Modern societies today contend with population dynamics that have never before existed. As the number of older people grows, these countries must determine how best to provide for the needs of this population. The constraints are real: fiscal and material resources are finite and must be shared in a way that is perceived as just. As such, societies confront the fundamental question of who gets what, how, and why, and ultimately must reappraise the principles determining why some people are considered more worthy of help than others. This study systematically explores the Japanese and American answers to this fundamental question. This is the only US-Japan comparative work of its kind, utilizing systematically comparable data from both countries. It also draws on interview material that presents the choices, disappointments, and satisfactions of old age in the individual’s own words.