America keeps a remarkably detailed ledger of what it believes older people cost. We count Medicare expenditures, hospitalizations, falls, dementia, disability, nursing-home use, food insecurity, and the number of people who need help bathing or dressing. These measures matter. They identify suffering, expose disparities, and help direct essential services. The problem begins when the ledger of need becomes our entire portrait of later life.

For most of human history, few people lived into their eighties or nineties. Today, longer lives are the norm. Advances in medicine, public health, nutrition, and education have transformed longevity from an individual achievement into a defining demographic reality of the twenty-first century.