Caring about Care: Why an Industrial Strategy for Care Makes Sense in Any Economy

At Roosevelt, we talk a lot about the need for an “industrial strategy for care work”—in fact, we talked about it just a few weeks ago here. We like the industrial strategy framework because it puts care where it should be: in the category of an essential good or service for which the government should have a vested interest in ensuring stable access.

“Stable” is key. Stable care sources are essential to the experience of the cared-for and their families. For too long—really the entire history of our country—the assumption has been that women will be the stable source of care for children, the elderly, and people with disabilities. That assumption has looked different at different times and places: unpaid slave labor, unpaid domestic labor, informal and low-paid care provided by family and friends. But throughout, sexist and racist labor markets have made women—and especially women of color—the most readily and consistently available care option. (Not-so-fun fact: In 2022, women were five to eight times more likely than men to reduce their hours or leave the labor force because of a care need in their families.)

As both a moral and practical matter, that is no longer working. This is not because we need to create more jobs and care is a good place to do them—although in some places that is true, as we discuss below. It’s because people don’t have access to stable care, and thus the quality of life they want and deserve.

Over the last half-century, as women’s options in the job market have expanded—a welcome development—the market has proven itself increasingly unable to reliably provide affordable, accessible care for all (or even most) who need it. In one 2023 survey, every state reported shortages of workers in home- and community-based long-term care services. These shortages are especially prevalent in low-income communities, where childcare deserts (areas where there are more children who need care than there are available care options) are concentrated.

A big reason for these care deserts is that wages are too low to attract and keep workers. The good news is we know public investment can help fix that; we also know that when public investment disappears, the problems come back. The question in front of us—and at the heart of ongoing research projects at the Roosevelt Institute—is what form public investment should take.

What we know for sure: A robust care strategy that puts a premium on stability is going to require workers. Maybe some of these workers will come from other industries and/or other countries, maybe some will reenter the labor force after being disconnected from it for long stints. But the plan should not be for care to be a job (paid or unpaid) of last resort, but rather a profession that we have made appealing to all genders.

Who will do high-quality care jobs?

In the current economy, we may have to look harder for workers, but there are still millions of Americans looking for steady, well-paid, full-time employment, especially in rural and underserved communities. Millions. And many of them live in the very communities that need deep care investments the most.

As Roosevelters Ira Regmi and David Stein point out, “the term full employment has been distorted since the 1970s, often referring to generally low overall unemployment rates—the rate that economists and policymakers believe will prevent inflation—rather than zero involuntary unemployment.”

You can see this in the numbers. May 2024 jobs data shows the overall unemployment rate at 4 percent. But the unemployment rate is 6.1 percent for Black Americans and 5 percent for Hispanic Americans—well above most definitions of “full employment.” There are 6.6 million Americans who would like to find work but can’t. An additional 4.4 million Americans are working part-time jobs but would prefer to be working full-time.

And those are just the people still counted as part of the labor force. Millions of Americans have stopped looking for work altogether. While the labor force participation rate for “prime-age” workers (those between 25 and 54) is the highest it’s been since 2002, it’s been steadily decreasing for workers without a high school degree and for men for at least the last 30 years.

Young men, in particular, have been dropping out of the labor force for decades. One study found that just over 30 percent of nonworking prime-age men “cited caring for others—including a seriously ill, special needs, disabled, or aging family member—as a reason for not working.” Much like women have for generations, these men are doing the labor of care without compensation.

The same study found that men who have dropped out of the labor force but could be brought back in cited “distance to work, including lack of affordable, nearby housing and/or transportation” as a key factor preventing them from doing so. They lack both jobs in their own communities and the ability to access jobs in distant cities and towns. Labor force participation is, in fact, much lower in rural communities than urban ones. In Virginia, for instance, the Richmond Fed found that 89 percent of men in urban areas worked or were looking for work, while only 68 percent of men in rural counties could say the same. More recent analysis shows a similar trend.

A robust care industrial policy would bring care jobs to these communities. It could both make these jobs better for the armies of women who take them on, and make it an attractive career path for men who have given up on looking for work in their home communities.

Won’t this be expensive?

Yes! Investing public money in care will be costly and in a way that is not familiar for many progressives who have spent years arguing that we need a public option in health care to control costs. Unlike health care, for which we pay more as a country and get less compared to our peers, in the care industries we simply have not been paying enough (again because we’ve been relying on unpaid and underpaid women). If we want stable care, we can’t keep treating it like it’s free.

That said, we can expect these investments will have a positive influence on our economy. We know, for instance, that labor force participation affects GDP. As labor force participation goes down, growth is stymied; as it goes up, GDP can improve. Transitioning more of those left out of the labor force into a growing, paid care industry could grow our economy in ways that help offset increasing costs.

And it’s worth remembering “the costs associated with maintaining the status quo.” Targeted investments in care, through both public money and through the government directing private funds, can actually take pressure off of other government programs currently struggling to accommodate our society’s care needs.

Dedicated state social insurance programs for long-term elder care, for example, could reduce state Medicaid spending. In 2019, Washington State introduced the Long-Term Care Trust Act, funded by an employee payroll tax of only 0.58 percent of wages. The program will reimburse beneficiaries for the cost of long-term care services received at home, in the community, or in a facility, up to $100 per day, to a lifetime total of $36,500 per person. The state government expects this program to save nearly $470 million a year in Medicaid spending, or $3.7 billion by 2050.

The policies we need for care are numerous, and sometimes we’ll need to make hard calls about how to prioritize them. A huge step in the right direction would be getting policymakers to simply acknowledge that government has long set the terms of the debate with policies that actively encourage an overreliance on unpaid female caregivers. Embracing an industrial policy strategy to tackle these problems and set priorities can move us away from the old paradigm toward one that faces our needs head-on.

The fact that a more robust care work industrial policy would create new jobs in our economy is helpful politically and psychologically. But investments in care work are not only about solving a macroeconomic problem. Care work shouldn’t be a priority only when it would help fight a recession. It should be a priority because it’s something Americans desperately need.

If You Ask Eleanor

“The closing of child care centers throughout the country certainly is bringing to light the fact that these centers were a real need. Many thought they were purely a war emergency measure. A few of us had an inkling that perhaps they were a need which was constantly with us, but one that we had neglected to face in the past. Now mothers have had the opportunity of going to work and leaving their children in a center where they felt secure. They knew that the children would be properly fed, given supervised recreation and occupation, and medical care if necessary. They were able to work better and they were less exhausted physically.”

– Eleanor Roosevelt, My Day (September 8, 1945)