For Love or Money: Care Provision in the United States

Chapter 8. A Care Policy and Research Agenda

/ 183 Chapter 8 A Care Policy and Research Agenda Nancy Folbre, Candace Howes, and Carrie Leana I n preceding chapters, we have developed a unified analysis of unpaid and paid care for three groups with particularly intense needs: children, individuals with disabilities, and the frail elderly. We have shown that the costs of care provision continue to be divided unequally between men and women, and that shortfalls in public support for care provision reduce living standards and intensify social inequality. In this conclusion, we summarize our analysis of care work and explain its implications for public policy. We also outline an agenda for policyrelevant research. THe ImPoRTANCe oF CARe WoRk We have offered three theoretical reasons for an emphasis on care work as an important category of analysis and a significant sector of the economy: • Care work has distinctive features that make intrinsic motivation and emotional attachment particularly consequential. Indeed, we define care work as work whose quality is likely to be affected by the caregiver’s concern for the well-being of the care recipient. • Care work contributes to the development and maintenance of human capabilities that represent a “public good.” Human capabilities have intrinsic value and also yield important positive spillovers for living standards, quality of life, and sustainable economic development. • The family, community, market, and state are all important sites of care provision , and with good reason: we cannot rely entirely on familial or community altruism, on market forces, or on public support. We need to devise ways to improve and coordinate care provision through all four types of institutions. 184 / For Love and Money We have offered empirical substantiation and illustration of this approach to care work by demonstrating that: • Survey data (including the nationally representative American Time Use Survey ) can be used to categorize and measure inputs of unpaid care. • Conventional labor force categories of “industry” and “occupation” illustrate both differences and similarities in paid care employment. • Both labor hours and imputed market values can be used to trace shifts in care provision across time, examine relative quantities of labor inputs, and explore interactions across the unpaid-paid boundary. • Federal and state care policies can be defined and critically assessed as a package, which implies the possibility of building political coalitions to improve them. The Increasing Cost of Care Continuing increases in the costs of care are likely to drive attention to this sector of the economy. Early childhood education is now widely considered a necessity for children; regardless of maternal employment, enrollment rates are high. The incidence of some childhood disabilities, such as autism and asthma, has increased in recent years.1 The aging of the population has combined with increases in average life expectancy to increase the likelihood that an elderly family member will suffer a debilitating injury or illness. Medicare and Medicaid pay some of the bills, but they do not adequately cover long-term care. Women’s increased participation in paid employment has reduced the time they devote to unpaid work, partly by making the costs of such work (such as forgone wages) more visible, and has also led to increases in men’s unpaid work, perhaps enhancing their appreciation of both its benefits and its costs. The advent of new information technologies has belied the predictions of economist William Baumol (1967) that the cost of services would inevitably grow faster than the costs of manufacturing. However, the very definition of care work dictates less substitutability between capital and labor and less potential for cost savings from automation and offshoring than in other forms of work. The price of care services has risen more rapidly than personal consumption expenditures (Folbre 2008c). Technological innovation may have the potential to improve the quality of care services, but it is unlikely to substantially reduce cost escalation, because most vulnerable individuals will continue to require hands-on, face-to-face, personal, and emotional attention. The Distribution of the Costs of Care Care provision imposes costs and risks on those who provide it, whether in unpaid or paid form. Rather than taking norms and preferences relevant to the supply of / 185 A Care Policy and Research Agenda care as a given, researchers should ask how such norms and preferences are socially constructed. Some important aspects of contemporary feminist discourse can be interpreted as an effort to individually and collectively renegotiate the distribution of the costs of care between men and women. For instance, feminists...