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America Runs on Care Work, and I’m Tired of Pretending Otherwise
The labor that sustains human life gets pushed to the margins, while the labor that scales software gets paraded on magazine covers.
Mar 08, 2026
A few days ago, I stared at a federal bar chart on my laptop and felt my stomach drop. I started asking people a party-trick question: What’s the biggest occupation in America? Almost everyone guessed something visible: teachers, retail, fast food, office work. That’s what our culture trains us to notice.
Then I pulled up the Bureau of Labor Statistics’ (BLS) “largest occupations” data, and the answer was sitting there in plain English: Home Health and Personal Care Aides, 3,988,140 people.
I’m not reading that as an abstract statistic but something I see daily through my work in running CareYaya, a social enterprise that helps families find affordable in-home care support. I hear the voices behind those numbers every day: the exhausted daughter trying to keep her job, the older man determined to stay in his own house, the care aide who shows up anyway even when her own life is fraying.
What hit me wasn’t just the size of the workforce, but the silence with which society treats caregivers.
Care work sits at the intersection of everything America avoids looking at directly: aging, disability, dependence, death, and the truth that every “independent” adult is one accident, cancer, or dementia diagnosis away from needing help.
In a country that can’t stop talking about “the economy,” I rarely see the economy described the way it actually functions at street level. I see caregivers keeping older adults safe so that family members can work, so the bills get paid, so other industries keep humming. I see care work acting like the hidden scaffolding under everything else.
And, I see how quickly that scaffolding gets treated as disposable labor.
When I talk to families, they often whisper about their difficulties getting care support almost like they’re confessing a moral failure. “We’re trying,” they tell me, as if the need for help is some private weakness instead of a predictable part of aging or serious illness. When I talk to care aides, they talk about the stress from the care work. They talk about rushing between clients. They talk about loving the work and sometimes still not being able to make rent.
PHI’s snapshot of the direct care workforce puts numbers to what I keep hearing, that median annual earnings for direct care workers were just $25,015. I read that figure and think about what it really means in 2026 America: The largest job category in the nation is, effectively, a low-wage backbone.
I also think about who gets stuck holding the bag. Care work is still treated as “women’s work” in the cultural imagination, and that bias leaks into policy, pay, and prestige. I watch the same pattern repeat: The labor that sustains human life gets pushed to the margins, while the labor that scales software gets paraded on magazine covers.
What makes me angrier is that this isn’t a small sector we can ignore until later. The BLS projects 17% growth from 2024 to 2034 for home health and personal care aides, with about 765,800 openings each year on average. This is not a “future” problem but rather a present problem that is going to grow much worse, faster.
And yet I keep watching public conversations drift toward fantasy. I hear endless speculation about AI replacing workers, while the largest workforce in America can’t even get a stable ladder, a living wage, or basic respect. I hear investors pitch “aging tech” like it’s a consumer gadget category, while the core issue is whether a real human being can afford to do this work and stay in it.
I don’t think this is an accident, but rather, a choice embedded in our system.
Care work sits at the intersection of everything America avoids looking at directly: aging, disability, dependence, death, and the truth that every “independent” adult is one accident, cancer, or dementia diagnosis away from needing help. So we do what societies often do with uncomfortable truths. We outsource them, we underpay them, and we call them “personal responsibility.”
Even the funding structure says it all. Medicaid is the main payer of long-term services and supports in the US, and a recent Centers for Medicaid and Medicare Services brief says so plainly: “Medicaid is the largest payer for long-term services and supports (LTSS) in the United States.” I read that line and think about the whiplash families face when they confront a vast public health need paired with political rhetoric that treats caregivers and recipients like line items to be squeezed.
So when I’m asked what to do, I start with a moral stance and then I get practical.
I want a country that pays the people who keep elders safe, like they truly matter. I want Medicaid rates and payment models that stop forcing providers into churn, and stop forcing workers into poverty. I want training and advancement pathways for care workers, and I want the caregiving workforce to have real power: bargaining power, scheduling power, and dignity at work.
I also want us to stop acting surprised when the care workforce pipeline breaks. If the biggest job in America is care, then the “care crisis” isn’t a niche issue, but a core labor rights issue; a public investment issue; and an economic issue that’s as critical as housing, wages, and healthcare.
When I look back at that BLS bar chart, I don’t see a pop-quiz type question anymore. I see millions of workers holding up millions of families. I see the work that makes the rest of American life possible.
And I can’t unsee the insult of how little we talk about it.
If I want anything from readers, it’s this: I want you to say the name of the job out loud, and then demand that we build an economy that treats it as essential, because it is.
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I'm Boycotting Trump's State of the Union and So Should You
If he doesn’t believe he’s my president, why should I treat him as my president and watch his State of the Union?
Feb 23, 2026
I’m not going to watch the State of the Union address Tuesday night. I urge you not to, either.
I hope Nielsen (or whoever makes such estimates these days) will find that far fewer Americans watched President Donald Trump’s State of the Union than have watched any other State of the Union in recent memory. It will drive Trump nuts.
There are plenty of other reasons for not watching.
First, he doesn’t deserve our attention. He’s abused and defiled the American presidency, even worse than he did in his first term.
I already know the real state of the union. It sucks.
He’s openly taken bribes. He’s blatantly usurped the powers of Congress. He has overtly used the Justice Department to punish people he considers his enemies and pardon people loyal to him. He has willfully rejected the rule of law, broken treaties, literally destroyed part of the White House, thumbed his nose at our allies (including our closest and heretofore loyal neighbors), and utterly failed his constitutional duty to take care that the laws are faithfully executed. He lies like most people breathe. He’s a fraud and a traitor.
Second, we already know what he’s going to say because he’s already stated and restated his lies every chance he gets. He says the economy is in wonderful shape, that he’s settled six wars, that he’s brought peace to the Middle East, that he’s made America safer and more secure, that the 2020 election was stolen from him, ad nauseam.
He assumes that if he repeats these lies often enough, people will believe them. Why should we give him more of an audience for his lies?
Third, he refuses to be president of the United States but only of the people who voted for him in 2024.
He talks in glowing terms about “my” people while denigrating “them”—those of us who didn’t vote for him, who still disapprove of him, or who refuse to give him whatever he wants.
He won’t even fund so-called blue states. So far this year he’s axed over $1.5 billion in blue-state grants, contrary to the wishes of Congress.
If he doesn’t believe he’s my president, why should I treat him as my president and watch his State of the Union?
Fourth and finally, I already know the real state of the union. It sucks.
The economy has been good for big business and wealthy Americans but shitty for small businesses and average working Americans.
Although Trump repeatedly promised that his tariffs would reduce US imports, shrink the trade deficit, and lead to a revival in American manufacturing, the opposite has happened. The annual trade deficit in goods last year hit a record high. And US manufacturers cut 108,000 jobs.
In the 2024 election, Trump also promised to bring down prices, but inflation is still steaming ahead. Prices grew at an annual rate of 3% in December. He’s so out of touch with what most Americans are enduring that he calls the crisis of affordability “fake news.”
He promised to control immigration, but 6 out of 10 Americans think he’s gone “too far” by sending federal agents into American cities who have caused mayhem and murder.
He promised to avoid foreign entanglements, but he abducted the president of Venezuela, killed more than 150 Venezuelans, and is now planning to attack Iran.
His menacing the Middle East has created another inflation risk: The possibility that a key oil export route will be disrupted has caused the price of Brent crude to soar.
For all these reasons, I’m not going to watch Trump’s State of the Union. I recommend that you don’t, either.
Your senators and representatives in Congress should boycott it, too. You might call their offices to suggest this. (Some Democrats are already planning to skip it, opting instead for a counter-programming event on the National Mall dubbed “The People’s State of the Union.” Good!)
And why the hell should justices of the Supreme Court show up, especially after he says he’s “ashamed” of the six who decided his tariffs exceeded his authority—calling the three Democratic appointees a “disgrace to our nation” and the three conservatives who voted against him “fools and lapdogs for the RINOs and the radical left Democrats,” “very unpatriotic and disloyal to our Constitution,” “swayed by foreign interests,” and “an embarrassment to their families”?
Boycott the State of the Union. It’s the least we can do.
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Watchdog Says the Fed, Not Inflation, Is Now the 'Biggest Threat' to the US Economy
"The Fed's continued high interest rates saddle people with debt, lock them out of the housing market, and threaten their jobs," said Rakeen Mabud of the Groundwork Collaborative.
Aug 14, 2024
The top economist at a progressive watchdog organization said Wednesday that the Federal Reserve has supplanted inflation as the greatest danger to the U.S. economy after new data from the Bureau of Labor Statistics showed that the Consumer Price Index fell below 3% last month—the first time it has done so since 2021.
"Inflation is no longer the biggest threat to the economy, the Fed is," said Groundwork Collaborative chief economist Rakeen Mabud, citing the central bank's persistent refusal to cut interest rates in the face of glaring warning signs throughout the U.S. economy, from the worsening housing crisis to slowing job growth. Housing costs accounted for "nearly 90% of the monthly increase" in consumer prices, according to the Bureau of Labor Statistics.
"The Fed's continued high interest rates saddle people with debt, lock them out of the housing market, and threaten their jobs," Mabud said Wednesday. "The Federal Reserve should hold an emergency meeting and cut rates immediately."
The Fed's current target interest rate range is at a 23-year high of 5.25% to 5.5%, where it has been kept for the past 12 months despite mounting calls for rate cuts from progressive lawmakers and economists as inflation continues to decline from its peak of 9.1% in June 2022.
"The Federal Reserve made a massive mistake in not cutting rates in July."
Rep. Brendan Boyle (D-Pa.), the ranking member of the House Budget Committee, said in a statement Wednesday that "the evidence is clear: Inflation is falling and wages are rising."
"It's past time for the Fed to secure this progress and begin lowering interest rates," Boyle added.
The next official two-day meeting of the Fed's policy-setting panel, the Federal Open Market Committee (FOMC), is scheduled for September 17-18. After Wednesday's inflation reading, the central bank is widely expected to enact a small rate cut at its September meeting, which will be held less than two months before the presidential election.
Donald Trump, the Republican nominee, has openly warned Powell against cutting rates prior to the election, apparently fearing the move would help Democrats.
Democratic lawmakers, for their part, have argued that a failure to cut rates "would indicate that the Fed is giving in to bullying" and "succumbing to political threats," as Sens. Elizabeth Warren (D-Mass.), John Hickenlooper (D-Colo.), and Sheldon Whitehouse (D-R.I.) put it in a
letter to Powell last month.
In an op-ed for Common Dreams last week, Mabud of the Groundwork Collaborative wrote that "the Federal Reserve made a massive mistake in not cutting rates in July."
"Powell himself has admitted that interest rate hikes can't tackle the supply-side issues at the root of today's inflation," Mabud wrote. "And now the data are clear that he is taking the economy to the brink, despite low inflation and rising unemployment."
"Making people walk an economic tightrope is not the path forward to a healthy economy," she added. "The Fed has a dual mandate to maintain stable prices and full employment. It's time for the Fed to take that mandate seriously and make a large and immediate emergency rate cut."
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