We Need a Care Package!

Eighty years ago, an organization named CARE—which stands for Cooperative for Assistance and Relief Everywhere—responded to worldwide hunger in the aftermath of World War II by sending millions of packages of food. This post commemorates that effort.

A diverse group of researchers and policy advocates met recently at the Political Economy Research Institute (PERI) at the University of Massachusetts Amherst to brainstorm and draft proposals for “game-changing” policies for the U.S. economy. As part of this larger effort, I led a small team asking a simple but profound question: what would our economy look like if we took seriously the work of caring for one another?

The short answer: not like what we have. 

In the United States, we rely on a patchwork of underfunded programs, unpaid labor (mostly by women), and heroic improvisation by families trying to hold things together. We treat care as a private burden rather than a public good. And then we act surprised when the system produces stress, inequality, and declining confidence in the future.

Three bold, interconnected proposals—universal child care, paid family and medical leave plus long-term care support, and a monthly child allowance—would transform life for American families. Together, they form a coherent package that addresses caregiving at every stage of life: from infancy through old age. Other wealthy nations have already figured this out. It's long past time the United States did too.

These proposals would work together to give families the flexibility they need. They build on policies that have already been put in place by individual states or experimented with at the federal level. They are game-changers because they are all conceived as free, universal benefits that would be funded by taxes on income from capital, rather than from labor (stay tuned for further reports from the Game-Changers: Economic Policies for a Working America project).  

Free Child Care for Every Family

Let's start with the basics: raising children costs money, and right now, most of that cost falls squarely on parents. Child care alone can run tens of thousands of dollars a year. The United States currently spends less than half as much of its GDP on early childhood programs as comparable wealthy nations do—a startling gap that has real consequences. One recent study put the cost of inadequate child care at $122 billion in lost earnings and productivity every year.

The proposal here is simple: fully universal, federally funded child care and early education services for all children from birth through school age. Not a voucher program. Not a means-tested subsidy that phases out just when families need it most. A real public system, the way we have public schools—because, as the proposal puts it, parents are "raising the next generation of workers and taxpayers," and society has a stake in that.

This isn't a fantasy. New Mexico launched free universal child care in 2025. The program, which evolved from an earlier expansion of child-care assistance begun in 2022, is funded largely through revenues connected to the state’s oil and gas wealth and the Early Childhood Education and Care Fund. Parents and teachers joined forces to make it happen.  

The U.S. military has run a high-quality subsidized child care system for decades. France, Denmark, Sweden—country after country has also made this work. Several American cities, including New York City, Boston, Seattle, San Antonio, and Washington, D.C., are already investing in public child care on their own.

What would a federal program like this cost? Based on earlier estimates, somewhere in the range of $150–$200 billion annually. That sounds like a lot until you compare it to the proposed $1.5 trillion “defense” budget for next fiscal year. 

Time to Care—Without Losing Your Job or Going Broke

Free child care services alone aren’t enough, because not all care can—or should—be outsourced.

We all need time to care for newborns, recover from illness, or support aging parents. Yet the United States remains a global outlier in failing to provide paid family and medical leave. The result is a quiet crisis: people skipping needed care, leaving jobs, or absorbing significant financial hardship.

State-level programs show a better path. A growing number of states now offer paid leave funded through social insurance—essentially pooling risk so that individuals aren’t left to fend for themselves. These programs improve health, strengthen employment continuity, and even reduce reliance on more expensive forms of care like nursing homes.

The Family and Medical Leave Act of 1993 guaranteed unpaid leave for workers at larger employers. But for many families, unpaid leave is no leave at all because they cannot afford to forgo wages. Among the lowest-wage workers, only 6% have access to paid family leave through their employers.

Thirteen states and the District of Columbia have already fixed this on their own, establishing paid family and medical leave programs financed through small payroll contributions—essentially a form of social insurance, like unemployment. The evidence from these states is clear: paid leave improves infant health, boosts maternal well-being, increases fathers' involvement in child care, and even reduces nursing home admissions. It works.

We should bring this policy to the national level, building on the best state models and adding something most state programs lack: a "use it or lose it" period reserved specifically for fathers. Research shows this is the single most effective way to increase paternal caregiving—which, in turn, improves outcomes for children, mothers, and families as a whole. Nordic countries have been doing this for decades with considerable success. 

The same logic extends to long-term care. More than 70% of Americans who reach the age of 65 will eventually need sustained assistance—help with bathing, eating, or getting around. Right now, the primary system for supporting this is Medicaid, available only after you've spent down nearly all your assets. Washington State has pioneered a different approach: a small mandatory payroll tax that builds a universal long-term care insurance benefit, available to the whole middle class, not just the poor. Starting in 2026, eligible workers—including family members—can access up to $36,500 in lifetime benefits for in-home care, equipment, and support. Other states are watching closely.

A federal mandate to bring both paid leave and long-term care insurance to all states would mean that no American family faces bankruptcy—or forces a loved one into a nursing home—simply because of a caregiving crisis.

A Monthly Check for Every Child

We also need a universal basic income for children, which could take the form of a monthly family allowance. A monthly cash payment—around $426 per child in today's dollars—could be delivered by the Social Security Administration to every family with a child under 18, regardless of income or employment status. The End Child Poverty Act provides the basis for our recommendations here, with extensive background provided by the People’s Policy Project.

We already know this approach works. In 2021, the expanded Child Tax Credit temporarily made the U.S. child benefit nearly universal and raised payments to $3,000–$3,600 per child per year, delivered monthly. The result? Child poverty fell to 5.2%—the lowest rate ever recorded. Three to four million children were lifted out of poverty every single month the program ran. Black child poverty dropped by over 40%. Hispanic child poverty plummeted from 30% to 8% over a decade, with much of that drop driven by the 2021 expansion.

Then Congress let the expansion expire at the end of 2021, and child poverty shot back up. It was a policy choice—not an inevitability.

Germany pays a flat monthly child benefit of about $295 per child, no strings attached. Canada's federal benefit runs nearly $500 per month for lower-income families. Most of the world's wealthy democracies have concluded that raising children is a social good, that all children deserve a basic floor of material security, and that monthly cash payments are one of the most effective ways to deliver it. The United States remains a glaring outlier.

A universal child allowance isn't charity—it's an acknowledgment that parenting is productive work, that children are society's future, and that the costs of raising them shouldn't fall entirely on those who directly care for them. 

The Case for the Whole Package

Together these policy proposals address a fundamental design flaw in the American system: we've built an economy that depends on unpaid and underpaid care and then penalizes the people who provide it. The hidden costs show up everywhere—in women's lower lifetime earnings, in stressed families, in high rates of child poverty, and in elderly people who are isolated and without help.

The critics will say we can't afford it. But we're already paying—in lost productivity, in worse health outcomes, in the sheer human cost of a system that leaves people to fend for themselves. We can't afford to keep pretending that the status quo works.

America needs this care package. Let's deliver it. 

 Nancy Folbre is a professor emerita of economics at the University of Massachusetts Amherst. Her research explores the interface between political economy and feminist theory.