This morning I read in my daily German “Bundschau” summary that people should not only take care of their kids but also of their (old) parents. If we think of “people” as a middle generation, we can translate this into: people have to pay for child care (as is the case today) but also for grandparent care, in the near future. In other words, people should take care of their infants and of their genitors.
The statement from the “Family Minister” of the German Federal Republic confirms that a “care” problem with regards to senior citizens has arisen, and she suggests that the country should start to come up with answers so that suitable solutions can be implemented that do not add more deficits to the already ballooning health care financials.
What is being sought is, essentially, to provide a legal framework guaranteeing the following: during the first 25 years of your lifetime your parents take care of you, then you have 25 years where you take of yourself and, eventually, of your kids, and during the next 20 years, a number that is getting bigger as we speak, you should take care of your parents. (And if your family has excellent longevity genes, one assumes that your kids will take care of you, and perhaps of your parents, as well.)
Let us make no mistake: that is exactly how lives were lived until, depending on country and region, one or two generations ago. Although, not quite, when you delve into the detail! Two generations ago people did not “take care of” but they “cared for”. The difference is not a semantic one; the difference is substantial and intrinsic. To “take care of” means “to make sure that something gets cared for, or resolved - one way or another”. To “care for” on the other hand implies a personal investment and commitment in doing the “caring”. We will deal in this exposé primarily with “to take care of”, leaving a part of the quality dimension untouched.
It strikes me that this last proposal to ostensibly improve care for senior citizens, is, in essence, a band-aid measure to stop the uncontrollable spiraling of health costs. Keeping elderly alive for ever longer, no matter how incapacitated they are, adds a big heap of money to the ever growing mountain, which is being being fed by more and more sophisticated treatments for the younger generations. Anyhow, on the face of it, by positing her concerns and her solutions, the honorable lady touched upon a number of important issues. I have listed five and will discuss them hereunder.
Issue #1: A problem that is purely financial
If “gerontocare” would be inexpensive, it is plausible to assume that no politician in his right mind would come up with a new “tax” of sorts, thus further straining voters’ budgets that are, today, already out of balance. But it is true, this type of care is indeed expensive. It is expensive because it is intensive and attracts supplementary medical care. Moreover there is a dearth of skilled personnel, creating a lot of frustration and emotional strain. With longevity on the increase and expectations about service and well being in lock step, the monetary costs are skyrocketing, while customer and provider happiness are not increasing. The easy solution for sequential thinkers – and all politicians belong to that class, at best – is to find a solution to stop the budgetary derailment. The answer is as simple as it is straightforward: the user pays, and if he cannot, the burden falls to the next in line, parent or child. The next step is marketing it.
Issue #2: The unbearable burden for the young adult
To start a family at twenty-five, or at any time really, is a momentous decision in one’s life (presumably two lives). It is an emotional step in the first place of course – also with the newborns in mind, but let us concentrate here on the financial implications for a modern family. Having children means after all that one trades financial riches for other than financial returns.
Today many young families experience, more than in the past, a substantial financial strain paying for raising children, be that related to infant care, education or, later on, lifestyle and entertainment. It might well be that, for multi-child families, it would be cheaper that one parent (or one full time equivalent parent) stays home to “care for” the children, than he/she goes off to a different work environment. As a matter of fact, without government subsidies, this situation would be the norm: paying for some else to take of the kids is not cheap.
We could start arguing about the values and consequences of egotistical and hedonistic (postmodern) lifestyles, but this is not the place for that discussion. The fact remains though that, once adults have reached the age of 45 or 50 - in this day and age they are often still raising under-age children, they will not be able to pay for the care of their parents, nor will they have the means (dexterity and experience, as well as motivation or priority). Neither will the large majority have any inclination to just “care for” - instead of (having someone) “take care of” – their genitors. How such a scenario will play out for the next and the next generation, under current lifestyle assumptions and complicated family structures, is an even bigger mys(t)ery. That is food for sequential thought for the next minister.
Issue #3: Shortage of “Care Professionals”
Assume for an instance that the government in general, and a well-meaning, emphatic Family Minister in particular, can push these kinds of care obligations through parliament. And suppose that more financial means thus become available. Who is going to provide the services? In most European countries the supply of professionals is insufficient to satisfy demand at this very moment. For the same compensation there will be no extra hands and heads … As a matter of fact, and because the nursing market is a monopsony (the large majority of services is, in the end, paid for by government subsidies and via government brokered salary levels), the first priority of this “business” – better compensation for nursing and care professionals – will not go away.
OK, now what? We import care personnel from other countries. Perhaps, if we get that idea past all the unions. Suppose we can, as is happening today in many countries. In Brussels, for instance, Romanian nurses are working in local hospitals and care centers. Unfortunately there language skills are insufficient, not to mention their lack of local cultural “baggage”. Can we imagine that our senior citizens will be looked after by professionals that have no “rapport whatsoever” with their patients? Can we imagine that children will have to pay for such a service being rendered to their genitors?
The first problem in the health care of European welfare states is not financing for senior citizen care. The very first problem is that there a lack of compassionate, altruistic citizens that are prepared, and happy, to take care of family, neighbors or strangers that are suffering and need to be looked after. Part of the reason is financial, and allowing salaries of nursing professionals to be determined, at least to some extent, in a more open market, will alleviate the shortage. The other part is emotional and more money is no solution, neither will foreign imports be.
Issue #4: The value of a care versus business career
Admitting that the nursing and caring professionals (including teachers) are, as it is, already underpaid due to this government-crippled labor market, adds an extra dimension to the propositions made under #2. Indeed, if a substantial minority of people today already might spend more than the salary of one parent on overall child care, education etcetera, what then is the true freer market cost of such services?
In particular it implies that a career in caring for his or her next of kin is valued higher than pursuing the average business career. Why then would parents elect to go off to another job than to, jointly or in mutual agreement, rather than raising their children or making the autumn of their parents’ lives more fun to live? For so long we have been bombarded by the demeaning nature of the housewife profession – the feminist movement has dominated this debate – but it turns out that this profession, even in purely monetary terms, is worth more than a plurality of other jobs. And, by the way, a mother or father, for that matter, with a university degree is not a disadvantage for the children that are being raised.
Issue #5: The emotional deficit
It is becoming very obvious that paying for the care of those people near to us, if only because we have wanted and created them, or they have wanted and created us, is economically not feasible, lest we are prepared to change our priorities, which would be self contradictory. Don’t we want those extra and nicer cars, those overseas vacations, the starred restaurants, etcetera? Is that not a large part of the reason why we want to make as much money as possible, including of course the emotional benefits related to showing off that we can afford it all?
Not only is the current situation regarding child and senior citizen care financial nonsense - for individuals, community and government alike, it is also ethical nonsense. The person that invented “quality time” should be treated in kind, a few spoonfuls whenever their friends have some time available. And the more friends they have, the longer the time between the shrinking spoons. There is no limit to the quality of time: kids as well as grandparents (or genitors) need and appreciate lots of time – be that presence, real availability, access, and other modes - from their immediate family.
What the minister does not perceive is that by expanding the system of paying for third party caretaking of children and genitors, the link between the kin gets weaker, because the personal involvement runs, in the end, only via banknotes. It is unlikely that the toddlers of today will be keen to share their hard-won little fortunes with their own offspring and, on top of that, pay for parents that meanwhile might be three times divorced, remarried and, in the process, creators of a cast of half-siblings.
Drawing grand conclusions on the basis of a narrow ministerial initiative is not appropriate. However, it is obvious that health care in general and seniors care in particular is an enormous challenge in the current western societies. That challenge has many dimensions of which the financial one, although in the spotlights, is not the most significant.
Rather than sequential thinking, society needs to put this issue in a broader context. In that context one has to deal with a number of basic questions of human life.
How do we want offspring to be raised or managed? There are others forms outside of “family”. How do we want life to be stretched, irrespective of its quality? Continuous resuscitation need not be the rule! What is society’s responsibility in the care for young and elder members? How much freedom and how much solidarity do we want? What is the emotional and/or financial responsibility of individuals regarding offspring and progeny?
Obviously, Western Democracy as we currently know it, will have a hard time finding answers. Indeed, as long as democratically elected leaders implement what their voters want to have, there is no innovation. Voters these days, as in most days past, never really want to give or contribute of their own volition). Meanwhile rapidly depleting state coffers will force society to stop and think again. Some countries in Europe are already in that dire predicament, with no serious solution in sight because its leaders are not brave enough (at least that!) to imagine a sustainable future framework for the much-celebrated but meanwhile suffocated welfare society.
Ushuaia, Argentina, on Tuesday, Feb 15th 2011