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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning, everyone. For the first segment of our show today, we will re-air an excerpt from the national call-in election special that I co hosted last night in partnership with Marketplace. In our series, America, Are We Ready? It was America are we ready to make family care more affordable, childcare and elder care? Also, the cost of care for any family member with a serious disability. This is such a central cost of living issue for so many Americans, I don't have to tell you. It's more on the political radar than in any other presidential election, one of our guests told us.

The background fact is that Democrats, including the Biden-Harris administration, have tried repeatedly to get childcare and elder care health through Congress, but it's always blocked by Republicans and recently, by Republicans plus Democrat, Joe Manchin. Remember that? Here's the central portion of last night's episode in which we directly compare the Trump and Harris campaigns on this issue. Then we'll do the rest of the show live.

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Kimberly Adams: It's America, Are We Ready to Control Family Care Costs? The last of three Wednesday night election specials on the impact of this election on the economy. I'm Kimberly Adams, senior Washington correspondent for the public radio program, Marketplace.

Brian Lehrer: I'm Brian Lehrer from WNYC. Our guest this hour is Heather Long, Washington Post economic columnist with a specialty in the US economy. We're inviting your personal stories about how your child or elder or disability care costs have gone up and what you think government should do about it.

Kimberly Adams: We're comparing Donald Trump and Kamala Harris and their parties on this issue. Let's hear a very concrete proposal from Kamala Harris earlier this month, appearing on The View on ABC, proposing something that elder care and disability care advocates have wanted for a very long time.

Kamala Harris: For the family to send them to a residential care facility to hire somebody is so expensive. To your point about being in the sandwich generation, there are so many people in our country who are right in the middle. They're taking care of their kids and they're taking care of their aging parents, and it's just almost impossible to do it all. What I am proposing is that, basically, what we will do is allow Medicare to cover in home health care.

People say, "Well, how are you going to pay for it?" Here's the thing. Here's how we pay for it. Part of what I also intend to do is allow Medicare to continue to negotiate drug prices against these big pharmaceutical companies, which means we are going to save Medicare the money because we're not going to be paying these high prices. Those resources are best then put in a way that helps a family like the one you are describing.

Brian Lehrer: Harris on the view. Heather, why doesn't Medicare already include in home care for seniors who can't do for themselves anymore? It seems like one of the biggest expenses many seniors eventually have. It seems like it would be so core to the Medicare program if it was being designed today.

Heather Long: Yes, it's a really good point, Brian. What you have at the moment is Medicare will cover basically short term help. Let's say a lot of seniors have knee replacement or a hip replacement. If you need help for a little while, they will pay for that home health aide to come or if you are homebound, so you truly have had so many mobility issues that you really cannot leave your house at all, then Medicare is usually able to step in. These are very tight rules, like you're saying, and they don't really match the needs of today, which is why Harris is proposing this really dramatic change.

Kimberly Adams: Let's go to another caller. Let's hear from Margaret in Sarasota, Florida. Hi, Margaret?

Margaret: Hi. I'm calling because I was a caregiver for four people in my family, elders. During the time that I was taking care of all of their needs-- so two of them, my dad and my husband, both were in wheelchairs. I had to help them with meal preparation, bathing, all of the errands, all of the doctor appointments, medication management, and just every-- it was like living for three people at a time.

Then my stepmother, she was a little bit in better shape, but she needed a lot of help with a lot of things, and my aunt also. As a result of being consumed by other people's needs, I wasn't able to have a full-time job and make a decent income. Then when my husband ended up dying, his income stopped, and I had only been making a tiny little income for those last few years because I could only work part time. Now, I'm completely financially strapped.

I heard what the other people have been saying, but it's true that you can get a little bit of home health care if you get out of a rehab facility following surgery or something like that. If you're completely disabled and dependent on somebody, an hour or two twice a week is not enough.

Brian Lehrer: Yes, that's not going to do it.

Margaret: These people need to get dressed in the morning. They need to eat, they need everything. They need their appointments and so on. I really think, in my opinion, that it would make life so much easier for so many people, and it would probably be better for the economy if people could work full time and have somebody else do the caregiving and then keep their family members at home still, but maybe go to daycare or something like that. Medicare and Medicaid--

Brian Lehrer: With all of this that you're laying out, Margaret, your experience, I think it's so instructive for so many people around the country who haven't had to deal with this yet. Would you like to see a universal-- probably through Medicare, program for at-home care for disabled or very elderly seniors?

Margaret: Yes. Right. Either have somebody come in and then the family member can go to work or pay the family member for the work that they're doing, because if this person goes to a facility, first of all, nobody wants that. Nobody wants to live in a place like that. It also costs Medicare or Medicaid $7,000 or $8,000 a month, whereas if they paid a family member to do the caregiving, they could probably pay them $2,000 or $3,000 a month. Bottom line, they would save a bunch of money.

Kimberly Adams: Thank you for that, Margaret.

Brian Lehrer: Margaret, thank you so much. As somebody in the middle of it, as much up to your neck in it with four people you were caring for as you were, your experience is so important to hear.

Kimberly Adams: Heather, Margaret raises a really interesting point about the cost that Medicare and Medicaid are paying for all these things. I mean, what have you seen in terms of Harris's answer to this about paying for adding home health aides to Medicare by negotiating drug prices and some of these other solutions? Is that going to be enough for the scale of what we actually need in terms of the care needs for our aging population?

Heather Long: It's a great question, Kimberly. There's a lot of debate about this. The Harris campaign and others often cite a Brookings Institution study that claims a plan like what she's outlined could cost 40 billion a year, but a lot of people then immediately say that's a really low estimate. It really depends-- just like you're saying in that prior caller, Margaret was making the point that it depends how many hours a day of care. Is this somebody who's going to come for three or four hours a day or is this someone who's going to be there all day long? The costs do go up quite exponentially from there.

I think you're right. A lot of that's still under debate. I do think Margaret also made a good point. She said if she had to be the one to continue to stay home to do that care the Trump plan answer to this would be to give some sort of tax credit to try to offset that income loss that also probably wouldn't fully compensate her. Either way, it's going to cost way more than both these candidates are talking about.

Brian Lehrer: We've been talking about Harris here. Elder care or caring for people with disabilities as an issue does not appear on the Trump and Vance campaign website at all. It does appear on the Republican National Committee's website, which puts it mostly in very general terms. "Republicans," it says, "will shift resources back to at-home senior care." Back from what? I'm not sure. "Overturn disincentives that lead to care worker shortages and support unpaid family caregivers through tax credits and reduced red tape." Do you know what shift resources back to at-home senior care means? Did it used to be there and somebody shifted it out? I thought we just established that Medicare never covered at-home care.

Heather Long: Yes. I tried to touch on this earlier, but I'll say it again. First of all, that line that you just read actually is on the donaldjtrump.com website.

Brian Lehrer: I stand corrected?

Heather Long: Second of all, yes, shift resources is a big question mark. There are no details on the website or on the plan you were just reading from. Typically, as I called around today, to people who've worked in this industry a long time, they said, look, when they read that line, their immediate thought was the traditional Republican line is to take money and reduce Medicaid. To take money out of Medicaid and perhaps shift it to some sort of at-home care expansion. It's unclear whether that at-home care expansion would be part of Medicare or Medicaid or part of something new, but that's the guess.

The argument there would be similar to what some of the callers have already said. Okay, Medicaid's paying all this money for these nursing home facilities. Our goal is really to have fewer people in nursing homes, so why don't we shift those resources?

Brian Lehrer: Let's take a childcare call now. Here's Dan in St. Louis. Dan, you're on America, Are we ready? Hi there?

Dan: Hey. Yes, I'm calling about childcare costs. I have three children and two of them went to St. Louis public school, the early childhood education, the cost was free. I'm not sure if they have slots for everyone, but I think everyone who applies gets in usually. My youngest doesn't go there and you pay out of pocket for that. Early childhood education in St. Louis can cost you anywhere from $900 a month to $1,300 a month. That costs quite a bit of money for middle-class and lower-income folks. My policy suggestion would be to have universal, free early childhood education.

Brian Lehrer: Thank you, Dan. Thank you very much. Let's play a clip of Kamala Harris just recently speaking about this in Pennsylvania. She proposed maybe not a universal childcare program per se, but a limit of the percentage of people's incomes that any family would have to pay for it.

Kamala Harris: Listen, they can't afford childcare and actually do the work that they want to do because it's too expensive and it doesn't actually level out in terms of the expense versus the income. My plan is that no family, no working family should pay more than 7% of their income in childcare.

Brian Lehrer: There's Harris, no more than 7% of your income in childcare. She'll have to figure out how to implement that. Here's a Trump clip from last month by comparison. This is at the Economic Club of New York. Asked how he would help families with the cost of childcare, he had no plan, but said his tariffs on imports would more than pay for it. Listen.

Donald Trump: Listen, I think when you talk about the kind of numbers that I'm talking about, that-- because childcare is childcare, it is something, you have to have it in this country. You have to have it. When you talk about those numbers compared to the kind of numbers that I'm talking about, by taxing foreign nations at levels that they're not used to, but they'll get used to it very quickly, and it's not going to stop them from doing business with us, but they'll have a very substantial tax when they send product into our country. Those numbers are so much bigger than any numbers that we're talking about, including childcare, that it's going to take care.

Kimberly Adams: Heather, how are these messages from the two candidates actually landing with the people really experiencing this? Because we've heard these stories about just how hard it is, how expensive it is, how much of people's incomes it's eating up. Is it resonating what people are hearing from the candidates on the campaign trail on this?

Heather Long: Yes, certainly some of my Washington Post colleagues have done some reporting on the ground across the country. Just like we've been hearing from callers this hour, it's definitely top of mind for certainly parents of kids under six who aren't yet in elementary school for the childcare issues. I think people have been really taken aback. Honestly, I watched the Trump town hall. I went on Fox News last week, and I thought childcare was by far one of Trump's worst answers. He didn't have a good response to that woman who was, as Brian pointed out, was practically ready to cry from her situation and the onerous costs.

He kept saying, "Oh, my daughter, Ivanka, is really into this issue, but he never actually offered a solution." There's some skepticism again. Can Vice President Harris's plan really work? How are you going to calculate 7% of income? The bottom line is the basic difference is, A, she has a plan, and B, she's talking about doing what pretty much every other advanced nation, Japan, Canada, most of Europe is doing, which is basically having the federal government subsidize childcare. That wasn't going to go as far as Dan or just prior caller who would like to see almost zero costs, but it sure would be a lot less than what people are paying right now.

Kimberly Adams: Let's hear now from Noreen in Tampa, Florida, who is facing retirement and actually has two children she's caring for with disabilities. Go ahead, Noreen.

Noreen: Thank you so much. Yes. Our family represents a few different society trends. We are parents who had kids later in life, so we're older parents who should be looking forward to retirement. We also happen to have two teenagers with disabilities. An important piece of that puzzle is that about one in 38 kids right now is identified as having autism. That prevalence has increased dramatically in the last 10-20 years. On top of that, we have a third societal trend where public school is less and less able to meet the needs of our kids with disabilities.

What I would like to see the candidates address is families like ours who are really not unusual. We are older parents raising kids with disabilities who have had a lot of extra costs because of those disabilities and because of the shortcomings of public school. I'd like to hear what have the candidates proposed for families like ours who have not been able to adequately save for retirement because of the costs of raising kids with disabilities.

Brian Lehrer: Heather, can you answer her question?

Heather Long: It's a powerful question. I think the best answer that I have is both campaigns are talking about increasing the child tax credits. The Trump and Vance campaign talks about raising it to $5,000. Vice President Harris talks about $6,000 for the first year of a child's life and then increasing back to 3,000 to 3,600. That's not going to go very far, but it certainly would be a lot more than what we have currently with the $2,000 child tax credit.

If you had both candidates on the phone right now that Vice President Harris would talk about her strong support for public schools, for fully funding public schools, for fully funding more help and resources to address students with additional needs. I think that would be a big part of it. Both candidates are obviously saying that they won't touch Social Security. However, Trump's plan not to tax Social Security benefits would unfortunately bring the insolvency date a lot closer, which would make me worried if I were in this caller's position of being worried about having enough for retirement.

Kimberly Adams: I do just want to quickly point out, Noreen was talking about her children with disabilities. We haven't heard much from the candidates on the campaign trail about what they would do for the disabled community and for caregivers of disabled young people or older people, and I think that's worth pointing out.

Brian Lehrer: Now, a Trump campaign press spokesperson, Karoline Leavitt, indicated that Trump would, "Continue to support expansions for family leave." Heather, where does that fall on either side of the partisan divide here? Does Trump support a federal paid family leave guarantee? Because I think the history here is that Democrats have proposed that for a long time and Republicans have already have always blocked that, not wanting to burden employers with government rules.

Heather Long: It's a great point. A lot has been made about the Trump administration expanding it to federal workers, some sort of paid leave, and a lot of credit has been given to Ivanka Trump for that. You're right, there was an opportunity there to strike a compromise with Democrats to not just do it for federal workers, but to do it for all workers across the country, and that didn't happen during the Trump administration. It's interesting to hear that spokesperson quote, because you sure don't hear any talk from President Trump when he's out on the campaign trail about wanting to extend paid family leave to all workers. You're right, that's another key difference between the candidates.

Brian Lehrer: Is Harris proposing a concrete family leave plan right now?

Heather Long: Yes, she is. And I think it's important to point out she's been a champion of that in her time in the Senate as well. It's not like this is a new issue for her.

Brian Lehrer: Washington Post economics columnist Heather Long. You've been listening to a re-broadcast of the national call-in election special, an excerpt from it that we did last night in partnership with Marketplace in our series, America, Are We Ready? Brian Lehrer on WNYC, the rest of the show live.

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