Old age

Medicare and Social Security apply one set of rules across the country, so differences by place in what they pay, and to whom, show how a single rule reaches different populations. This part asks whether the programs of old age follow the neighborhood gradients of the earlier parts or cut across them. The first chapter describes places and the second describes people.

Chapter 8.1, Disability, retirement and Medicare finds that adult disability rises with neighborhood deprivation, and that the age structure of a neighborhood accounts for little of it. The disabled-worker share of Social Security beneficiaries is larger in more deprived ZIP codes, and the size of a retired worker's benefit follows ZIP code income. Medicare payments per fee-for-service beneficiary show no detectable difference across county deprivation, although the mix of services behind the total differs. The most deprived counties are mostly small ones, so that comparison sets small counties against large ones. The payments are not adjusted for how sick beneficiaries are, so equal payments do not mean equal need or equal care. The last section turns to county estimates of the expected age at death by household income quartile, and weighted by residents the poorest quartile varies more across counties than the richest. That comparison depends on the weights, and the chapter reports it both ways.

A box in the chapter reports studies of what Medicare eligibility, disability allowance and a Social Security benefit notch changed for the people they reached. Those designs estimate what a program changes at a threshold or on the margin of a decision, and none of them estimates whether the programs would narrow the differences between places that the rest of the chapter describes.

Chapter 8.2, Well-being across the life span asks how people rate their lives and describe their days at different ages, and whether the pattern differs between richer and poorer places. It uses Gallup interviews, which compare people of different ages at about the same time, so age and birth cohort are mixed together, and the oldest respondents are survivors of their cohort. The chapter describes how well-being differs across ages in those interviews and does not follow any person through a life.