Abstract:

Four forces shape U.S. policy on aging: austerity, federalism, deregulation, & the medical-industrial complex. Two major trends in the development of policy are the commodification of the aged & their needs & a social class basis for the distribution of benefits, differentiating the deserving from the undeserving elderly. Ideologies of individualism, self-help, privatization, & competition are used to delegitimize public programs & to reduce expectations about what government can & should do to ameliorate social problems. Recent policy is characterized not only by reduction of federal funds for domestic social spending, but also by a restructuring of the community care delivery system as it operates in the private, nonprofit sector of the economy. The emergent processes of this restructuring-eg, targeting of services based on ability to pay & individual characteristics, medicalization, & absorption of nonprofit agencies by for-profit agencies-& their consequences are viewed in light of the search for new sources of capital investment in the domestic markets. This analysis raises important political questions concerning the transformation of relations between the state & the nonprofit sector.