This book is a valuable guide to understanding social insurance, the debate over Social Security and Medicare, and the broader politics and policy surrounding old age and ageing in the United States (US). The authors, economist James Schulz, and political scientist Robert Binstock, bring substantial credentials to their analysis, each having served as President of the Gerontological Society of America (GSA), and having been prolific and well-respected gerontology scholars for decades. The book has 10 chapters that describe and address the claims and validity of the current discourse on the demographics of ageing and its alleged crisis, much of which is raised by conservative scholars and think-tanks in support of their goal of privatising the US welfare state. The goal of the book is to ‘go beyond simply challenging the pronouncements and conclusions of the doomsayers and their erroneous demographic determinism’. In the context of rising ‘anxiety in the country’ around ‘globalisation, flat wages, permanently lost jobs, disappearing [private] pension benefits and … government assistance’, the authors seek to assist readers (1) to ‘better understand the changes … occurring nationally with regard to shifting demography and its impact on the elderly and their retirement decisions’; (2) to inform them ‘about the personal situations they are likely to run into as they prepare for retirement’; and more participatively (3) to ‘contribute to the major dialogue (policy discussions) that must take place on the interdependent issues related to the economics and politics of aging’ (Preface, p. ix).

Chapter 1, ‘Baby boomers and the merchants of doom’, speaks of those who contend that there is collective adversity because the US is an ‘aging nation’ with the changing demographics of young and old. The term ‘merchant’ is used ‘because of … [their] selling [of] their concerns to promote various interests – a particular ideological point of view (in many cases), opportunistic selling of financial services products … and/or blatant hostility toward older people in general’. ‘Doom’ is used ‘to emphasize that one of their selling techniques is to portray impending disasters’ (p. 12). The doomsayers' solutions would ‘wipe out most of the economic and social gains our nation made in the twentieth century related to life in old age’ (p. 4), including cutting or eliminating Social Security, rationing health care for older people, lowering or terminating employer-sponsored pension benefits, raising the retirement age, and increasing individual risk for retirement income. Schulz and Binstock counter that ‘the changing demographic structure of the population … does not necessitate a radical overhaul of our social institutions and a decline in our well-being during our later years’. In short, the book sets forth the argument that ‘there is no need to drastically change the many positive aspects of old age that the current generation of old people enjoy’ (p. 4). Chapter 2, ‘The phony threat of population aging’, will sharpen the reader's understanding of ‘demographic determinism’ with sections on Why was Malthus wrong?, Demography is not destiny, and Voodoo demographics. The authors provide lucid comparisons of the different implications of applying different types of dependency ratios (see The aged dependents, Count children too, and Count all workers, pp. 26–34). Chapter 4 also addresses the role of pensions in market economies, evaluating pension plans, and workable solutions to the Social Security solvency question.

Chapter 3, ‘The search for security with dignity’, is a major strength of the book with its attention to social insurance and the increasing importance of state provision of Social Security in the lives of older persons and their families, particularly in view of the increasing economic risks and uncertainty in jobs, private pensions, skyrocketing health costs, and family dynamics. The sections on A contributory program to deal with the unexpected, Prepare for the unexpected, Preserving dignity (pp. 53–55), and Mother, apple pie, and Social Security (pp. 61–63) together with Chapter 4, ‘Dealing with risk’, are a welcome addition to the literature. This is particularly so for US readers where there is much negative press about the (in)solvency of Social Security and widespread promotion of privatisation proposals – and minimal public dialogue on the rationale for and benefits of social insurance.

Chapters 5 and 6 on ‘The company pension’ and ‘The pension lottery’ respectively chronicle the history and uncertainty of private pensions, and the authors conclude that ‘employer-sponsored pension plans cannot be counted on as a reliable and adequate source of supplemental income for future retirees receiving modest Social Security benefits’ (p. 88). Companies, bolstered by favourable judicial rulings, have abandoned, evaded (by bankruptcy rulings and other mechanisms), reduced, and radically altered their plans and benefits, while switching from defined-benefit (DB) to defined-contribution (DC) plans. The importance of state provision of the Social Security DB has increased as it represents the highest and rising percentage of income for those aged 65 or more years (at 39% of total income in 2002), and is the source of 90 per cent or more of the income for more than three-quarters of single and minority older women. Employer-pensions comprise 20 per cent of all sources of retirement income, and less than one-half of all employees have coverage. Predictably, the lowest rates of and benefit amounts from employer pensions are received by those who need it most, minorities and women. There is a useful discussion of international pension reforms including privatisation efforts in the United Kingdom and Chile (pp. 126–34). Chapter 7, ‘To work or not to work’, addresses age-specific labour-participation trends and work in later life, positing that ‘the strong anti-work attitudes of employers, unions, politicians and workers toward older workers [will] continue’ (p. 151). Although running counter to the rising calls by policy makers for elders to work longer, data are presented on substantial attitudinal and other barriers of potential employers and older workers to any real major shift in workforce composition (e.g. poor health of older workers, rigid work schedules and low wages). Raising more questions than answers, the authors observe that income distribution issues as between the rich and poor are ‘at the heart of the matter’ (p. 170), and note that surveys demonstrate scant public support for increasing the Social Security retirement age of eligibility.

Chapter 8, ‘Health and longevity’, focuses on long-term care and its prospects, as well as ageing and health care including the cost and rationing debates. Evidence-based data underscore multiple myths to illustrate that age-based cut-offs in Medicare (rationing) would do little to stem the upward spiral of programme expenditures. The cost problems of Medicare and Medicaid (health insurance for the poor), prescription drug utilisation, and technology are appropriately examined in the context of the larger health-care system, illustrating that Medicare's issues are only part of a flawed overall health-care system (p. 197). While most Organisation for Economic Co-operation and Development (OECD) countries assure health coverage for most of their citizens, ‘the US rate of government-assured health care is 33 per cent … the lowest of the 30 OECD nations’ (p. 197). A section is devoted to the commercial and clinical anti-ageing movement and market comprising cosmetic treatment and surgery; exercise and therapy; vitamins, minerals and supplements; and cosmetics (estimated at $64 billion by 2007, p. 182). Although inferences may be drawn from the information presented, the book offers little explicit critical analysis with regard to the role and consequences for ageing of the high profits, corporate conglomerates, and the now $2+ trillion US medical-industrial complex. The authors observe, however, that ‘the increasing costs of drugs and … high-tech diagnostic and interventional tools have nothing to do with population aging but have a lot to do with the mushrooming general expenditures on health care’ (italics in original, p. 194).

Chapter 9 on ‘The politics of aging: a gerontocracy?’ presents Binstock's well-honed arguments on ‘the flawed postulate that older persons vote as a self-interested bloc’ (p. 209). Consistent with the attention that pluralist political science gives to the diversity of interest groups, the chapter introduces the mass-membership organisations, the 51 Leadership Coalition of Aging Organizations (LCAO), and the ‘unique position of AARP’ (American Association of Retired Persons). A section on the controversial Medicare Modernization Act 2003 (MMA) credits AARP's role in its passage as ‘the most influential that any old-age interest group has ever had in American politics over the years’ (p. 215), the keystone of which is a major step in Medicare privatisation through the Part D prescription drug benefit and other ‘modernisation’ components. AARP has garnered huge direct financial gains (by some estimates, in the billions) as a provider, through United Health Care, of the privatised and state-subsidised Part D and Medicare Advantage programmes. Elder out-of-pocket medical costs are escalating while (astonishingly) the federal government is prohibited from price negotiations with pharmaceutical companies. The chapter concludes with a section on baby boomers and the politics of ageing, which raises questions about their voter participation and potential ‘old-age political consciousness’ (p. 222).

Chapter 10, ‘Framing the issues for an aging nation’, reviews the book's main themes and restates the view that, ‘the ingenious solution of the Social Security approach was (and still is) the national pooling of risks through insurance mechanisms, a solution that has produced meaningful financial security with dignity for most older Americans’ (p. 225); and that ‘the Social Security old-age benefits financing problem is the one that can be fixed most easily’ (p. 225). Observing that, ‘the uneven distribution of security from risks is why insurance was invented – to deal with the unexpected by spreading the risks’ (p. 229), Schulz and Binstock concur with Jacob Hacker (Reference Hacker2006) that ‘Social insurance … transformed the dislocations of modern capitalism into risks that that could be managed and redistributed, rather than blows-of-fate that could only be feared and suffered’ (p. 229). Sections on Framing the issues build up to the theme that, ‘we're all in this together’ (p. 232).

The authors call for more public education about various ‘scenarios that depict what life will be like for aged baby-boomers and their families (italics in original) if nothing is done to maintain Social Security and Medicare in forms that sustain government support at a level that is reasonably comparable to what older Americans experienced in the last … decades of the twentieth century and the first years of the twety-first’ (p. 234). Their proposal for a solution was found surprising and disappointing: ‘perhaps the most effective issue-framing strategy to counter the Merchants of Doom would be for AARP to form a coalition with advocates for children … and [others] concerned with the welfare of family members of all ages’, to ‘launch a sustained media campaign’ to ‘portray the aging of the baby boomers as a challenge confronting the baby boomers themselves, their families and society – rather than as a Social Security and a Medicare crisis’ (p. 233, italics in original). Their point is well taken, however, that the packaging of ‘policy options for our ageing nation as family policies’ (p. 235, italics in original) could be key to securing political support across the generations.

The authors' analyses and observations are valuable, current and in some cases prescient, but the reader will not find a critical lens or reflections from feminist, race or class perspectives. For example, feminist, race and class issues underlying Social Security, and health and long-term care policy in the US are hardly found in this text although prominent in the wider literature. Burning issues from a critical perspective concerning the role of the state, global capitalism, and rising inequalities are mentioned (and treated with a velvet glove?), without much follow up or discussion of their location in a broader set of economic, political and cultural processes that are underway.

Overall, in Aging Nation, Schulz and Binstock contribute a highly readable, factually grounded and detailed rejoinder to much of what the doomsayers, crisis mongers and policy pundits say in connecting the politics of demography and economics of ageing in the United States. Building upon an historically-informed presentation on the origins of Social Security, the authors offer a strong rationale for its increasing importance in view of the present inadequate and faltering private pension system and the rising risks of economic and health security facing the entire population. This book goes a long way towards achieving its goals in explaining ‘why, whether we like it or not, the days of major individual and family provision for old age are gone’ (p. 20) and why ‘our changing demography is not the key determinant of our destiny’ (p. 23).