Susan Jacoby sees nothing ennobling and much to dread in the onset of old age, particularly as it plays itself out in America. Now 65 herself, she has little patience with all the happy talk about potential medical breakthroughs that promise to turn “ninety [into] the new fifty.” In Never Say Die, she argues that Americans can either fool themselves into believing that their bout with old age will somehow be magically better than it has been for all previous generations, or they can work for social and political changes that will cushion the ravages of the final years.

In addition to her substantial research on the problems of aging, Jacoby has confronted many of them personally. Her beloved grandmother, by her own assessment, “outlived her usefulness” and died surrounded by other old people “too demented to carry on any kind of conversation.” Her once-vigorous father died in his early 70s of lung cancer, and her longtime companion was stricken by Alzheimer’s disease before also succumbing to cancer. Until she became old enough to qualify for Medicare, Jacoby was paying 15 percent of her after-tax income for health insurance. All these experiences convinced her that aging must be treated as a common social problem, not an individual one.

“The two overwhelming problems of real old age in the United States today,” she writes, “are health, which generally worsens over time, and the tendency of all but the richest Americans to grow poorer as they grow older.” She points out that nearly half of Americans over the age of 85 suffer from some form of dementia, a situation imposing almost intolerable burdens on all but the richest families. Home health care, while cheaper and more desirable than institutional care, still goes underfunded, and women, who tend to earn less and live longer than men, become increasingly at peril as they age. Health care needs to be funded by higher taxes and made available to all, Jacoby argues, both to be just and to avoid tension between young payers and old recipients.

While Jacoby agrees that it makes sense to seek medical advances to prolong the quality of life, she insists that it’s much more important to address the consequences of aging as they exist now—and will for the foreseeable future.


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