Melinda Gates: This pandemic has exposed our nation’s broken caregiving system

A mother greets her daughters at their school in Tulsa on Nov. 9.
Dec. 2, 2020 at 4:46 p.m. EST

Melinda Gates is the founder of Pivotal Ventures and the co-chair of the Bill & Melinda Gates Foundation.

For a brief history of presidential responses to national crises over the past century, you could start by looking at the list of White House “czars.”

The term was born in 1918 when President Woodrow Wilson appointed financier Bernard Baruch to coordinate the production and purchase of war supplies for World War I. The press dubbed Baruch the “industry czar,” and although his role disappeared when the war ended, “czar” became shorthand for a certain kind of high-level administration role periodically created to focus accountability on key issues.

During World War II, President Franklin D. Roosevelt appointed a long list of czars, including for food, prices and rubber. During the oil crisis of the 1970s, President Richard Nixon named an energy czar. In 2009, with the American automobile industry near collapse, President Barack Obama proved that one can indeed govern in poetry by naming a czar . . . for cars.

Opinion | Covid-19 exposed how important health workers are. Elder care is just as essential.
As America ages, more men and women are becoming their parents' caregivers. People like Christina Keys want policies to ease the financial and emotional burden. (Video: Kate Woodsome/Photo: Christina Keys/Danielle Kunitz/The Washington Post)

Now, as President-elect Joe Biden prepares to take office under the shadow of interlocking public health and economic crises, I am one of many advocates hoping that he will elevate a new issue as a presidential priority by appointing a czar for caregiving.

The coronavirus has laid bare what was painfully clear to many families already: The caregiving system in the United States is broken, and it is women who are paying the price.

Even before the pandemic began, child-care and long-term care solutions were often unaffordable and inaccessible, and women were filling the gaps at tremendous cost to their own economic potential.

Now, with child-care centers closed, schools operating remotely and families caring for sick adults and aging parents at home, what was previously untenable has become almost impossible — especially for single mothers, essential workers and others working low-wage jobs with unpredictable hours.

Recent jobs reports paint a grim picture of an economy that is hemorrhaging jobs held by women (865,000 in September alone), some of whom may never return to the workforce. A survey by the Lean In organization and the McKinsey consulting firm found that a staggering 1 in 4 women are considering downshifting their careers or leaving their jobs because of the pandemic. Meanwhile, 1 in 5 child-care jobs has disappeared, affecting women of color disproportionately and contributing to an unemployment rate for Black and Latina women that is hovering around 9 percent.

Women’s covid-forced exodus from the economy is a blow to decades of progress toward gender equality — and there is little evidence that progress will recover soon. As Adrienne Schweer at the Bipartisan Policy Center put it to me last spring, if the status quo continues, it will cleave the post-pandemic economy into two classes of workers: people with caregiving responsibilities and everyone else.

But as Biden made clear when he laid out a visionary caregiving agenda this summer, it doesn’t have to be this way. And by creating a new position to lead a multiagency caregiving response, he could ensure that, for the first time ever, the federal government is formally considering the needs of caregivers in all policymaking and legislation. (Given how many Americans have caregiving responsibilities, you might assume that such a role already exists, but, in fact, it never has.) Because caregiving cuts across so many departments and issue areas — health, education and labor — reform is best driven by someone positioned high enough to take a sweeping view of the policy landscape and empowered with the resources and authority to elevate promising solutions.

On Day One of the Biden administration, a caregiving point person could begin working with Congress to provide immediate relief to American families by extending and expanding temporary paid-leave provisions, passing at least $50 billion in funding to stabilize the teetering child-care industry and directing additional resources to Medicaid to clear 800,000 adults off the waiting list for long-term care services.

Once these emergency measures are in place, the administration’s attention could turn to advancing a national paid family and medical leave law — a long-overdue policy with bipartisan support and a proven impact on women’s workforce retention.

The caregiving point person could also support the Biden administration’s bold caregiving ambitions by tracking policy proposals and pilot projects in cities and states across the country, and by encouraging innovative, market-based solutions to better serve families. Those good ideas are out there — they deserve White House attention.

The president-elect has taken care of aging parents and been a single father to two young boys. He knows from his own experience that today’s caregiving crisis is not a symptom of the pandemic but a preexisting condition. If there ever was a president who understands why this issue must be a priority, it’s him. And if there was ever a moment caregivers needed a full-time champion in the administration, it’s right now.

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