Jason Purnell, vice president for community health at BJC Health, introduced the first set of panelists who would offer perspectives drawing on both scholarship and praxis: Edward (Ed) Baptist, professor of history at Cornell University; Darrick Hamilton, Henry Cohen Professor of Economics and Urban Policy and the founding director of the Institute
for the Study of Race, Power, and Political Economy at the New School; and Ai-jen Poo, co-founder of Caring Across Generations and the National Domestic Workers Alliance. Purnell asked the speakers to begin with brief introductory remarks.
Baptist first outlined three categories of dispossession that show how inequities for care workers have accumulated historically—theft of land from Indigenous people, extraction of labor from enslaved people, and extraction from enslaved people of reproductive labor or the labor required to raise children to adulthood. Regarding the first, Baptist noted that the land included the entire continent and its natural resources, and for the second, historical data, though not perfect, indicates the primacy of cotton cultivated primarily “by enslaved people on land that had been taken from Indigenous people.” The third category pertains to reproductive labor, the work not just of carrying a pregnancy and giving birth but also of raising children to adulthood. In the context of slave labor and communities of enslaved people, the work of raising children was displaced on other members of the family or community, as exemplified in the childhood of Frederick Douglass, who was raised by his grandmother, and whose mother could only visit him at night, when she was not laboring for the white family that enslaved her. Slave owners extracted both the labor of the enslaved people and their reproductive labor, both for the raising of enslaved children and for the children of the white families for whom they labored.
American culture, Baptist stated, has historically associated caregiving work, work that straddled the boundaries between productive and reproductive labor, with slavery and with women, both Black women, and after waves of immigration, with non-white immigrant women. The historical conditions of “unpleasant choices and inequitable chances” that characterized this work persist, and, Baptist said, continue to shape the circumstances of today’s care workers.
Darrick Hamilton asserted that “the moral devaluation of Black people and women is well-ingrained in the American political economy and has been so for a long time,” as they are frequently performing the precarious but essential work that lacks workplace protections, living wages, and adequate benefits. He added that Americans embrace a false dichotomy between what is described as labor and what is described as industrial policy. The latter centers firms or companies, but it is time, he stated, to center workers everywhere and implement anti-racist and anti-sexist concepts of economic rights in order to provide an economy that is fairer and stimulates balanced growth. Hamilton proceeded to explain what he meant by anti-racist and anti-sexist, pointing out that the Social Security Act and the Wagner Act (both 1935) that allowed collective bargaining excluded agricultural and domestic workers, which at
the time included over half of Black men and approximately 90 percent of Black women. All members of society will need care at some point in their lives, and the distribution of care in the context of the economic and social power imbalance that characterizes care workers “cannot be left to the whim of a proverbial market where both quantity and quality may be rationed for the purpose of segmenting markets and generating profits.” Intentional social and industrial policy should inform care distribution, and it needs to include increasing both access to quality care and equitable wages for care work, Hamilton stated, and he pointed to specific levers that can be used to change the status quo. Although it is often assumed that the market is to be blamed for low wages of care workers, many workers are paid through Medicaid—70 percent of home health care industry revenues comes from the federal government. The government, Hamilton asserted, can raise reimbursement rates and thus raise the wages for this work. Hamilton proposed a care economy with direct public hiring that would improve the quality of jobs and called on policymakers to shift their focus from keeping businesses afloat to what is good for workers and the public infrastructure. Accomplishing such a shift would require centering “universal social benefits like child care, elder care, health care, housing, and quality jobs, economic rights for workers, in particular, including paid family leave, medical leave” as part of investments in the national infrastructure.
In her opening remarks, Ai-jen Poo introduced the National Domestic Workers Alliance, a community of 250,000 nannies, house cleaners, and home care workers, most of whom are women (92 percent), mostly women of color, and comprising “the largest concentration of undocumented immigrant workers of any sector.” Although their work, Poo added, is work that makes all other work possible, it has always been undervalued and underpaid, making it one of the most insecure types of work in the American economy. At the start of the pandemic, 82 percent of domestic workers did not have a single paid sick day, and most of them have no access to health care or a social safety net, making the effects of the pandemic devastating for a workforce still facing a 25 percent unemployment rate. The care workforce is also the fastest growing due to more aging Americans and 4 million babies being born each year. In an echo of Baptist’s framing of reproductive labor that is extracted, Poo noted that care workers earn on average $18,200 per year and can hardly take care of themselves and their own families, while they care for the families of their employers. Poo added that many care workers see their role as a calling, but for some, the extremely low pay, which makes it impossible to “make ends meet” forces them to shift to manufacturing or other better paying jobs, creating high rates of turnover. The Build Back Better Act, Poo stated, offers an opportunity to transform care jobs, to make them quality jobs
for the 21st century that would markedly improve the economic security of women, and women of color in particular. This is an opportunity, she underscored, to right the wrongs of the policies that excluded care work from equal protection and denied the basic humanity and dignity of care workers.
Purnell asked the panelists to talk about the countervailing historical, economic, and cultural forces that stand in the way of the transformation just described. Hamilton said that the status quo for the care economy—exploitation and extraction—is the result of intentional policy informed by the iterative intertwining of isms (e.g., racism, sexism) with politics and economics throughout history. But history is not destiny, and today, different choices can be made that recognize that the status quo is the way society works and the way power is distributed, and that changes are needed. Poo added that care work has always been associated with people without political and economic power, Black women, immigrant women, and women of marginalized social status. National policies have reinforced narratives about the acceptability of seeing care work as less than real work, of seeing care workers as “the help,” even into the 21st century. The pandemic has occasioned a narrative shift, making care workers and other workers visible, and forcing a recognition that their work is essential to the health, safety, and well-being of all of society.
Poo elaborated on the growing momentum for public policy that centers the care economy by noting that care has long been thought of as a personal responsibility mostly borne by women in American households, women expected to figure it out and manage in addition to all other duties and roles. But care work is a public good and infrastructure as important as tunnels and bridges, and public policy is needed to treat it as such and build a strong caregiving workforce.
These opportunities came before and were squandered, Baptist added, reflecting on the Reconstruction after the Civil War,1 and the opportunity to create policies that would accord women, and especially Black women dignity and fair wages; the New Deal and the safety net that it built for some parts of the workforce; and the Civil Rights movement, in which domestic workers played essential roles. But these moments of inflection, those opportunities, were missed. For instance, the New Deal, as previously noted, left out agricultural and domestic workers from the protections of the Social Security Act.
Purnell asked panelists to discuss possibilities that exist for coalition building and allyship between the recipients of care and those who provide caregiving services. Poo responded that she sees endless opportunity,
1 See for example Romero and Perez, 2016. https://journals.sagepub.com/doi/pdf/10.1177/0002764215607572 (accessed May 18, 2022).
for example, as shown by the coalition she has been helping build, Care Can’t Wait, comprising people who advocate for older adults, people with disabilities, family caregivers and care workers, and labor organizations. This coalition and others are mobilizing on issues that include child care and (universal) pre-K, paid family and medical leave, and both community- and home-based services for older adults and people with disabilities. These efforts are relevant to everyone because “all of us have people in our lives who need care and are struggling in different ways to manage it, even people with wealth” and a strong care infrastructure is important to everyone.
Hamilton added that the building of such coalitions must transcend alignment of class and should be “grounded in a morality that recognizes our common humanity that is explicit in being anti-racist and anti-sexist.” A lesson to be learned from the New Deal is that coalitions formed to advocate for its policies allowed othering people based on their race. Baptist, also reflecting on the view of immigrants, mentioned research that indicates that African Americans born in the United States are more likely to support loosening restrictions on immigration when compared to some immigrant groups. This illustrates “the complexity and the difficulty of making solidarity . . . in a world in which we are told that there are so many differences between us, which are essential, and that there are in groups and out groups and there is a possibility of achieving relative status.”
Purnell asked panelists about the protections needed for workers, beyond fair economic compensation. Poo spoke about the National Domestic Workers Bill of Rights, which is intended not only to remedy the exclusion of domestic workers from the New Deal, but also to put in place a new framework for recognizing and protecting them from threats to health and safety, and against harassment and discrimination. The approach includes a standards board that includes workers, employers, and the federal government to agree on a set of fair standards—an important stipulation because this is a disaggregated workforce working in private homes. Poo shared that the city of Houston, Texas, had recently established the first essential workers health and safety standards board, which includes workers, business, and government. Hamilton added that the rights framing is important, and economic rights are one type of rights that should be included in any conversation about freedom and choice. Empowering workers, he noted, requires providing a federal job guarantee that removes the threat of unemployment if someone stands up to their employer. Worker benefits and an economic bill of rights should be portable, Hamilton argued, so workers can change jobs. The guarantee is needed to give workers some “modicum of resources when they negotiate their status.” Asked by Baptist to comment on the child tax
credit as a strategy to improve the economic status of families, Hamilton expressed his support and explained that the tax credit is a major fiscal tool but cutting child poverty in half is insufficient because any poverty is problematic. “It is a policy choice that we have anybody poor and the tax code is a . . . viable way to redress poverty,” Hamilton added.
Purnell asked panelists what narratives could help society move toward a shared humanity and morality that is aligned with the ideas being discussed. Hamilton asserted that if shared prosperity is a core value, thinking about growth per capita is unhelpful and insufficient because it does not consider distribution, human capabilities, and racism and sexism. Poo added that conversations about the care economy are about universal values, or at least universal experiences, as indicated by the public polling on caregiving policies in Build Back Better. She then added that polling indicated that “everybody understands that care work is about the human potential of children, the dignity of older people, the people who raised us, who care for us, the ability of people with disabilities to actually live whole dignified lives in their communities and not be segregated into institutions.” These issues, Poo added, are fundamental because they are about being human.
Purnell asked whether some of the private and personal dimensions of caregiving and receiving care complicate the conversations about the universality of these experiences. Poo agreed that was a challenge, but the pandemic crisis provided an opportunity to bridge the personal and the public for conversations about the public care infrastructure everyone needs.
A viewer asked Poo to comment on worker co-ops2 such as the Cooperative Home Care Associates of New York. Poo praised the model built by home care workers and currently the largest worker-owned cooperative (approximately 3,000 worker owners) in any sector of the economy in the United States.
Purnell turned to the question of resources, and how society can pay for all the policies needed for a strong care economy. Hamilton outlined three answers: (1) current government spending does not seem “grounded in inclusive economics, social equity, and civic engagement”; (2) the nation’s monetary power allows it to pay for anything that is desired, and investing in productive activities (such as the care economy) would have value; and (3) such investments would generate a stimulus. What happens if society does not make the investments being discussed? Hamilton said that investing in the care economy would make the United States less vulnerable to what he described as:
2 Worker cooperative (co-op).
despotic uses of power that lead to concentration of economic and political power at the top. In other words, the more unequal we are, the more desperate people are, the more lack of an infrastructure that ensures that they will have economic security, the more they can be attracted to relative status, the more we are susceptible to pitting one group of individuals against another.
Purnell invited the panelists to offer closing remarks. Poo outlined scenarios of child rearing, onset of disability, and aging in the context of supportive policies that ensure quality, reliable, and dignified care in the community, and she called on audience members to make their voices heard to “underscore the urgency of investing in our care economy.” Baptist called for committing to the work of solidarity. Hamilton urged viewers to not “allow despair and inequality prevent us from defining and reimagining the world that we want to achieve” given the nation’s powerful government and economy, and the policy choices that can define a just future.
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