An Aging "Crisis" in Australia?
An Aging "Crisis" in Australia?
Public debate about ageing swings between extremes of moral pessimism, such as economic rationalist concerns about growing levels of public dependency, and romanticism, such as the optimism of health promotion and age activists. The new report by Pamela Kinnear "Population Ageing: Crisis or Transition" from the Australia Institute is on the side of optimism. She also smells a conspiracy when a conservative government is associated with reports of the unsustainability of costs of ageing and seeks to reduce public expenditures. We should be cautious in this line of arguement. Excessive optimism about ageing is an even better reason to cut public expenditures than is a pessimistic position.
Kinnear's Report has had good media coverage. Despite reports that it is 'new', the 'no crisis' argument originates from Barer's 1980s Australian Institute of Health (now AIHW) comparison of health costs between Medibank 1976 and Medicare 1986. This showed very minor effects of ageing on health cost increases, a result confirmed in more recent work by AIHW. In fact the Australia Institute Report depends heavily on official data from AIHW and other sources. The 'no crisis' position reached the Government 'mainstream' when it was fully supported in the National Strategy for an Ageing Australia. This is a further reason to be cautious of the conspiracy theories. Incumbent governments have a vested interest in positive reports of areas of responsibility.
Some reporting on the publication shows the dangers of uncritical optimism. The Australian (18/12/01, page 9) reports: 'Only 7 percent of older Australian live in residential care, with most, 93 percent, willing and able to live in private homes.' Whilst factually accurate, it is reported in a way that is insensitive to the lack of choice and poor conditions of many older people living in the community.
The argument about whether we are having a crisis of ageing or not should not distract us from major policy reform that is urgently required. Costs of ageing grow steadily with an ageing society even taking account of Kinnear's comments on the methodology of some reports. The Howard Government has adopted an 'implicit' user pays policy to supplement general revenue funding. By contrast in April 2000, Japan introduced long-term care insurance (Kaigottoken). This welfare conservative state mandated socialised care for older Japanese! Is this an option for Australia?
Japan also shifted its balance of care strongly towards community care. Despite Australia's Home and Community Care Program and Community Aged Car Packages, the per capita (person in need) HACC subsidy declined through the 1990s. Residential care increased its share of aged care expenditures and is still pushed strongly by the industry lobby. Do we need to redirect more resources towards community care?
Older workers are likely to slowly grow in numbers with the ageing of the babyboom - an issue well explored in the Access Economics Report. Independent retirees dependent on superannuation will be more numerous and will shift the fulcrum of ageing politics and public policy. Then there are intractable issues of Commonwealth State responsibilities. In summary we may not have a demographic crisis of ageing but unless we move soon we can create a crisis in policy. Let's get beyond crisis talk and debate policy!
Copies of Professor Mc Callum's 'A Comparison of Aged Care in Australian and Japan' (December 2000) and 'Ensuring Quality of Later Life' are available through the Whitlam Institute. Email: whitlam@uws.edu.au
