Families Are Drowning in Care Costs. Here’s How To Change That.

Every day in the United States, more than 10,000 babies are born and 10,000 people turn 65. But America doesn’t have anything close to a comprehensive family policy. That means no guaranteed paid family leave, no universal child care or preschool and a patchwork system of elder and disability care that leaves millions without support.

American families are drowning as a result. In some states, the average cost of a full-time child-care program is nearing $20,000 a year; the median yearly cost of a private room in a nursing home is over $100,000 — a figure that well exceeds the median household income in the United States. And workers in the child care and eldercare industries routinely make poverty wages.

Ai-jen Poo is a co-founder and the executive director of the National Domestic Workers Alliance, a MacArthur “genius” grant winner and the author of “The Age of Dignity: Preparing for the Elder Boom in a Changing America.”

Fixing America’s systems of care has been Poo’s life’s work. But for her, the current state of America’s care infrastructure is more than a looming crisis; it’s a huge opportunity — one that, if solved, could supercharge the American economy, ensure dignified care across our life spans and revolutionize the future of work. And Poo’s movement may be on the brink of a major victory: If signed into law, the Build Back Better Act would be the most transformative investment in children and caregiving in generations.

This conversation is about how caring for the people we love became so atrociously unaffordable and unmanageable — and what it would take to change that. It also explores why Poo thinks we should view child care and eldercare as essential infrastructure for running our economy and society, the racialized history of why the United States lags behind most of its peers in developing comprehensive family policy, the cultural narratives that have caused America to undervalue care work for so long, how solving the care crisis would be a policy “win-win-win” for everyone, Poo’s view that “care is a problem the market cannot solve” and why Poo believes that the future of work is inextricably linked to the future of care.

Mentioned:

“Prep School for Poor Kids: The Long-Run Impacts of Head Start on Human Capital and Economic Self-Sufficiency” by Martha J. Bailey et al.

Book recommendations:

The Sum of Us by Heather McGhee

Caste by Isabel Wilkerson

Being Mortal by Atul Gawande

This episode is guest-hosted by Heather McGhee, a public policy expert whose work focuses on the intersection of race, inequality, and social policy. She is the chairman of the board of directors of the racial justice organization Color of Change, the former president of the think tank Demos and author of “The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together” and. You can follow her on Twitter @HMcGhee. (Learn more about the other guest hosts during Ezra’s parental leave here.)

Thoughts? Guest suggestions? Email us at ezrakleinshow@nytimes.com.

You can find transcripts (posted midday) and more episodes of "The Ezra Klein Show" at nytimes.com/ezra-klein-podcast, and you can find Ezra on Twitter @ezraklein. Book recommendations from all our guests are listed at https://www.nytimes.com/article/ezra-klein-show-book-recs.

“The Ezra Klein Show” is produced by Annie Galvin, Jeff Geld and Rogé Karma; fact-checking by Michelle Harris; original music by Isaac Jones; mixing by Jeff Geld; audience strategy by Shannon Busta. Special thanks to Kristin Lin and Alison Bruzek.