Care From the First Year of Life to the Last
Childcare, eldercare, and the people who provide both, treated as the infrastructure they are.
Pillar 3 · The Foundations of a Dignified Life
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Every human life begins and ends in dependence. Someone cared for you before you could care for yourself, and someone will likely care for you when you no longer can. Care is not a niche issue or a women’s issue or a family’s private problem. It is the work that makes all other work possible, and it holds up the entire economy from underneath. A country that treats care as invisible gets exactly what we have: parents priced out of work by childcare that costs more than college, aging people stranded without help, a paid care workforce so underpaid it cannot hold its people, and 59 million family members quietly absorbing a trillion dollars a year of unpaid work.1
This brief proposes six things: cap what families pay for childcare at 7 percent of income and build the supply to back it, pay the people who do the work, support the invisible workforce of family caregivers with a tax credit, paid leave, Social Security credit, respite, and training, make aging at home the default it should be, grow the paid care workforce including through the legal immigration front door, and count care so it stops being invisible. The clock is running: by 2034, adults over 65 will outnumber children under 18 for the first time in American history.
The Principle
Every human life begins and ends in dependence. Someone cared for you before you could care for yourself, and someone will likely care for you when you no longer can. Between those two points, most people will spend years caring for someone else: a child, an aging parent, a spouse, a sibling with a disability. Care is not a niche issue or a women’s issue or a family’s private problem. It is the work that makes all other work possible, and it holds up the entire economy from underneath.
A country that treats care as invisible gets exactly what we have: parents priced out of work by childcare that costs more than college, aging people stranded without help, a paid care workforce so underpaid it cannot hold its people, and tens of millions of family members quietly absorbing a burden that breaks their finances, their careers, and often their health. The principle of this brief is that care is infrastructure. A serious country builds it the way it builds roads and power, because everything else runs on it. Everyone gets a floor. The deepest barriers get the deepest investment.
The System Failure
Start with the beginning of life. The average cost of center-based infant care in America is about $1,230 a month, and in 28 states the annual bill for infant care exceeds the cost of public college tuition. In Washington, D.C. it runs over $24,000 a year, more than four times the tuition at a public college and about the rent on a one-bedroom apartment. The federal government defines affordable childcare as costing no more than 7 percent of household income. Not one state in the country meets that standard for infant care. Not one. And even where families can pay, the care often is not there: more than half of Americans now live in a childcare desert, an area where licensed slots are so scarce that at least three young children compete for every one. Subsidies fall short of the actual cost of care by more than $400 a month in half the states. The predictable result is parents, overwhelmingly mothers, pushed out of work or into impossible arithmetic, at exactly the moment their families can least afford it.
Now the end of life, where the failure is larger and mostly hidden. The long-term care system in this country runs on an invisible workforce of family members. Fifty-nine million Americans provided unpaid care to adults in 2024, delivering 49.5 billion hours of it, the equivalent of nearly 24 million full-time workers, roughly 17 percent of the nation’s entire full-time workforce. AARP values that care at more than one trillion dollars a year, which is more than the country spends on Medicaid and more than private business spends on health care. This is the largest workforce in America, and it is unpaid, unsupported, and mostly untrained: more than half of family caregivers now perform medical tasks like managing feeding tubes, catheters, and ventilators, and only about one in five has ever received any training for it. The average caregiver also spends more than $7,200 a year out of pocket, and 61 percent hold a job at the same time, sacrificing wages, advancement, and retirement savings to do work the system has silently assigned them.
The paid side of the system cannot take the weight either. Direct care workers, the aides and attendants who make it possible for people to stay in their homes, earned a median wage of $17.36 an hour in 20242, with median annual earnings just under $26,000, and home care workers earn less than $23,000 a year, so little that nearly three in five rely on public assistance. The shortage of them means that even families who can afford help often cannot find it. Long-term care costs run from roughly $20,000 a year for adult day care to over $100,000 for a private nursing-home room, and national spending on long-term services is projected to nearly double within the decade.
And the clock is running. By 2034, for the first time in American history, adults over 65 will outnumber children under 18, at the very moment the pool of potential family caregivers is shrinking relative to the people who will need them. We are aging into the largest care demand in our history with a system that was never really a system at all, just millions of families holding it up alone. That is not a personal failing to be managed. It is a structural failure to be fixed, and the cheapest disaster is the one we prevent.
The Proposal
Six planks, running from the first year of life to the last.
- Cap what families pay for childcare, and build the supply to back it. Set a national standard that no family pays more than 7 percent of its income for childcare, the government’s own definition of affordable, phased in with the deepest help first for the families furthest under water. A cap without supply is a waiting list, so pair it with direct investment in building capacity where the deserts are: funding to open and expand licensed centers and home-based providers, especially in the rural and working-class areas where more than half the country now lives without adequate options. Demand-side help and supply-side building move together or neither works.
- Pay the people who do the work. Childcare is expensive and childcare workers are poor at the same time, which tells you the problem is not greed, it is a broken market: parents cannot pay more and workers cannot earn less. The same is true of direct care workers in eldercare and disability care. Public investment has to go through the workforce, with wage floors and standards attached to public dollars, so that care jobs become jobs someone can live on and stay in. High turnover is not a staffing nuisance, it is a quality-of-care crisis, and wages are the fix.
- Support the invisible workforce. Family caregivers provide a trillion dollars of care a year and get almost nothing back. Change that with a federal caregiver tax credit against the thousands they spend out of pocket, paid family and medical leave so caring for a parent does not cost a job, Social Security credit for years spent caregiving so the penalty does not follow people into their own old age, respite care so caregivers can rest before they break, and training for the medical tasks the system already expects them to perform. We are not creating a new obligation. We are finally recognizing one that 59 million people are already carrying.
- Make aging at home the default it should be. Most people want to age in their own homes, and home care is usually cheaper than institutional care, yet the system’s money and defaults still tilt toward institutions while hundreds of thousands wait for home and community-based services. Fund home and community care to clear the waiting lists, and connect it to the healthcare pillar’s long-term care commitment, so the place a person ages is a choice and not a default set by a payment rule.
- Grow the paid care workforce, including through the front door. The country cannot meet the coming demand with the workforce it has. Build career pathways and apprenticeships into direct care, make it a track within the national service program in the civic pillar, and use the legal immigration channels in the immigration pillar for care work, where the labor shortage is not speculative but measured. This is where three pillars of this platform lock together on purpose.
- Count care, so it stops being invisible. What is not measured is not managed. Require standardized public data on the care workforce, paid and unpaid, its size, wages, turnover, and gaps, so that policy is built on the true scale of the system rather than on its invisibility. A trillion-dollar workforce should at minimum appear in the national accounts of what the country runs on.
Disability Rights Are Labor Rights
The invest-in-people doctrine has a test case hiding in plain sight: Section 14(c) of the Fair Labor Standards Act still lets certified employers pay roughly 39,000 disabled workers below the minimum wage, about half of them $3.50 an hour or less, some as little as 25 cents.3 Twenty-five states have already restricted or ended the practice; a federal phase-out was proposed and then withdrawn in 2025. The position: finish the job federally, phase out 14(c) with transition support for workers and providers, and pair it with what the evidence shows works, competitive integrated employment, enforced ADA accessibility everywhere public life happens, home and community-based services funded so disabled people direct their own lives, and the universal design standard this platform already writes into its service and new-places briefs. A country that says work confers dignity cannot keep a legal category of workers whose work is priced at a quarter an hour.
Implementation Pathway
The childcare cap and supply investment are federal legislation, delivered through the states, building on the existing block-grant machinery rather than inventing a new one. Wage standards travel with the public dollars, through Medicaid rates for direct care and through the terms of childcare funding, which makes them enforceable without a new agency. The caregiver credit, paid leave, and Social Security caregiving credit are federal statutes. Home and community-based funding runs through Medicaid, where the waiting lists live. The workforce pathways run through the service and immigration pillars already built. None of this is exotic. Most of it is money and standards moving through pipes that already exist, which is exactly why the failure to do it is a choice.
Funding and Public-Value Logic
The honest answer on cost is that the country is already paying, in the least efficient and most brutal currency available: a trillion dollars a year in unpaid labor extracted mostly from women, parents pushed out of the workforce at the peak of their productivity, caregivers spending down their savings and their health, and a preventable slide toward the most expensive care settings because the cheaper ones were never funded. Childcare investment returns workforce participation and lifelong gains for children, which is why economists across the spectrum score early care among the highest-return public investments there is. Home care is cheaper than the institutional care it replaces. Paying care workers reduces the turnover that drives up cost and drives down quality. The choice is not between spending and not spending. It is between building a care system on purpose and keeping the hidden one that bills families directly and breaks them quietly.
Risks and Guardrails
The first risk is a cap without supply, which produces waiting lists instead of affordability, so the demand and supply sides are built to move together and measured together. The second is that public money inflates prices instead of wages, so the wage standards travel with the dollars and the books stay open. The third is over-institutionalizing what should stay human-scale: home-based providers, family child care, and community care are part of the answer, not obstacles to it, and the funding has to reach them and not only the large centers. The fourth is treating family caregiving support as a substitute for building the paid system, when it is a complement; recognizing the invisible workforce must not become a way of keeping it invisible and merely tipping it. And the honest constraint is fiscal sequencing: this is real money, so it phases in floor-first, deepest need first, exactly as the platform’s standard says.
Metrics for Success
Judge the agenda on affordability, supply, the workforce, and the caregivers.
- The share of families paying more than 7 percent of income for childcare, tracked toward zero, and the share of the population living in a childcare desert.
- Parental, and especially maternal, workforce participation as care becomes available.
- Direct care and childcare wages and turnover, measured against the cost and quality of care.
- Waiting lists for home and community-based services, tracked toward zero, and the share of long-term care delivered at home by choice.
- Out-of-pocket caregiver spending, caregiver employment retention, and uptake of the credit, leave, and respite supports.
- The size and readiness of the paid care workforce against the 2034 demographic line.
Opposition and Responses
Some will say care is a family responsibility, not the government’s. Families are already carrying it, to the tune of a trillion dollars a year in unpaid work, and no one proposes taking that from them. The question is whether a caregiver doing a nurse’s tasks with no training, no leave, and $7,200 a year in personal costs is being supported or exploited. Honoring family responsibility means backing it, not billing it.
Some will say we can’t afford universal childcare. We are already paying more than the program would cost, in mothers pushed out of the workforce, in lost lifetime earnings and tax revenue, and in childcare bills that exceed college tuition in most states. Early care is among the highest-return investments government can make, and the current arrangement is the expensive option.
Some will say this will just drive up the price of care. Only if the money moves without standards, which is why wage floors and cost transparency travel with every public dollar. The point is to fix a market where parents cannot pay more and workers cannot earn less, not to pour subsidy into the same broken structure.
Some will say immigrant care workers take American jobs. The direct care shortage is measured, current, and growing, and it is already leaving families without help they can pay for. Filling a real gap through legal channels, with full labor rights and the same wage floor, protects the workers already here rather than undercutting them. A deportable underclass is what undercuts wages; a legal, rights-bearing workforce does not.
Some will say aging at home sounds nice but institutions exist for a reason. They do, and they remain for those who need them. The point is that the system’s defaults should not send people to the most expensive and least wanted setting because the cheaper, preferred one was never funded. Choice, not a payment rule, should decide where a person ages.
What Would Change Our Position
The care agenda bets that raising the floor raises the supply. If Medicaid wage pass-throughs shrank total care capacity instead, agencies exiting faster than workers arrived, the mechanism failed and gets redesigned. If childcare cost caps reduced available slots rather than expanding them, same answer. The tracked falsifiers are vacancy rates, turnover, and total hours of care delivered: if those move the wrong way while wages rise, this platform says so and adjusts, rather than declaring victory on the wage number alone.
Public-Facing Language
Here is the short version. Every one of us starts life needing care and most of us will end life needing it, and in between, millions of us will provide it. Right now the system runs on parents paying more for daycare than for college, on care workers paid too little to stay, and on 59 million family members doing a trillion dollars of unpaid work a year with no training, no leave, and no recognition. That is not a care system. It is a quiet emergency held together by exhausted people. So cap what families pay for childcare and build the supply to match. Pay care workers enough to stay. Back the family caregivers who are already doing the work, with a tax credit, paid leave, and the training the job now demands. And fund care at home, because that is where people want to age. Care is the work that makes all other work possible. It is time the country treated it that way.