse testified about their experience during a two-day hearing. Their testimonies came after whistleblowers presented serious 

concerns to the committee about nursing home abuse and neglect 

in one of the biggest States and most progressive States of our 

country. 

At the committee’s request, the General Accounting Office did a 

hard-hitting analysis that has been the benchmark for improving 

the quality of care ever since in our nursing homes. And a lot of 

our time covered the impending baby boom retirement that is now 

upon us and how to prepare Medicare, social security, and the 

workforce for that sea change, of which none of those changes suggested by our committee has obviously been adopted. 

Aging Committee hearings then and now convey that certain 

issues are fundamental to everyone, regardless of age. What kind 

of a society we choose to be and what role our government plays 

in shaping that society are the Aging Committee’s bread and butter. How do we increase the prospect of a safe, comfortable experience in a nursing home? How is Medicare waste, fraud, and abuse 

putting beneficiaries at risk? How should everyone begin saving 

money for retirement, and how much savings is necessary? 

As the Aging Committee explores these questions, the committee 

offers watch over the executive branch to ensure that priorities do 

not get lost through inertia. Federal agencies can move slowly. Initiatives like changing the predictability of nursing home inspections require a lot of people doing a lot of work to shake up the 

status quo. 

There are always dozens of topics that require attention. Even 

now, Chairman Kohl and I are rattling the cages at the Center for 

Medicare and Medicaid Services to implement our new law on sunshine for drug company payments to doctors. Our partnership on 

this and other issues raises another positive point about the Aging 

Committee, and that is bipartisanship, or maybe it would be more 

accurately called nonpartisanship; the fact that this committee is 

not responsible for legislation—in other words, it does not initiate 

bills. It then frees the committee from a lot of partisanship that 

might otherwise happen. In fact, I do not remember any partisanship, and all the years that I was on the committee, and particularly those years that I worked with John Breaux. 

12 

Aging Committee work might translate into legislation on some 

other committee, as it did for me as I followed on as being chairman of the Finance Committee. But the Aging Committee itself is 

able to devote the full resources to educating, to exposing, and to 

illuminating the issues of the day. It is a unique creation. It does 

valuable work for our entire society. Whether we are 92 years of 

age or even 22 years of age, we are all aging. Is it not that simple? 

The Senate Special Committee on Aging cannot reverse the aging 

process, but it helps to make parts of the process better for most 

everybody in America. So, I want this committee, even though I do 

not serve on it, to continue and, most importantly, to continue the 

successes going forward, so that the next 50 years do just as good 

of a job for a better society as the last 50 years. 

Thank you all very much. 

[Applause.] 

Ms. WHITMAN. Thank you, Senator Grassley, you were one of the 

great chairmen of the committee, as many people know. 

Next, I would like to take the opportunity to introduce Dr. Robyn 

Stone, who is the executive director of the LeadingAge Center for 

Applied Research. Dr. Stone is a noted researcher and authority on 

aging and long-term care policy. Formerly, she served as executive 

director of the International Longevity Center in New York, and 

served as the Assistant Secretary of Aging during the Clinton Administration. 

Next, we have Dr. Henry Aaron, who is the Bruce and Virginia 

MacLaury Senior Fellow at the Brookings Institution. Dr. Aaron’s 

research has explored reforms to health systems, such as Medicare 

and Medicaid, as well as income support programs, including social 

security. He was recently nominated to serve as a member of the 

Social Security Advisory Board. 

And, finally, we have Dr. Jonathan Rowe, who is a professor at 

the Department of Health Policy and Management at Columbia 

University School of Public Health. Dr. Rowe has held many leadership positions in top health care organizations and academic institutions, including the CEO of Mount Sinai, New York Health 

System, and is founding director of the division of aging at Harvard 

Medical School. 

We are going to start with Kathy. 

STATEMENT OF KATHY GREENLEE, ASSISTANT SECRETARY 

FOR THE ADMINISTRATION ON AGING 

Ms. GREENLEE. Thank you, Senator Kohl, Senator Grassley, and 

the rest of the committee. I am pleased to join you today to celebrate the 50th anniversary of this particular committee. 1961 was 

an important year for seniors, and it is just fabulous to be able to 

join you and really recognize the value of this committee. And as 

both Senators Kohl and Grassley mentioned, that aging is a nonpartisan issue. It is quite appropriate, I believe, that this committee has always operated in a nonpartisan fashion or bipartisan 

fashion, to help advance issues that sometimes have never been 

looked at before, but can be surfaced here in this committee. 

There was another key event in 1961, and that was the first year 

that there was a White House Conference on Aging. At that time, 

Dr. Arthur Fleming was the secretary of the Department of HEW, 

13 

Health, Education, and Welfare. I wanted to share with you a 

quote from Dr. Fleming from 1961 since we are celebrating that 

very important year. So, I quote: ‘‘We have not yet adjusted our 

sense of values, our social and cultural ways of life, our public and 

private programs, to accommodate the concerns of this vast legion 

of old and aging people. For far too many people, old age means 

inadequate income, poor or marginal health, improper housing, isolation from family and friends, the discouragement of being shunted aside from the mainstream of life.’’ That is the end of the quote. 

One of my greatest professional regrets is that I never had the 

opportunity to meet Dr. Fleming, and I know many of you have 

and worked with him as a colleague. There are many times I wish 

we could talk to him still and say, now what, Dr. Fleming? I mean, 

he was such a visionary, both through his service as Secretary and 

as the Commissioner at the Administration on Aging. We have 

done many things in 50 years; that is the reason we are here to 

celebrate the accomplishments. But I wanted to share the quote to 

also point out that we still have work to do to achieve the vision 

and the issues he raised back in 1961, that the work will continue. 

And our mission is critically important. 

As Deb said, she asked us three questions and gave us 5 minutes. I have probably used a great deal of that already. Each of 

these questions could be the subject of an entire course in college. 

The first question is, how far have we come over the five past decades, and where are we today? 

You could look at the past five decades, and I have had the opportunity to do this in some sense, and I believe that there are four 

large social movements that have informed each other in the past 

50 years—the movement of people with intellectual and developmental disabilities and their families, the movement of people with 

physical disabilities, the movement of people with mental illness 

and mental health issues and their advocates, as well as aging. 

Those four social movements have been propelling us forward to 

support dignity, and independence, and community living. I wanted 

to frame those four as I list the key milestones that I see when I 

look at the past 50 years. 

For me, most importantly, would be 1965, with the passage of 

Medicare, providing acute care services for seniors and people with 

disabilities, and Medicaid, which now, as you know, supports longterm care funding for people in institutions and in the community, 

and, of course, the passage of the Older Americans Act, which has 

always had the role of providing preventative services to help people remain independent and in their community for as long as possible. 

I would also call out 1987. OBRA 87 and the Federal Nursing 

Home Reform Act was critical to changing the lives, the experience 

and the quality of care of individuals living in nursing homes. I 

first read over OBRA 87 when I was the long-term care ombudsman in Kansas. If you have not read OBRA 87, you should because 

as soon as you put it down, you will pick up the IOM study from 

the year before, because when you read the law that was passed, 

you will ask, why were these laws needed? What was happening 

that caused a Federal response to this magnitude? OBRA 87 was 

14 

visionary and impactful, and leads much of the culture change 

work we are doing still in nursing homes. 

This was followed in 1990 by the Americans with Disabilities 

Act, which has had a significant impact on the lives of people with 

disabilities and seniors as we integrate into community settings of 

all types. Following the ADA, of course, was the 1999 decision of 

the Supreme Court in the Olmstead case, the Georgia case, brought 

to us primarily from the field of developmental and intellectual disabilities. This is why these issues have informed each other, which, 

of course, gave us the requirement that States provide communitybased services as a placement, if appropriate, and something that 

they are able to fund. 

And then, of course, 2010. I believe the Affordable Care Act is 

another huge leap forward for seniors in this country. As we have 

expanded coverage, we have provided additional benefits for seniors, preventative benefits, wellness benefits, and worked to protect 

the life of the program by tackling fraud. 

That is my list. Any of us could look back at the last 50 years, 

and pull out things that have all kept moving us forward toward 

community care. Those issues, along with Social Security, have 

done much to address the poverty issues and the health issues that 

Dr. Fleming recognized in 1961. 

Deb’s second question, where will we be in the next two decades? 

That is a little smaller than the first question. I think it is a time 

of demographic challenge, and I know we all have the information 

about the number of baby boomers turning 65—9,000 or 10,000 a 

day in this country, and that will continue; that one of the fastest 

growing segments is the group that is 85 years old and older. 

I believe that this is an opportunity as well as a challenge for 

this country, and John mentioned that earlier. Talking about what 

I call social capital, which is the number of healthy, long lives we 

have and we have coming that can build additional assets and resources as people continue to stay in the workforce, or older adults 

who move out of the workforce into second careers, encore careers, 

and volunteership. This will be something we so much need as we 

continue to provide community supports and livelihood in the community for seniors. This, I think will change the future. 

There are also other advances that we will take advantage of in 

the next 50 years—technologies, exciting innovations with regard 

to how to support individuals and families with technologies. 

I think another issue that we have to recognize as a huge opportunity for us is this incredibly diverse nation that we live in, and 

the incredible diversity of the seniors that we have, and what a 

rich blend they bring to us as a community and as a country. We 

need to support all individuals as they age and embrace them and 

the richness of their lives, and also support person-centered approaches—respect, dignity, independence, and valuing self-determination. 

If I could change two or three things—I think it was the final 

thing on my list of two or three things, which is hard to narrow 

down. But to me, they seem to be, I think, obvious. I am completely 

committed to the issue of prevention across the lifespan. I believe 

it is imperative as we move forward to talk about health and 

wellness, that we frame prevention from this particular angle, that 

15 

we talk about prevention as a life span approach. Investing in children, investing in middle-aged individuals, and investing in seniors 

is all worth the investment. For those of us who work in the field 

of aging, sometimes it is hard to get attention to people who are 

older, but it is worth the investment. It is never too late to be 

healthy. And for a senior, falls prevention, medication management, chronic disease management, is the type of prevention that 

we need to continue to support to help them with good quality of 

life, and long life, and less expensive care. So, prevention is one of 

the three things that I would change or continue to push. 

The second thing on my list would be what I call a more holistic 

approach to integrating the three huge systems of acute care delivery, long-term care delivery, and community services; that these 

three systems create both the barriers and impediments as people 

try to navigate through and receive care. They must continue to be 

integrated. I believe the Affordable Care Act brought us tremendous opportunity with this integration. 

What we are doing at the Administration on Aging right now is 

focusing specifically on care transitions and training the Aging Network to take advantage of their 45 years of experience, to partner 

with acute care providers and long-term care providers to help people return to the community in a successful way, and live there 

longer. I believe integration of these three systems has to continue, 

and we have all kinds of opportunities to deliver better quality care 

at less cost. So, I would put that on my list as second. 

And the third is I believe we need to continue to focus on the 

community and the family as the focal point for our delivery of 

services, and this is where the Older Americans Act was visionary. 

The Older Americans Act was the original home- and communitybased service program in this country for older adults. We need to 

continue to support it, and we need to continue to help family caregivers and the other partners—the questions you were asking. It 

is not just about working within HHS, or even at AOA, but working with the Department of Transportation, and HUD, and the 

other Federal agencies to tackle all of the issues that are there and 

present. If we will be successful in community tenure for older 

adults, we must tackle transportation. It, to me, is one of the hardest issues in front of us as we help people stay independent. 

I think there is much we have done, much we can do still to 

achieve Dr. Fleming’s vision. We can continue to fight to reduce 

poverty and isolation, maintain dignity, and increased choices for 

older persons and people with disabilities. 

I am pleased to be serving as the Assistant Secretary for Aging. 

I am pleased to be able to participate with the work of this committee, with all of the advocates, both here and across the country. 

This is fabulous work, it is meaningful work, and things that we 

can do so that in 50 years when they come back, what we do will 

be on this list because there is so much more ahead of us and so 

many more opportunities with such a vibrant and positive aging 

America. 

Thank you. 

[Applause.] 

Ms. WHITMAN. Thank you, Secretary Greenlee. 

Dr. Hodes. 

16 

STATEMENT OF RICHARD J. HODES, DIRECTOR OF THE 

NATIONAL INSTITUTE ON AGING 

Dr. HODES. Chairman Kohl, thank you again for the opportunity 

to be here and participate in the celebration of the 50 years of this 

Special Committee on Aging. The National Institute on Aging was 

established in 1974, very much through the offices of this committee. And since that time, we have worked very closely through 

our joint goal in improving the quality, as well as length of life for 

older Americans. 

It is a very different world now than it was 50 years ago. Some 

of this is illustrated in statistics. The Census’ most recent estimate 

in 2010 is that there are approximately Americans over age 65; 

that is, 40 million more than there were 50 years ago, more than 

double that number. The trends are going to continue as we see the 

demographics progress, so that there were estimates again this 

past year of about 1.9 million Americans aged 90 and older. That 

is expected to increase by 2050 to nine million—truly enormous 

changes. 

The changes are not just national but international and worldwide. Sometime in this decade, the number of individuals in the 

world over 65 will exceed that of children under five for the first 

time in human history, with enormous implications reflecting on 

the successes we have had in prolonging life and health, but also 

the challenges to a society that is very different than the species 

ever enjoyed in the past. 

We have, in addition to extending life, seen great evidence that 

it is possible to improve the quality of years. And over the closing 

decades, the 20th century, for example, studies showed a very 

gratifying decrease in the rates of disability in older men and 

women, demonstrating that by prolonging life, we are not by any 

means committing people to life with disability, but a life with hope 

of avoiding that disability. 

As we tried to juxtapose what has happened in the past, the 

present, and the future, the studies that continue to monitor these 

trends give us pause and real warning as we look at the generations that are going to be the next generations of the elderly, the 

baby boomers, emerging, whether the trend is in part due to lifestyle issues, such as obesity, inactivity, that really threaten to compromise, if not reverse, some of the enormous changes that we have 

made. And this, again, translates to some of the needs and hopes 

for the future. 

We have made progress in understanding how to treat and prevent some of the very important causes of disability and death in 

the elderly. So, for example, the identification of effectiveness of 

treating hypertension in older men and women with relatively inexpensive and well-tolerated treatments has shown really to very 

dramatically reduce the risks of coronary vascular disease, of heart 

attacks, of strokes, congestive heart failure. More recently, it has 

been shown that it is possible to reduce the risks of diabetes 

mellitus in older men and women, contrary to the expectations of 

some, showing that individuals over age 60 through a lifestyle 

intervention, that show the ability to change diet and exercise and 

activity that was remarkable. Seventy-one percent reduction in the 

rates of disability in that age group, which if translated to the pubVerDate Nov 24 2008 14:44 Mar 19, 2012 Jkt 072923 PO 00000 Frm 00021 Fmt 6633 Sfmt 6633 C:\DOCS\72923.TXT DPROCT
17 

lic would be an enormous advance in quality of life, as well as the 

burden on society for medical care, and, most importantly, to improve the quality of life. 

There are other areas in which we have made progress. For example, understanding the nature of cognition in aging has been 

translated in some very practical ways to understanding what it is 

about cognitive changes that can interfere with important life 

tasks, such as driving, or the important markers of independence, 

but also as viewed by some of risk in older men and women behind 

the wheel. It has been possible to understand the cognitive characteristics which predict who is at risk for driving accidents. More 

importantly still, it has been possible to show that cognitive training can alter performance on these laboratory computer-driven 

tests. And, of course, most importantly, the recent demonstration, 

in at least one report, that this kind of training can reduce by more 

than 50 percent the risk of accidents by older drivers. 

Not only has this been a laboratory finding, but it has been one 

embraced by various aspects of private and public sector, so that 

several motor vehicle bureaus in the country are now using this 

test in evaluating driving abilities, and that now most recently 

some of the insurance companies are actually giving discounts to 

individuals who go through this training, reflecting the way that 

very real consequences come from research endeavors. 

There are other areas—threats to well-being, individual and public, are not yet met. One of the more prominent and evident is in 

Alzheimer’s disease, one of the more frightening diseases to all of 

us, to the community, to individuals, to the public. 

This year, the passage of the National Alzheimer’s Plan Act, an 

enormous rededication to a concerted effort to try to ultimately decrease the progression, prevent disease, is the hallmark of the new 

iteration of national/international public/private partnerships to 

that end. 

We have learned an enormous amount about genetics and genetic 

risk factors, about brain imaging, and biochemical testing that can 

identify the very early stage of disease, even before there are symptoms. We now have the challenge before us, the very real challenge, 

of translating that into interventions. 

So, in terms of the present and where we stand, we have a society which has seen an extension of the life expectancy over the 

20th century from some 47 years in this country at the beginning 

of the country to 77 at the end. We have challenges before us, 

which threaten to compromise or reverse that through the trends 

we see in disability, related lifestyle changes, and a commitment to 

the need to go further. 

In terms of the magic wand, the things that we need to the future to make the trajectory of life and health of older Americans 

as successful as can be, they really fall into several categories. 

There are things we know how to do—preventing heart disease, 

preventing diabetes—where the translation into practice is not 

what it needs to be. And there the challenge is to find ways to disseminate best practices into practices that transfer to individuals 

and their life expectancy and their health expectancy. 

There are other areas, such as those represented by research ongoing in conditions such as cancer and Alzheimer’s disease where 

18 

we need to learn a lot more about translating the dramatic high 

tech basic findings that we have now into ultimate interventions. 

And, in addition to these disease-specific areas, the research of 

the National Institute on Aging, facilitated by this committee into 

the very basic process of aging itself, offers a new set of opportunities that have become all the more relevant in recent years. So, for 

example, it has been found that changes in chromosome structures 

called telomeres, or in oxidative damage, or in the senescence of individual cells are very much related to dysfunction in organs and 

tissues and the health and well-being of experimental systems and 

humans. 

And most recently it has been shown, for example, that eliminating the very small number of cells that are senescent, that have 

a very specific phenotype when one looks under the microscope or 

analyzes their gene expressions. Eliminating a very small number 

of cells in experimental animal systems can in fact reverse the 

manifestations of aging in multiple tissues, and providing an opportunity to execute what many in the field of aging research would 

argue that, in addition to disease-specific interventions, better understanding the basic processes that accompany aging may allow 

interventions that will, in fact, have global impacts, not on a single 

disease, but on many of the undesirable consequences of aging, so 

that it becomes less of an age, less of a time of life when disease 

threatens, and more of a time when the enormous potential and 

productivity of older men and women are able to execute themselves. 

And we at the NIA and NIH in general are committed to this 

kind of research and the support provided, and are grateful again 

to the support over this past 50 years by you and by this committee. Thank you. 

[Applause.] 

Ms. WHITMAN. Next, we have Michael Harsh. 

STATEMENT OF MICHAEL HARSH, CHIEF TECHNOLOGY 

OFFICER, GE HEALTHCARE 

Mr. HARSH. Boy, as I am up here today, I realize that now I need 

glasses, so I guess it has changed. 

I am Mike Harsh. I am the vice president and chief technology 

officer for GE Healthcare. We are a $17 billion diagnostic health 

care IT and life science division of General Electric. 

It is a pleasure to be here. I want to thank Senator Kohl for the 

opportunity, Senator Grassley for hosting this program, and for 

your leadership in advancing American health care. 

You know, I have led R&D at GE Healthcare in Milwaukee, Wisconsin, Senator Herb Kohl’s home State, for quite a while. I have 

had a chance to work at our GE global research labs in upstate 

New York just outside of Albany. Additionally, I am a member of 

the College of Fellows of the American Institute for Medical and 

Biological Engineers. My 34 years of seeing health care innovation 

up close and its impact on patients, health care providers, and society as a whole provides the foundation for my comments today in 

this important forum on the challenges, promise, and potential of 

aging in America. 

19 

Medical technology has come a long way in the last 100 years. 

Developments in IT, imaging, biology, have really changed the 

medical paradigm from a see and treat it—and I just want to say 

again, see it and treat it way of treating disease—to where we are 

moving towards a predict and prevent. That will dramatically 

change how physicians are able to address the increasingly complex 

needs in a global aging population. 

You know, there has been an explosive growth in medical technology in the last century, you know, with the development of xrays. As the 21st century dawns, you know, governments have put 

pressure on health care systems to be more productive. Technology 

must now align with the new realities of health care, providing patient and diagnostic economic value. Specifically, society is demanding that technology reduce the overall cost burden of delivering care. Technology must help deliver higher-quality and efficient health care to an increased number of individuals, thus, increasing access while lowering overall costs. 

As diagnostics and therapy shift to the molecular level, molecular 

diagnostics will enable earlier, more precise disease detection and 

allow physicians to understand more about the individual patient. 

Life sciences will enable the next generation of biotherapies, which 

increasingly will be delivered in tandem with diagnostics. Now, let 

me give an example. In neurodegenerative disease, molecular 

agents and biomarkers for in vivo or in body and in vitro testing 

will help determine the pathology behind early cognitive impairment, leading to earlier diagnosis and treatments. Bio signatures 

are what we call these. With the advent of disease-modifying drugs, 

this brings the opportunity to improve people’s quality of life as 

they age, and this is particularly significant for our seniors who 

could experience memory loss and impairment through a neurological condition, such as Alzheimer’s and dementia. 

Now, looking forward, here are some concepts representing how 

technology may change the future of medicine. Health monitoring 

will be a part of everyone’s existence. Again, looking at the bio signatures that we can monitor, we will have early warning systems 

that alert people when very early changes in their bodies, at a 

stage when disease is typically easier to treat, but before we see 

symptoms. You can look at reversing the course of the disease. 

Manufacturing artificial blood, repairing tissues, and reconstructing organs with these cell-based therapies and tissue engineering is just another possibility that we see. 

Now, two or three things that have changed could put us on a 

better path to the future. I think, number one, and I want to say 

this, is effective regulation of medical devices is necessary for ensuring patient safety and protecting public health. And, number 

two, we need to move the system from a sick care system over to 

a truly preventative health care system. And this is really key for 

everyone in this room. Aging starts the day we are born. Prevention, combined with prediction in early diagnosis, enabled by the 

convergence that we see today between the biosciences, the diagnostic tests that we have and the equipment, the IT systems, mean 

that it is already possible to diagnose diseases on that were 

undetectable in the 1980s. Again, this means better quality of life 

for our seniors and our aging population. 

20 

In conclusion, the future of health care technology holds tremendous promise for increasing patient access, earlier diagnosis and 

treatment of disease, improving health care quality and decreasing 

overall health care costs. All of us hopefully will experience this 

aging process, and health care innovation increasingly make possible an unprecedented quality of life for seniors in which living old 

can be living well. 

We all know America was built on the premise of what might be 

possible, a notion that spurs great achievement. That same promise 

holds true for health care. 

I would like to thank you for allowing me the time to be here 

and celebrate this 50-year achievement of the Senate Special Committee on Aging. I am a technologist; I want to paraphrase one 

technology guy I always looked up to, and that is Albert Einstein. 

He had this great statement. It was, ‘‘Imagination is more important than knowledge. Knowledge is limited to all we know, while 

imagination embraces the entire world, all there ever will be to 

know.’’ 

I want to thank you for your time today. 

[Applause.] 

Ms. WHITMAN. Next to discuss healthy aging, Dr. Jack Rowe. 

STATEMENT OF JACK ROWE, DIRECTOR, MACARTHUR FOUNDATION RESEARCH NETWORK ON SUCCESSFUL AGING AND 

PROFESSOR AT THE COLUMBIA UNIVERSITY MAILMAN 

SCHOOL OF PUBLIC HEALTH 

Dr. ROWE. Thank you very much, Senator Kohl, and Ms. Montgomery, Ms. Whitman, for including me in this set of conversations. 

I would like to convey some of the thoughts that my colleagues 

at the MacArthur Foundation Research Network on an Aging Society and I have developed with respect to the agenda of the committee. We start with a clear view that if we continue our preoccupation with entitlements, and we really continue to view the 

entire problem as balancing the Medicare and social security trust 

funds, that we will be in very big trouble. 

The fundamental observation is that the core institutions of our 

society, whether it be work, retirement, transportation, or education, were not designed to support a population that is going to 

have the age distribution of our future society. And so, unless we 

are able to find a way to hasten the adaptation of those core institutions, even if we balance the entitlement trust funds, we will not 

have a society which is productive or equitable or cohesive. We will 

have a society in which the tendencies to be torn apart and have 

generations pitted against generations, and have pitted against 

have-nots, will be aggravated even further than they are now. 

Let me comment on two general areas. One is health care, which 

I am going to just comment on because Ms. Whitman said that, 

some of these problems are not new, that they have been around 

a long time. And why have you not solved these problems? Why did 

you not solve these problems ever? I certainly concur that these 

issues are heardy perennials with these issues, but, you know, it 

is not so much whether the problem is a new problem, but whether 

or not it is a problem whose time has come. And it seems to me 

21 

that with respect to health care, we may be in a situation where 

we can solve one of the core problems. 

One core problem is providing access to health care for people, 

but it is a hollow promise to provide access to health insurance to 

everyone and not have providers there who are capable of providing 

the care. We know we have a dramatic shortage of primary care 

providers, and we know, especially with respect to older persons 

that there are not enough geriatric specialists, and that the general 

health care workforce does not have enough expertise in the care 

of the elderly. The Institute of Medicine had a report a couple of 

years ago on this that I testified on to Senator Kohl and his committee at that time. And the Institute of Medicine has followed up 

with a more recent report on nursing as well that includes these 

issues. 

I think the time has come for many of those well thought out and 

generally well-received recommendations be implemented. The window of opportunity is opening now. We are changing the way we 

pay for health care. Affordable care organizations focus on preventing admissions and readmissions and on paying for quality. All 

these changes are removing some of the barriers that we have had 

before to enhance geriatric care. I am very optimistic about that. 

With respect to the issue of productivity and the workforce, there 

are two or three observations. One is that we need to understand 

what the future population is going to look like. And Richard 

Hodes pointed out that the decades-long, quite substantial, progressive reduction in disability we saw may have ended at the beginning of the last decade, and things have been going perhaps sideways since then. And that may result in our having a population 

of older people with greater demands for personal care services 

than we had been expecting or hoping. We were feeling that disability was going to progressively decline. It may not. And there 

are even studies now that suggest that disability is increasing in 

the near elderly. 

We were also thinking that the older population was going to be 

able to participate in the workforce because they are all going to 

be fit, and it looks like perhaps that is not the case, since the disability rate may be increasing in the near elderly. And technology 

may help there, but we need to understand that better. 

We also need to understand how we can incent employers to keep 

people in the workforce. We need to work with employers to de-mythologize the well-known, and Mr. Aaron can talk to this better 

than I, lump of labor fallacy that you need to get older people out 

of the workforce in order to make room for younger workers. That 

is just not the case. I believe prevailing economic opinion would 

support that. But I think we have an opportunity to work with employers, now that evidence is available that productivity is retained 

in the older workforce well into the 60s, if we can get some of the 

right incentives in place. 

Let me end with just two quick points. One is that I think our 

attitude, and this has been mentioned already, should be a life 

course attitude. We have got to get rid of this counterproductive 

children against the elderly approach with people writing articles 

about how much more money is spent on old people than children, 

when, of course, they are including health care, but they are not 

22 

including education, in the equation. We do not have time for that. 

We have to go to the next room, sort of, you know. And we have 

to start looking across the workforce and look in a way that is 

intergenerational. 

That last point that I would make, and this was suggested by 

Lisa Berkman, one of the colleagues in the Network, is maybe we 

can learn something from the environmental movement here. 

Whenever you want to do something in a community, you have to 

do an environmental impact assessment. What impact will this activity have on the environment, positive, negative, neutral? Fine. 

Maybe we need an aging society impact assessment. Maybe every 

time something gets done, somebody needs to stop and say, wait a 

minute, what is the impact of this on a society with a fundamentally different age distribution, or is this actually moving in the 

wrong direction, or the right direction, or is it neutral? And just 

having to do that, just like John Rother pointed out, just having 

to write a report at the end of the year is sometimes therapeutic, 

and so that I think that there may be some benefit. 

Thank you again for including me here today. 

[Applause.] 

Ms. WHITMAN. Next, we have Robyn Stone to talk about the future of housing. 

STATEMENT OF ROBYN STONE, EXECUTIVE DIRECTOR, 

LEADINGAGE CENTER FOR APPLIED RESEARCH 

Dr. STONE. Thank you for this opportunity to talk about this 

issue. And I am actually in my brief five minutes, I am going to 

try to frame the issue of housing within the larger issue that I 

know so well, which is really long-term care policy. And the reason 

I speak to housing in terms of that is that really housing and services are co-equal. You cannot have a long-term care system, you 

cannot remain in the community for as long as possible, you do not 

have shelter, as well as the services to support you. 

And I want to start by saying that long-term care and housing 

policy has really come a long way since this committee was established in the 60s. And I actually started in the mid-70s as a director of a Title VII nutrition program. This was actually before Title 

VII was folded into Title III of the Older Americans Act. So, I have 

been around aging services for a very long time. 

And I do want to highlight the fact that although families and 

other unpaid caregivers continue to provide the bulk of services in 

all settings today, a fragmented formal system has evolved over the 

past 50 years to meet the long-term care and housing needs of our 

Nation’s elderly population. 

I want to commend the committee for a number of things. Certainly with the advent of Medicaid and, to a lesser extent, Medicare, we have a nursing home market today that was really started 

in the 1960s. And from that very start, the committee has been a 

vigilant advocate for resident rights and quality, including its advocacy for, first, the ombudsman program, which started in the 70s, 

Nursing Home Reform Act, which OBRA 87, continuing efforts to 

really have strong oversight and enforcement, and the recent culture change provisions that are in the ACA. 

23 

However, one of the major moves, and Kathy spoke to this, is the 

shift towards home- and community-based services. That can be attributed in large part to actually the Aging Network in the late 60s 

and early 70s, culminating in the Medicaid waiver programs in the 

early 80s, albeit tremendously variable across States. 

The Congregant Housing Services Act, supported by the committee early on in 1978, was actually the first national program to 

link affordable elderly housing with services. And, by the way, that 

program has been frozen for a number of years as we see the 202 

program and a number of other housing programs really slipping 

away between our fingers. And I am going to return to that in a 

little bit. 

The field has also experienced a great growth in primarily the 

private sector assisted living market, with some experimentation 

with residential alternatives through various State-based Medicaid 

waiver programs. Despite the fact that most individuals needing 

long-term care also suffer from multiple chronic conditions that 

often need medical intervention, care delivery has developed primarily in silos. But one of the first programs to actually integrate 

acute, primary, and long-term services, the OnLok program in San 

Francisco. And many of you may not know this, but it was initially 

developed through a Title IV AOA demonstration grant in the early 

1970s, which was supported very strongly by this committee. So, 

integration really had its source through this committee and 

through the Older Americans Act. 

Three decades later, the program of all-inclusive care for the elderly, known as PACE, is a permanent Medicare provider, and 

really has set the gold standard for service integration and care coordination. And over the years, the committee has supported experimentation with a range of integrated approaches, and was a 

strong advocate for the most recent ACA demonstrations designed 

to improve quality and reduce costs. 

Until 2000, the paid long-term care workforce was just an afterthought. The committee was instrumental in raising this issue as 

a priority, and the efforts have included hearings following the release of the seminal IOM report, ‘‘Retooling for an Aging America,’’ 

which Jack was the chair of, and advocating for the inclusion of 

education and training opportunities for long-term care professional and direct care workers in the ACA. And the committee remains committed to this area, as is evidenced by its ongoing work 

to get funding for these authorized programs. 

So, where do we go from here? And this is where housing really 

comes in. The United States is still a relatively young country compared with most countries in the developed world. But the three 

issues that loom large over the next 20 years include how modes 

of service delivery might evolve in response to consumer preferences, ability to purchase care, and changes in public policy; 

whether and how a quality, competent workforce will be developed 

to meet the service demands; and how services and housing can be 

made affordable for the vast majority of older adults who are at 

risk for needing long-term care and for the Federal and State governments that currently foot much of the bill. 

My vision for 2030, while it is not possible to predict the service 

system that will evolve, would include these elements. Family careVerDate Nov 24 2008 14:44 Mar 19, 2012 Jkt 072923 PO 00000 Frm 00028 Fmt 6633 Sfmt 6633 C:\DOCS\72923.TXT DPROCT
24 

givers will probably continue to play a pivotal role in the delivery 

of long-term care services. To the extent, however, that it is financially feasible and preferred, they will augment their hands-on care 

and oversight through the purchase of home- and community-based 

services and technology. Technological advances, including the development of web-based social networks, sensors, and electronic 

medication reminders, will support more long-distance caregiving, 

leading to an expansion of geriatric care managers and brokers to 

assist in these efforts. 

The ability of technology, of course, to complement informal 

caregiving is contingent on the mitigation of the myriad barriers to 

the development, adoption, and wide scale use. 

The committee has a major role to play in ensuring that family 

caregivers continue to receive support, and that they are integrated 

into the long-term care decision-making process. The National 

Family Care Support Program, which was created in 2000, at least 

formulae acknowledged family caregivers as a specific target population, but to date that program has been really limited in its funding. Ongoing advocacy will be required to expand the magnitude 

and scope of that program, as well as other efforts to really help 

to alleviate caregiver burnout and burden. 

The primary role of nursing homes in 2030, in my vision, will be 

to provide post-acute care to medically complex individuals being 

discharged from the hospital, or those who require significant 

rehab, such as the events following a stroke or opposed hip replacement. I do not believe that we will need nursing homes in 2030. 

This is, however, contingent on affordable options out in the community. These facilities could also provide a venue for the delivery 

of palliative care to individuals in the active stage of dying, who 

were not able to remain at home or in another residential setting. 

By 2030, the demand for home- and community-based options 

will increase substantially, and home-based care will be provided 

by a combination of in person and electronic monitoring systems to 

facilitate the potential for a larger proportion of the elderly longterm care population to receive services in their own homes or 

apartments. In addition, the expansion of universal design features 

in building, construction, and modifications will help to create 

home environments that adapt to the needs of individuals as they 

age and become more disabled. 

Now, many individuals will be living in NORCs, naturally occurring retirement communities. They can be vertical or they can be 

horizontal, across streets, blocks, or neighborhoods of single family 

homes. Regardless of this configuration, community members will 

take advantage of the economies of scale and joint purchasing 

power afforded by living in NORCs to organize packages of social, 

wellness, health, and long-term care services that are available in 

the community. 

Now, prior to the passage of Medicare and Medicaid, one-third of 

the elderly lived in poverty. During the following three decades, 

that percentage decreased precipitously. At the same time, the gap 

between the haves and the have nots within the older adult group 

has actually expanded, particularly for non-white elderly. And the 

latest recession, which disproportionately affected current and 

soon-to-be retirees, raises serious questions about how future coVerDate Nov 24 2008 14:44 Mar 19, 2012 Jkt 072923 PO 00000 Frm 00029 Fmt 6633 Sfmt 6633 C:\DOCS\72923.TXT DPROCT
25 

horts of older adults, facing long-term care decisions, will be able 

to pay for services. Ironically, those who are currently at either financial extreme are more likely than modest and middle-income elderly individuals to have access to service options. Low-income elderly at least can qualify for Medicaid. They may also have access 

to publicly subsidized housing and community-based care. They 

may also qualify for publicly subsidized programs that will assist 

them to live in the community. 

Financially secure elderly individuals have the resources to pay 

privately for home care, and when that is no longer viable, to move 

into an assisted living facility. Individuals who want the security 

of a continuum of services may sell their homes and move into a 

continuing care retirement community, or they may create their 

own village, a grassroots membership-based nonprofit organization 

that provides support and community to residents who wish to remain in their own homes or in apartments. 

For the vast majority of the elderly and their families, however, 

affordability of long-term care service options is, and will remain, 

the ultimate concern. What we need to do, and one of the most 

thorny issues that must be addressed if affordable residential options are to be available in the future is we have got to figure out 

how to cover housing costs for individuals who can no longer remain in their own homes or rental apartments due to financial 

and/or health reasons. Currently, low- and modest-income, older 

adults who have spent down their assets and income to qualify for 

Medicaid will have their room and board covered if they enter a 

nursing home, but Medicaid reimbursement rates for other residential settings, such as assisted living or adult foster care, are generally not sufficient to cover the costs of room and board. And for 

those who do not qualify for Medicaid, there are no financial mechanisms. 

Recognizing that Medicaid assisted living has not provided an affordable option, a number of States, including Vermont and Oregon, have brought together staff from Medicaid and State housing 

agencies to explore how they can more efficiently package their 

service and congregate housing dollars to better serve their dual eligible populations. At the national level, HUD and DHHS are finally exploring ways to better integrate low-income senior housing 

and services. These efforts reflect a growing recognition that affordable shelter and services are both essential to the development of 

a viable community-based system for moderate- and low-income 

older adults, groups that are largely likely to represent a large proportion of future cohorts of America’s elderly population. 

The nexus between housing and services, therefore, is, is a perfect place for the committee to focus its attention as we move into 

the future. Thank you very much for allowing me to speak to you 

today. 

[Applause.] 

Ms. WHITMAN. And batting clean up to talk about income issues, 

we have Dr. Henry Aaron. 

26 

STATEMENT OF HENRY AARON, BRUCE AND VIRGINIA 

MACLAURY SENIOR FELLOW, THE BROOKINGS INSTITUTION 

Dr. AARON. Mr. Chairman, thank you very much for the honor 

and pleasure of being able to participate in this event. I have to 

comment that as a person whose last name begins with two A’s, 

I am not accustomed to speaking last——[Laughter.] 

Dr. AARON [continuing]. But I am sure it will be good for my 

character. 

I want to take an even broader look at the history of what it 

means to grow old in the United States than was the charge given 

to us, to look at the last five decades. I am going to look at four 

cohorts, starting with the Americans born in 1860 and moving forward through 1890, 1930, and 1960. 

If we go back and look at that oldest age cohort, we will discover 

that the process of growing old was radically different from what 

it is today. Three-quarters of the men who were born in 1860, and 

who still managed to be alive at age 65, had to continue to work 

until they died, became disabled, or were put out of work by economic calamity. Precisely such a calamity did occur—the Great Depression—when the 1860 cohort was 69 years old. 

By 1932, a quarter of the workforce was unemployed. The elderly 

were more likely than the young to lose their jobs and less likely 

to find new ones. Protracted unemployment, bank failures, plunging stock prices, and collapsing real estate values destroyed the 

savings of those in the middle and working classes who had 

scrimped and saved for retirement. That has a distressingly contemporary feel to it, actually. 

Private charities were overwhelmed. Public charities dried up as 

State and local governments ran out of money as revenues plummeted. 

The first social security check was not paid until those in the 

1860 cohort had reached age 80, and few were eligible for benefits. 

For the one-third of the 1860 cohort, only one-third, who survived 

to their 69th birthday when the Depression hit, the final years 

were actually pretty grim. 

For those who were born in 1890, at the end of the 19th century, 

the cohort benefitted from steady, if unspectacular, growth in incomes. The improvements in health and education were substantial, but even so, more than a third of those who reached age 20, 

of women, were dead by the time they reached their 65th birthday, 

and 40 percent of men who reached age 20 were dead by the time 

they reached age 65. 

This cohort reached age 65 in the mid-1950s. At that time, fewer 

than half of them had health insurance. Coverage was often uncertain because insurers could and did raise premiums sharply or refused to renew coverage for those whose health had begun to deteriorate. 

Congress had passed the Social Security Act in 1935, subsequently increased benefits, and extended coverage in 1939, and 

again in 1950. Because of those liberalizations, members of this cohort born in 1890 received benefits that were greater than the earmarked taxes that they and their employers had paid, but the benefits were not very large. Only about a third of taxable earnings 

was the benefit level until age 50. 

27 

Moving ahead yet again to those born in 1930, there were 2.6 

million births in that year. That cohort enjoyed advantages that 

had been unavailable in previous generations. The educational 

achievements were striking, but the economic advances were absolutely breathtaking. Between the end of World War II and the mid1970s, output per person more than doubled. At the start of their 

working lives, members of the 1930s cohort earned hourly wages 

three times higher than those that had been earned by those born 

in the 1890 cohort had earned in their first jobs. And by the time 

the 1930 cohort retired or turned age 65, average earnings in the 

Nation had risen by an additional third. 

As they approached retirement age in the mid-1990s, members 

of this cohort had options and resources that few of their parents 

had enjoyed. Most had assets that provided substantial financial 

security, including social security. They also had better protection 

against medical costs than ever before. Medicare had been enacted 

in 1965 and provided basic health insurance coverage for the elderly and for the disabled, and eight out of 10 of those covered by 

Medicare also had supplementary coverage on top of that. 

Now, whatever the future may hold for people born back in those 

years, the circumstances represented a revolutionary improvement 

over the experiences of their predecessors. 

The cohort born in 1960 was still better educated than any of 

their predecessors. As a striking fact, nearly 90 percent graduated 

from high school, and the fraction of the people who were born in 

that year who got education beyond college was as high as the proportion who had graduated from high school a century earlier. Furthermore, people born in 1960 told pollsters that they hoped to retire earlier than had their predecessors. To a significant extent, 

however, they discovered they were not able to do so, and continued to work a bit longer than people had previously. 

My time is nearing its end, but I do want to say a few words 

about the prospects for the future, which seem to be a bit more 

troubling. 

The past record of more or less continued growth in income, and 

improvement in educational performance and, as we have heard, 

health results, are now in jeopardy. Average earnings of men have 

fallen for about four decades. High school completion rates nationally are falling. Male college attendance rates and completion rates 

are falling. The one encouraging bright spot is the continued increase in female college attendance and completion rates. 

But for a variety of reasons, I think private calculations and 

shifts in public policy, workers are likely to continue to work to 

older ages in the future than they have done in the past. This is 

a good trend for reasons that Jack Rowe indicated in his remarks. 

It simultaneously provides resources to those affected, and lightens 

the burden of support for the rest of the population. 

I also want to endorse in my last comment something that Jack 

said in his. As I look around the room, I think I see far more people 

under the age of 40 than over the age of 60. And I consider that 

a very good sign for our prospects of avoiding the kind of 

intergenerational fratricide that he so correctly deplored in his concluding remarks. 

Thank you. 

28 

[Applause.] 

Ms. WHITMAN. So, we have had an incredible panel of speakers. 

I am going to take the opportunity to ask some questions before 

our last speaker. And we are going to have Laura Carstensen later 

wrap some things up. 

But I thought I would take the opportunity to pick your brains 

on some of the projections of the future, and the pathways in which 

we as a committee can grow as well. Specifically, several of you 

talked about the opportunities to transform our approach on health 

from one based on disease treatment to one based on prevention. 

I think Secretary Greenlee, Michael Harsh, and several others 

talked about this as being the future of health care, and having 

such a significant potential to improve both the health and the longevity of older Americans. 

But what practical steps do we need to do to make that shift toward prevention, and what are the things that we can put in place 

now that will pay off in the future? Question for anyone who wants 

to answer, but first Secretary Greenlee. 

Ms. GREENLEE. Well, you will be pleased to know that Dr. Hodes 

and I have met. I went over to talk to him fairly soon after starting 

this job because I believe that what we need to be focused on quite 

a lot is research, both research based from universities, and research based at the NIA that we can translate into our network. 

What the Aging Network is really called to do at this point that 

is different is gather a different kind of outcome data that we need 

to continue to focus on, building the case and showing the evidence 

and the outcomes for both health and medical savings, cost savings. 

That is the piece that is new. 

If you think about the Older Americans Act nutrition program, 

which is 40 percent of our funding, we can demonstrate how many 

millions of meals we serve. We believe that that is a valuable output that we should be measuring. But we must add to that outcome a measurement of the long-term impact on health and the 

avoidance of other more chronic health conditions or acute episodes. With that research we will be able to continue to engage 

with policymakers. 

Ms. WHITMAN. Yes. 

Dr. ROWE. I think we need to move beyond the view that the critical period for intervention and prevention is youth. There is an implicit feeling that people have that, if you are trying to prevent 

something in old age, well the horse is out of the barn, and older 

individuals, do not respond to change, et cetera. And with the exception of maybe flu shots, prevention just is not something that 

has to do with geriatric care. 

My favorite example is the diabetes prevention program, which 

showed, as many of you probably know, that a fairly intensive lifestyle intervention, reduced the onset of diabetes in a high-risk population by 58 percent. People of all ages who were included—young 

adults, middle aged, and older persons. It turns out that the age 

group that had the greatest positive effect from the intervention 

were the older persons. A very, very significant finding. 

So, I think as we develop policies, as we fund programs in Medicare and Medicaid, as we educate health care providers, whether 

they are nurses or physicians, we need to change the set of inforVerDate Nov 24 2008 14:44 Mar 19, 2012 Jkt 072923 PO 00000 Frm 00033 Fmt 6633 Sfmt 6633 C:\DOCS\72923.TXT DPROCT
29 

mation and beliefs that they have about prevention throughout the 

life course. That would be, I think, a very significant advance. 

Ms. WHITMAN. Dr. Hodes, Mr. Harsh. 

Mr. HARSH. Yeah. I guess one thing I would like to say is, you 

know, we have got research going on right on different aging studies, one with Mayo Clinic, where we are looking at essentially, you 

know, we call it bio signature, but there are a lot of signatures that 

you can pick off by looking at the combination of many different 

tests, very simple screening tests, before you wind up with a very 

expensive scan, before the symptoms really present themselves in 

a way that will find people kind of fumbling through the health 

care system, which, you know, really costs a lot of money and does 

not help. And there are ways that we can pull this information out 

much sooner so that we can actually look at bringing that care up 

much quicker, and really driving, you know, costs out of the health 

care, and increasing quality of life. 

So, again, when I look at some of the big challenges I see right 

now where we are headed is things around just computational biology and being able to really get after how do I compare apples and 

oranges? You know, what are the signatures that I want to look at 

when I look at the genomics, all the omics levels? These are the 

things where I see where the research is going where we can start 

to pull this diagnosis farther upstream. 

Dr. HODES. I think that I would enjoy commenting to the topics 

that Mike and Jack have mentioned. Just to elaborate on it is this, 

71 percent decrease in incident cases of diabetes in the group 60 

and older with a very reasonable lifestyle intervention. 

In terms of how to now translate that, this is one of the categories where we know something works. How do we make it happen? An example, I think, within the Federal purview, at least, 

that is promising, are the conversations we have had between CMS 

and at NIH. So, Don Berwick, Francis Collins, and a group from 

each of our agencies, converging to look at cases in which perhaps 

at least innovative thought about how appropriate incentives and 

even compensation for effective prevention can occur. 

So many of you will know that after this laboratory setting intervention, which prevented diabetes onset, there have been continuations of those, now looking at setting, such as the YMCA, so the 

diabetes prevention study in the Y to see whether it will be effective in such a setting, looking for practical ways to make this happen. So, this is the kind of collaboration across agencies and ultimately with public forces that can be enormously productive in 

terms of government and other private sectors. 

I would just note another partnership that has been particularly 

gratifying over these past years has been ADNI, the Alzheimer’s 

Disease Neuroimaging Initiative. It is designed to look at, as I 

mentioned briefly in passing, early changes by neuro-imaging, by 

other molecular signatures, that precede clinical disease, the notion 

being that if one can find those early changes, one has a better opportunity to intervene early and prevent them, and you can also 

track the success or failure of interventions. 

Government, imaging companies, bio tech, pharma,have all been 

collaborators in this very important initiative with the FDA and 

NIH and a number of private and public sector philanthropies as 

30 

well, an enormous partnership because it reflects the fact that 

there is common conviction that in those so-called pre-competitive 

spaces, we can look for opportunities that will profit nobody preferentially in the short term, will profit everyone in the long term, 

aimed at prevention to echo that. 

But the partnerships are there, and I think the room for optimism is in the fact that they are recognized and reflected in partnerships across this breadth of agencies, national and, in fact, 

international. 

Ms. WHITMAN. Thank you. 

John. 

Mr. ROTHER. Just a quick comment, that we typically think of 

prevention in individual terms. I think the new frontier is going to 

be the social aspects of prevention, whether it is in the food supply, 

the environment, or even the level of stress in our societies. And 

I think that is going to raise some very tough questions about how 

we go about keeping people healthy when it is going to require 

magnitude order of changes throughout the economy and our culture. 

Ms. WHITMAN. Good point. The reaction to large and growing 

budget deficits lately has been to look for ways to cut spending on 

a wide range of programs, benefits, and services. However, we are 

now facing increasing demands on these programs, both due to the 

economic downturn and the aging in the population. How will an 

era of prolonged fiscal restraint impact the futures each of you 

have predicted? And when is spending today truly an investment 

in the future? And I am opening that up to anyone who wants to 

answer it. As you know, we have all got a lot of scissors out here 

on Capitol Hill, and we are cutting as ruthlessly as we can. What 

things do we need to protect? What things are the most valuable? 

Mr. HARSH. I can just start from a technology standpoint and instrumentation standpoint what our focus has been because would 

say, although it was there to some extent, you know, I was around 

when imaging just exploded. And it was, like, if you could image 

faster, see more, get greater coverage, more resolution, wow, that 

was great. When I look at it today, you know, we do not start a 

program unless we fully know up front what it is going to do in 

terms of increasing the access of that technology for health care, 

what it is going to do for the total cost, and is it going to deliver 

better quality of outcomes and quality to the patient? So, everything we do today has completely changed our head around making 

sure that we fully manage quality access and costs in every one of 

our development programs that we start on. 

Dr. HUDSON. There is no magic answer to this, but I think it is 

important to keep in mind as one sector or the other worries about 

cutting costs, and all sectors worry about cutting costs. It could be 

the public sector. It could be the private sector. It could be the formal care giving sector. It could be the informal family sector. But 

costs are shifted; they are not eliminated. And public policy people 

need to keep that in mind, particularly in the area of aging and 

long-term care, that formal services that are not available and traditional kinds of things that Robyn has been talking about are 

going to fall to the informal sector. 

31 

And that dissertation we had last year at the National Academy 

of Social Insurance investigated why 37 million caregivers have no 

real political presence, and they really cannot afford a lot more 

burden. So, I hope public policymakers keep that in mind as they 

try to escape the immediate dollar figures they are concerned with. 

Ms. WHITMAN. Robyn. 

Dr. STONE. Yeah, I guess I think there are some ways to think 

about some making lemonade out of lemons in times of fiscal constraints. And one of the things that really moved me to look at affordable senior housing and linkages with services is the potential 

for the economies of scale of large numbers of folks living together 

where you have the potential to actually redistribute dollars as opposed to needing new dollars. 

And I say this with the caveat that this could pie in the sky if 

it is not operationalized well, and that is to say that I think there 

are a lot of efficiencies and economies to be gotten out of our current system, and that is really dependent on how those decisions 

are made, who gets the resources, and how they are used. 

And one of the things that you can do that other committees 

really cannot, because you are not wedded to the jurisdiction of a 

particular committee, is to look across jurisdictional issues. So, for 

example, you can look at services and housing, and think about 

how you redeploy resources in a different way that is going to be 

a win/win. And if we find, for example, that you are able to serve 

large groups of seniors living in properties that through prevention, 

service integration, and self-care management, and some of those 

savings can be accrued, they need to then be brought back and put 

into the housing site. 

So, I think there needs to be a lot more experimentation around 

how we use current dollars because I think there is a lot of room 

for that in this system. Going forward is a different question, but 

going across jurisdictional lines, which is so hard in Congress, at 

least you have the potential to be able to do that, to look at these 

various pots of dollars that could be used in a different way, which 

is very, very difficult for agencies to do in the executive branch. I 

know because I have been there. And I think you can at least raise 

the question of how these dollars could be used differently. 

Ms. WHITMAN. Thank you. 

Henry Aaron. 

Dr. AARON. If there is one basic principle or law in economics, 

it is when the price goes up, you tend to buy less of it. As we live 

longer, the price of social insurance in general goes up, and, therefore, there are very strong pressures to buy less of it. 

Now, the point here, I think, is that, and I am going to state 

what I think is a solution, but not how you get there. And that, 

it seems to me, is the core problem. The solution is for people to 

be able, for a larger share of their lives, to be able to support themselves, which mean working longer, if they are able to do so. This 

is an extremely controversial area. And finding ways to create incentives so that people choose to do so, and businesses choose to 

employ them, it seems to me is the key. 

I say that because by any reasonable metric, current levels of 

benefits in the United States are, if anything, parsimonious. They 

are low compared to what past levels of benefits have been, and 

32 

compared to those available in other countries. So, the challenge is, 

I believe, to sustain benefit levels within a system in which people 

have incentives and abilities to continue working until later ages. 

Ms. WHITMAN. I am going to move forward to our last panelist 

because I want to save a little bit of time at the end for audience 

questions. I have several of my own that I will throw in if nobody 

else takes the microphone. 

To close our forum, I have asked the wonderful Dr. Laura 

Carstensen to not only share her reflections on the last panel’s 

presentations, but also to take an even broader view and discuss 

how the culture of aging is transforming our society. 

Laura Carstensen currently is a professor and the Farleigh 

Dickson, Jr., professor of public policy at Stanford University. She 

is also the founding director of the Stanford Center on Longevity, 

which explores innovative ways to solve the problems of people 

over 50, and improve the well-being of people of all ages. 

Thank you so much, Laura. 

STATEMENT OF LAURA CARSTENSEN, PROFESSOR OF PSYCHOLOGY AND THE FAIRLEIGH S. DICKINSON, JR., PROFESSOR IN PUBLIC POLICY AT STANFORD UNIVERSITY 

Dr. CARSTENSEN. Thank you, Deb. It is a great privilege to be 

here with my distinguished colleagues today. Thank you very much 

for including me. 

The changes that we are living through today at this point in 

human history represent a remarkable cultural achievement. Rob 

Hudson and John Rother spoke about the history of the Senate 

Special Committee on Aging, and the role that that has played in 

culture and improving the welfare of aging individuals. And then, 

Henry Aaron brought it back even further in history to the 1800s, 

and made the point very eloquently that how you age really depends on the year you were born. So, history is important. 

And it may be useful for me to just zoom out even farther and 

talk about just how remarkable and quickly this change, again, 

that we are experiencing today came about. 

More years were added to average life expectancy in the 20th 

century than all years added across all prior millennia of human 

evolution combined. In historical terms, in a blink of an eye, we 

nearly doubled the length of the lives that we are living. 

Now, during most of human evolution, life was short. It hovered 

somewhere around 18 or 19. We do not know for sure, but lots of 

people did not survive. And this length of life was really just barely 

long enough to ensure survival of the species. I mean, in humans 

you have to grow old enough to be able to reproduce, and then 

hang around long enough to make sure your offspring can grow old 

enough to reproduce. Touch and go. 

Now, evolution did act on aging through natural selection. It 

acted in a way that evolution acts at a snail-like pace. And life expectancy inched up and inched up and inched up over hundreds 

and thousands of years. 

By 1800 in this country, life expectancy was somewhere in the 

mid-30s. By 1900, it was 47. And less than a century later, life expectancy was 77. Today, it is 78. And this increase is not finished 

33 

with us yet. In recent years, a month or so has been added to average life expectancy at 65 every year. 

Now, across that very same period that life expectancy was going 

up so dramatically, fertility rates were falling and fell by half; in 

some parts of the world, even more. And it was these two phenomena together that created aging societies. If life expectancy had 

gone up, but fertility had remained high, we would not have aging 

societies; we would have more long-lived people. But those two 

forces together created and restructured the distribution of age in 

the population. 

In the United States, which reflects trends found in most developed countries, the proportion of older people in the population 

went from 4 percent in 1900 to 13 percent today, and it will increase to about 20 percent by 2030. Now, of course, in other parts 

of the world, in Japan and much of Europe, this proportional 

change is even greater. In Germany, already 16 percent of the population is over 65. In Japan, it is 20 percent now, and will go to 

28 percent by 2030. We are young kids on the block compared to 

most developed nations. 

Now, keep in mind as we talk about these numbers and we talk 

about this increase in life expectancy that the innate capacity to 

live longer has not changed. We are no genetically heartier than 

our ancestors were 10,000 years ago. What has changed are the 

odds of making it to old age. And they have changed so much that 

that pyramid that has represented the distribution of age in the 

population with many, many at the bottom winnowed to a tiny 

peak at the top, those who survived to very old age, is being reshaped into a rectangle. 

The story of how we somehow launched ourselves into this era 

of very long life does not actually begin with a story about old people at all; it begins with a story about babies. The kind of increase 

that we saw in life expectancy in the 20th century, the average 

length of life came about largely because fewer of the young ones 

dies. In 1900, 25 percent of babies born in the United States died 

before they reached five, and many more of them died before they 

reached 12. And of the survivors, a large percentage were orphaned 

before they reached 18. Death was common at all ages, but it was 

especially common in the very early lives. Life expectancy increased so much because we saved the lives of the youngest among 

us. 

So, how did we do that? Well, the short answer is science and 

technology. The remarkable increase in life expectancy is really a 

product of culture, the crucible that holds science and technology 

and large-scale efforts to change behavior, to change the way we 

live, so that we improve the health and well-being of entire populations. 

Our ancestors in the 20th century discovered the causes of diseases and the ways that they spread. They instituted grand public 

health programs that vaccinated people against diseases that they 

would never have to suffer. They did not stop there. They pasteurized milk, they purified the water ways. They implemented the systematic disposal of waste, and historians today write that you can 

thank your garbage collectors as much as your physicians for this 

34 

increase in life expectancy because that reduced the spread of disease. 

But we did not stop there, or, I should say, they did not stop 

there. As fertility rates fell, we came to invest increasingly in the 

youngest among us. Laws were passed that kept children out of 

factories and mines. Public education became available in every 

State in this Nation. We came to understand the nutritional needs 

of young children through science, but then through culture we developed food fortification programs in the United States and Europe that built vitamins into the food supply, and virtually eliminated rickets and other nutritional disorders in just 20 years. In 

other words, we built a world that is exquisitely designed to support young life. 

So, here we are at a point in history where four, five, and conceivably six generations may be alive at the same time. This is a 

game changer in human history, a dramatic change. By 2015, as 

you heard, there will be more Americans over the age of 60 than 

under 15, and by 2030, all nations around the world, all developed 

nations, let me say, will be old nations. 

Now, the fact that most children born in the developed world 

today are having the opportunity to live out their full lives, having 

the opportunity to grow old is a fantastic cultural achievement. But 

the dramatic increase in the numbers of people who are making it 

into their 60s and 70s and 80s and 90s is generating a profound 

mismatch between the cultural norms that guide us through life 

and the length of our lives. And we humans are creatures of culture. We look to culture to tell us when to get an education, when 

to marry, when to start families, when to work, when to retire. And 

life expectancy increased so quickly that we are immersed in cultures designed around lives half as long. 

So, when we think about older society, it is no wonder that mostly there is concern. You know, we see a crisis on the horizon. We 

fear that aging societies are going to break the bank, force young 

people to bear undue burdens, and eventually force societies to 

make stark choices between whether to provide services and resources for our children or our parents and our aging selves. 

I do not have to tell folks in this room that Medicare is in real 

financial trouble, and there are real vulnerabilities associated with 

age. As you heard from Robyn Stone and Secretary Greenlee, older 

populations mean populations with more chronic diseases and more 

people who require better care, better prevention, those people who 

are the very most vulnerable among us. 

And societies today are enormously ill prepared for populations 

of older people, older people especially with chronic diseases. And 

if nothing changes, societies will be top heavy with frail, and dependent, and disengaged people with relatively few people to support them. And if that is the future of our Nation, then we will endure many hardships. 

But as you have heard from so many of my colleagues this afternoon, that future is not an inevitability. In fact, when you think 

about how quickly we doubled life expectancy, it is amazing that 

older people are doing as well as they are. I mean, today the physical and the social environments that we live in were quite literally 

built by and for young people. The tacit uses are staircasers of 

35 

automobiles, of parks, of telephones, of highways, of train stations, 

of housing, workplaces. These were all built around young populations, so we expect workers to be agile and fast. Medical science, 

a key part of culture, has focused more on cures for acute diseases 

than on prevention of chronic diseases. And many societal roles 

were also designed when life expectancy was 47. And so, they were 

designed without the knowledge of the unique capabilities that 

older people, older citizens, may bring to this country. 

So, even though agism is often invoked, and, to some degree, has 

to play a role in this, we live in a world that only recently came 

to have large numbers of older people. Now, even so, research has 

shown us in recent years that the aging process is not best characterized by a sweeping downward trajectory. There are many aspects of functioning that actually improve with age; knowledge, expertise, emotional stability go up. And we have also observed already at this point in human history that among the affluent and 

the well-educated, we are seeing people flourish into very advanced 

ages. People who exercise, who live particular lifestyles, fare better 

in old age than people who do not. So, we see lots and lots of variability, and to scientists, variability speaks against inevitability. 

Variability in aging means that it is not aging per se that is the 

culprit, but rather something about the way that we are aging. 

It is time now for a profound change to culture. We have never 

needed to invest in science and technology more than we need to 

invest today. And the really good news, as you heard from Richard 

Hodes and from Michael Harsh, is that the potentials of science 

and technology are truly breathtaking. We need to rise to the challenges of aging populations. We need to find cures for diseases like 

Alzheimer’s disease and arthritis. We need to find ways to make 

technology available to help people monitor their own quality of life 

and their own health state, and to allow people, even those with 

significant chronic diseases, to live independently. 

If we invest in improving the lives of people 50 and older as 

much as our ancestors did 100 years ago to improving the lives of 

the youngest among us, then older societies can be better societies 

than we have ever known. In order to do so, we will need to do, 

as Jack Rowe argues so forcefully, shift our unis of analysis from 

only focusing on the elderly to focusing on society. Aging societies 

will fail or succeed largely based on the new meanings that we ascribe to both healthy and unhealthy lives. 

As John Rother said this afternoon, we need to consider and really dwell on the possibilities for major lifelong social investments, 

ones as large as the concept of public education a century ago. And 

if we do, then we can transform societies in ways that will make 

aging societies better societies. And to fail to do so would represent 

a real tragic squandering of this truly remarkable gift of life. 

Thank you. 

[Applause.] 

Ms. WHITMAN. We chose to end with Laura because her predictions of a long, bright future ahead, and the challenges we face 

in a positive way, are really the lens at which I think the committee views our future. 

36 

I have appreciated all of the speakers today. You have given me 

a long agenda of items that the committee needs to address in our 

last year of Chairman Kohl’s leadership, and also into the future. 

I am going to take the option of not keeping you here for questions because many people are headed over to the Gerontological 

Society of America’s reception that is being held in 325 Russell, 

and you will probably be able to ask questions of the individuals, 

if the audience does not mind, at that opportunity. 

But, again, I thank you all, especially the audience members, 

former staffers whose shoes that we all hope to fill every day and 

aspire to contribute to the way that they have in the past. I thank 

you all to my speakers today; each and every one of you was terrific. And I thank you to the vision of the future that we are all 

hoping to create. 

So, thank you very much. 

[Applause.] 

[Whereupon, at 4:45 p.m., the hearing was adjourned.] 

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