Kamala Harris’s big policy proposal is care
With a transformative announcement on paying for long-term care for older Americans, Harris aims to make the care economy a reality
When Joe Biden launched his 2024 campaign at the State of the Union all those eons ago, he centered his bid around what we called a care agenda - a constellation of pragmatic, real-world fixes for the very broken system serving those who need care, those who provide it, and those who need to make it happen — that is, every single American, at one point or another).
This week, Kamala Harris upped the ante on the care agenda, and during her appearance on “The View” (part of the campaign’s media blitz) laid out a proposal that could remake the way we look at aging — expanding Medicare to cover the cost of long-term care at home, and letting people Medicaid-related spend-down requirements that can force care recipients and their families into poverty.
There are so many people in our country who are right in the middle. They’re taking care of their kids and they’re taking care of their aging parents, and it’s just almost impossible to do it all, especially if they work. — Kamala Harris/CNN
And with that, Harris introduced a potentially sweeping change to the way the country looks at aging and pays for the needs of older Americans — and one that makes real the notion of a “care economy” we’ve talked about repeatedly in the newsletter this past year.
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Harris’s proposal draws on research published this September by the Brookings Institution, which outlines the scope of the issue, and outlines some practical solutions within reach — mostly achieved by augmenting Medicare.
Almost one in five Americans over age 65 are unable to manage basic activities of daily life—bathing, dressing, eating, toileting—without assistance. Among those over age 85, the proportion is closer to half. Friends and family members can and do help out, but even so, about half of people reaching the age of 65-years of age will use paid long-term services and supports (LTSS) at some point. Most Americans do not have enough income or savings to cover these costs. — Brookings.
Americans currently dish out huge sums each year to cobble together the coverage that is technically accessible to them, from in-home caregivers on up through assisted living and nursing home stays. According to KFF, 7.7 million people used long term care in 2020, at an average cost of $60,000 per year.
The good news is that the current landscape of home care financial protections is so limited that even a modest program that made conservative choices across these parameters, with costs we estimate at around $40 billion annually, would make many people who currently lack services much better off. Turning the dials more generously would, of course, cost more—and it would extend more benefits to more frail and vulnerable Medicare beneficiaries. — Brookings
Democrats tend to get asked how they’ll pay for things, and Harris proposes to do so via more robust backing for Medicare to negotiate drug prices. But that question aside, a program of the cost Brookings estimates — $40 billion — isn’t that expensive. It’s an order of magnitude less that then what people spend now, and frees up millions of people to do other things, productive or otherwise, removing a huge drain on society and the economy.
That addresses what organizer Ai-jen Poo has told us, care is not just a need, it’s an untapped economic motor - every carer is a worker, and care allows people to make choices — making care functional means unsticking the economy. It means unsticking society. It means freedom.
Against a backdrop of lies, this is something that speaks to deep truths about America. Millions of older people need help, and millions more (the Harris campaign estimates 105 million Americans) struggle to provide it. Elder care is a crisis; it ruins lives and cuts off the young from their futures. Republicans continue to fake care for future generations with tweaks to the estate tax (something that pertains to a vanishingly small percentage of very, very wealthy people), promises to address the looming insolvency of Social Security by raising the retirement age
J.D. Vance may pontificate about fancy-free grandparents taking years of (unpaid?) leave to care for family members, but the reality — and chances are you probably know what we’re talking about — is that caring for your parents and relatives as they age is not just an all-consuming task, but can easily mean years of anxiety, a fast or slow descent into poverty (and maybe multigenerational poverty), broken relationships, job loss – and that’s not even the worst-case scenario. Because while you’re doing that, you likely have kids to care for too.
So the situation is dire before we even consider child care. Let’s just say that the sandwich generation — that’s 25 percent of Americans, mind you — gets served a shit sandwich more often than not. And that’s what this proposal is really all about. Taking better care of older Americans means taking better care of those coming up in their wake. And that’s everyone.
When we talked to organizer George Goehl last month about the work he’s been doing lately in rural communities (chronicled in the second season of his podcast, “To See Each Other,” which you should check out), he told us that when he listened to what communities wanted, the thing that was most on their minds was care. And they’ve been organizing to protect it - we’re talking about rural folks in deep red districts, fighting for better care for their aging relatives.
There is no way to look at what Harris has proposed here and suggest there’s not a clear choice to make in this presidential election, or that she isn’t making a serious policy statement. This is a leader taking on a serious issue — one of the most challenging problems that faces Americans, every American — with the seriousness it deserves and responding with a substantive proposal that really could help build a better future.
How’s that for vibes?
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“… care is not just a need, it’s an untapped economic motor - every carer is a worker, and care allows people to make choices — making care functional means unsticking the economy. It means unsticking society. It means freedom.“
Seems you’ve been reading Prof. Timothy Snyder’s new book, On Freedom!? He delves deep into this very idea of freedom as he explores America’s pinched views on “negative freedom” vs. a more robust, expansive view of positive freedom as you and AiJen expose.
Excellent review of Harris-Walz proposal.
Love, love this. Finally we will have a leader who deeply understands some of the things that matter most in life: care, to be seen, love and freedom.