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We talk constantly about agein politics, in leadership, in debates about retirement and the future of work. Yet we rarely stop to ask a simple question: What is age, exactly? Most of us rely on a single number, as if people were stamped with a vintage year like bottles of wine. But age is far from a fixed or universal metric. It is multidimensional, deeply unequal, and increasingly misleading when used as a shortcut for ability, potential, or readiness. As people live longer, change careers more often, and experience work in different conditions, understanding what age actually measures is becoming essential for companies trying to build fairer workplaces and adapt to demographic shifts. The future of work will not be shaped by older workers alone. It will be shaped by widening age gaps. And by how organizations respond. Chronological age: The number of years since birth This most familiar kind of age governs everything from school entry and voting rights to retirement policies and workplace norms. Yet this way of organizing human life is a relatively recent bureaucratic invention, made possible by modern administrative systems. {"blockType":"mv-promo-block","data":{"imageDesktopUrl":"https:\/\/images.fastcompany.com\/image\/upload\/f_webp,q_auto,c_fit\/wp-cms-2\/2026\/01\/PhotoLVitaud-169.jpg","imageMobileUrl":"https:\/\/images.fastcompany.com\/image\/upload\/f_webp,q_auto,c_fit\/wp-cms-2\/2026\/01\/PhotoLVitaud-11.jpg","eyebrow":"","headline":"\u003Cstrong\u003ESubscribe to Laetitia@Work\u003C\/strong\u003E","dek":"Women power the worlds productivity its time we talked more about it. Explore a woman-centered take on work, from hidden discrimination to cultural myths about aging and care. Dont miss the next issue subscribe to Laetitia@Work.","subhed":"","description":"","ctaText":"Learn More","ctaUrl":"http:\/\/laetitiaatwork.substack.com","theme":{"bg":"#2b2d30","text":"#ffffff","eyebrow":"#9aa2aa","subhed":"#ffffff","buttonBg":"#3b3f46","buttonHoverBg":"#3b3f46","buttonText":"#ffffff"},"imageDesktopId":91472264,"imageMobileId":91472265,"shareable":false,"slug":""}} Chronological age made sense in standardized industrial societies, where careers were linear, life expectancy was shorter, and work was more uniform. Today, it is a blunt instrument. As a predictor of health, performance, motivation, or longevity, it performs poorly. Two people of the same age can have radically different capacities and trajectories, shaped by education, income, working conditions, stress, and life events. But organizations still lean heavily on this number to make decisions about hiring, promotion, development, and exit. In a world of increasingly unequal aging, this reliance is becoming not just inaccurate but unfair. Biological age: The condition of the body and brain Advances in medicine and epidemiology show that people age at dramatically different speeds. Some 55-year-olds have the physiological profile of someone in their forties. Others show signs typically associated with much later life. These differences are shaped by socioeconomic conditions, education, exposure to chronic stress, environmental factors, and levels of autonomy at work. Long hours, repetitive strain, shift work, and lack of control take a biological toll over time. Thats why for some workers longer careers are perfectly sustainable while for others, worn down by decades of strain, working longer can mean never enjoying a healthy retirement. Biological age forces us to confront an uncomfortable truth: Aging is not equal, and work is one of the most powerful drivers of that inequality. Subjective age: All about self-perception Most adults report feeling younger than their chronological age, sometimes by a decade or more. And thats great because feeling younger is often associated with better physical health, cognitive resilience, and emotional well-being. But the gap matters. Feeling moderately younger can be energizing. Feeling dramatically younger can slip into denial, leading people to ignore health signals or overestimate physical limits. Subjective age shapes confidence, ambition, openness to learning, how people interpret feedback, and how they imagine their future. Interestingly, as people age their definition of what counts as old tends to move upward. Its a reminder that age is psychological and cultural, constantly renegotiated. Professional age: The number of years in a company or a craft How long you have been doing a particular role or craft or been working in an industry matters probably more than the birth date on your ID. Its increasingly common to be a beginner at 50, a mid-career experimenter at 60, or a seasoned expert at 30. People retrain, pivot industries, take career breaks, and reinvent themselves in ways that would have been rare a generation ago. Alas, many organizations still assume that chronological age and expertise rise together, which causes a mismatch between talent practices and reality. Experienced beginners are underestimated. Young experts are questioned. The gaps between these different ages tend to grow Gaps grow between chronological and biological age, shaped by inequality and work conditions. Between chronological and subjective age, shaped by health, mindset, and culture. Between chronological and professional age, shaped by career transitions and lifelong learning. Workplaces built on the assumption that age neatly tracks with ability, experience, or stamina are increasingly out of sync with society. As these gaps widen, age-based policies become less sustainable and more discriminatory. And they waste enormous amounts of human capital. Make the workplace more age-agnostic To address these issues, we need to move toward a more age-agnostic approach. For example:1. Stop using age as a proxy for skill, adaptability, or potential. Move away from coded assumptions about being too young or too old. Base decisions on actual competencies, learning habits, motivation, and the cognitive and physical requirements of roles. Chronological age predicts little of this. 2. Redesign work for people who age differently. Introduce more flexibility in schedules and locations, invest in ergonomic improvements, rotate tasks to reduce physical strain, increase autonomy, and offer phased retirement or transitions into mentoring and knowledge-transfer roles. The goal is to reduce the biological cost of work. 3. Treat reskilling as a lifelong process. As career transitions become normal, invest in training without age limits. Support adult apprenticeships and coaching for second- and third-career moves. Fifty-year-old juniors may be among the most underutilized talent pools. 4. Actively audit for hidden age bias. Scrutinize recruiting and promotion practices for coded language (high-energy, digital native) and reluctance to train older employees. Address ageism with explicit guidelines and accountability. 5. Promote intergenerational collaboration. Build mixed-age teams where experience and fresh perspectives reinforce each other through reverse mentoring, cross-generational projects, and shared problem-solving. Age diversity is also cognitive diversity. Age is not a single measure. It is a constellation of biological, psychological, social, and professional realities that rarely align. The companies that will thrive in an aging, unequal, multistage career world are the ones that understand these gaps, reduce the inequalities behind them, and design systems that support people across long, varied working lives. {"blockType":"mv-promo-block","data":{"imageDesktopUrl":"https:\/\/images.fastcompany.com\/image\/upload\/f_webp,q_auto,c_fit\/wp-cms-2\/2026\/01\/PhotoLVitaud-169.jpg","imageMobileUrl":"https:\/\/images.fastcompany.com\/image\/upload\/f_webp,q_auto,c_fit\/wp-cms-2\/2026\/01\/PhotoLVitaud-11.jpg","eyebrow":"","headline":"\u003Cstrong\u003ESubscribe to Laetitia@Work\u003C\/strong\u003E","dek":"Women power the worlds productivity its time we talked more about it. Explore a woman-centered take on work, from hidden discrimination to cultural myths about aging and care. Dont miss the next issue subscribe to Laetitia@Work.","subhed":"","description":"","ctaText":"Learn More","ctaUrl":"http:\/\/laetitiaatwork.substack.com","theme":{"bg":"#2b2d30","text":"#ffffff","eyebrow":"#9aa2aa","subhed":"#ffffff","buttonBg":"#3b3f46","buttonHoverBg":"#3b3f46","buttonText":"#ffffff"},"imageDesktopId":91472264,"imageMobileId":91472265,"shareable":false,"slug":""}}
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E-Commerce
Medicare has launched a six-year pilot program that could eventually transform access to healthcare for some of the millions of people across the U.S. who rely on it for their health insurance coverage. Traditional Medicare is a government-administered insurance plan for people over 65 or with disabilities. About half of the 67 million Americans insured through Medicare have this coverage. The rest have Medicare Advantage plans administered by private companies. The pilot program, dubbed the Wasteful and Inappropriate Service Reduction Model, is an experimental program that began to affect people enrolled in traditional Medicare from six states in January 2026. During this pilot, medical providers must apply for permission, or prior authorization, before giving 14 kinds of health procedures and devices. The program uses artificial intelligence software to identify treatment requests it deems unnecessary or harmful and denies them. This is similar to the way many Medicare Advantage plans work. As health economists who have studied Medicare and the use of AI in prior authorization, we believe this pilot could save Medicare money, but it should be closely monitored to ensure that it does not harm the health of patients enrolled in the traditional Medicare program. Prior authorization The pilot marks a dramatic change. Unlike other types of health insurance, including Medicare Advantage, traditional Medicare generally does not require healthcare providers to submit requests for Medicare to authorize the treatments they recommend to patients. Requiring prior authorization for these procedures and devices could reduce wasteful spending and help patients by steering them away from unnecessary treatments. However, there is a risk that it could also delay or interfere with some necessary care and add to the paperwork providers must contend with. Prior authorization is widely used by Medicare Advantage plans. Many insurance companies hire technology firms to make prior authorization decisions for their Medicare Advantage plans. Pilots are a key way that Medicare improves its services. Medicare tests changes on a small number of people or providers to see whether they should be implemented more broadly. The six states participating are Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. The 14 services that require prior authorization during this pilot include steroid injections for pain management and incontinence-control devices. The pilot ends December 2031. If the Centers for Medicare & Medicaid Services, which administers Medicare, deems the pilot successful, the Department of Health and Human Services could expand the program to include more procedures and more states. Introducing a hurdle This pilot isnt changing the rules for what traditional Medicare covers. Instead, it adds an extra hurdle for medical providers before they can administer, for example, arthroscopic treatment for an osteoarthritic knee. If Medicare issues a denial rather than authorizing the service, the patient goes without that treatment unless their provider files an appeal and prevails. Medicare has hired tech companies to do the work of denying or approving prior authorization requests, with the aid of artificial intelligence. Many of these are the same companies that do prior authorizations for Medicare Advantage plans. The government pays the companies a percentage of what Medicare would have spent on the denied treatments. This means companies are paid more when they deny more prior authorization requests. Medicare monitors the pilot program for inappropriate denials. What to watch for Past research has shown that when insurers require prior authorization, the people they cover get fewer services. This pilot is likely to reduce treatments and Medicare spending, though how much remains unknown. The Centers for Medicare & Medicaid Services chose the services targeted by the pilot because there is evidence they are given excessively in many cases. If the program denies cases where a health service is inappropriate, or of low value for a patients health, people enrolled in traditional Medicare could benefit. But for each treatment targeted by the pilot, there are some cases where that kind of healthcare is necessary. If the programs AI-based decision method has trouble identifying these necessary cases and denies them, eople could lose access to care they need. The pilot also adds to the paperwork that medical providers must do. Paperwork is already a major burden for providers and contributes to burnout. AIs role No matter how the government evaluates prior authorizations, we think this pilot is likely to reduce the use of the targeted treatments. The impact of using AI to evaluate these prior authorizations is unclear. AI could allow tech companies to automatically approve more cases, which could speed up decisions. However, companies could use the time saved by AI to put more effort into having people review cases flagged by AI, which could increase denials. Many private insurers already use AI for Medicare Advantage prior authorization decisions, although there has been limited research on these models, and little is known about how accurate AI is for this purpose. What evidence there is suggests that AI-aided prior authorization leads to higher denial rates and larger reductions in healthcare use than when insurers make prior authorization decisions without using AI. The bottom line Any money the government saves during the pilot will depend on whether and how frequently these treatments are used inappropriately and how aggressively tech companies deny care. In our view, this pilot will likely create winners and losers. Tech companies may benefit financially, though how much will depend on how big the treatment reductions are. But medical providers will have more paperwork to deal with and will get paid less if some of their Medicare requests are denied. The impact on patients will depend on how well tech companies identify care that probably would be unnecessary and avoid denying care that is essential. Taxpayers, who pay into Medicare during their working years, stand to benefit if the pilot can cut long-term Medicare costsan important goal, given Medicares growing budget crisis. Like in Medicare Advantage, savings from prior authorization requirements in this pilot are split with private companies. Unlike in Medicare Advantage, however, this split is based on a fixed, observable percentage so that payments to private companies cannot exceed total savings, and the benefits of the program are easier for Medicare to quantify. In our view, given the potential trade-offs, Medicare will need to evaluate the results of this pilot carefully before expanding it to more statesespecially if it also expands the program to include services where unnecessary care is less common. Grace Mackleby is a research scientist of health policy and economics at the University of Southern California. Jeff Marr is an assistant professor of health services, policy, and practice at Brown University. This article is republished from The Conversation under a Creative Commons license. Read the original article.
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E-Commerce
Nikolai Tesla was a revolutionary thinker with bold, transformative ideas. Yet it was George Westinghouse and Thomas Edison who shaped how electricity was brought to the world. The personal computer was invented at Xerox PARC (Palo Alto Research Center), but it was Apple that brought the Macintosh to market. William Coley pioneered cancer immunotherapy, but James Allison made it a reality. We grow up believing that if an idea is good, it will naturally rise to the top. Yet thats rarely, if ever, true. To make an impact, you need to understand power and influence. It isnt about titles, authority, or formal position. Its about understanding how decisions actually get made, how people get mobilized, and how systems really change. To do that, you need to master three forms of power: hard power, soft power, and network power. Hard power compels. Soft power persuades. Network power amplifies. Real influence comes from knowing how to combine all three. Thats the difference between having a good idea and building the traction you need to bring about the impact you want to see. How a Group of Kids Harnessed Institutional Hard Power to Bring Down a Dictator In 1998, five young activists met in a café in Belgrade. Still in their twenties, they were, to all outward appearances, nothing special. They werent rich, or powerful. They didnt hold important positions or have access to significant resources. Nevertheless, that day they conceived a plan to overthrow their countrys brutal Milo¹evię regime. The next day six friends joined them, and together they became the 11 founders of the activist group Otpor. They had some experience with activism, taking part in the protests against the war in Bosnia in 1992 and then in the Zajedno movement in 1996. But those efforts had fallen short, and Milo¹evię continued to rule with an iron hand. Yet they had learned from the experience, and an activist introduced them to the Albert Einstein Institution as well as the ideas of Gene Sharp. They found that there are sources of power that support the status quo and these have an institutional basis. As long as these remain in place, nothing will ever change. But if you can shift them, anything becomes possible. Even a seemingly all-powerful dictator needs to control or influence institutions to carry out their will. So Otpor set out to influence key institutions, such as the media, local businesses, and international organizations, and had a particularly innovative strategy for influencing the police. When Milo¹evię tried to steal the election, people took to the streets, in what is now known as the Bulldozer Revolution. Those institutional shifts proved decisive in bringing down his government. The Serbian strongman would die in his prison cell in The Hague in 2006. Everyone with an idea is, in some way, like those five kids in the café in Belgrade. If youre ever going to get anywhere, you need access to hard power. And that means unless you already control institutions that can make decisions, youre going to have to learn how to influence them. Thats the essence of hard power strategy: shaping decisions by shaping institutions. The Pervasive Soft Power of Ramanujan As the story of Otpor shows, influencing the hard power of institutional authority is critical for driving through transformational change. Otherssuch as the Occupy movement, Black Lives Matter, and the Gezi Park protests in Turkeywere able to mobilize massive numbers of people, but without institutional influence they were unable to achieve significant progress. Still, you cant just use institutional heft to overpower. You also need to attract people to your cause, and thats where soft power comes in. Consider the story of Ramanujan, a destitute Indian with little formal education. In 1913, he sent his work to G.H. Hardy, a prominent mathematician working at one of the worlds most prestigious institutions, Cambridge University. It feels almost strange to ask why Ramanujan reached out to Hardy and not the other way around. As a leading professor at a major center of learning, Hardy carried a lot of institutional clout, while Ramanujan had none. But in the end, it was Hardy who did Ramanujans bidding and, in fact, considered it to be one of the greatest privileges of his life to do so. How did that happen? Ramanujan was able to harness the three foundational elements of soft power: ethos, pathos, and logoscredibility, emotion, and logic. Ramanujan was, by any measure, one of the greatest mathematical minds the world has ever produced. His story as a poverty-stricken man doing complex mathematical proofs in his spare time was emotionally compelling, and the logic of bringing him to Cambridge was clear and undeniable. In other words, for a variety of reasons Hardy found Ramanujan attractive, and thats at the core of the concept of soft powerit is the power to influence without coercion. Hard power might get people to do what you want, but that can create resentment and backfire. Soft power is how you get people to want what you want, and that can sometimes be more valuable. The Power of Tony Sopranos Networks As a Mafia boss, Tony Soprano clearly understood hard power and strictly enforced his will. He was also no stranger to soft power, joking and cajoling with his associates. But at the root of Tonys power were his networks. He was, in gangland parlance, connected, not only to other criminals, but to government officials, religious leaders, and legitimate businesspeople. Yet it isnt only mob bosses who nee to be connected. One of the best examples is the Medici Family in Renaissance Florence. The Medici weren’t kings. They didn’t hold official power, but they became one of the most powerful families in Europe. How? Because they sat at the center of multiple overlapping networks. Through their bank, they were connected to merchants, princes, and even popes. They built alliances through strategic marriages. They funded artists, scientists, and thinkers. And they acted as bridgesconnecting powerful people who wouldn’t otherwise talk to one another. That made them extraordinarily influential. That’s network power. The same pattern shows up again and again. Bill Gates used network power to weaken IBM and dominate the tech industry for over a decade. Microsoft didn’t own the hardware. It didn’t control distribution. But everyone needed its software. That’s what made the company dominant. That’s network power. In the 1980s, when home video recorders were just coming to market, Betamax built a better product, but VHS built a better network and came to dominate the market. Next time you make a purchase, think about what you use to pay. Visa, Mastercard, American Expressthat’s also network power at work. While soft power can persuade and hard power can compel, it is network power that can help you gain scale, expanding access to information and providing the connectivity needed to communicate ideas and actions widely. Setting Your Ideas Up for Success Most of us grow up believing in merit. Were raised to think that the truth will win out and the best idea will always win in the end. Unfortunately, thats not really true. As much as we might like to believe that our ideas can stand on their own, the truth is that we need power and influence to put them into action. Stanford professor Jeffrey Pfeffer, who teaches the incredibly popular course Building Power to Lead, defines power as the ability to get things done your way in contested situations, and that gets to the meat of it. People dont encounter our ideas in a vacuum, but in a sea of other ideas, ambitions, prerogatives, and priorities. For people to adopt an idea, it needs to cross their thresholds of resistance, points at which joining in no longer feels risky or costly. To get them over that hump, we need to access power and influence, which comes in three forms: hard power, soft power, and network power. Hard power lowers thresholds by changing incentives. Soft power lowers them by making adoption desirable. Network power builds momentum and propagates the idea forward. These dont work in isolation, but in combination. Hard power can force a decision, but risks resentment. Soft power can win buy-in, but without connection to authority, it cant deliver results. Network power can get you access, but not action. When you use all three in tandem, however, you dont just push ideas forward, you pull people in, motivate them to make your cause their own, and encourage others to do so as well. So dont just ask whether your idea is good enough. Think about how youre going to access the power and influence you need to set it up for success. That, more than anything, will determine whether you succeed or fail.
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E-Commerce
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