The Care Gap
Many progressives sense that we as a society are not providing adequate care for those in need. But we did not know precisely how many people need and are receiving adequate care, until now. In Striking a Balance, I use U.S. Census Bureau figures from 2004 to estimate the “care gap,” or the difference between the number of people needing care, and those receiving adequate care.
Out of a population of 284 million, just under 100 million people need care, or around 35 percent of Americans. That figure includes around 64 million children under the age of 16, who presumably need care, and 35 million adults with disabilities. Using disabilities rather than, say, the number of adults over age 65 accounts for the fact that almost two-thirds of the elderly are able to take care of themselves.
Poverty is undoubtedly the main source of inadequate care. Current anti-poverty programs leave two of every five children eligible for the Head Start program out in the cold, and children born into poverty are eight times more likely than to go hungry, three times more likely to have no regular source of health care, and are 1.6 times more likely to die in infancy. For disabled adults, employees who experience a work-related disability must wait 29 months to be eligible for Medicare: an estimated four percent of the group dies while on the waiting list. And Medicaid, our health insurance plan for the poor, has been slashed to the point where doctors are reimbursed at only 60 percent of the Medicare rates, undoubtedly causing many of the poor to be turned away.
If poverty signals an inability to obtain adequate care, then there is indeed a care gap. Almost 20 percent of those needing care live under the federal poverty line, while just under 10 percent of non-disabled adults fall into that category. As a result, over half of all Americans living in poverty are either children or adults with disabilities. So much for the myth that the poor are mainly healthy adults too lazy to get a job. Indeed, we reserve our highest rates of poverty for those who are most vulnerable. Girls with disabilities exhibit a poverty rate hovering just under 30 percent.
But the federal poverty line undoubtedly understates the level of income needed for adequate care. If we instead use a basic family budget figure calculated by the Economic Policy Institute, at 150 percent above the federal poverty line, almost 48 percent of those needing care or over 47 million individuals have fallen into the care gap.
Even that figure is undoubtedly too low. Higher income families often use child care centers or nursing homes to cover the gap, yet recent studies suggest that 80 percent of child care centers are substandard, while over 90 percent of nursing homes are so understaffed that they are dangerous. Therefore, a very conservative estimate of the care gap would add three percent to the figure above, suggesting that over 50 million individuals, and over half the population who need care, are receiving inadequate care or none at all. Almost one-fifth of the U.S. population suffers from the care gap.
All of this ignores the fact that even non-disabled adults need care in the form of health insurance. Other Census Bureau data from 2004 implies that at least 26.5 million non-disabled adults have no health insurance coverage. If we were to count these individuals as suffering from the care gap as well, then over 75 million people, or one-quarter of the population, has fallen into the gap.
In the richest nation in the history of the planet, the care gap should be a great source of shame. It should also be a source of motivation for political change along the lines of the Work and Family Bill of Rights or the Motherhood Manifesto.
Robert Drago is the author of Striking a Balance: Work, Family, Life. He is Professor of Labor Studies and Women’s Studies at Penn State University, Professorial Fellow at the University of Melbourne, and a co-founder of the Take Care Net.