Finding creative solutions to America’s care crisis

Many of us struggle to get help taking care of our kids or aging loved ones. How might we rethink the U.S. care economy?

Today, On Point: Finding creative solutions to America’s care crisis.

Nancy Folbre, professor emerita of economics at the University of Massachusetts-Amherst. Her research focuses on “care work,” or the parts of an economy involving child care, elder care, and other caregiving.

Michele Allgood, executive director, Gracious Living Adult Day and Health Care Center in Huntersville, North Carolina.

Oren Cass, executive director of American Compass, a conservative think tank focused on economic policy.

Kate Noble, president and CEO of Growing Up New Mexico, an organization that runs early childhood programs in New Mexico and also advocates for policy improvements.

Part I

DEBORAH BECKER: If you're the primary caretaker for a loved one right now, you might be feeling overwhelmed. Chances are you're also working full time while you're responsible for the care of either a child or a senior, maybe both. More than half of all workers in the United States have care responsibilities outside their full-time jobs.

That's about 90 million people, according to a 2022 report from Boston Consulting Group. And almost half of those caregivers rely on day care or elder care facilities or paid in-home care. The rest depends on unpaid labor. That report says this is a care crisis, creating not only stress for individuals and families.

But a huge loss to the nation's economy. So what are some possible solutions? How can we support caregivers and the millions of people who rely on them? Joining us for the conversation this hour is Nancy Folbre. She is professor emerita of economics at the University of Massachusetts-Amherst. Her research focuses on care work.

Nancy, welcome to On Point.

NANCY FOLBRE: Thank you so much. It's great to be here, Deborah.

BECKER: Also with us, Michelle Allgood. She's Executive Director of Gracious Living Adult Day and Health Care Center in Huntersville, North Carolina. Michelle, welcome.

MICHELLE ALLGOOD: Hello. Hello, Deborah. Hello.

FOLBRE: So Nancy, let's start with you. We know that there are some really dire statistics, right?

Related to the amount of care needed for elders, for children, tell us more about what the care economy is and what's needed to take care of this growing number of people.

FOLBRE: I think the biggest problem with the care economy is that policy makers just don't provide enough public support.

Either for services outside the home or for parents or family caregivers. And the basic reason for that is that there is this persistent tendency to view family care as though it's a kind of hobby, something that people do because they enjoy it, rather than as a real contribution to the overall economy.

And I think that's the mindset that we really need to change.

BECKER: I guess I wonder though, why aren't people louder about this? If so many people are affected, as we know, it may be viewed as a hobby, but that could change if people were loud enough. So why aren't they?

FOLBRE: First of all, I think people are getting loud and louder because they're recognizing the root of the problem. But we inhabit a culture that for centuries basically has treated care as women's moral responsibility.

And we still live in a world where women family members are the care providers of last resort. It's very convenient to just say, Oh, if we just hold back, if we just wait it out, they're always going to come forward and take care of it, because of their sense of moral obligation and personal connection.

And I think what's happening now is that level of emotional connection and moral obligation is just reaching a burnout point. It's no longer sustainable.

BECKER: So describe what we're looking at right now. Like how, certainly we've read by 2030, just six years from now, one in five Americans will be over the age of 65.

Some estimates suggesting one million more children under the age of five than there are now, by 2030 as well. So those numbers just keep going up and up. What are we looking at? What are we projecting for this and how do we start to think about dealing with it?

FOLBRE: You make a very good point that care burdens are likely to increase in the future.

I think it's also really important to point out that right now, a lot of care deficits are causing problems, a lot of stress for families, a lot of deprivation for kids. And a lot of harm to communities. I think things are going to definitely make it worse in the future. I think just looking at the present right now we're seeing something of a crisis.

There's major shortages of childcare services and elder care services in the U.S. today. And we're also seeing big problems in the related industries of health and education.

BECKER: So is there one that's more dire than the other, which is worse, child or elder care?

FOLBRE: It's like comparing apples and oranges, child care is very different from elder care.

It's pretty easy to predict what a two-year-old needs in terms of time and effort. I'm 71 years old, my care needs are very unpredictable. Right now, I'm in great health, I might fall and break my hip. Just because somebody is in their 70s or 80s doesn't mean that they need constant care.

It's more of the risk. For elder care, it's more the incredible risk of needing assistance that one can't obtain or can't pay for.

BECKER: I want to bring Michelle into the conversation. Michelle as we said, you are the director of Gracious Living Adult Day and Health Care Center in North Carolina. And you're someone who had part of what's called the sandwich generation caregiver, right? Taking care of both kids and a parent at the same time. And that's how you really understand this care economy firsthand. I understand you started taking care of your mom after she had a massive stroke.

You had three children at the time, and you had to leave your job. Tell us about what that experience was like for you. And where did you find resources to deal with all of that?

ALLGOOD: Yes, and actually. Nancy said it, said what I've been saying all along, no one at the time, and still today, no one cares about the trajectory of a woman's career.

No one cared that I was leaving a career that I loved and thought that I would retire from. It was just implied that I would take care of my mother. And I did not have a lot of resources. In my head, the thought was that I would bring her home with us and I would be everything.

The superwoman. I'd take care of my kids, my husband, and my mother with her varying needs. And you'd work, right? And you'd get promoted.

ALLGOOD: And work. And I would work. And I was on the ABP track, so I would be promoted. But. I failed at all of that. And every day it became more and more blatant to me that I was failing at everything.

I felt like such a failure. I was tired. My self-worth was going down because I couldn't really juggle work and caring for a new stroke patient. It just, it came to the point where I just knew I had to leave my career. And then with my children, trying to, I must say, it was easier for me to find a daycare situation.

Of course, with my one-year-old son, but not so much my mother. And I think that was where I got the 'Aha!' moment. It was like, okay if I could find a place where I could drop mom off and also just like I dropped my son off, that'd be great. So I tried to find one, but it was 30 minutes away.

And it just, it was not bright and sunny like my son's daycare was. It was very drab and very sad. And I think at that moment, it was like, okay, this can be done better, and this is so necessary. Because the resources just are not available. Just not.

BECKER: So it prompted you to do something, to take action yourself.

But before we get to that, can I just say, Michelle, I don't know that I'd say failing. It sounds to me like you were trying to do the impossible.

ALLGOOD: (LAUGHS) Yes, I understand that, but it felt like failure to me, and I hear it from so many other caregivers that are trying to juggle this wall. They're walking along, but they feel like they are failing at every moment.

To become, even sink into a depression. It's not unheard of with caregivers. It just, it's very difficult.

BECKER: I wonder, Nancy, what do you hear in Michelle's story?

FOLBRE: Oh, I just hear all of the contradictions that have plagued us as a country for many years that we really need to deal with more directly.

I think willingness to care for family members and community members is such a precious resource. But if you don't respect it and you don't reward it and you don't support it, you're going to deplete it. People are going to begin just being forced to opt out of it. And that is, I think, the real heart of the care crisis.

BECKER: I wonder, Michelle, you did eventually come around to being able to make something really positive out of this experience and taking matters into your own hands and creating adult daycare. How important is this? Do you think? And are you unusual? Or do you think that there is a growing understanding that businesses like yours are really important and there are more of them?

ALLGOOD: Unfortunately, we are unusual. We adult day and health is an invaluable alternative. It really is. I've seen people be able to return to work return — and mostly women. I'm not saying that I don't have some males, but mostly women. They're able to return to work, able to have a sense of self, even to go golfing or just to have coffee or take a shower without a shadow.

We're expanding to three centers rather rapidly, just because I have people that drive an hour and 20 minutes in the day, in the morning, so that they can go to work. They come back and drive another hour and 20 minutes, or it might be because it's the evening traffic, hour and 40 minutes, but this is what they're doing. Just so that they can have the career choice that they want, or really provide for their families. Because many people are, because of the strain of caregiving, maybe have lost a spouse.

They've decided to divorce because the spouse felt that they weren't getting what they needed. I see that a lot. We are, there are many communities that don't have resources like Adult Day and Health Care.

Part II

BECKER: Michelle, I just was wondering, because I feel like you told us that you were dealing with an awful lot. Caring for elderly mom, your children. You ended up quitting your job and starting an adult daycare facility in North Carolina. And there's an amazing demand and need for this. But I think our listeners would really want to hear from you is what did you do to prevent burnout?

How did you replenish yourself when you were dealing with all of that extra?

ALLGOOD: Oh ... Really at the time that I was going through it, I just hit a wall. I think that once I hit the wall, I realized that I needed to focus on some self-care, even getting away. If it was just for an afternoon, I would request that my aunt, my mother's sister, that she come in if she could, and sit with her while I just had a few minutes to myself.

It was very difficult to find that space. And honestly, I don't think I had enough of it. I just hit a wall. There's just not enough resources to figure out how you can carve out that space for self-care.

BECKER: Are there potential or creative solutions that you've heard about that you think, that might work? Or help? Maybe not work. Maybe we won't solve it overnight, but maybe help?

ALLGOOD: Honestly, I found the most respite in Adult Day and Health Care. That's why I'm a huge proponent. And it is for nine of the 11 years, I really, I did not take a salary just because I felt so strongly about the work that we do.

Just, I know that what we provide is a breather. We're like CPR for the caregiver. We give them an opportunity to have a peace of mind while they drop off their loved one. Really, we're gonna have to have more resources like respite care. There's a huge demand for even overnight respite care or weekend respite care.

BECKER: And who can, who, yeah, who pays though?

ALLGOOD: Ah, yeah that's the key.

FOLBRE: Okay, my turn.

BECKER: Okay. Your turn, Nancy. Who pays?

ALLGOOD: Yes. Yes. Nancy. Nancy, hit it. Policymakers. Talk about it.

FOLBRE: We need more public support for care. We have a public education system. It doesn't cover kids under the age of five. We have a Medicare system.

It doesn't cover care needs that are not medical in nature. Our capabilities, the capabilities of our children and the maintenance of the capabilities of our adults and elderly. This is a public good. It's really important to the well-being of the economy as a whole, and we should be providing more support from it for it.

And there are many examples from other countries of policies that have really reduced care stresses and their efforts underway in almost every state in the country to try and solve the problem with greater state spending. So I just, I see it as a real political problem. It's not that we don't have a solution or that we need a more creative solution.

The challenge is to build political support for a greater public commitment.

BECKER: Right. But Michelle, who pays now?

ALLGOOD: Currently, we have private pay mostly, but we do have a home and community block grant that does provide grant funding for some of our participants' families. And that, she, Nancy has hit the nail on the head.

She is spot on because what has happened is with that Home and Community Block Grant Fund and any grants that are funded by the state or federal sources, there's not enough money in those buckets. Just not. We've had people on waitlists. Honestly, for this Huntersville site, we have 62 people on a waitlist that are waiting for funding through the Home and Community Block Grant.

For the new Nations Ford site, which is South Charlotte and Pineville, we have other people who are also waiting. I don't have those numbers in front of me, but they're waiting for funding. So these families are just holding their breath. They're hitting a wall, but they have to wait for that respite to come because they can't afford now.

And we are the low-cost alternative. Our families pay $85 a day from 6 a.m. to 6:30 p.m., we provide breakfast, lunch, and a snack at three. But again, when you're not prepared to pay that on a daily basis, what do you do? You wait for funding and there is none.

BECKER: I want to talk about some of the other options and what they might be and some of the ways that some states are looking into caregiving both for elders and for children. I have to say $85 a day sounds a little bit less expensive than childcare. It just seems as if this is really putting the pinch on families in so many ways.

So Nancy, I wonder, can you tell us, aside from you grant funding or various things like that. What are you seeing out there in terms of what some states might be doing on either end of this, elder or childcare to try to make sure that there is at least a push in the direction toward funding some of these initiatives?

FOLBRE: That is a great question because I think there's not enough kind of awareness and publicity around what some possible solutions are. In terms of home and community-based care, the Medicaid program allowed states to experiment with some new ways of dealing with elder care. And I think the way that some states like California and Oregon have organized it is a really interesting model. Because they have made it possible to allocate some of those Medicaid funds to support home based care.

So a family provider can actually get paid through the Medicaid program to provide care at home.

BECKER: Elder care, childcare, any kind of care, both?

FOLBRE: Not childcare, but care of someone who is frail or disabled or needs help. But that Medicaid program is income tested. So it's only available to a very small percentage of the population.

And it also involves a lot of bureaucracy and paperwork. So not everybody in those states is even aware of that option, but I think that a model of encouraging supporting home and community-based care with a combination of public services and more support for family caregivers is a winning combo.

BECKER: I want to bring up something that we heard about in New Mexico and that is using some of the state's royalties from oil and natural gas to pay for early childhood care and education. This is apparently a land grant permanent fund in New Mexico. And it actually required a change to the state's constitution.

And we spoke with Kate Noble, she's executive director of Growing Up New Mexico which runs some early childhood programs in this state. And what Noble said was that there was a lot of support among folks for getting more funding for early childhood. And they now get about $125 million in regular yearly funding for early childhood programs like pre-K.

And she says this could also free up other state money. So let's listen to what she said about states.

KATE NOBLE: It is an elegantly designed fund that catches excess revenue from a bunch of different sources. When you prioritize early childhood and say, if we have extra money, we're going to put it in a savings account in a trust fund for early childhood.

That is a design that can happen anywhere. Whether you have a land grant permanent fund or not, whether it makes sense to do a voter ballot measure or not, I guess I'd say get creative because this is popular.

BECKER: Nancy Folbre, this is popular. Get creative. What about, is that good advice to folks and what about this idea of having a little bit of the oil and gas revenue or another source of revenue used to pay for some of this caregiving?

FOLBRE: I think it's a great example and it really exemplifies the amazing work that people are doing all over the country trying to brainstorm about these issues. Oil revenues are only a real source for some states that have public oil reserves and also our utilization of oil and fossil fuels is going to be declining in the very near future as it has already begun to decline.

So I would see that particular strategy is a short-term solution. I like what's happening in Vermont. In Vermont, they have basically passed legislation, establishing a very small payroll tax to be a dedicated source of funding for childcare. That makes a lot of sense to me that employers should be helping pay the costs of building the next labor force, the labor force of the future. And by all accounts, that program is moving forward pretty successfully.

BECKER: Aside from Vermont, aside from New Mexico, any other ideas out there that are getting any traction or even maybe not so much just a funding model, but what about increasing political support model?

FOLBRE: There are so many different organizations that are really putting their shoulder to the wheel on this, on childcare, on eldercare. In my view, what we really need is a coalition of advocates across the whole care sector. Not just young children, not just the elderly, but basically thinking also about healthcare and education. Because all of these parts of the economy are developing or maintaining human capabilities or human capital. And I think if we built a kind of a coalition across different demographic constituencies, we would have a more political clout.

BECKER: And I think that if you did have a political clout, do you think that we would see examples or programs like we hear about in other countries, where it would be almost guaranteed that we would have, in fact, support for caregiving.

FOLBRE: Absolutely. Actually, a really good model is right to the north of us. Canada has moved towards a universal childcare finance model. They're ironing out the details. But I think it's the wave of the future.

BECKER: What about government health insurance and what it covers? And what about the idea of long-term care insurance when we're talking specifically about elder care here? Could these programs be improved or expanded to cover more of this caregiving that we're talking about?

And is there any discussion about that?

FOLRE: Yeah, it's a fascinating discussion because you would think that private insurance would see this as a great potential business model. Because there's growing demand for eldercare, but it turns out that private long-term insurance has not been very successful.

And the reason for that is that it's very hard to predict who's going to need assistance. It's really hard to set premiums in an efficient way for a private insurance company. If you're offering health insurance to the current population, you can collect all sorts of data on who gets sick and how much does treatment of their illnesses cost and so forth.

And you can build a kind of model for setting rates. You don't really know what 20 or 30 years in the future, what the cost of caring for an elderly or disabled person is going to be. So I think the private market just can't really step into that role. So I think we need to think of it as a public insurance model, that's based on some universal benefits and some sharing of the costs. So that we can design something sustainable in the area of public finance. And there are other countries like Scotland that have moved very much in that direction.

BECKER: If the private market seems to be very interested in nursing homes, right?

Certainly, but maybe why is that different?

FOLBRE: First of all, nursing homes also get a substantial amount of money for Medicare and Medicaid. A lot of what the private nursing home business is doing is basically taking advantage of what is already a public revenue stream as it were.

And what we see in the nursing home market is a very segmented market where if you're willing to pay and can pay privately, you can get really good care in a nursing home. But almost all of the nursing homes that have a pretty high percentage of Medicaid financed patients in particular are pretty low quality. And a lot of them are suffering from a big labor shortage, because it's difficult for them to raise wages given the limits on the federal revenue stream.

BECKER: So no insurance at this point. I just want to go back to Michelle; in the minute we have before we go to a break. Michelle, we have about a minute here, but is there any sort of discussion about having insurance coverage for elder daycare and the services similar to what you provide?

ALLGOOD: Yes, long term care does provide, they will fund their stays here on a per diem rate. However, many of our participants families did not prepare and they don't have long term care and they can't get it now.

BECKER: So right now, it's not an option right now but there could be work toward that in the future.

Part III

BECKER: We've been talking about the U.S. and this crisis of caregiving for both elders and for children.

We don't have enough of it and the demand is only going up and it's very expensive. Many people point to some international countries. They say other countries are doing this well, which of course raises the question, is this a cultural problem? Ilana Buhl ... is an American parent living in Denmark, and she shares her experiences with this on Instagram and TikTok accounts called @the_lykke_charm.

And she says the United States needs to catch up to Denmark's policies.

ILANA BUHL: Children and families are valued so much here, and you see it in every aspect of society. Starting with pregnancy and birth, your health care is free. Taxpayer funded, yeah. But if you're pregnant, you don't have to worry about not being able to afford your prenatal care or your hospital stay.

There's a year of paid parental leave split between the parents. From birth until children are 18 years old, parents get a stipend from the government to help pay for child related expenses, regardless of their income. Daycare and preschool are heavily subsidized by the government to be affordable for families.

And why shouldn't we do all these things? You don't have to like children. You don't have to want children. You don't have to have children to acknowledge that the children are the future of this nation and of the world. And in my opinion, children, all children, should be given the best that we can give them.

BECKER: That's Ilana Buhl, an American parent living in Denmark. I'm wondering, Nancy Folbre, when you hear that, when you hear all of those things that are being offered to parents in Denmark, why isn't that being done in the United States?

FOLBRE: I think I have a pretty good answer to that.

And it's not about differences in culture. It's about differences in inequality.

BECKER: What do you mean?

FOLBRE: In the U.S., we have a lot more income inequality than in Denmark, and we also have more racial, ethnic divisions than they do. It's hard to get people to cooperate when they're in very different places or where they feel like they're at odds with one another.

And what we see in the U.S. is that if you're an affluent family, you may dislike the price tag that you pay for child care and elder care, but it's available to you. The real problem is at the middle and the bottom of the income distribution, which is where public provision would make a difference.

To think of it in terms of political coalitions, I think we're very split along lines of income and race and gender, as well as other things, and it's making it very hard for us to cooperate.

BECKER: But it would seem as if it would be at least somewhat easier than other issues to form a coalition around children.

And parents, that would be more universal and perhaps people could find some common ground and --

FOLBRE: Don't forget that because fertility rates are pretty low now, the percentage of households in the U.S., family households that have a child under the age of five is pretty small.

It's about 14%. The irony is that when there are fewer kids, it costs less to provide them with the resources that they need. But on the other hand, there are fewer households that have an economic stake in providing public services.

BECKER: So again, it comes back to not being able to get political support for things like they might have in Denmark that would help parents.

And it's all about the political support and without it, there's not much we can do.

FOLBRE: Yeah, I think that's a really good summary, but I wouldn't say without it, there's not much we can do. Because without it, that means we need to really work on, on, on developing it. Maybe talk about the need for creative solutions.

That's where we really, that's what we really need there.

BECKER: One idea that we've heard about is paying folks. To actually take care of their parents, children under five especially. There was a 2021 survey by the conservative think tank American Compass. And in that survey, 53% of married mothers said they would prefer to have one full time earner and one stay at home parent while they were raising kids under five. We don't know how many moms were surveyed here, but overall, this was about 1,100 people, almost 1,200 people who reported being a parent or guardian.

And Oren Cass, who's American Compass executive director, said that you could help a lot by sending a monthly check to working families with children, and this would really help alleviate some of the burden on these families and families who are really desperately trying to hang on to a middle-class lifestyle. Let's listen.

OREN CASS: You want to make it higher for younger kids because that's both when the costs tend to be highest and when you're most likely to have parents spending significant time out of the workforce.

So we've proposed something on the order of $400 a month for children until the age of six, and then $250 a month once children are six or older. And a family with two or three kids could be receiving upwards of $10,000, which would go a very long way toward certainly covering the cost of childcare, if that's what the family wants to do, but equally making up lost earnings if you have a parent staying at home, which we know is what most families would prefer.

BECKER: Nancy Folbre, what do you make of that? First of all, the idea that from American Compass about this and, $400 a month for children, up to $10,000 a year to support families. It's a good idea?

FOLBRE: Do you really think that Oren Cass invented this idea at American Compass?

BECKER: No, I do not think he invented the idea, but he's talking to us about it and he's outlining it.

FOLBRE: But I would just like to point out that this is exactly what the Biden administration did with the expansion of the child tax credit. And it was Republicans in Congress that basically discontinued the expansion of the credit, which in term, in quantitative terms was quite similar to what Oren Cass is calling for.

... I think he's a minority within the Republican party that has been willing to argue for more economic support for families. But the fact is that the Republican party overall is very resistant to any such policies.

BECKER: What about the policy itself? What about paying people to take care of, helping people, subsidies?

There are various pilot programs going on around the country along these lines to help low-income families in general, but could it work or are we just way too divided to even be thinking about things like this?

FOLBRE: We already have something like that with the child tax credit, which is now $2,000 per child and under the Biden American Rescue Plan, it went up to almost $4,000 per child. And yes, I think that should be a big part of the overall package of family support, because we want to give people a lot of flexibility and choice. However, I don't think it should be traded off against the provision of child care services or elder care services.

I think we need to think about the overall package. And putting it together and not, I think right now, the partisan divide is very much around the issue of providing more public services and playing that off against more tax credits for families. I think it's definitely an idea that we want to move forward.

BECKER: And what about other kind of maybe outside the box proposals maybe intergenerational, co-habitating communities? Is there any kind of support for this? Are you hearing about anything that you think maybe is starting out small and could be replicated. What would you say about those ideas to solve maybe housing, childcare, and eldercare all in one community?

FOLBRE: Yeah, I really like the communitarian imagination around that kind of intentional communities. And trying to rethink the way our housing system is structured. I think it's right now, it's a boutique movement that you can find good examples, but they tend to be small and mostly in college towns.

But I think they are really performing a valuable service in getting people to rethink our current living arrangements. And housing arrangements.

BECKER: So they're valuable but they're small scale at this point. And we don't know if there will be support for them to be modeled on a larger scale.

FOLBRE: Yeah. And just look at the tensions between a plan like that. And the way economists usually talk about the economy, in general, economists really like the idea of labor mobility. It's really good. If people can go to where the jobs are, and it's good to have that kind of individual flexibility that everybody can find the job that they need.

These are economic pressures that make it very difficult to hold families and communities together. And one of the things we've seen is that in rural areas, the younger generation has basically left home because all of the decent jobs are in big cities. So that's a kind of economic force that makes it very difficult to see this communitarian strategy working on a very large scale.

BECKER: What do you think are some of the consequences of not taking action on this?

FOLBRE: I think the way to think about it is the same way that we think about climate change. Climate change, it's very hard to see exactly how much it's going to cost, right? Because we don't really know. It's hard to measure. The specific causes and the specific consequences.

And yet what we're learning, and we're learning better every year, is that these kind of diffuse effects in the public environment end up causing meteorological problems that are extremely costly in terms of impact on agriculture, impact on public health, the spread of disease, so forth and so on.

So the care problem is similar in that it's about protecting and improving the public environment. And it's hard to get people to actually recognize the economic benefits because it's hard to put a precise dollar value on what person A contributes to it or what person B contributes to it.

I think we need to recognize that the social climate is really key to our economic prosperity and that good care provision is really central to our social climate. When we can't provide the care that our families need, it's not, they're not, it's not just the families that have care needs that suffer.

It's everybody who's living with them. And living in this situation where people are, like Michelle, in her really poignant description, are really stressed out and find it difficult to hold their lives together.

BECKER: I wonder, wasn't this always an issue, or at least for decades now, right?

That child care has been an issue, elder care has been an issue, but there's certainly a lot more discussion about it now. Is there, are people more willing to talk about it? Is there more awareness or is there a bigger problem?

FOLBRE: I think it's mostly that women now have more political bargaining power, frankly.

I think one of the reasons we didn't have a care crisis in the past was that women were really strongly discouraged from doing anything but taking primary responsibility for care provision. And, that's changed, and I think that's a good thing for obvious reasons. But it also means we need to renegotiate care responsibilities and it's hard, that process of renegotiation is pretty fraught. It's pretty difficult.

BECKER: And percentage wise, are costs so much more higher now than they were, say, 20, 30 years ago?

FOLBRE: We didn't measure the costs because a lot of the costs were in unpaid work. And we've only, actually, this is the area of research that I specialize in is looking at the amount of unpaid work time that goes into the care of dependents and what it would actually cost if you paid somebody to do it.

It turns out the cost of raising a child is really huge, not because of paying for childcare, but because of the way in which it reduces a family's ability to earn income.

BECKER: So give me a ballpark.

FOLBRE: A ballpark of?

BECKER: Cost. It's really huge. What does that mean?

FOLBRE: Let's see. About half of all work in the U.S. is unpaid work. And I'm defining work as work that somebody else could, in principle, be paid to do. Okay. So that's not all child care, but a lot of it is child care and elder care and related things to that. Some of it is housework, cooking dinner, taking out the garbage. It's half of all labor time.

Okay. Basically, depending on the wage rate that you wanted to assign to that unpaid work, the economy almost doubles in size when you take that unpaid work into account.