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October 27, 2004

Comments

Tara

I don't really understand what she's saying. Is she saying that children should personally take care of the physical needs of their aging parents?

zuzu

Oh, my, where to start with this one?

Why is the choice between women caring for children and the elderly, and the state? Why aren't men urged to fill in the gap? After all, if you want to talk about a free-rider problem, you should look no further than men who leave the vast majority care of their parents and children to the women in their family, even where those women are wage-earners.

And let's talk about the free-rider premise, shall we?

Cambridge economist Partha Dasgupta noted an interesting "free rider" problem: childless individuals (who as a group enjoy a higher standard of living than child-rearing persons as a group) expect to be cared for in old age through benefits financed by a labor force that they are not helping to replenish.

How, exactly, is it free-riding when one finances benefits of those in the older generation as a member of the labor force and then quite reasonably expects to be taken care of in the same way? How, exactly, is it free-riding when one is expected to pay, as a member of the labor force, for the education and care of children, even if one does not have children who are using these benefits?

As a person with no children who intends to have no children, I am quite offended by the suggestion that somehow I am taking more than my fair share by not squeezing out a couple of young'uns. I am happy to contribute to society at large, but don't expect me to support any position that views me as some kind of freeloader.

La Lubu

I'm dubious of the claim that changes in sexual and marital behavior have altered the experience of childhood. Children in the old days who grew up in tenements saw more real, live sexual behavior....they were just supposed to avert their eyes and pretend nothing was happening (not much privacy when there's seven family members and two rooms). That, and let's face it...except for a tiny, privileged few, there wasn't ever a blissful time of carefree childhood. Children back in the day were expected to work, and work hard...very hard. It was a long battle to get children out of the factories and coal mines, and into school, y'know?

I do think about the aging issue that she brought up...a lot. My folks are both the oldest of large families. Their large group of brothers and sisters have been able to help one another out when the chips were down (and they always are, for someone). Me, I'm an only child. And my mother isn't well. And there isn't going to be much I can do to help her. We don't live within daily driving distance, and when her health turns worse, she can't move in with me, because her insurance will not pay for this area's hospitals (she is on an HMO). I don't have the ability to move, because she lives in an economically depressed area....no jobs for me, so no way to support myself or my daughter (let alone pay for a luxury like health insurance for us!). I won't be able to help her financially either. I wish there was a way to make caring for my mother work....but under the current scenario, there isn't.

Fact is, this is not their failing for not having more children. This is an institutional failure....one that could be corrected, if we as a society valued either children or older people. We don't. A lot of flowery rhetoric, but the actions show the real values.

La Lubu

For a look through the looking-glass, where would we be if birth rates hadn't fallen? Would we have either the people or the financial resources to care for our children and elders? Or would we have instead been unable to keep those high numbers of youth employed....would the strain on society led to poverty, war, and chaos, as many nations with a majority-youth population face right here, right now?

We have our situation. We also have the tools to solve it. We just have to want to, collectively. But, the U.S.A. has historically had difficulty with the individualism vs. communalism balance...there's still the strong cultural idea that these are individual problems, not endemic societal problems. If you can cobble together something that works for you and your family, then good for you. If not, tough shit...that's your problem. Deal with it.

mythago

Then again, I don't know that it's any more progressive to want what rich old folks have now, which is usually to have working-class immigrant women wiping their soiled bottoms instead.

The arguments for employing such women are exactly those that you used to justify hiring household help, and that are used to laud women who are stay-at-home moms. Isn't caring for the elderly a worthwhile, dignified occupation? Isn't it more than a little rude of you to dismiss that kind of care as "wiping their soiled bottoms" (and then wondering why women might disdain such work)?

And what zuzu said. I tire of reading about how women no longer do certain jobs, as if only women can be expected to stoop to them.

Hugo

Oh, mythago, I think there's a colossal difference between paying someone to clean up stuff and paying someone to clean up us. Or maybe I'm wrong, but it seems screamingly obvious that activities that involve humans touching each other, in whatever fashion, are far more significant than humans touching toilet bowls.

mythago

So are you saying that it's OK to pay someone to scrub your toilet but demeaning to pay them to help you use that toilet? I'm not following your point. Mine was that you can hardly dis work one minute ('wiping bottoms') and then be surprised when the number of people willing to do that work for free (women) declines.

Jonathan Dresner

With due respect to your social conservative leanings, the idea that individual actions in the aggregate exert a profound influence on what kind of society we are bringing into being has been a mainstay of liberal and progressive movements for decades. It's also very similar to what I tell my students at the beginning and middle and end of my World History surveys: History, particularly social systems and economic changes, is the accumulation of literally millions of individual decisions.

Amanda

Hugo, this isn't a dry topic to the feminist faction of your readers, who are the very ones who are deeply tired of being told that we are beyond selfish for not turning our labor and our very bodies over to be used for the "social good", as if having some freedom for women isn't a social good in itself.

Hugo

Where have I suggested that women should be turning their bodies over to the state, or becoming baby machines? I'm simply pointing out that we haven't thought through the consequences of a radically reduced birth rate in terms of our long-term ability to support social services -- unless we want to start killing off our elderly.

I don't think it's demeaning to pay someone to help you use the toilet -- I think it's more intimate, and thus deserving of greater respect and compensation. It's one thing to "outsource" one's cleaning; another thing to outsource grandma.

Amanda

Oh god I wasn't accusing you of that. I mean that the subject is of interest, as some people *do* think that.

Hugo

Whew. Sorry if I got touchy. Still have sudafed in the old system!

La Lubu

Countries that have high birthrates, that have say, over half their population under the age of 21 (or more), do not seem to be having an easier time of caring for their elders. Poverty, disease, war, and all the social chaos that follows makes life as an elder, or life at any other age, difficult. Many elders have lost all the children that would care for them to disease and war. Or starvation. High birthrates do not necessarily equal social stability.

Hugo, do you care to clarify the "outsourcing grandma" comment? This is a guilt trip that is commonly foisted onto women when they face the difficult choice of putting their loved ones in hospice or nursing care. The guilt trip is not foisted onto men. Men are not expected to leave their jobs (whether or not they can afford it) to care for ill, debilitated, or dying loved ones. Women are, whether or not we can afford it. This is not an academic discussion for women; it's painful and far too close to home.

Here in the United States, there is no supporting social structures to allow people the ability to care for their own, if they are able and willing. None. Meanwhile, the onus is put on women to somehow work up a magical solution to the struggle, just as we are expected to whip up a magical solution for childcare on our own. Or magically whip up that phenomenal husband that's supposed to solve all our problems.

I don't put the burden on men, as a class, either. Most of the men I know who have been in this quandary have done the same damn thing as the women.....the best they could. There's no social structure that is supporting them in this struggle, either. This is a societal problem. We are not a bucolic, agrarian society anymore, and we need to realize that and get on with solutions that work in our time and place.

joe

"Here in the United States, there is no supporting social structures to allow people the ability to care for their own, if they are able and willing. None

La Luba: Maybe you could be more specific; I am not sure what you mean. There are tax write offs for dependants. There is Medicare and Medicaid, which between the two pay for the vast amount of convalescent care and both pay substantial amounts for equipment used at home. What more would you want? Subsidized payments to stay home and take care of the elderly.

What I have noticed intelligent folks do is save for convalescent care, buy supplemental insurance, and fill out advance directives which offload the burden of decision making put on their children and limit much unnecessary healthcare i.e. costs( this probably being the most important). What I am implying is that there needs be some ethical/moral decisions made prior to added social reform, so that social reforms don’t become the burden in themselves.

Hugo

La Lubu:

I'm all in favor of changing our tax policy in order to make it easier for folks to care for their families. I'm not suggesting this is women's burden alone -- I am suggesting that in a world of shifting demographics, that we need to think about how it is we are going to care for dependents.

Joe, I honor those folks who have the resources to afford insurance and the wisdom and foresight to do so. However, I am of the mind that we have an obligation to care as much for the poor as for the rich and for the unthinking as for the clever. Private solutions that are choice-based invariably provide more choice for the rich. I want solutions that are available regardless of financial resources.

And you're right, women are the ones traditionally saddled with caring for the elderly. I have no trouble encouraging men to be far more compassionate and nurturing to the old as well as to the young.

zuzu

Tax write-offs do little good when one has to forego an income to care for others.

joe

Well, Hugo, I am sure you are aware that Medicare is available for those that have worked in this country and those that want to buy into it-- this is not based on how clever or not one is. Medicaid is set up for the poor and disabled and the poorer one is the less a person pays-- not to mention Medicaid picks up the tab for Medicare premiums for the poor. All one has to be is intelligent enough to sign up. The rich don’t qualify for free healthcare through Medicaid, maybe they should be entitled to the same benefits being that they pay for it were as the poor don’t.

I’ll let you in on a secret about Medicaid. I you are so well off to afford private care when need be, then do it. Supplemental insurance is great as long as one can do for themselves. But when then time of convalescence arrives, get ride of your insurance and apply for Medicaid. When it comes to choices they are much better for one on Medicaid then the person who has bought supplemental insurance.

I think you might be surprised just how many men do care for their parents directly and how many men work to care for the elderly in convalescence.

joe

I was thinking of this comment of mine:

"Subsidized payments to stay home and take care of the elderly."

A fellow worker of mine, her mom gets paid $2500 to $3000 a month, from some state organization, to watch her daughter's five children so her daughter can work for $16,000 a year. I like this, pay me $16,000 a year to take care of the elderly and pay my wife $30,000 a year to take care of my children. Something seems incredibly wrong here.

La Lubu

"all one has to do is be intelligent enough to sign up for it."

(breathe deeply, Lubu....patienza, patienza...)

It's pretty easy to be too poor to pay your medical bills, and not be poor enough to qualify for Medicaid. Or Social Security assistance. If you are on unemployment and only have one dependent, you already earn too much. I know. I've been there, with my premature daughter. The system is not set up to help working class families keep out of bankruptcy. The system will not give a helping hand to people who only need a helping hand. It is an all-or-nothing system. If you have nothing, you can qualify. If you have a little bit, you get no help.

Also, there needs to be cost-containment for health care providers. Really. The insurance providers only pay what "the going rate" is. Health care providers can charge more than that....but not to recipients of public aid. Only to people like me, who have insurance. Excellent, very expensive insurance, might I add. Now, why would they charge more, knowing they're not going to get it? 'Cuz if they can force you into bankruptcy, they can write off their overcharges! I will not let them force me into bankruptcy...I pay what I can. I was charged three times the going rate for neonatology services (although, one wonders what the "going rate" would be, seeing as that NICU was the only one around). They would not negotiate their charges with case management. This is legal. Despicable, but legal. If my daughter had the good fortune of being born at the hospital she was eventually transferred to, I would not have any bills....that was a compassionate hospital. Relying on the charity of others is more often than not a losing proposition. Very rarely will you receive any help. That is why there should be social systems in place to pick up the slack. Look around. Most of us aren't deadbeats, and we're doing the best we can....we just have very limited resources. There's only twenty-four hours in a day.

And speaking of subsidized care, why not? We already have unemployment insurance. Why not allow people to take unemployment insurance while taking unpaid FMLA? That is one option that could help. Yes, it would cost. But again, it's a choice of values. We seem to have an unlimited amount of slush money for war chests and their contractors.

I don't know what your local newspaper looks like Joe, but here I can't open up the paper without seeing notices for fundraising parties to assist people with their medical bills....sometimes for them, sometimes for their children. Occasionally, I'll see a notice of a fund set up to help a family with funeral costs. Am I alone in thinking this is pathetic? That the wealthiest nation in the world can't come up with a way to help working people pay for medical care? Where is the compassion?! Where is the outrage?!

Most of us don't have the luxury of "buying supplemental insurance." Even financial advisers recommend don't recommend long-term disability insurance for most people, because such insurance is very expensive. Most of us don't have the luxury to leave work at will. And if by "advance directives", you mean talking Mama into just doing without all that pesky chemo, so she can die a little faster, a little cheaper...you don't want to go there.

La Lubu

Now, to get back to the original article...she seems to condone family members pitching in to help each other out. That is already the status quo. She seems to think that the lower birthrate, meaning fewer children to band together, pitch in, and help out, is creating problems. She's part right.

She's also part wrong. Large families make sense for low-technology, agrarian societies that need more man- and womanpower. Large families in an industrialized society translate into high unemployment. That brings its own set of challenges. Challenges that she hasn't examined in this article.

Why should it only be family members who are responsible? Why should each individual family have to forge their own path (if indeed, they are able....if indeed, there even is a family to speak of?)? Why do we not see this as a societal problem, with societal solutions? Because there is not just one cookie-cutter solution.

For me, one possible solution would be requiring my mother's HMO to pay for medical care here in my area, so she could move in with me when the time comes. I could provide care after work. During working hours, her insurance would probably pick up costs (or partial costs) of in-home assistance. Having the unemployment fund available to people who otherwise do not have access to paid FMLA is another solution. These are relatively cheap solutions. A hand-up, not a handout.

I'd like to hear from other folks here. What do you see in terms of possible solutions?

La Lubu

And Joe? You're right...it doesn't make sense for the system to be willing to pay the grandmother $2500-$3000 a month for childcare services while the mother only earns $16,000 a year. Not very cost-effective. The mother is probably also receiving Medicaid benefits, and food stamps, and housing benefits.

Meanwhile, if they paid the mother that $30,000-36,000 grand a year, she could pay for her own food and housing, she wouldn't need child care, and she'd be able to contribute towards health insurance (she wouldn't be able to pick up the full cost of family health insurance at that income, but she could contribute a co-pay, adjusted for income, y'know?).

joe

Back to the example of my fellow worker... I should also mention, see receives food stamps, she is on medical, her children are on healthy families, she receives food stamps, and I really don't know if she has subsidized housing. The fact is, I earn twice as much as she does and she enjoys the same standard of living I do— because I have to pay for what she doesn’t. This is the all or nothing you speak about. Getting back on subject and my point with subsidy, there is a problem and the solutions I am hearing involve throwing more money at the problem and therefore incurring the problems like I have state in example.

joe

"Also, there needs to be cost-containment for health care providers. Really. The insurance providers only pay what "the going rate" is. Health care providers can charge more than that....but not to recipients of public aid."

and so you know there is cost-containment to medicaid-- that is why some providers don't take medicaid.

zuzu

Medicaid picks up the tab for Medicare premiums for the poor.

But only the poor as measured by poverty level. There's a story in last week's New Yorker about an elderly woman who's just not quite poor enough for Medicaid to pick up her Medicaid tab, even though her income is around $10,000 a year.

We definitely, in this society, need to have a better safety net. When my mother, age 65, had a heart attack and looked to be unable to work, my siblings and I got together to decide what to do. Let me tell you, the four brothers looked at the two sisters to do the work. Mom got some Social Security, but my dad didn't have a pension because he got laid off right before it vested. She had very little in savings.

Our best solution, believe it or not, was to have her become a dependent of either my brother or my sister and her husband, since my brother and BIL are in the military. The dirty little secret of the American military is that it's quite a socialist organization: pay and housing, while often inadequate, are based not only on rank but on family size. Health benefits are universal and extensive (though apparently endangered). It's downright Canadian.

Sadly, my mom ended up dying, and we never did have to come to a decision. But I'm already planning for my retirement because I don't want to have to rely on someone else's charity.

joe

Let me come out a tad more on this. The fellow worker I spoke of is a nurse assistant and I am the nurse. The facility I work at is probably one of the larger in the nation. It is a convalescent hospital with around a 370 bed capacity. To be frank, the rich, poor and middle classes all abuse Medicaid. If you take into account the number of convalescent homes with the number of people in need of convalescent care, you might realize that the vast majority of folks are taken care of at home, whoever the caregivers are—they are managing.

Hugo’s comment, “When I grow old and feeble, I hope to be cared for by those I love -- up to a point.” This is interesting to me, because I feel the same way. But I have notice those of other cultures not so timid in doing this work—even to the point of the SON or daughter helping with showering or toileting of the parent.

In favor of our culture, we tend to see the futility in doing everything we can to keep a parent alive—just because medical science can. Many from other cultures have a world view that not only are they required to care for their parents in old age—but this concept somehow carries over to idea that their parent needs to be kept alive by whatever means possible, for as long as they can. Would you like an explanation to the extreme sadness this leads?

I think a merging of these world views would be beneficial to all. When collectively we have reached this point, it would be a wise place to start on what forms of social aid would be beneficial. It seems best to have a moral or ethical ideal in place prior to legislating reform—but that is tough, exceedingly tough to do. Till then, I guess we keep throwing money at the problem.

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