Yes, Child Care and Elder Care Are Also Infrastructure
Both snarled traffic and a morning without a home health aide can make you late for work.,
Ask any of the parents who have spent the last year at home with their children, while trying to participate in Zoom meetings, whether child care enables them to show up to work and perform at their best. The direct conflict between children’s need to be cared for during the day and working parents’ need to devote their attention to their jobs exploded into full view during the pandemic, not just for families but for their employers and co-workers. Suddenly it was everyone’s problem.
It’s an unfamiliar experience in a country where we’ve treated these kinds of conflicts as private crises to be solved individually. But it has always been true that without an adequate system of child care, elder care and paid leave, personal emergencies and family demands often derail Americans’ ability to get to work — and to concentrate once they’re there. An older parent’s sudden decline forces a child to quit his job when he can’t afford round-the-clock care. A catastrophic injury means a worker has to take weeks off, costing her her job when her employer loses patience. A day care center’s sudden closure forces a full-time student with children to drop out of classes while she hunts for another option.
We’re in the middle of a loud debate over what, exactly, counts as “infrastructure.” The word has come to be associated with the country’s physical assets: our national highway system, the pipes that bring us water and the cables that bring us electricity, the tarmac in our airports and the tracks on our train routes. These things are infrastructure because they are underlying systems that facilitate other critical functions — moving people and goods, connecting communities, delivering necessities. They are important for what they make possible.
But they are not the only systems that undergird critical needs. President Biden’s next legislative priority is fixing the country’s decrepit infrastructure as a way to help the economy rebound from the pandemic, and he’s taking a more expansive view of what falls into that category. The first half of his package expands home- and community-based care for seniors and the disabled, and he has promised to include more so-called soft infrastructure in his follow-up American Family Plan, including investments in child care and paid leave.
Republicans are lining up their opposition to the package behind the idea that these things aren’t “real” infrastructure. “There is a core infrastructure bill that we could pass” focused on “roads and bridges and even reaching out to broadband,” Senator John Cornyn, Republican of Texas, told “Fox News Sunday.” “So let’s do it and leave the rest for another day and another fight.” Business lobbyists are pushing hard to get Mr. Biden to drop the caregiving parts of his package. But it’s not just conservatives; it’s (mostly) men of differing political persuasions. Politico’s Playbook deemed it “silly” to call home care services for the elderly and disabled infrastructure.
It’s only silly if you think men in hard hats are the only ones who work on systems that are critical to the functioning of our economy and our society. The women of color who predominantly take care of young children, elders and disabled family members, allowing everyone else to go to work and school, might disagree. They have long known that their work makes everyone else’s possible, whether we invest in it adequately or not. Both snarled traffic and a morning without a home health aide can make you late for work.
Even before Covid, it was clear to anyone who looked at the data that child care allowed parents to get to their jobs, and a lack of it did the opposite. In 2016, nearly two million American parents said they had to quit their job, refuse a new one, or significantly change the one they had thanks to problems with child care. One of the reasons that the United States has fallen so far behind our international peers when it comes to the share of women in the labor force is that we invest so few resources in child care and early education. Since the 1990s, the rising cost of private day care has reduced employment for American mothers of children ages 5 and younger by 13 percent.
The opposite of this is also true. Widely available and affordable care makes getting to work possible. After Quebec implemented low-cost universal child care in 1996, the percentage of prime-aged women in the province who were working reached the highest rate in the world by 2017 after increasing 16 percent for mothers of young children. The same has happened in the United States. Washington, D.C., instituted free universal preschool in 2009 and the share of women in the city’s labor force increased by 10 percentage points.
The idea that child care that allows parents, and in particular mothers, to work is critical infrastructure is not even a new concept in our country. In 1940, the government passed the Lanham Act to fund the construction and maintenance of infrastructure deemed critical to the country as it fought World War II. But then it became clear that there wouldn’t be enough childless women to work in all the factories we’d built while men were fighting abroad. Newspapers ran stories about children chained in trailer homes and locked in cars because their mothers had no other options when they went to work. The government needed bodies in factories to make guns and planes to fight the war.
So Lanham funds were used to build and maintain physical child-care centers, pay and train the teachers inside them, and cover operating expenses for a new national network of affordable, quality child-care centers that were open to all, not just Rosies in factories. The mothers who enrolled their children in these centers weren’t just freed up to work during the war. The experience of accessible care that allowed them to seek employment left them more likely to work years after the centers closed.
If child care is infrastructure, then, it should be nearly self-evident that care for the elderly and disabled is, too. Children aren’t the only members of our families who require daily care. But we offer miserly support for those who need to secure and pay for it. Medicare doesn’t cover nursing home or assisted living stays, only Medicaid does, requiring families with resources to spend them down before they can get assistance with the exorbitant cost. Medicare also doesn’t cover in-home care, and not all state Medicaid programs cover it. Some of those that do cap the number of people who can get help, leaving people to languish on waiting lists for years.
So many family members simply have to care for disabled children or siblings, or aging parents or spouses, by themselves. Those who care for their spouses or parents are much less likely to work. The ones who try to hold on to a career miss more than a week of work each year, on average, thanks to these additional responsibilities.
Paid leave might seem like a counterintuitive plank in an infrastructure package given that it helps people stay away from work. But it does so when we are at our most vulnerable — when a new child arrives who demands constant feeding and attention, after a serious injury that leaves someone unable to work for long periods of time, or when a loved one lands in the hospital. Without paid leave, these events often explode people’s lives into unrecognizable bits, including their bond to their jobs.
Paid leave keeps that bond sealed. Studies in California, the first state with its own paid family leave system, have found that those who use paid leave are more likely to return to their jobs when their time off is over. Paid leave helps mothers in particular stay connected to their jobs before and after the arrival of a new child. On top of that, an analysis of more than 10,000 companies found that after they offered paid leave the majority had an increase in revenue and profit per each employee — in other words, it allowed workers to perform better.
The peace of mind that comes from knowing we can take time off without endangering our jobs or our livelihoods if life-changing emergencies arise allows us to devote ourselves to getting our work done. Yet the United States has fallen behind other countries in the share of women in the work force, not just because of a lack of child-care investment, but also because of a refusal to guarantee paid leave for all.
That elder care, care for the disabled, child care and paid leave enable the functioning of our economy is not the only reason the country should invest in them. Paid family leave improves child and parental health, which also lead to a better-functioning country and society. High-quality child-care facilitates children’s development. Disabled and elderly Americans deserve to live their lives with dignity.
All of these things clearly undergird the functioning of our economy, just as a smooth road allows trucks to transport goods to stores and drivers to get to their workplaces. It’s one thing to debate whether or not to invest in them. But there’s no rational argument for why they should be excluded from Mr. Biden’s focus on repairing and upgrading the systems that keep our country running.