Robert Kuttner in The American Prospect:
Joe Biden’s American Families Plan is something of a miracle. It carries out goals that advocates have only dreamed of. These include $225 billion for day care, so that no family pays more than 7 percent of its income on child care; universal pre-kindergarten; paid family and medical leave; as well as better pay for care workers and $200 billion to assure four million uninsured people will gain health coverage.
All this, and more, is nothing short of astonishing. And yet, there is a deeper challenge that these superb proposals don’t reach.
Far too much of the entire caregiving sector has been commercialized by for-profit vendors, from health care, to residential and home nursing care for the elderly, and even child care and pre-kindergarten. These entrepreneurs use taxpayer dollars and consumer premiums to maximize profits.
What’s wrong with that? Doesn’t the profit motive optimize efficiencies?
Not in the caregiving sector it doesn’t. As they say at the business schools, good management produces an “alignment of incentives.” But mix caregiving with commercial vendors, and incentives are often backwards.