costs of the new Medicare catastrophic illness legislation are not borne out. In addition, large numbers of Americans are currently pauperized and emotionally drained by the expense of long-term care. As our population ages in the years ahead, the situation is only going to become worse. Yet we have not developed a workable public or private insurance approach to cope with the problem of long-term care.

In summary, the present system represents a paradoxical mixture of generosity and stinginess, huge spending and huge gaps. Few realize that the inequality of wealth is greater among the elderly than among other age groups. Moreover, the disparities in old age between the haves and the have-nots are likely to grow in the years ahead. This is because of the emerging difference between two groups: those depending almost exclusively on Social Security benefits that will grow more slowly than in the past, and those who will have profited from the escalating values of home ownership, from tax-favored savings initiated in the 1970s, and from expansions in private pension coverage that are most extensive for workers in higher-paying jobs.

Tragically, however, there is one great equalizer as Americans reach very old age and lose the physical or mental capacities to live independently. Only the extremely affluent will be able to pay for long-term care from their own resources. If we could look into the nursing homes of America, we would see, as we did in looking at infants through the nursery windows, the fundamental human vulnerability that we all ultimately share.

The basic theme of this chapter is straightforward: Some elderly Americans are not receiving enough help, while others are not contributing as much as they could. There is a growing mismatch between the vulnerability of old people and our social institutions that were designed to assuage it. Those elderly who can contribute more should do so—to help those who have been left behind, to help ensure a solvent Medicare system and a humane system of long-term care for themselves and others. New policies must not undermine the economic security and opportunity that have already been achieved for older citizens. But there are fair, progressive ways for the affluent elderly to help fill the gaps that exist in our social protection system, and we should not shrink from asking them to do so.