A Looming Crisis

Book cover
Faith in the Futureby By Harold G. Koenig and Douglas M. LawsonTempleton Foundation Press. 216p $24.95

What are the challenges facing health care in America, and will the members of America’s 350,000 religious congregations be able to help prevent or lessen the looming health care crisis unleashed by relentless demographic pressures and rising costs? That is the question addressed in this book. Despite the apocalyptic tone of the question, there is a measured, even hopeful reply offered by the authors, Harold Koenig, M.D., whose research has focused on the benefits of religion on health, and Douglas Lawson, Ph.D., who is an expert on volunteering.

The book itself is the byproduct of a major conference, Faith in the Future: Religion, Aging, and Healthcare in the 21st Century, held in March 2001 at Duke University, and according to the authors is a synthesis of the findings of the conference. In citing the most current data on aging and religion, the book also expands upon the work of the conference. But for all its currency, it confronts a problem familiar to anyone who has been following the so-called graying of Americanamely, the unprecedented growth in the number of people 65 and older, who are surviving, thanks to the efficacy of modern medicine and public health, with chronic illness successfully managed by long-term health care. The projections for those 85 years and older bear this out, with an anticipated rise from 4 million now to at least 18 million in 2050. This dramatic increase is accompanied by an equally dramatic decrease in the projections for that part of the population who, as wage earners, would be expected to provide the revenues from which to pay for the medical care of the increasing number of elderly. The refusal by more and more H.M.O.’s to enroll Medicare patients is one clear indication of this.


The crisis to which Koenig and Lawson point alarmingly will be triggered by the impending retirement of those famous baby-boomers. By 2011, 40 million of them will have reached age 65, with a 50 percent increase in that number by 2033. Meanwhile, Medicare expenses will increase from the 1999 figure of $213 billion to $450 billion by 2011. Within the same period, total public and private expenditures for health care in the United States will grow from $1.2 trillion to $2.8 trillion annually. Caught, as it were, between the two arms of this demographic vise and its unavoidable financial consequences, America, the authors contend, cannot pay its way out completely. The costs are already too great. Does that mean that we can expect only catastrophe to come from the crisis?

Not necessarily is the reply, if we recognize the resources available from within the aging population itself and if we can structure the use of these resources in and through faith-based institutions around the country. The central argument of this book is that despite the sheer size and complexity of the problem, religious institutions can take the lead by mounting nationwide a voluntary social services program to avert what otherwise could be a societal breakdown.

That may turn out to be true. But whereas the authors portray the nature and extent of the challenge with an exhaustive array of demographic and economic data, the details of their plan remain surprisingly sketchy. They cite models like Habitat for Humanity and the growing network of parish nursing programs. They point out that of the country’s charities rated most effective, five are religious-based.

They also point to the financial support the Clinton administration and the Bush administration have given to faith-based organizations as they seek to address social problems, such as access to health care for the elderly. But how all these independent initiatives would be united in some kind of national network of voluntary services to avoid duplication, and how they would be able to focus effectively on what is represented as a looming national crisis, remains unclear. Who would set priorities, and how would these priorities dovetail with those of the federal, state and local government agencies? What would be the cost of putting a network like the one envisaged here into place? Is it realistic to think that the spirit that motivates movements like the parish nursing program might be harnessed to serve as a collaborator with government in what is merely a social services enterprise?

One suspects that the authors may be seeing too much of the organizational features of these faith community initiatives and their potential for mobilization in a national emergency, while seeing too little of the incalculable spirit that permeates them.

In this regard, a major disappointment with this book is its failure to explore what, religiously speaking, is the meaning and purpose of aging. Some of this is understandable, since even major religions have forgotten that there is a wisdom about aging to be found in their spiritual traditions. On careful examination, three consistent themes are evident in Christianity: age as a blessing, as a process of growth, and as the occasion for ethical witness. Similar themes are to be found in all the major religious traditions.

As people live both longer and more productively, aging becomes increasingly a significant moment in the human life span. Informed by an understanding of aging rediscovered in our religious traditions, those for whom the time for aging has come and those who accompany their aging can do so from that ultimate perspective characteristic of religion. If Carl Jung is correct, a positive experience of aging depends upon spiritual growth. That suggests, not a rescue operation from aging but a commitment to it as the culminating phase in the life cycle, worthy of the respect traditionally accorded it in Hinduism and Islam, for example. This is faith in a future that offers a rather different approach to understanding and providing for successful aging. Instead of stepping in where the government has irresponsibly stepped out, religion, even as it performs the corporal works of mercy, must work singlemindedly at this critical juncture for a society in which the aging can realistically live with the expectations expressed in the Rig Veda (1.116): Let me be lord over this world, with good cattle and good sons; let me see and win a long life-span and enter old age as if going home.

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