Chapter 9: An Open Letter to All Those Who Are or will Be 65

5. Let Us Help the Young
One of the old arguments against the fourth pillar is that ‘old’ persons by working later fill jobs that would otherwise be available to the young. Quite apart from the fact that opportunities for job substitution are not as frequent as one might think, this argument is both specious and misleading: for the young themselves will be increasingly discouraged from working if they have to forego a growing share of their wages in order to finance retirees’ pensions. Moreover, available jobs are to be found in sectors such as teaching, tourism, health, research which suit the over 60s most. Finally, people everywhere are talking about the approaching labour shortage (already noticeable in some sectors), which will have to be met in part by recourse to immigrant labour. This means that there is a place, for “foreigners” as well as for retirees who should no longer be treated as outsiders by the communities in which they live.


6. Towards a Fiscal System that Aims at Social Progress
Our demand for part-time work for the 60 to 80 year-olds does, however, call for additional comment and qualification. First, job seniority can no longer be applied. One could not expect to be able to continue up the “career ladder” as one did before retirement at age 65 especially in middle- or senior-grade jobs, or to expect to be able to earn half of one’s final salary or more, except possibly if one is holding a key position in management. Let us not forget: the fourth pillar is very much part of a social strategy of which all four pillars are essential components. This would dovetail with the financial interest of those able to offer employment but are often prevented from doing so because of the cost. What is more, after 65 you will not have to contribute (or you will pay much less) to your first and second-pillar pensions. There should be fiscal adjustments as well. You will, after all, be taxed on your global income including your, sometimes partial, first and second-pillar pensions, other income as well as your fourth-pillar earnings.
All parties stand to gain: the State, employers and especially you who will achieve greater long term financial security, greater social satisfaction and, at the end of the day, better health. For the self-employed, the issue of an age limit for retirement is already much less drastic. The proportion of freelance work tends to increase, due to the specific stimulus of the four pillars system, with a full range of mixed options between salaried employment and full self-employment.
We must not forget that paid part-time employment, however, is by no means the only kind of productive work. Voluntary work is catching on everywhere and it is high time that this sector’s contribution to the national wealth be acknowledged by means of economic indicators. Voluntary and remunerated work are becoming increasingly interdependent and can be complementary as well as representing an alternative economy. Should we, for example, build more crèches and/or promote child care at home? Our somewhat distorted traditional economic thinking tends to approach everything in purely budgetary terms. Today, however, in growth sectors like education, health, tourism, cultural pursuits and so forth, voluntary and remunerated work frequently combine in different ways. For this reason economic analysis tools are needed to take greater cognizance of this fact which is not the present situation. Such recognition will only serve to increase the job satisfaction of those working in the voluntary sector and encourage them to further efforts. If it is true that in our society money is essential, it is, at the same time, absurd to suggest that only what is paid for is of value. This attitude explains the lack of appreciation for housework and the devaluing of farm work during the first phase of the industrial revolution. The time has come for a more complete inventory of all activities contributing to the wealth of nations.
One consequence of the acknowledgement of the economic value of voluntary work would be the introduction of economic incentives (tax breaks and modest subsidies) to encourage its development.
As far as our fourth pillar is concerned it could well include voluntary work. However, as an essential component of our four pillars system, it must be made to contribute directly or indirectly to our financial equilibrium. For the more affluent among us the problem of fourth-pillar earnings is doubtlessly less important. Artistic and cultural pursuits, friendship, billiards and cards, travel and hobbies of all kinds have always constituted a very active non-remunerated fourth pillar, and this brings us to what is often termed the “leisure society”. It must be acknowledged that leisure pursuits too can be, and frequently are, productive ac­­tivities in a number of fields. All agreeable and exciting work becomes a pleasure, often more enjoyable than a hobby. Whatever the case, the question is always the same: does the activity in question enhance our personal well-being and add to the wealth of society?

7. Freedom to be Conquered
All is very well, I hear you say, but after 30 or 40 years of working, you have had enough and want a bit of peace and quiet, time for yourself! Fair enough; but let us be clear about the terms we use. To enjoy this peace and quiet it is well to employ a four pillars strategy to insure ourselves against economic risk and the hazards of living. Maybe those who are very well off can settle for the opinion of a good financial adviser. And not always.
As for having time for yourself, I have seen many friends “achieving” freedom by retir­ing. They have looked forward to savouring a problem-free existence and making the most of every good opportunity that presents itself. In most cases, however they do find themselves on a fast track to decline, unless they happen to be committed to some sort of activity, albeit entirely voluntary. Perhaps it is also a matter of individual choice. I personally find that life’s problems and accidents occur whether we like it or not and often unexpectedly. I maintain that it is better to anticipate them even at the risk of disappointment: at least they will be occurring in the domain of our own choosing and we will enjoy a slight extra advantage when it comes to dealing with them.
That said, from a social point of view and for the vast majority of workers even in rich, industrialized countries, there remains the major challenge of preparing for being 60 or 65. It is a question of avoiding automatic marginalization, however fine the words that accompany it, so that each of us can make use of a certain margin for initiative.. The basic point here is that the priority purpose of lifelong training should be to provide preparation for an active life after 65.
I am someone who since 1959, has always worked full time. But I have always had a second, and even a third, part-time activity alongside my main one. And it is thanks to these parallel activities that I have been able to change jobs in a way that was useful. It is also true, perhaps, that I have been blessed so far with good health that has made it possible for me to live such a life. Not everyone has to do as I have done. Let us just say, however, that from the age of 50, we are able to develop the professional knowledge and training that we have in order to update them and from them create other, possibly complementary ones. Over time, we should be able to recognize where in terms of knowledge and experience our strengths lie, and what our shortcomings are which affect our lives and work negatively.
Ultimately, recognizing where we have gone wrong and where our knowledge is insufficient or downright wrong provide opportunities for improvement and for learning from our mistakes and from our ignorance. Since all human knowledge is both incomplete and partial, even for the greatest experts, we are in good company. The task of sifting our knowledge, of rooting out outdated ideas or those that are downright detrimental to what we do is a difficult one. Basically, specially with advancing age, we cannot change all that much, but the more we recognize our mistakes or our ignorance, the more we shall fill our lungs and minds with fresh air. The point of all of this is, of course, that we should live better.
Modern technology, also the spirit with which it is used, will help all of us enormously with learning to adjust to the fourth pillar. Even Einstein, who was not reckoned to have been a particularly good pupil at school, when he developed the theory that was to earn him a Nobel Prize for physics and, with it, fame, had conducted the main part of his research being a minor employee in the Patents Office in Berne. Here is a good example of how to pursue an activity which is initially secondary, and parallel to one’s main job. Admittedly, very few of us will become 21st century Einsteins, but I do believe that most of us will carve out our own slice of life till at least 80 and enjoy the benefits it brings in every area. God speed and good luck.

8. Managing the Cost of Better Health Well
The last point concerns health, yours and mine, starting from the ages of 60–65 till 80 with a view to enabling us to lead an active and satisfying life. Almost every study carried out on people of our age shows that the best way of maintaining good health is to remain sensibly active. Then there are the recommendations about a wholesome, balanced diet, a modicum of physical exercise, and exhortations to give up smoking. However you can take consolation from the fact that a glass or two of good wine is not only permitted but desirable.
That said, with advancing age, the human machine needs to be repaired and to be able to utilise some spare parts. This has been possible for almost a century now with constantly improving results. The textbooks on the history of medicine all concur that up to the end of the 19th century the work of doctors didn’t have even a minimal influence on the course of events, their ministrations being practically without effect. We live in a blessed age even though accidents still occur, diagnoses are not always correct and treatment is at times ineffective. But in spite of everything, we manage to treat at least one in two cancer cases successfully.
Take hip replacement for example. There comes a time when your thigh bone or femur can no longer turn within the pelvis because of the wear and tear on the cartilage, which is like the lubricating oil that makes a door turn easily on its hinges. After the age of 60, one in ten persons ends up having problems of this sort and is in considerable pain. If the average age of the population remains 60 years or less, then very few people are affected. In the past, up to the middle of the last century, when the hip joint seized up the only solution was to insert a pin to block leg movement and reduce the pain, with the consequent and final loss of mobility and any kind of part time work. In 2001, 1,100,000 hip replacement operations were performed worldwide and the average age for a first replacement was 63 years. The total bill for these operations (pre- and post-operative costs included) amounted to around €20 billion. There are, of course, various other types of prosthesis. As a result, health costs are rising and on average you and I are feeling increasingly better. Perhaps one day it will be possible to replace the cartilage or grow a new one. In fact it is very probable within a few decades, prob­able and also very necessary, given the lengthening of lifecycle of our planet’s population. Over time, new treatments could both cost less and be more easily borne by the patient who at present must wait several weeks, sometimes even months, while not only for bone and pros­thesis, but also for muscles which were sectioned to provide access to weld back together.
The results, however, are there and numerous replacement carriers go skiing or mountain climbing. Our generation is thus able to enjoy a whole new lease of life.
Another example is the screening and treatment of colonic cancer both of which can be performed at a relatively low cost thanks to optical fibres.
We live, then, right at the heart of a period when vast amounts of biological and chemical research are going to make possible and even guarantee the increasingly high levels of health and well-being that will help us build our lives after 65.
It is right that we reflect on the economic value of such health costs. If they are rising, it is largely so that we can increasingly benefit from advances in medicine. There are, of course, other kinds of problems — the efficacy of treatment, or the abuse of pharmaceuticals — but at the heart of the matter is the fact that we spend more on health to be able to live better and longer. And if in this sector there are crises, breakdowns and even major incidents, it is equally true that such things occur in every domain of human endeavour.
One is, however, struck by the fact that medical ‘costs’ are often presented as negative costs. I personally can see no difference between buying a car to be fully mobile (except in city centres) and paying for the sort of treatments such as those mentioned above that simply enable us to use our own bodies to move about. In both instances, car and health treatment, we are paying for efficiencies that enable us to live better. This idea, which may seem at first glance to be naive, actually opens up a whole new vision of the economy and economic thought which I have had the occasion to develop further elsewhere.
Finally there is one further important point we need to bear in mind: health costs are not evenly distributed across our lifecycle. Early childhood excepted, they increase on average with age and also in line with new therapeutic procedures. The problem, therefore, is financ­ing such costs with advancing age.
In many countries, health is essentially part of a State-run welfare system. In others, there are private systems often involving public participation or subsidies. However, in the health sector, there remains the question as to whether the system should be run wholly or in part on the basis of the supporting first pillar (the pay-as-you-go system) or whether money reserves also need to be built up, especially during the healthier relatively disease-free years so as to meet the higher costs that occur after 60. The private insurance companies assure us that reserves are accumulated during the low-cost years in order to offset the higher costs that occur with advancing age. But this is far from satisfactory. On the one hand, the reserves in question only very partially offset the rise in costs (and premiums) for people of advanced age. On the other, especially in a free-market system, year on year, companies are in competition with one another leaving very little surplus for the accumulation of significant reserve funds. It seems to me that we, as consumers, would be well advised to combine a good universal pay-as-you-go system with something akin to the second-pillar pension schemes based on a capacity to generate reserves which can be used whenever they are needed. On the other hand the two forms of the second pillar could be combined in a single scheme.
This issue is not simple and we can do no more here than point to one or two fundamental aspects; for example, the fact that health inevitably has to be managed throughout the lifecycle. There is also the matter of being able to take immediate action when required: for example, hip arthritis triggering appalling pain may occur practically without warning. Having to spend sometimes months on a waiting list is simply not acceptable. How, then, can the private and public systems best complement each other? If the interests of the patient were taken into account, it should not be so difficult to find an answer. The situation varies considerably from one country to the next, but one is frankly baffled by the then British Prime Minister, Tony Blair’s statement, made some years ago, that things were improving because the patient waiting list had dropped by 100,000 out of 1.3 million.
I think you will agree with me on at least one point: the health system must work at its best for our personal quality of life not only between the ages of 65 and 80 years, but also beyond that age group.

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