Every day in the United States, 10,000 people turn 65, according to the UN Population Division. We are about to have the largest older population ever. At the same time, nearly 4 million babies are born every year, leaving many Americans juggling caring for young children and aging parents. Caregiving is often cast as nonproductive labor, despite the incredible mental, emotional and physical toll it can take. It’s increasingly clear that more resources are urgently needed to support caregivers. How can we rethink our social and economic policies to ensure that more people can age with dignity? Ai-jen Poo is president of the National Domestic Workers Alliance and executive director of Caring Across Generations. She is also author of the 2015 book “The Age of Dignity: Preparing for the Elder Boom in a Changing America.” She joins WITHpod to discuss her personal experiences that led her to be an activist, the need for more infrastructure to support caring for aging populations, the care economy and more.
Note: This is a rough transcript — please excuse any typos.
Ai-jen Poo: I think the problem here is, is that we’ve been taught that care is an individual, personal responsibility, and if you can’t figure it out, it’s your failure, it’s your fault. You didn’t save, you didn’t buy the long-term care insurance, you’re a bad parent, you don’t have the right job. When actually, this is a collective social need we have as a society.
Chris Hayes: Hello and welcome to “Why Is This Happening?” with me, your host, Chris Hayes.
Well, most of the people that listen to this podcast know, because I do talk about my family a lot, that my wife, Kate, and I have three kids, 11, 9, and 5. And Kate, I talk about Kate a lot because she’s the best. Kate is a law professor, and she hosts a podcast, and she also writes for “The New York Times,” and she does a million different things, and she’s like the most productive human being I’ve ever encountered in my life. And I host “All In with Chris Hayes,” weeknights on MSNBC and I have this podcast and I do some other things. I’m writing a book.
People are sometimes, like, how do you do all that? And the answer is we are lucky enough to make enough money that we can hire amazing people to provide childcare in the times when we can’t be around our kids. I mean, that’s the number one answer to that.
We also live in a city where my parents live, so we have grandparents as well. They come down like once a week or so. I have a brother who lives in the same neighborhood, which is amazing. And occasionally, there’s definitely been moments of like, all right, the youngest has to be here, the oldest has to be here, the middle child has to be here, all at the same time. We got two covered. And then my brother who’s the best, I could text him and be like, bro, we need someone to do like the third child to get them to this birthday party.
And I am completely clear-eyed about the level of fortune and privilege we have in terms of this. So the answer to that question is always like, well, we are very lucky both in terms of having family around and also being able to pay people to provide childcare. And I should say these people are just totally incredible people that I love deep in my heart and admire. That’s the answer to that question.
Of course, everyone has some version of this, and I want to just sort of go from my household before get into the conversation and zoom out to like way, way out, which is to talk about an inherent tension in capitalism that’s unresolvable. And it’s this, the way capitalism works is we have a wage labor system in which people have jobs and then they are paid for those jobs, and that creates market income. And that market income is what allows them to purchase the necessities of life, shelter, food, in our system, healthcare, maybe, if you’re lucky, and all of that, right? So that’s the basic system. We get that.
There’s a problem here, which is that, in any given society, if you look at a demographic like bell curve, right? Like, a bunch of the people in the society are not wage earners. Like, a 6-month-old doesn’t earn wages. A 12-year-old hopefully shouldn’t be earning wages. But when you get down to the working age population, that’s a significant subsection, depends on the demographics of a society. It might be half. It might be a little less than half, 40 percent, somewhere around there. All the other people who are not wage earners, and then you have people with disabilities, right? You have people who have chronic illness.
Now you got a system where, okay, some subsection is going to be producing market income. All those other people are not producing at market income. But in many cases, those other people also need care. You know, I’m sure people listening to this have cared for parents or aunts and uncles who were aging. You know, we care for our kids. Again, a 6-month-old can’t do a lot by themselves. Like, someone’s got to look after it, right?
So you end up in this weird situation where that care work, right, is generally coded as a sort of familial obligation, and I think, you know, that makes sense in some way. Like, I don’t think about my wife and I caring for our 6-month-old child as like a job in the same sense I think of my job-job, right? It’s something different. It’s primal. It’s, you know, the source of the chain of human being from the beginning of time, right?
But in a sort of strict sense, it’s taking hours that can then not go to producing market income. And then if I’m not around, I need to pay someone in the market through my wages to get a person to do that, right? So then that person has that job doing that care.
But then I need to make sure that money balances out, right? I’ve had this a million times with people that I know, where a family member, one of two parents quits their job because they basically say, when we looked at the math, what I was paying for childcare was, you know, about the same as what I was earning after taxes.
So, it’s like, well, I could go and be away from my kids all day and work. And now, for some people that’s a worthwhile trade. Some people were even willing to take a hit on that because they’re financially able to. But the math of all this is super hairy.
And then you’ve got also the fact that care work is just, because it sits in this world, that is again connected to the great chain of being a human life on the planet, it’s a different kind of work. You know, I talk for a living. I’m not like holding the hand of a frail elderly person as they, you know, are going through the horrible fear that comes with a medical examination or having to go through routine tests. Like, this is much more emotionally freighted work.
And again, all of it sits in this weird place that’s sort of like half in the capitalism space of a market job, that paid through market labor or market prices. And then something that’s just like irreducibly deeply human and non-markety.
And a society that’s a capitalist society has to come up with a way of dealing with this. There there’s different ways. I mean, Social Security is one of them, right? You have to come up with a bunch of different ways. And every country that has what we would call a mixed economy, right, a capitalist economy with some government state provision of welfare state, like a big part of what the welfare state is, is figuring out what to do with the populations that generate market income and need care. That’s sort of almost priority number one. You can’t throw them in the factories, so what are you going to do?
Our system of dealing with this is pretty bad, I think. It’s bad at both ends, both for kids and for seniors. And we’re about to enter a world in which because demographics are not, I said before bell curve, they’re not a normal distribution because there are generations that have larger amounts of people than others, right? The baby boom generation aging means that there’s an unprecedented need for this kind of care for folks that are my parents’ age.
And the best philosopher or strategist, tactician thinker on this central problem is my guest today. Ai-jen Poo is the president of the National Domestic Workers Alliance. She’s executive director of Caring Across Generations. She’s the author of “The Age of Dignity: Preparing for the Elder Boom in Changing America.” And it’s a great pleasure to have Ai-jen, who I’ve known for years, on the program. How are you?
Ai-jen Poo: Hi. It’s so great to be with you, Chris.
Chris Hayes: Well, it was overly theoretical, maybe, opening.
Ai-jen Poo: No. You said it all.
Chris Hayes: Can I ask you first before we get into this stuff, which I think about all the time, and again hits home, as I started off the conversation, tell me your background and your trajectory that you started thinking and working on this issue?
Ai-jen Poo: Well, I would say I moved to New York City for college and because I’m bilingual, I was raised in part by my grandparents, so I knew how to speak Mandarin, and I saw there was a need for bilingual hotline volunteers for an Asian women shelter that supported domestic violence survivors in the Asian immigrant community in New York City. I decided to sign up to get trained to be a hotline volunteer. And it was so interesting because the calls that came in were not really what I expected.
A lot of the calls in the middle of the night were, sure, they were all from survivors of abuse, but the questions were a lot about care. How do I find childcare when I work the late shift? Or how do I take care of my two kids without a second income and pay the rent? And where do I find housing that’s affordable for somebody who works in a nail salon and has two kids.
Chris Hayes: So these are women trying to solve this basic logistical and financial problem, if they want to leave, right? If they’re like, how do I get out of this? They’ve got to figure out solutions to that problem.
Ai-jen Poo: Exactly. And so that was one piece of it. And then it was actually quite a number of women working as care workers who also called, and they were particularly isolated, and there were all kinds of emotional and mental health challenges and needs for support.
And I just remember thinking, one, so much of what it takes to survive has to do with support for care and has to do with access to jobs that actually pay enough to pay for care.
Chris Hayes: And so that was the beginning of the light bulb moment was serving, as a translator on this helpline?
Ai-jen Poo: Yeah. That was part of it.
And then I had my own family issues where my grandparents played a huge role in raising me. And I had kind of a care village, like you have, of my grandparents, my parents, their friends who were students and others who all chipped in and, of course, we piece together childcare and all the pieces.
But my grandparents lived with us for a significant amount of my childhood, so I was very close to my grandfather, my grandmother, both of them. And as my grandfather aged, he needed more and more care, especially when he hit his late 80s, early 90s, and he lost his sight. And we just couldn’t find the right care to support him and had to place him in a nursing home against his wishes.
And the conditions in that nursing home, I will never forget. When I visited him there, I was shocked at the fact that he shared a room with five people, that the food was completely inedible. He became just a shadow of who —
Chris Hayes: Yeah.
Ai-jen Poo: — I knew who he was in a matter of weeks. The lights didn’t work. And then the staffing, oh my goodness, the workers who worked in that facility were in charge of 30-some people each. It was just completely untenable.
And so, it was so dehumanizing. And for somebody who had spent his life contributing so much and taking care of me and so many others, to not be able to have a dignified quality of life at the end of life really broke my heart a thousand ways. And it added a different dimension to this work that I do, and really made me focus on how do we create environments where people can live at every stage of life with dignity.
Chris Hayes: I want to pick up on one detail there, because I think it’s part of the challenges we face. So there’s the structure of American society and the threadbare welfare state, particularly compared to other, you know, OECD, social democracies. But there’s also this age thing. So, you know, one way that the problem gets solved between the populations that can’t provide wage work is that one of those cares for the other, right?
Particularly when people have children in their mid-20s, right? So you’re looking at, you know, you’re 25, you’ve got a newborn, and your parents are 50. You know, then you’ve got a situation in which they can do a lot of care and that’s been the way. Grandparents looking after children is, I think, a fairly cross-cultural staple of how this tends to work.
When that starts to get attenuated, if you have your first child at 36, then you start to get into, well, I’m 36 and my parents are 72. So a lot of people because of just when people have children and stuff, it’s a very different situation now in which that, you know, grandparents caring for kids becomes a little more difficult just in the way that aging works.
Ai-jen Poo: Yeah. I mean, this is part of a much larger trend that’s happening right now, and you spoke to it in your opening. The fact that the boomers are aging and combined with the fact that people are living longer than ever before, thanks to advances in healthcare —
Chris Hayes: Right.
Ai-jen Poo: — and technology, we are about to have the largest older population we’ve ever had. And essentially, we have added an entire generation onto our lifespan in this country, without changing —
Chris Hayes: Right.
Ai-jen Poo: — anything about our policy or our culture to support quality of life and care and the needs of an additional generation on our lifespan. At the same time, we have millennials having children. So every year, 4 million babies born, every year, 4 million people turn 65 and live longer than ever. And who we have in the middle is us, and we’re both managing care at a time when we have less of it. And it’s that panini effect, some people use the sandwich generation metaphor. I find sandwich to be a little gentle as a metaphor for this dynamic that we’re kind of —
Chris Hayes: You mean you want to think about being pressed on a hot grill is why you used panini.
Ai-jen Poo: I mean, that’s how it feels like.
Chris Hayes: Yeah.
Ai-jen Poo: I feel like that’s more accurate.
Chris Hayes: Yeah. I mean, just in terms of like, the distribution of the population, we just haven’t done this before because of how singular the baby boom generation is, basically.
Ai-jen Poo: Absolutely. That’s right. And we have 70 percent of kids under the age of 12 in the U.S. growing up in households where all of the adults in the household have to work —
Chris Hayes: Right.
Ai-jen Poo: — outside of the home.
Chris Hayes: Right.
Ai-jen Poo: So at a time when we actually need more care than ever before, we have less of it available to us, and that’s where the idea that we need a really strong care workforce is so essential. And it’s not to displace the incredible role that our grandparents, family, friends, neighbors will play in care. It’s more just that it’s an all hands on deck situation in 21st century America, where actually we need all of that care, plus the nannies and the childcare workers, the early childhood educators, the direct care workers, everybody to be a part of how we care for our families.
Chris Hayes: More of our conversation after this quick break.
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Chris Hayes: As someone who’s spent, literally, I think at this point, decades thinking about this, like, how would you describe care? What does that word mean in the context we’re using it here?
Ai-jen Poo: So how we describe care in this moment, or define it, is it is childcare. So the supports, the nurturing that our children need from the time they’re born. It includes aging care for people who need more assistance as they age or become more frail. And then it’s also inclusive of disability care. Lots of us have loved ones who have disabilities, who need supports in order to live full lives. That’s also included here.
And some of the policies like paid family and medical leave are also how we think about these issues too, because it is about the ability to take time, to take care of the people that we love when we need to. And it’s a basic human need. And right now, we’re one of the few countries in the world, developed countries in the world that has no federal paid family medical leave program. So that would also be included in how I think about care.
Chris Hayes: Just to pause here and sort of zero in on this a little bit, there’s a qualitative, subjective difference. There’s all kinds of service work, and service work can have all kinds of difficulties to it and sometimes can be wrenching in interpersonal reasons, you know, being a barista, working in the grocery store. There’s a million different ways in which you can have people yell at you. You can have people who are very difficult.
But there is something that seems to me a difference about care work that has to do with its like, intimacy. Like, feeding a person is a very intimate act.
Ai-jen Poo: Yeah.
Chris Hayes: I’m trying to grasp this without sort of adverting to spiritual terms, but there’s just something like really deep and profound about the kind of work you’re describing, over and above it as a category and how it fits in people’s lives or how it fits in policy, like, as a subjective experience, I guess, is what I’m getting at.
Ai-jen Poo: Yeah. I mean, I think it’s true that this work is so deep, deeply personal, intimate, and essential in a way —
Chris Hayes: Yeah.
Ai-jen Poo: — that goes beyond how we define essential work. It’s so fundamental to human life itself. And I mean, from the time we’re born to the time we die, we rely upon the care of others, and we’ve somehow cast it as non-productive labor, and we have a hard time even calling it labor because it is so essential and so emotional and fraught in many ways. But it is actually the essential work of the human experience. And it’s more than just a job for people who do care work as a profession. It is a calling.
I mean, the women that I work with every day, who go to work every day no matter what the circumstance is, and they show up and they nurture the potential of our babies and help them navigate the earliest stages of their lives, and then the others who make sure that the people like my grandfather, who raised me, are able to actually live and age with as much agency and as much dignity and humanity as possible.
There are women who I talk to who really see this work as a calling, like they were born to care for others, to help the elderly in their communities. And I’ve seen great caregivers in action. I mean, I have seen the Beyoncé of caregiving over and over again with people that you know were just born to do —
Chris Hayes: Yeah.
Ai-jen Poo: — what they’re doing and there’s nothing like it.
Chris Hayes: This relates to another obvious aspect of this that’s worth just pausing on, which is it’s very, very gendered work. You’ve described women. You’ve described women in, you know, calling the hotline when you began to talk. You described the women that you’ve worked with. You know, it’s not exclusively women. There are absolutely male caregivers at all ages along the spectrum.
But for a whole bunch of complicated reasons that have to do with the, you know, intersection of sort of cultural expectations, cultural training around care, which I think is part of it, that women get sort of very early messages about it is their job to care, and they take that on. And also sort of questions about wage power, right? Like, work that’s valued and not valued in the marketplace. It is overwhelmingly female. And I guess one question is like, do you view it as essentially that? Like, is it weird to say, is that part of the problem we have right now?
Ai-jen Poo: Well, I would say that the root issue is that the kind of contributions of women especially in our economy have been undervalued —
Chris Hayes: Right.
Ai-jen Poo: — and valued less than the contributions of men. And so that work associated with women and associated with kind of a gender role that women play in our society is then devalued and undervalued. And it’s also been associated as a profession. Care work has been associated with women of color. Some of the first care workers —
Chris Hayes: Yeah.
Ai-jen Poo: — in the U.S. were Black women, enslaved Black women. And the way it’s been treated in law and policy is directly related to the association with women and with Black women.
And in fact, I don’t know if you know this history, but when the New Deal was being negotiated, which included some of our core foundational labor laws that most of us kind of take for granted when we go to work every day, like the right to minimum wage, Social Security, the right to organize and form a union, two groups of workers were excluded from all of those labor rights in the 1930s, farm workers and domestic workers, because Southern Dixiecrats refused to support those laws if they included those workers. Equal protections for Black workers, essentially.
And that exclusion has been an imprint and pattern in our law and policy that not only is a reflection of our cultural devaluing of this work, but reinforces it over and over again to the point where even today, we don’t call it the profession that it is. Oftentimes, we refer to it as help, right?
Chris Hayes: Yeah.
Ai-jen Poo: And meanwhile, millions of women —
Chris Hayes: It’s a great point.
Ai-jen Poo: — go to work every day, doing this work as their profession.
Chris Hayes: Well, it’s fascinating too when you think about that intimacy, the intimacy on the other side, right? So the intimacy for the person that is hiring the worker, it’s such a complicated relationship because it’s so much more than a job, right?
But then that can be a real slippery slope on the part of the employer, which is like, I’m kind of your boss, but we’re kind of friends. You’re part of the family. But it’s like, well, that can very easily slide into like, well, you don’t have to play by any rules, and you don’t have to withhold payroll taxes, so people don’t have Social Security accounts. We’re paying you under the table. And like, there’s no labor law, and, you know, if you work over 40 hours a week, you’re not getting overtime, but it’s an informal arrangement. It’s domestic.
So you can see that being, I think, sometimes with ill intent and sometimes with a lack of self-awareness, that domesticness being leveraged precisely in the way you’re talking about it. This like, sort of, carved-out form of labor that isn’t actually regulated by the state.
Ai-jen Poo: I mean, I think the fact that we have so undervalued this entire part of our lives in the economy has created a whole bunch of different dynamics, including the fact that the care economy is like a Wild West in many ways.
Chris Hayes: Totally.
Ai-jen Poo: And even for employers who want to do the right thing, it’s oftentimes really hard to figure out what that is. And it’s not like any other sector, like, you form a union. How do you form a union in an environment like domestic work, where there’s no collective and there’s no one to bargain with?
Chris Hayes: Total itemization (ph). Yeah.
Ai-jen Poo: And you just have basically families who need care and are struggling in their own right. And what it creates is a dynamic where, for the women who are disproportionately women of color, who do this work as their profession, it’s some of the most undervalued and insecure work in our entire economy. And the whole dynamic is one of the biggest drivers of inequality that no one ever talks about.
Chris Hayes: Yeah. It’s funny if you close your eyes and you think about status and you think about particularly political rhetoric around jobs, like, so much work, so much around bringing back manufacturing, blue collar jobs, construction jobs, and just the notion of when you close your eyes, it’s men doing those jobs. And there’s just a totally different rhetoric around like elder care. There’s certain kinds of callings that have this, like, just sort of mythos emanating off of them, and like, that’s not one of them, you know, the way that like the farmer and the railroad. Which is not to say that people that work in those environments have particularly good arrangements either, like workers are getting screwed all over the place.
But in the cultural representation, in our conceptions of status and our conceptions of, you know, what a good job is, like, the sort of idea around manufacturing is both that it’s male, but also that it used to be very unionized and could provide a stable income. And there’s some sort of backsliding that happened with industrialization and deunionization. But we never had that for care work, so it’s hard to kind of conceive of it in those same terms, alongside the sort of status and equity of how gendered it is.
Ai-jen Poo: I’m so glad you raised that because this is something I think about all the time. The fact is that these jobs, care jobs, are jobs that are consistently the fastest growing jobs in our entire workforce because of the huge demand on the part of a growing aging population and a growing set of millennial families and young parents.
So we have a huge demand. We also have a workforce that can’t be outsourced and can’t be automated because no matter what you ask ChatGPT, it’s not going to be able to take care of your parent or your kid.
Chris Hayes: Yeah. It could automate my job faster than it can caring for an elderly relative, 100 percent.
Ai-jen Poo: Exactly. And for all of these reasons combined, economists are predicting that in the next 10 to 15 years, care jobs could be the largest job category —
Chris Hayes: Wow.
Ai-jen Poo: — in the entire U.S. economy. And it makes perfect sense. Meanwhile, the median wage for a home care worker in the United States is $21,700 per year. What metropolitan area in this country can you survive and take care of your family on $21,000 per year? I can’t think of one.
But the opportunity here is huge, because if you think about what an incredible leverage point it would be to make these jobs good jobs with living wages and benefits and real economic opportunity, you’re talking about a triple dignity effect.
If you made these jobs dignified jobs, that would not only benefit the workers and their families, and we know that’s going to be a growing number of people, but it also benefits the babies, the kids, the older adults, the people with disabilities.
Chris Hayes: The recipients of the care.
Ai-jen Poo: The recipients of the care.
Chris Hayes: Yes.
Ai-jen Poo: And it benefits you and me, who are the working parents and family caregivers who need that support in order to go to work every day. Talk about a great investment in our future.
Chris Hayes: Okay. But there’s an obvious price problem here, right, which is the fundamental dynamic of care is that one person’s wage is another person’s price, right? And that is an abstraction that most people are not encountering in the marketplace because most people are not employers. Most people are workers. Most people are employees.
But when you get to the care economy where you have often a one-to-one matching, one or two care worker per household, all of a sudden, people that are wage earners themselves, who think of themselves as workers, are bosses. And their price for care is the wage of the person they’re paying for.
And if you say we want to make this care more accessible for folks and also a living wage, a wage that people can live on, right, I mean, first reaction, a lot of people would be like, I can’t afford to pay more than I’m paying in care right now. Like, I know so many people that are basically, particularly with young children —
Ai-jen Poo: Yeah.
Chris Hayes: — or aging parents —
Ai-jen Poo: Yeah.
Chris Hayes: — this is the single biggest expense they have, by far the biggest expense. And if it goes up in price, they’re screwed. So, like, how do you square that circle?
Ai-jen Poo: I think the problem here is, is that we’ve been taught that care is an individual personal responsibility, and if you can’t figure it out, it’s your failure.
Chris Hayes: Right.
Ai-jen Poo: It’s your fault. You didn’t save, you didn’t buy the long-term care insurance, you’re a bad parent, you don’t have the right job, when actually this is a collective social need we have as a society, that we should all be collectively investing in, like public infrastructure. This is why I’m obsessed with calling care infrastructure.
Chris Hayes: By the way, care as infrastructure was an entire two-week Fox News’ news cycle, in which it was, like, that’s manifestly ridiculous. Like, these people are trying to redefine everything.
Ai-jen Poo: It really was, and I was proud of that because it is the conversation we need to be having. What is our responsibility to working families in this country? And I think Senator Casey said it best. He said, some people need a bridge or a tunnel to get to work and other people need childcare and other people need home care.
Chris Hayes: That’s a great point.
Ai-jen Poo: And I think that that’s essentially what we’re saying here, is that when you leave it up to the individual, it simply does not work. You are essentially leaving it up to the market, and the market cannot solve for this collective social challenge we have. We have to do it together.
Chris Hayes: But, I mean, together, again, not to be too crass about it, but the answer, as I understand it and having read the portions of care proposals that you’ve put out and that were getting, you know, bandied about in the early parts of the IRA, Inflation Reduction Act, before it got killed, and we can talk about that, is that the government subsidizes it, basically. I mean, that’s how you make those two things match, right?
Ai-jen Poo: That’s right.
Chris Hayes: The price that I pay for care and the wage that the care worker gives, there’s going to be a government subsidy that makes that math work out, such that I can afford care and the care worker can get a good wage.
Ai-jen Poo: That’s exactly right. Because we live in a country where 60 percent of the workforce earns less than $50,000 per year. And if the average cost of childcare is more than 10 grand a year, the average cost of a room in a nursing home is 90 grand a year, literally, the numbers do not work, and it’s not our fault.
Chris Hayes: Right.
Ai-jen Poo: It’s because we’ve designed a system where, system is a stretch, by the way.
Chris Hayes: Yeah. Right. Yeah.
Ai-jen Poo: We live in an environment where literally people have been paying for care in incredibly costly, inefficient, ineffective ways. Having a role for government here, including a subsidy, is the way that we actually create efficiencies in our shared need to take care of the people that we love. It’s a question of math and a question of what kind of country we want to be.
Chris Hayes: Well, it goes back a little to the, you know, Elizabeth Warren’s first big books called “The Two-Income Trap”, which she co-wrote with her daughter, and something that is remarked upon across a political spectrum, which is that the nature of what increasingly seems an anomalous period of American capitalism and wage compression after World War II in the ‘50s, ‘60s and into the’70s, before the ‘80s was such that wages rose enough, such that one household earner could afford a middle class life.
And if you have one wage income coming into a household that’s providing, then other people, and often this is very gendered, right? Man working, a woman as a caregiver and stay-at-home mom, but also grandparents, right? Like, if that one wage is enough to provide, then you can have this kind of care economy working in a non-market sense. But when that goes away and then everyone has got to work, like, all of a sudden, it just evaporates.
So this is as much a sort of symptom of that, you know, the kind of diminishing real purchasing power of wages particularly around the pillars of middle class life, as anything, right? You can’t get your way out of it by continuing to drive wages down, because when you talk about the women that are providing the care, they have kids too, that need childcare. Like —
Ai-jen Poo: Yes.
Chris Hayes: — the problem never goes away.
Ai-jen Poo: No. In fact, it is a little bit absurd that the people that we’re relying upon to take care of the people that we love can’t take care of their own families, doing this work as a profession.
And I want to just bring it back to the earlier point on manufacturing. The fact is, whether we recognize it or not, the working class hero of today is a woman of color in scrubs —
Chris Hayes: Right.
Ai-jen Poo: — and it’s also the construction worker —
Chris Hayes: Yeah.
Ai-jen Poo: — and the manufacturing worker.
Chris Hayes: Yeah.
Ai-jen Poo: But it is also her.
Chris Hayes: Yeah.
Ai-jen Poo: And if we were to make her job a good job, we would establish the foundation of an economic framework that could be like what manufacturing was –
Chris Hayes: Right.
Ai-jen Poo: — for a previous generation, where a rising labor movement transformed manufacturing jobs into living wage jobs, with real security —
Chris Hayes: Yeah.
Ai-jen Poo: — and mobility, where one generation could do better than the next. If we do that for care jobs, we could potentially once again transform the dynamic of inequality in this country in a way that is so long overdue, Chris.
Chris Hayes: We’ll be right back after we take this quick break.
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Chris Hayes: I want to throw two different sets of critiques at you about this vision. So the first is one that came from some conservatives during the discussion of this. Again, we’ll get to this in a second, but a sort of legislative version of the vision that you’re outlining was originally included in the Inflation Reduction Act and ended up getting cut out.
But one of the reactions was liberals want to take from the family and give to the state, right? So the idea is like, the family is the cornerstone institution of all societies in American life in this version of a conservative critique. And you’re going to sort of institutionalize a form of state subsidy for care that is going to kind of remove it from the family. And then, like, next thing you know, your 3-year-old isn’t at home with you learning good conservative values or Christian values or your values, they’re now in a preschool that is being subsidized by the state, where they’re going to get the woke mind virus or whatever. But that’s the sort of caricatured version.
The less caricatured version is just like, how you produce this new market with high standards that people are dealing with, without overmarketizing care, if that makes sense.
Ai-jen Poo: I think it’s a false choice, honestly, and I think this ship has sailed largely that, you know —
Chris Hayes: That’s a fair point. Yeah.
Ai-jen Poo: — I mean —
Chris Hayes: Yeah. What are you going to do, right? Yeah.
Ai-jen Poo: I mean, you know, I would say this to my conservative friends, which is that the fact of the matter is that 70 percent of our kits are growing up in households where all of the adults have to work outside of the house in order to make ends meet, literally to put food on the table and pay the rent.
And in that environment, what do we owe our kids? And what do we owe those workers? So in some ways, it’s like, they’re putting a choice on the table that doesn’t exist for the most part.
Chris Hayes: Yeah, it’s a good point.
Ai-jen Poo: And then the other piece of this is, I just think about what kind of potential could be unleashed if we were able to support our caregivers. There’s 53 million family caregivers in this country and two-thirds of them are women, a third men, which is a lot, by the way. And if we removed these financial and kind of practical stressors around care from what working family caregivers have to manage every day, imagine the talent potential we could unleash in the workforce to solve problems, to make life better in this country, to generate kind of a healthy economy for the 21st century.
I think it is a cost that we are paying out of pocket anyway, if we actually paid for it in a way that was proactive, the way that we invest in infrastructure. This is, again, why I come back to the infrastructure metaphor, because it’s like infrastructure investments or smart investments in times of crisis because they immediately create jobs that put money in the economy and they long-term support the kind of foundations of what the society and the economy needs.
And the same is true for care. We’re talking about childcare for our future workforce, right? To nurture our children into well-adjusted humans, full, you know, adult humans. We’re talking about reducing the waste in the healthcare system. There’s like a trillion dollars of waste in our healthcare system every year that’s concentrated around end of life healthcare. The best prevention —
Chris Hayes: It’s crazy.
Ai-jen Poo: — is good caregiving. Like, you’re on the front lines, you know when somebody got the wrong medication. You know —
Chris Hayes: Right.
Ai-jen Poo: — if they do or don’t need to be hospitalized. Like, the amount of money we could save in every direction if we actually made this investment is kind of stunning.
Chris Hayes: It seems to me there’s an argument. This argument never got through, I think, to people, partly because I think the sort of hermetically sealed bubbles of American media and the fact that, you know, the right wing, sort of had it out for this vision from the beginning and were sort of attacking it, oh, this is boondoggle.
But like, okay, just take, you know, someone who’s 75, 80, do you want to go to a nursing home? You have an option between two things, a nursing home where people are paid $25,000 a year, or a nursing home where people paid $50,000 a year, blind choice. Like, what’s your choice? It’s like, everyone is choosing the latter. Is there a person alive who’s like, no, no, no, no, no, give me one where people are paid really crappily? Like, of course not. Of course, no one wants that.
Ai-jen Poo: Right.
Chris Hayes: So it’s like somehow this simple choice which is like, do you want someone barely eking it out, caring for you in your elderly years? Or do you want someone who isn’t? It just seems like such an obvious choice, but somehow that obvious choice got very much garbled and sort of, you know, disqualified, I think, to the audience for whom it really does matter, which are tens of millions of aging Americans.
Ai-jen Poo: Oh yeah. An incredibly important part of our electorate, by the way.
Chris Hayes: Yes. The most important part of our electorate, actually.
Ai-jen Poo: And what’s so funny about this is that there’s such huge support. I know people say this about every issue, but it’s actually true. In poll after poll that we do, the support from Republican voters, independent voters and Democratic voters alike is so high for publicly funded care.
Literally, there’s a poll that we just got back that showed across partisan lines, more than 70 percent support some kind of a public investment in the care infrastructure.
And I remember during the Build Back Better, Inflation Reduction Act kind of negotiations, Senator King said that the cost of home-based care, which is what the proposal was for, it was for an investment in home and community-based care for older adults and people with disabilities, that would both increase access to those services and raise the wages for the workforce, he said that this was the exact right investment in the right people at the right time because nursing homes cost states, all 50 states in the United States of America, nursing homes cost Medicaid three times what home and community-based care costs, which is what most of us prefer, right?
Chris Hayes: It’s like the biggest line item in every state budget.
Ai-jen Poo: Yes.
Chris Hayes: It’s like when you look at every state, it’s like who’s the highest paid employee? It’s always the football coach of the state school. And if you say like, what’s the thing that the state spends the most money on? It’s like always Medicaid, with the biggest chunk being —
Ai-jen Poo: Being nursing homes.
Chris Hayes: — nursing homes. That’s where the money goes. Right.
Ai-jen Poo: And meanwhile, 88 percent of people, according to the AARP survey, want to age at home, not at a nursing home.
Chris Hayes: Yeah. I mean, again, I don’t think that’s controversial, which do you prefer —
Ai-jen Poo: Right.
Chris Hayes: — blind test across every line of cultural and political difference, you know. I mean, honestly, I don’t think that’s like a —
Ai-jen Poo: Yeah.
Chris Hayes: — tough one. Yeah. You know, I think about domestic policy in the progressive space as a sort of process of like, ripening because I’ve now been doing this long enough, you know, 20 years, that I saw like, Barack Obama gets elected and, like, healthcare was ripe. Like, they had tried with Clinton, they had developed all this stuff, and it was both the interest groups, the policy, all the things were sort of set up that it could happen. Climate wasn’t, and it got killed, right? So it’s like healthcare made it over, and climate didn’t.
This time around, climate was in the Build Back Better agenda and the care economy. Climate was riper. You know, we already had like a failed climate bill 15 years earlier, which I had watched die. It was ripe enough to get over the hump, the care wasn’t, but I don’t think that means it’s dead by any way, by any means, because I think that it’s partly this process of, you know, building support and making the argument. So what is your sort of lesson takeaway from those negotiations?
Ai-jen Poo: I think that it’s incredible how far we’ve come on an issue that everybody thought was a personal responsibility.
Chris Hayes: Totally. Yeah.
Ai-jen Poo: Right? Like, if you think about the shifts that have been transformational in the last two years alone under the Biden administration, care rose from what was maybe at best seen as kind of a women’s issue, right, family issue, women priority, to the center of the Biden economic agenda.
And then, it emerged in a holistic way. It wasn’t just childcare. It wasn’t just paid leave, and it wasn’t just aging and disability care. It was all of it. And the Biden team said, you know what, actually, there is an agenda —
Chris Hayes: Yeah.
Ai-jen Poo: — that has to be holistic about what intergenerational families in the U.S. need. And then the third part of it was the foregrounding of the care workforce. There is actually, in countries, even in Scandinavia, which we always look to as kind of like having the kind of infrastructure —
Chris Hayes: Right.
Ai-jen Poo: Even in Scandinavia, care workers are not paid well.
Chris Hayes: Yeah.
Ai-jen Poo: And we could be a country that actually leads the world in transforming the quality of these jobs, and actually this conversation was about that. What was being proposed, for example, in Biden’s American Jobs Plan was the single largest direct investment in good jobs that would have directly benefited women and women of color in the history of the United States. And by the way, it would have helped millions of families get access to the care that they need.
And so, I think a lot about the Affordable Care Act, now that you mentioned Barack Obama, because I feel like we won the policy, but we spent the next decade fighting for the narrative about healthcare. And I feel like what we’ve done here is we have made huge amounts of progress on the narrative, and we came literally within spitting distance of winning the policy.
Chris Hayes: A few votes, a few votes probably, right?
Ai-jen Poo: Right.
Chris Hayes: I mean, literally.
Ai-jen Poo: Of like a generational breakthrough —
Chris Hayes: Yeah.
Ai-jen Poo: — in economic policy. And we are still rising every day. Our coalition grows. I feel like we didn’t lose in the Inflation Reduction Act. I feel like we are on our way to winning.
Chris Hayes: Yeah. Yeah, I mean, I feel that way too, actually, why I use that sort of ripening idea and the —
Ai-jen Poo: It’s a great idea.
Chris Hayes: — climate and ACA, because it does take a while to get everything together.
You know, there’s sort of two aspects of this, right? There’s the public argument. There’s a public opinion argument, that’s persuasion, right? And then there’s the interest group stuff, which is both an internal interest group question among progressive groups about prioritization, which is, you know, every time Bernie Sanders, God bless him, would come on my show, I’d be like, what’s your priority? He’s like, all of it. I’m like, that’s literally the opposite of prioritization.
Like, it’s literally the case. The prioritization embedded in its definition is zero-sum, in which a thing has to go first. And it’s, like, no one wants to hear that in left interest group battles because everyone is on the same team. But it’s like something is going to go and something is not. So there’s like a prioritization question among sort of interest group stuff.
And then I also wonder in the political economy, like, are the nursing homes organized against this, for instance? Are there groups that are like the fossil fuel industry is with climate? Are there groups that are like over our dead bodies about this sort of agenda?
Ai-jen Poo: I think what is interesting is that our opposition is kind of everywhere and nowhere. It is like these deeply held cultural norms and beliefs.
Chris Hayes: That’s the big thing. Yeah.
Ai-jen Poo: You know?
Chris Hayes: Yeah.
Ai-jen Poo: And then there is a whole kind of ideology around what government can —
Chris Hayes: Totally.
Ai-jen Poo: — and should play.
Chris Hayes: I mean, that was my sense, unlike, say, the tax preparer companies coming in and like, you know, killing free tax prep every year because, like, that’s just their bottom line. My sense of what happened in the IRA and Build Back Better negotiations from an outside was it wasn’t like big nursing care came in and killed this. It was these sort of cultural narratives were in the head of a few key senators, particularly Joe Manchin, and that sort of won the day more than anything.
Ai-jen Poo: Yeah. And I think the work of the next couple years is, talk about a kitchen table conversation, right? There is not a kitchen table in this country where people aren’t talking about care for their loved ones in one form or another.
And the work is helping everyday families and voters connect the dots between those pain points and struggles that they’re feeling and talking about every day, with policy, with voting. And that’s what we’re about right now, is like, actually knocking doors, talking to voters in every community that we can about this being our moment to transform this thing that we’ve seen as like this personal burden and maybe failure in our lives as the biggest opportunity for economic change in our lives and in our country.
Chris Hayes: You know, there’s a kind of laboratory, the states thing that happens with these kinds of policies, and we saw this, again, in healthcare, we’ve seen it in climate, we’ve seen it in all sorts of places. Again, this is the kind of thing that the money involved and the scope really does have to be done at the federal level. It’s a little like state-based healthcare reform just because of what we’re talking about. But I wonder if there’s models in the state that you feel are promising in this area.
Ai-jen Poo: You know, I think Washington state is such an interesting place right now, because if you think about the care infrastructures, including childcare, paid family medical leave, aging and disability care, and a strong care workforce, Washington state, I think, has done the most to put those building blocks into place, including the country’s first ever long-term care benefit to make long-term care more affordable and accessible —
Chris Hayes: Oh, wow.
Ai-jen Poo: — to middle class families. And they just passed a childcare bill that includes giving access to immigrants —
Chris Hayes: Wow.
Ai-jen Poo: — for childcare. So it’s kind of like they are really on the front lines. Washington state has this incredible institution called the Washington State Home Care Training Fund. That is the second largest educational institution in the state after the University of Washington, trains 40,000 home care workers per year in 12 different languages —
Chris Hayes: Wow.
Ai-jen Poo: — culturally competent rooted care training. And the starting salary for a home care worker in Washington state is about 17 an hour.
Chris Hayes: Wow.
Ai-jen Poo: And they’re union members. They’re members of —
Chris Hayes: Right.
Ai-jen Poo: — SEIU 775 —
Chris Hayes: Right.
Ai-jen Poo: — just to shout them out.
Chris Hayes: Yes. Yeah.
Ai-jen Poo: And they have retirement, they have healthcare. And as a result, Washington is one of the most prepared states for the coming age wave in the country.
Chris Hayes: That’s really promising. And I know SEIU has done really groundbreaking work on this. In fact, I think I wrote up and covered a few fights they had in Illinois like 15 years ago, on exactly this, where they had sort of members, and they were negotiating higher rates with the state.
I’m really obsessed with this topic, so it’s so great to have you on, Ai-jen. It’s one of those things that, like, really touches everyone’s life and sometimes it’s a difficult thing to name because of that sort of individualized angst that we all have about it, but it’s really important. So, thank you for coming to the program.
Ai-jen Poo: Thank you so much for having me. This was such a fun conversation.
Chris Hayes: Ai-jen Poo is the president of the National Domestic Workers Alliance and executive director of Caring Across Generations. Her first book, “The Age of Dignity: Preparing for the Elder Boom in a Changing America” is available wherever you get your books, and she’s working on her second one now, so look for it.
Once again, great thanks to Ai-jen Poo. I wasn’t lying when I said I think about this conversation a lot because, obviously, when you’re the parent of young kids and also, you know, in that kind of sandwiched generation, it’s a constant thing that you’re thinking about, and I hope you found it useful too.
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“Why Is This Happening?” is presented by MSNBC and NBC News, produced by Doni Holloway and Brendan O’Melia, engineered by Bob Mallory, and featuring music by Eddie Cooper. You can see more of our work, including links to things we mentioned here, by going to nbcnews.com/whyisthishappening.
Tweet us with the hashtag #WITHpod, email WITHpod@gmail.com. Follow us on TikTok by searching for WITHpod. “Why Is This Happening?” is presented by MSNBC and NBC News, produced by Doni Holloway and Brendan O’Melia, engineered by Bob Mallory and features music by Eddie Cooper. You can see more of our work, including links to things we mentioned here, by going to nbcnews.com/whyisthishappening.