On November 19, the House of Representatives passed the $2.2 trillion budget reconciliation bill, which includes a broad package of social spending consisting of universal preschool, expanded Medicare and Medicaid, paid family leave, and more. The bill now moves to the Senate, where it requires support from all fifty Democrats.
The current bill is much smaller than President Joe Biden’s original $3.5 trillion plan, owing largely to the recalcitrance of conservative Democrats who professed concern about the bill’s price tag. Explaining his opposition to the original plan, West Virginia senator Joe Manchin argued that “the amount we spend now must be balanced with what we need and can afford.”
It’s a line often repeated whenever new government social programs are under consideration: it might be a nice idea, but we as a country just can’t afford it.
But this logic is flawed, as it fails to account for an important detail: when it comes to social spending, Americans are already paying the bills. Regardless of what legislation Congress does or does not pass, Americans will continue to get sick, parents will need to figure out how to look after and educate their young children, adult children will scramble to secure care for their aging parents, climate change will continue to ravage communities, and so on.
So the question before us is not whether we can afford to pay for new social programs and benefits. It’s how to best cover social expenses that Americans are already paying for.
There are three possible answers to the question of who pays for social expenses. First, governments can pay by taxing their citizens to fund social programs. Second, employers can pay by using corporate revenues to provide employment-related benefits. Third, individuals and families can pay out of pocket, rely on unpaid labor from friends and relatives, or make do without.
For much of the twentieth century, the United States had a workable answer to the “Who pays?” question that drew on a mix of all three sources. Government provided certain social benefits like Social Security, Medicare, and public education. Aided by government tax incentives, many employers offered a wide range of benefits like health insurance and pensions, creating what political scientist Jacob Hacker refers to as a “public-private welfare regime.” And with one-third of the labor force unionized, and even nonunion employers pressured to match union-scale wages and benefits, many workers earned enough to support their families and handle the social expenses not covered by government- and employer-based programs.
This distinctively American answer to the “Who pays?” question had serious flaws. It underserved or left out large swaths of the population, particularly people of color. It was also based on the male breadwinner model, which assumed that male wage earners could rely on the unpaid (and undervalued) labor of women in the home to take care of workers and their families. Despite these limitations, it contributed to a dramatic reduction in income inequality and created more secure living conditions for millions of Americans.
But instead of fixing the flaws in the postwar system, employers and governments abandoned it starting in the 1970s. Attacking the unions that had fought for and won many of the benefits that characterized the postwar model, employers slashed jobs, froze pay, and cut or outright eliminated health insurance, pensions, and other fringe benefits. For them, the answer to “Who pays?” was now “Not us.”
For its part, government social spending has been uneven. Large universal programs like Medicare and Social Security have proven resistant to most retrenchment efforts, and Obamacare included a major expansion of Medicaid — though this was blocked in some Republican-dominated states. Meanwhile, more means-tested programs targeting low-income Americans have proven more vulnerable. In a context where employers have sharply cut back their commitment to providing social benefits, and individuals and their families are faced with stagnating wages, government’s response has proven inadequate.
The result is that the answer to the “Who pays?” question has increasingly become “Individuals and their families.” For those who can afford skyrocketing private health insurance premiums and co-pays, rising prescription drug costs, escalating childcare and eldercare costs, and the annual maximum contributions to their 401(k)s, this might be a minor annoyance. But with average wages far too low and income inequality at levels not seen since the 1920s, these added expenses have left most individuals and families strained, stressed, and scrambling to make ends meet.
Provisions in the Build Back Better Act would reduce the strain on individuals and families by covering more of the costs associated with taking care of each other. But these would not be new costs. They would be costs individuals and families are already incurring. The difference would be who pays: instead of being concentrated among those directly affected, government programs would spread those already existing costs over the broader population of taxpayers.
This is not a new concept. Everyone pays taxes to fund K–12 education, including people without school-age children and parents who send their children to private school. People currently working pay payroll taxes to fund the Social Security benefits of those who are no longer working. The reconciliation bill would simply apply this idea to a wider set of caring costs.
Making benefits free at the point of service may lead individuals and families to use more of them. But social expenses have long-term benefits. Eliminating college tuition so that more students can graduate without crushing student debt loads benefits everyone. Paying parents to stay home with their young children reduces short-term parental stress while improving child development.
We can debate which proposed new social programs would or would not be worth the investment. But an honest debate starts with recognizing that the question is not whether we can afford it. The question is who pays for it. When Joe Manchin and other deficit hawks claim that we can’t afford new social programs, what they are really saying is, “We think that individuals and families should figure out how to handle these costs on their own.”
American individuals and families have been handling these rising social costs on their own for the past four decades, and they have paid the price. It’s time to try something different.