The baby boom generation, which has been shaking up American society for more than a half-century, is about to unleash one last revolution.
Starting next month, the first of the nation's 75 million baby boomers – born in the generation after World War II, between 1946 and 1964 – will reach age 65, setting the stage for a huge retirement rush that will test the resources of government and boomers alike. The frontier will be health care, and the danger is that the combination of rising costs and boomer retirements could swamp the health system.
Nowhere is the challenge bigger than in California, with the nation's largest boomer population (nearly 9 million) and a safety net already under enormous financial pressure.
"Two realities are on a collision course," said Gary Passmore, director of the Congress of California Seniors, which lobbies on behalf of older adults. "The number of seniors is growing, by amounts that nobody can yet appreciate." Simultaneously, he said, revenues "at every level of government … are really stressed. These two things are going to create enormous tension."
It's not just the safety net that will be tested. Boomers of all stripes must adjust to a transformed health care system less centered on hospitals and nursing homes and more focused on cost savings. Many will be expected to shoulder more of their own health costs.
The spike in California's 65-and-over population will happen suddenly. The number of Californians reaching 65 in 2012 will be up nearly 25 percent from this year's total.
By 2040, with boomers well into their retirement, a projected 11.5 million people will be 65 and older in California, more than twice today's total. Meanwhile, the number of people 85 and older will more than triple, to nearly 2 million, as life expectancy continues to grow.
This will put enormous pressure on Medicare, the subsidized national health system for 47 million older adults. Medicare costs have been climbing so quickly, even before the first boomer retires, that future retirees should anticipate some combination of scaled-back benefits and higher out-of-pocket costs.
But Medicare isn't the only problem area as the boomer retirement gets under way:
• State and local health programs in California have already been cut back and more reductions are certain. The safety net for the poor is weakening, and many government programs promoting innovation in health delivery have been pared.
• Parts of the state already are experiencing shortages in primary care doctors and geriatricians.
Many boomers haven't saved enough during their working years, and have been stymied in the past decade by plummeting home values, a stagnant stock market, the elimination of pension plans and, for some, long periods of unemployment.
Rita Rogers, a part-time legal assistant who lives at Sun City Lincoln Hills, will be in the vanguard of retiring boomers, turning 65 on Jan. 9. She's been looking forward to her new Medicare policy for years but admits she was surprised to learn that there is much Medicare doesn't cover.
"You grow up and always hear Medicare is the answer to everything," she said. "I wasn't aware of all the things I have to pay for. … This stuff worries me."
At the same time, Rogers figures her generation will be the impetus for solutions.
"The whole system's going to have to revolve around the needs of the boomers," she said. "We're going to end up being the catalyst for that change."
Many of the biggest challenges will come as boomers get deeper into retirement, but some will surface immediately.
One of them is finding a doctor who accepts Medicare. California has among the worst doctor participation rates in Medicare – 92.6 percent here compared with 95.1 percent nationally – according to the Centers for Medicare & Medicaid Services.
"There are fewer and fewer primary care doctors who are accepting new Medicare patients today," said Dr. Don Wreden, president and CEO of the Sutter Medical Group in Sacramento, Nevada, Placer and El Dorado counties. The problem is especially strong in parts of the state where Medicare physician fees are lower than in adjoining regions, and some doctors are turning away their own patients when they join Medicare.
Health care experts say there's a clear message for retirement-bound boomers: They'll need to shoulder more responsibility for their own health.
"The window of opportunity is slamming shut," said Will Tift, planner for the Area 4 Agency on Aging unit that serves Sacramento and six other counties. "We really need for those boomers to do all they can now physically, financially, socially to make sure they will be able to live independently when they can't drive anymore or get upstairs anymore."