OpEd
If this administration convened a White House Conference on Aging tomorrow, I’m not sure I would want to attend. I’m also not sure I could afford to stay home. That tension isn’t ambivalence. It’s the product of 40 years of watching what happens when institutions designed for accountability get captured by the interests they were meant to examine.
I have seen it in nursing-home surveys where deficiencies were negotiated down before the ink dried. I have seen it in commissions whose membership guaranteed their conclusions before the first meeting. I know what managed consensus looks like. I can recognize a stage before the curtain rises.
A White House Conference on Aging convened by this administration would not be the 1971 conference, where Nixon—whatever his other failures—allowed a process that strengthened the Older Americans Act, the National Institute on Aging, and Supplemental Security Income. It wouldn’t even be the 1981 conference, where Reagan’s team arrived with an agenda and left having lost floor votes to advocates who knew their procedural rights and used them.
It would more likely resemble what the 2005 conference became: a curated event producing a report that industry could cite for a decade as evidence that someone in power had listened. The agenda would be shaped to celebrate market innovation. Medicaid would be discussed in the language of fraud and dependency, not adequacy and dignity.
‘73 million older Americans are moving into the peak years for long-term care need right now, without a national reckoning, without a democratic instrument, without even a functioning website.’
Workforce shortages would be attributed to overregulation rather than poverty wages. Private equity would not be named. The word extraction would not appear. And somewhere in the final report, amid statistics about the older population and photographs of smiling delegates, there would be a paragraph about reducing the burden of government on families, which is a polite way of describing what happens when you cut the programs that keep people alive.
I know this not because I am cynical about government. I am not. I have worked inside institutions my entire professional life because I believe they can be made to serve their stated purposes. I know this because I have watched the architecture of this administration, the dismantling of federal oversight capacity, the acceleration of the extraction economy in healthcare, the systematic removal of the civil servants who carried institutional memory about what the regulations actually required and why. You cannot hold a legitimate national reckoning about the care of vulnerable people while simultaneously defunding the agencies responsible for their protection. The contradiction is not subtle.
And yet.
The 1981 conference remains instructive precisely because the Reagan administration did not get what it came for. Advocates showed up prepared. They understood the rules. They had done the organizing before they walked in the door. They turned a managed event into a contested one, and some of what they won on that floor shaped policy for years afterward. The instrument, even in hostile hands, created a space that advocates could enter and refuse to vacate.
This is the calculation I cannot resolve from the outside. Whether a conference under this administration would offer that kind of floor and whether the procedural architecture would permit genuine contestation, whether advocates have the organizational capacity to use it, whether the legitimacy granted to the convener would outweigh the leverage gained by the participants. I don’t know. What I know is that 73 million older Americans are moving into the peak years for long-term care need right now, without a national reckoning, without a democratic instrument, without even a functioning website.
The silence is not neutral. Choosing not to convene is itself a policy. And when the people most affected by that silence are also the people least able to make themselves heard—those in memory care units, in underfunded rural facilities, in the last years of lives that were not wealthy or powerful or visible—the silence becomes something more than administrative neglect. It becomes a statement about whose aging counts.
So, would I attend? I think I would go. I would go the way advocates went in 1981, not to validate the process, but to refuse to let it proceed without a reckoning. I would go because the alternative is to leave the floor to those who would use it to confirm what they had already decided.
I would go because I have spent enough of my life watching the costs of principled absence. And I would go because at 78, with 40 years of this work behind me, I have earned the right to be inconvenient.
The conference should have happened. If it happens now, we cannot afford to let it happen without us.
James A. Lomastro, PhD, covered the 2005 White House Conference on Aging for The Healthcare Ledger in a six-part series. He is a national CARF surveyor and serves pro bono with Dignity Alliance Massachusetts. He lives in Conway, Mass.
