This work investigates the historical evolution of aging in American society to identify the systemic failures in contemporary social support structures. David Hackett Fischer, a distinguished historian, utilizes a comparative framework to analyze how attitudes toward the elderly shifted from the eighteenth century through the twentieth century. By contrasting past societal norms with modern bureaucratic approaches, he argues that current programs like Social Security and Medicare are insufficient to meet the needs of an aging population.

Scholars frequently cite this text as a foundational study in the history of American social policy and gerontology. Readers often note the academic rigor of the prose and the author's ability to connect historical trends to contemporary legislative challenges.