Privatizing the Welfare State

Abstract The growth of the private sector in the Medicare and Medicaid programs is a sea change, leading many to argue that the old age welfare state is effectively becoming privatized. I examine these trends, but focus on the consequences for how older adults experience their interactions with government. In particular, I examine how privatization increases administrative burden for beneficiaries. Older adults must navigate hundreds of choices, leading to significant confusion. Most fail to pick policies that maximize their benefits and reduce their cost. This confusion harms beneficiaries. They end up with suboptimal coverage, with increased out of pocket costs and decreased access to care. The confusion, however, generates profits for insurers. Part of a symposium sponsored by the Women's Issues Interest Group.

publication of the Aging Enterprise over 40 years ago. This book quickly achieved iconic status among gerontologists and other social scientists as one of the founding texts in critical gerontology, which Dr. Estes has played a leading role in developing with numerous publications over the course of her illustrious career. The panelists will focus on Dr. Estes' application of the theoretical frameworks offered by the social construction of reality and the political economy of aging to a critique of federal and state policies designed to improve the quality of life of older Americans. Many of the programs and policies included in Dr. Estes' critique are still in place, including the Older Americans Act and the nonprofit aging network. On the other hand, much about the aging enterprise has changed since 1979. The panelists, Drs. Chris Phillipson, Pamela Herd and Larry Polivka, will discuss the value of and challenges to these theoretical and empirical perspectives within the current contemporary neoliberal political economy that has gradually displaced the welfare state capitalism of the postwar period. As this shift has occurred in the political economy, a neoliberal policy agenda featuring for-profit privatization of public services, including aging services, has become dominant at the federal and state levels. Dr. Estes will respond to the panelists' presentations and discuss the future of critical gerontology. Women's Issues Interest Group Sponsored Symposium.

THE POLITICAL ECONOMY OF AGING SERVICES IN THE UNITED STATES SINCE THE AGING ENTERPRISE Larry Polivka, Florida State University, Tallahassee, Florida, United States
The Aging Enterprise was the first book length analysis of the origins and operations of the aging services system that grew out of the 1963 Older Americans Act and provided the first state system of community-based services. The book also featured an original critique of the aging services system based on an application of the theoretical perspectives that were new to social gerontology. This presentation will use one of these perspectives, the political economy of aging in the U.S., to chart changes in aging services systems since the publication of The Aging Enterprise. The presentation will show that Estes' pioneering work on the application of the political economy perspective on aging policies and programs in the US, is more relevant to our understanding of these programs than it was 40 years ago, by describing and analyzing the increasing control of for profit corporations over the aging services systems. Part of a symposium sponsored by the Women's Issues Interest Group.

REASSESSING THE AGING ENTERPRISE: NEW PERSPECTIVES ON THE SOCIAL CONSTRUCTION OF LATER LIFE Chris Phillipson, Manchester Institute for Collaborative Research into Ageing, Manchester, England, United Kingdom
Four decades on from the publication of 'The Ageing Enterprise', this paper provides a critical review of the relationship between social theory and social policies for later life. To what extent do current theoretical perspectives in gerontology bear the influence of ideas laid out in that pioneering book? How has the 'ageing enterprise' fared given the dominant ideology of neo-liberalism and the precarious lives faced by people moving through the life course? The paper considers these questions in the context of globalization processes, and the imposition of austerity policies. The paper will consider the continuing importance of 'The Ageing Enterprise' by reviewing three main themes: first, assessing the changing relationship between the state and social policy; second, through examining current perspectives within critical gerontology; third, highlighting new forms of empowerment developing amongst older people, and the relationship of these to the values and ideas expressed in 'The Ageing Enterprise'. Part of a symposium sponsored by the Women's Issues Interest Group.

PRIVATIZING THE WELFARE STATE Pamela Herd, Georgetown University, Washington, District of Columbia, United States
The growth of the private sector in the Medicare and Medicaid programs is a sea change, leading many to argue that the old age welfare state is effectively becoming privatized. I examine these trends, but focus on the consequences for how older adults experience their interactions with government. In particular, I examine how privatization increases administrative burden for beneficiaries. Older adults must navigate hundreds of choices, leading to significant confusion. Most fail to pick policies that maximize their benefits and reduce their cost. This confusion harms beneficiaries. They end up with suboptimal coverage, with increased out of pocket costs and decreased access to care. The confusion, however, generates profits for insurers. Part of a symposium sponsored by the Women's Issues Interest Group.

THE BOLD PUBLIC HEALTH RESPONSE TO ALZHEIMER'S DISEASE AND RELATED DEMENTIAS: PAST, PRESENT, AND FUTURE
Chair: Lisa McGuire Co-Chair: Nia Reed Achieving meaningful progress against Alzheimer's disease and related dementias (ADRD) requires an urgent public health response. Since 2005, the Alzheimer's Association, Centers for Disease Control and Prevention (CDC), and other public health partners collaborated on the Healthy Brain Initiative (HBI). HBI seeks to advance public health awareness of and action on ADRD as a public health issue. The HBI Road Map Series, State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map (S&L RM) and Road Map for Indian Country, provide the public health with concrete steps to respond to the growing burden of ADRD in communities, consistent with the aim of the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act (P.L. 115-406). This series of RMs for state, local, and tribal public health provide flexible menus of actions to address cognitive health, including ADRD, and support for dementia caregivers with population-based approaches. The purpose of this session is to illustrate public health's role with ADRD-past, present, and future. An overview of the evolution of HBI RM series will be provided (McGuire) and preliminary evaluation data of 24 actions from S&L RM will be presented GSA 2020 Annual Scientific Meeting Innovation in Aging, 2020, Vol. 4, No. S1