Millions of Americans work inside our homes–as carers and cleaners–taking care of the people and places we value most. Though they do the most important work in our lives, work that we would only entrust to few others, they are some of the most marginalized workers in our economy–and the work they do continues to be undervalued and underappreciated. Abdul breaks down the consequences of that for our society. Then he speaks with Ai-Jen Poo, co-founder and Executive Director of the National Domestic Workers Alliance.

Transcript

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Dr. Abdul El-Sayed: A Trump-appointed judge struck down the CDC’s mask mandate on public transit, which the Biden administration is now appealing. The CDC launched a new public health forecasting center to get ahead of the next potential pandemic before it infects millions. And Tucker Carlson released a documentary on plummeting testosterone rates, encouraging his viewers—and I can’t make this up—to tan their testicles. Yup, I said that. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. I want you to think about the people you care about most, the people you’d give anything for: partners, and parents, close friends or children. Now, if one of them were sick or injured or was diagnosed with a life-altering, debilitating disease, what would you want for them? You’d want them to have the best round-the-clock care available. You’d want every detail thought through and managed. You’d want them to have every pain and discomfort attended to and for their dignity to be protected even as they needed support to do the most intimate things. If you could, you probably care for them yourself. It’s that important. But then caring can be a 24-hour job. And each of us has other responsibilities, other people we have to care for, work we have to get done. For millions of people, this isn’t a hypothetical dilemma. It’s their everyday life. And in America, we pretend like these needs don’t exist. Our hyper individualistic culture assumes that everyone just has to figure out how to defend for themselves, how to pick themselves up by their own bootstraps. But that system fundamentally fails to consider the fact that for millions of people, that simply isn’t possible. Humans have taken care of each other since the beginning. Collaborative communities sharing in the work of raising and caring for one another, our children, folks with disabilities, and our seniors. Today, our atomized lives mean that we can outsource all the care we can’t provide on our own. For some folks, that means bartering time with each other through carpools or favors within a network of friends to make ends meet. For others, it means forgoing work opportunities to stay home and provide care. And for those with the means, it means hiring people who can provide those services for us. But here’s the issue: What happens when the burdens of caring for the folks you love are too heavy to bear alone? What if you can’t forgo that paycheck even when your loved one can’t forgo the care, dignity and support for people who need care can’t just be a hold out for the rich. Everyone deserves it and too few get it. The burdens tend to fall hardest on low-income folks, on people of color, and on women. Not only are these communities least likely to get the care and services they need and deserve in sickness or old age, but they’re the ones who are most likely to have to sacrifice to provide it to those who do. And what about the folks who are paid to provide that care, disproportionately, women of color? Despite the incredible value they offer, they remain underpaid and shoved into the shadows of our economy, unprotected by basic worker rights laws. And all of this is about to get a whole lot worse. In 2021, America’s population grew by a measly 0.1%, the slowest rate of population growth since the nation’s founding. Projections even estimate that our population could face a contraction in the near future. It’s happening because of a declining birthrate and slowing immigration. But when young people are born and young people don’t move here, our population as a whole, it ages. And without the infrastructure in place to care for an aging population, more people are going to be forced to make difficult choices about how to care for their elders, choices that our government should be buying us out of. President Biden’s languishing Build Back Better package has called for a major expansion in home and community-based services for seniors and people with disabilities. That funding would provide high-quality, good-paying jobs to provide critical services that allow people who need them to live at home and in their own communities. But for months, Build Back Better has hit roadblock after roadblock, and we’ve been stuck with our deadly status quo. Today, I wanted to dive deep into this home care crisis and our possible ways out. Our guest today has been thinking about, advocating for, and organizing around a revolution in the way we think about domestic work in our country. Ai-Jen Poo is the Executive Director of the National Domestic Workers Alliance and Caring Across Generations. She joins me to explain the home care crises we face, the challenges to solving it, and why she’s hopeful we can win. Here’s Ai-Jen Poo:

Dr. Abdul El-Sayed: Let me know when you’re ready. And then we can, we can jump right in.

Ai-Jen Poo: All right. We’re in business.

Dr. Abdul El-Sayed: All right! Can you introduce yourself for the tape?

Ai-Jen Poo: Sure. My name is Ai-Jen Poo and I’m the director of Caring Across Generations and the National Domestic Workers Alliance.

Dr. Abdul El-Sayed: To jump in, can you tell us a little bit more about the National Domestic Workers Alliance? What is it and what was the thrust behind building it?

Ai-Jen Poo: Yes. The National Domestic Workers Alliance is a national organization of nannies, house cleaners, and home care workers, and we have a community of about 250,000 domestic workers from around the country, in all 50 states, and also a network of 70 local affiliate organizations and chapters who work in the local community with domestic workers to improve the conditions of their work, and their life, and to advocate for the kind of change that is so long overdue, that recognizes the value, the essential value of domestic work in our economy and in our society.

Dr. Abdul El-Sayed: I really appreciate that, because the implicit is that we definitely don’t value domestic work enough. And, you know, you’ve outlined a sort of class of worker, folks who work in homes. What are the unique characteristics of domestic workers, and what are the circumstances about their work that we should understand?

Ai-Jen Poo: Well, so domestic workers, the way we define domestic worker is anyone who works inside the private home context providing caregiving or cleaning services, and that can be child care, it can be elder care, it can be support for a person with a disability or who’s ill. And then it’s cleaners, house cleaners, and it’s work that is overwhelmingly done by women—92% women, majority women of color, including many immigrant women. It’s the part of the workforce that has the highest concentration of undocumented workers of any sector of our economy. And it is work that is both incredibly vital—we call it the work that makes all other work possible, because it enables all of us to do what we do in the world, knowing that some of the most precious elements of our lives are in good hands, and yet it’s some of the most undervalued, vulnerable and unprotected work. And if you think about it, there’s a whole bunch of factors why that is the case. One, the reality is, is this work is almost defined by its invisibility. You could go into any neighborhood, not know which homes are also workplaces. There’s no list, there’s no registry—all hidden behind closed doors, and you’re isolated. Oftentimes, the only people who know that you work there are you and your employer or the family that you work for. There’s also a really long history of explicit exclusion from basic rights and protections, dating all the way back to the New Deal, when Southern members of Congress, southern Dixiecrats, said, There is no way we are going to support the labor laws that you’re talking about in the New Deal if they include protections for farm workers and domestic workers, who are Black workers at the time. So that racial exclusion defined how this workforce was treated in law and policy literally for generations. So exclusion after exclusion, from minimum wage, from Social Security, from occupational safety and health protections—that’s kind of what happened over and over again for this workforce of overwhelmingly Black, brown, indigenous women of color, immigrant women, women of marginalized social status. And to this day, coming into the COVID pandemic, 82% of domestic workers didn’t have a single paid sick day.

Dr. Abdul El-Sayed: Wow.

Ai-Jen Poo: 90% of domestic workers lost all of their jobs and income overnight when the shutdown happened in COVID. And we just surveyed recently in this month—or March—and found that we’re now at about a 20% unemployment rate. So a lot of people have gone back to work, but those who are working are still underemployed, and seven in ten earn less than $15 an hour.

Dr. Abdul El-Sayed: Wow. So what you’re outlining here is almost a circumstance by which people who are multiply marginalized occupied these really critical roles in our society. And because of that, they’ve been excluded from the same kinds of worker protections that protect workers across the rest of our economy, which has created almost a subclass of work into which people who are much more typically marginalized are then selected again.

Ai-Jen Poo: That’s right.

Dr. Abdul El-Sayed: So it’s this almost vicious cycle of marginalization, you know, it’s almost like a class of marginalization into a particular area of work. I know for you, this work is personal and you have a personal story that brought you to this work. Can you tell us that story?

Ai-Jen Poo: Well, I think there’s layers of it. As you know, one piece of it is being raised by really strong immigrant women, myself, my mother, and my grandmother, and seeing how much of the work that they did that really held us all up in our family really went unnoticed, unrecognized, kind of taken for granted, particularly the caregiving work. And they were expected to do that on top of going out and working. My grandmother was a nurse, my mom became a doctor eventually. And so I think just how much of the work that women do in our lives is completely assumed and taken for granted, and yet it’s essential. So that’s one thing I noticed really early on. The second piece was because my grandparents played such a huge role in my life, and I grew up in an intergenerational household, as my grandparents aged and became more frail and needed more support, my grandfather ended up in a position where he lost all of his vision and we had a really tough time finding the right assistance for him. And he wanted more than anything to just be able to stay at home and age at home. And we had to place him in a nursing home against his wishes. And I will never, ever forget visiting him there. He shared a room with about half a dozen other people, half of whom were comatose and completely unmoving, still, and the other half were in all kinds of discomfort and pain. And my grandfather had become, in just a matter of weeks, a shell of who he was because of the fear and the dehumanization that was life in that institution. And the staff were completely overstretched, responsible for literally dozens of people who had really intense needs, and it was just an impossible and miserable situation for everyone involved. And I remember thinking, How could it be that people like my grandfather, who gave us their lives—they spent their lives raising us, expanding what was possible for us—at this time in their life when they need support in order to live well and have dignity, we can’t deliver it.

Dr. Abdul El-Sayed: Hmm. You know, a lot of people in that circumstance would have gotten extremely frustrated with the staff at the nursing home. And what strikes me is that you showed a certain level of empathy to those people and recognizing that it was not the ill will of anyone in that system per se, it was the impossibility of the system itself to actually achieve the outcomes that anybody wanted for it.

Dr. Abdul El-Sayed, narrating: We’ll be back for more with Ai-Jen Poo, after this break.

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Dr. Abdul El-Sayed, narrating: And we’re back with more of my conversation with Ai-Jen Poo.

Dr. Abdul El-Sayed: You know, in your conversations with the staff at the nursing home, what did they share with you about their experience working there and what they needed to actually be able to provide your grandfather with the dignity that he deserved?

Ai-Jen Poo: They did not have time to talk to us. They, it was literally physically impossible for them to spend the time that they needed to spend with us and make the rounds to make sure that there was like a basic level of safety for the patients in their care. And what’s been created is essentially a set of impossible choices for these workers, direct care workers, who are also, by the way, working for incredibly low wages. Also, by the way, overwhelmingly women and women of color, oftentimes without their own job security, health care, paid time off, poverty wages—and they’re responsible for dozens of people on an entire floor and they have to make the rounds, and basic things like food, bathing are a real struggle for them to achieve, and so, and just the medication to keep track of, and all of the families—I mean, we were just one of six families in one room.

Dr. Abdul El-Sayed: Hmm.

Ai-Jen Poo: So I just think and I remember watching and thinking how impossible a scenario that would be and also seeing in those women my mom and my grandmother, and knowing that those women also have families. That’s the thing.

Dr. Abdul El-Sayed: I’m really sorry to hear about that experience, obviously, for your grandfather and for your family, and, you know, for so many people involved in the system that, you know, takes profits out, it literally harvests our seniors for profit. And these workers are people who are working in a nursing home, in an outside facility. And you talked about the, your grandfather’s wishes to have been able to age in place. How do we move from a externally-based system of care for people who are either disabled or elderly, into a system where people can actually move in place, and what is the role that domestic workers are going to have to play in that?

Ai-Jen Poo: I really believe that there’s no way that we can care for a growing, aging population in this country without really investing in this workforce and making sure that these jobs become good jobs that you can take pride in and support your family on, and literally, one generation can do better than the next, the way that we did for manufacturing jobs in the twenties and thirties—which, by the way, used to be poverty wage, dangerous jobs that lots of immigrant women did, and we made them jobs that literally created economic mobility for several generations. And we have to do that again for this workforce. And these are going to be a huge share of the jobs of the future, whether we do that or not, because of the demand. Every 8 seconds, someone turns 65 in America, and people are living longer than ever because of advances in technology and health care, so we’ve basically added an entire generation onto our life span in the United States. People are living an average of 20 years longer than they were when we first started putting our safety net into place. There is no way, even if all of us are providing unpaid care for our family members and really focused on it, there’s no way we’re going to meet the need for care without a really strong, stable workforce, in the millions of workers. And so we’ve got to make them good jobs so that we can sustain workers in these professions, and we’ve got to make sure that they feel recognized and supported for the essential role they’re going to play in the health and well-being of this huge population of our country. And it takes infrastructure to do that. And that’s why this whole infrastructure conversation has been fascinating to me, because, yes, we absolutely need bridges and tunnels and broadband and transportation hubs that work and that are modernized—and we also need caregiving policies, programs, and a workforce that is well-supported and modernized and updated and reflective of what 21st century American families need. And then and only then will we be ready for what is to come with this age wave that we’re experiencing.

Dr. Abdul El-Sayed: Yeah, I really appreciate that frame, because you talk about this as the human infrastructure that we fundamentally need to be able to survive and thrive in this country. And, you know, we know about building the physical infrastructure, we know about girders and steel—and what does it take to build a human infrastructure that we can rely upon, that is dignifying of both the people who serve in it and are served by it?

Ai-Jen Poo: Well, the Senate right now is discussing an aspect of this, which is investing in Medicaid, home and community-based services, which is a really important part, it’s actually the core part of our existing infrastructure, to provide this care in the home and community. This is a program that is a part of the Medicaid program that is the program through which about 70% of the home care workforce currently works, and it’s a program that over 800,000 people are on waiting lists who are eligible for this program but can’t get access to the services because there either isn’t a workforce in place or the funding isn’t there in the state. And that is why it’s so essential that the Senate is discussing a big investment in this program as a part of the budget process, the budget reconciliation legislation this year, because what that would do is essentially get people off of those waiting lists, get these essential services to people with disabilities and older people who need them so they can stay at home—people like my grandfather—so that they can stay at home. And it raises wages for home care workers, provides funding to be able, for states to be able to raise the wages so that workers can sustain doing this work and take care of themselves and their families, too. And that’s the essential piece here. Until we stabilize the workforce and make these jobs good jobs—right now, they’re poverty-wage jobs that earn on average $18,200 per year. So we are seeing huge, a huge exodus from this workforce, even for people who see this work as a calling but can’t sustain it because it’s just not enough to make ends meet. So that’s what this bill that the Senate is discussing, a huge step forward in putting the building blocks in place so that we actually have that infrastructure. But then we need to get in there with the states and advocate for programs that really work for both the consumers and the workers—establish training standards, create demonstration projects where we can get the kind of data we need to modernize these programs and meet this huge and growing demand.

Dr. Abdul El-Sayed: You know, it strikes me that the program is a Medicaid program. And, you know, if you map where Medicaid has been expanded under the Affordable Care Act and where it hasn’t, the places where it hasn’t been expanded tend to be historically part of the Confederacy, where the racism has often kept those states from expanding with the idea that low-income Black folks are not deserving of health care, which is mainly what Medicaid is. And you know that maps on the on the service side to what you talked about in terms of the ways that largely Black folk were intentionally excluded from worker protections. And, you know, I wish that we had moved as far as 70 or even 12 years ought to have moved us in terms of the racism in particular communities, but unfortunately, we see every day that we haven’t. And I want to ask you, how do you engage with someone who may be ideologically opposed to expanding any part of Medicaid and ideologically opposed to expanding quality, dignified protections and income for a service workforce that is predominantly Black or brown and oftentimes undocumented? How do you make the case to them?

Ai-Jen Poo: Well, there’s at least two ways that I would approach it. And it has to do with this belief that I have that there are at least two truths operating at any given point: there’s what’s factually true, and then there’s what’s emotionally true. And they’re not the same. And both truths shape how we think and feel and the decisions we make, they shape our behaviors and our choices. And on the factual argument side, there is a really clear set of arguments for how investing in home and community-based care is so much more cost effective than institution-based care. And specifically to the Medicaid program, states spend on average three times as much per person to put them in an institution than to deliver the care that they need in the home and community. So we could reduce the cost to states by two thirds if we actually had a home and community-based infrastructure in place and, you know, investing in home care jobs becoming good jobs— there are 52 million working family caregivers who are struggling to hold down their jobs in the labor market and care for aging relatives or loved ones with disabilities. And they’re often spending more than 20 hours a week on top of their full time jobs on that care, and they’re often pushed in and out of the workforce because they’re trying to navigate that care. It would do so much for productivity across sectors if there were actually an infrastructure to guarantee that people could have access to home and community-based care for their loved ones, because these jobs, care jobs are what I call job-enabling jobs, so making them good jobs that are secure, not just secure—not only secures those workers and their families, but it secures all of us who rely on the work that they do in order to go to work in our jobs, right? This kind of ripple effect. So that’s the like rational argument.

Dr. Abdul El-Sayed: Yeah. To just to add on to your logical truth piece here, we saw a disproportionate number of women leave the workforce through the pandemic, in large part because they were now burdened by childcare in a way that, you know, schools had had taken care of in the past. And the implications of that, not just for families themselves, but for the overall productivity of our society, is profound. And, you know, we can’t, you know, also just we can’t ignore the fact that not only are the people who are doing this work disproportionately women, but the people who will suffer without access to domestic work tend to also be disproportionately women, and so, you know, the multiplier effects on productivity that you talk about are really quite profound and have a huge impact on the kinds of disparities that we see.

Ai-Jen Poo: Equity.

Dr. Abdul El-Sayed: Exactly.

Ai-Jen Poo: That’s right. Exactly.

Dr. Abdul El-Sayed: But now to your emotional truth, which I worry, because, you know, when it comes to the Medicare—the Medicaid point: in rejecting Medicaid expansion, literally these states are leaving money on the table to provide health care for their people and so, you know, that emotional truth may be the most impactful one, and I’d love to hear your perspective on that.

Ai-Jen Poo: Well, the emotional truth is that what people are dealing with in this country, I think in general, is a whole lot of fear of the unknown. And part of what’s unfolding for a lot of people is their parents aging, and they’re coming into a role of having to be the parents of their parents, like take care of their parents. And not having saved because most people are living paycheck to paycheck in this country, not having a way to pay for the care that their parents need, worried about having to sell their cabin or their land in order to pay for the care. And it’s this unraveling, and it’s like a kind of loss of control and everything that you know. And I think, you know, being able, everybody has a relationship to care, right? Like, we may not all be parents, but we all have parents, you know, or somebody who raised us and cared for us, who’s aging and who is going to need assistance. And so to be able to tap into people’s personal experiences and stories and say, you know what? It’s not your failure. Our culture has kind of taught us that if for some reason, we can’t afford the care that we need or we can’t manage it or we’re struggling, it’s because we personally failed. We didn’t save or we don’t have the right job, or we didn’t buy that insurance when we were supposed to, or any number of self-blame narratives. And to say to people, No, you have every right to be, to feel lost, to feel isolated, to be frustrated and pissed off, and it’s because you are doing everything right and it’s not enough. And that is not your fault. This is a collective issue and you are not alone. There’s 52 million of us! You know? And just to actually meet people where they are in the emotional dimension of what this is about, and we’re fortunate that care is very emotional.

Dr. Abdul El-Sayed: Yeah. What strikes me about that is exactly that, when you when you personalize it to the experience of your loved one and what you want for your loved ones as they age, or should they have a disability that requires home or community-based care, what you want for them and what do you want that person who is providing that care, or those people who are providing that care, what do you want their lives to be like? Because, you know, if they’re frustrated because they can’t make ends meet and they’re worried about their circumstances at home, that’s going to show up in the workplace. And if that workplace is feeding and bathing and caring for your loved one, then you have to ask yourself about whether or not you think it’s okay that the people who provide such intimate, critical care for your loved one go without the basic means of a dignified life. And so, you know, really does come back to those workers. Now, you talked a bit about the home and community-based care package, and that was originally part of the Build Back Better bill. Can you walk us through where that is right now in terms of the potential for passing, and, you know, if like other parts of the bill, it’s taken a few knocks in terms of, you know, the robustness or the size of what was previously planned?

Ai-Jen Poo: Sure. Well, the president’s original vision was to invest $400 billion in Medicaid home and community-based services with two goals. The first to expand access to home care, home and community-based services for older people and people with disabilities and their families. And so to clear that waiting list, make sure that all of those people can get the services that they are eligible for! And then to raise wages for the workers. Those are the two goals of that funding. And when the House passed the Build Back Better Act last year, the Build Back Better Act included not the full 400 billion, but 150 billion for that very same purpose. Okay? So we’ve already, the amount has been reduced, but still, I just want to say, I know these numbers are so abstract and so hard to wrap your head around— know it’s really hard for me to wrap my head around, billions! I don’t even know, ‘B’, what?—but that would be the single largest investment in the creation of good jobs that would directly benefit women and women of color in the history of the United States.

Dr. Abdul El-Sayed: Mm. A big deal.

Ai-Jen Poo: So that is a really profound statement, and it’s even more profound when you put it in the context of the New Deal, and the explicit exclusion of this very group of workers from equal protections because of racism, the fact that we’re putting this investment front and center in an economic agenda is actually really profound. And I try to remind myself of that, that we can make history and we can make big leaps forward when it comes to equity, but where we are now, to your original question is: it’s gone through the House, now we’re in the Senate. There will be a window of a few a couple of months where the Senate will be discussing what should potentially go in a budget reconciliation bill.

Dr. Abdul El-Sayed: Like a Build Back kind of.

Ai-Jen Poo: Yeah! Yeah! Yeah, yeah. We’re not calling it Build Back Better. We’re calling it a budget bill.

Dr. Abdul El-Sayed: The budget bill.

Ai-Jen Poo: A budget bill that reflects the president and the Senate’s economic goals. And those goals are to lower costs for families and to reduce the deficit. And so that is what’s being debated right now, is how do we lower costs for families and reduce the deficit, given what’s going on in the world right now? And so that is what the Senate is going to be discussing. And I believe that Medicaid home and community-based services is one of the pieces that could be a part of how we think about investing in health care, investing in lowering costs for families as a part of the budget reconciliation conversation. And I think the window between Mother’s Day and Father’s Day, which is how we’re thinking about the campaign, is a really important time for all of you listening out there to make sure that your senators know that you really care about care and about care workers and about home care being included in the budget bill in the Senate.

Dr. Abdul El-Sayed, narrating: We’ll be back for more with Ai-Jen Poo after this break.

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Dr. Abdul El-Sayed, narrating: And we’re back with more of my conversation with Ai-Jen Poo.

Dr. Abdul El-Sayed: I want to ask you, above and beyond the investment that we need to make in this, what kind of regulatory policies do we need to protect domestic workers and create some safety around the risk of exploitation that that they face?

Ai-Jen Poo: I’m so glad that you asked that question because we’re simultaneously trying to move a bill called the Domestic Workers Bill of Rights through the House at this very moment. And it’s a bill that is sponsored by Congresswoman Jayapal and Senator Gillibrand. And what it does is it sets up a framework for protecting this workforce that not only addresses some of the exclusions from the 1930s that are still in place, but it actually establishes paid sick days, protection from discrimination and harassment—some really core labor rights and protections that will enable this workforce to actually come into the 21st century. And it includes also establishing what we call the Domestic Worker Standards Board, which will essentially be a vehicle for workers to be able to be at the table to set standards going into the future. It sets up a tripartite process where the federal government, domestic workers, and employers are able to come together and say, Here’s what the wages should be, here’s what the time off structure should be, here’s what the benefit structure should be, so we can actually get these jobs on a pathway to becoming good jobs. And the last thing I’ll say about this is, because there is such a high concentration of immigrant workers in this workforce, I also want us to be thinking about a path to citizenship for this workforce, and there’s a clear need for this work. The workers are already interdependent with all of our families, and we can bring this huge workforce out of the shadows, into training programs and certification programs and onto a pathway to citizenship, which will both help us meet the need for this in terms of the amount of care that will be needed in the next decade and a half, and also allow this workforce to fully be integrated into the economy. And that’ll be a big piece of how we make sure that the standards are enforceable so that we can’t keep pushing people into the shadows because of their immigration status.

Dr. Abdul El-Sayed: Yeah, that’s a really important point considering, you know, you shared that statistic about every 8 seconds, somebody turning 65. The other thing people have to understand about the demographic structure of our country is that we are we are facing a demographic cliff. And what I mean by that is that for every one of those people who turn 65, it’s not like we have a new person in waiting. We’re just not reproducing at the same level. And the way that societies have had to deal with that is to make sure that you can offer spaces for immigration for folks into our societies. And that happens at all levels. There’s a, you know, conversation often when you talk about immigration where you exclude certain types of immigrants. So if they’re coming on an H-1B visa and they have specialized skills, we say, you know, we want those immigrants, but then immigrants who don’t have those technical skills, maybe, maybe less so. But the truth of the matter is, is that those are specialized skills, the skills that we’ve talked about all day, the will and the care to care for your loved one. Those are really special skills. And, you know, if you think about it, if you don’t believe me, think about who would be providing those services if it wasn’t somebody who was a domestic worker. It would be you. Why? Because, you know, the assumption is that nobody is going to care for someone like I do, and so if they’re special people, then the people caring for them have special skills.

Ai-Jen Poo: That’s right.

Dr. Abdul El-Sayed: And so we have to really be thoughtful about how we talk about immigration, recognizing that we are we are quickly losing ground on this. I remember visiting Japan about seven years ago now and having a conversation about the demographic cliff that they are down, they are actively falling down, and the conversation that we shared about the fundamental need to rethink what has been a very strict immigration policy in that country. And what’s sad to me is that, you know, in our society, we are of two minds about this, right. On the one hand, you know, you and I are both children of immigrants and we have a swath of American society who values our immigrant history and traditions. And then there is another swath of society that wants to demonize immigrants of all stripes, not recognizing that, you know, in fact, when we think about the demographics of the programs that we talked about and we think about who is most quickly turning 65, you’re talking about the same kinds of folks who would demonize immigrants, on the other hand. And so I just think we have to be really thoughtful about the fact that from a structural standpoint, we cannot continue to think that immigration is anything but a friend because otherwise we face a lot of challenges. I want to ask you lastly, you know, this is a very fraught time, whether you’re talking about the the war in Ukraine, the ongoing pandemic, or even inflation taking people’s paychecks and doing what it will with them—what gives you hope as you look across the horizon?

Ai-Jen Poo: I have to be honest with you and tell you that it’s the domestic workers that are in our community who give me so much hope, because to bear witness to women who get up every single day and care no matter what. The capacity, the boundless capacity you have to care for your own family and then go to work and care for somebody else’s, and then come home and care for yours again, and then get on a Zoom with your organization and lead us towards passing a budget reconciliation bill that gets more care to more people—I mean, it’s extraordinary what the workers in our community do. And I’ve seen how powerful it is. It’s has made the impossible possible in passing bills, domestic worker bills of rights around the country, in winning victories against abusive employers, and all kinds of things, and in restoring this idea that we can be caring in our law and policy and in our relationships and in our economy. And so I just, I draw strength from that because it is so powerful. And I know that for generations, domestic workers have organized and come together, and each generation has made more possible for the next and we’re doing our piece of it. And I think about how little our foremothers, our movement mothers had, and they did their piece of it. And I think this, we’re in this generational moment where care has to be central, so we have the potential to do so much more than they did in terms of making things better for future generations. And that actually energizes me more than hope. It’s like motivation.

Dr. Abdul El-Sayed: I appreciate that. It’s a beautiful place to end it. I want to ask you, how can people get involved? What can listeners do to help us drive for a more dignified America where we care for folks and we care for the carers.

Ai-Jen Poo: You can sign up at domesticworkers dot org. Or also join our caring coalition called Caring Across Generations. If you’re a family caregiver, we have all kinds of resources for you there. And we’re all part of this growing movement of people who are demanding that we build a care infrastructure who support all of us who want to care for our families and each other.

Dr. Abdul El-Sayed: That was Ai-Jen Poo. She is the leader of both the National Domestic Workers Alliance and Caring Across generations. We really appreciate you joining us and educating us on the challenges that we face and the opportunities that we have to take them on.

Ai-Jen Poo: Thank you so much for having me.

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now: well, after more than two years of close calls but negative tests, COVID has finally caught up with me. I began feeling body aches and chills a few nights ago, only to wake up feeling like I got hit by a truck. I took a rapid test and came back positive. All I’ve been able to do consistently since, is sleep. It’s striking because everything we’re hearing is that COVID is over, that we really ought to move on. As some have put it, we’re in the, quote unquote, “choose your own adventure” portion of the pandemic. The problem is that as cases continue to increase, thousands of people are going to get infected for the first time just like me. But they’re going to get COVID in a time when, however disorganized our approach has been, there’s even less organization now. Communities across the country have decommissioned testing sites. When I tried to figure out how to access test to treat, my local health department’s website had a bunch of dead links. I’m a physician, an epidemiologist. I’m pretty health literate, and if trying to figure out how to approach isolation and quarantine, how to access test to treat was hard for me, I can’t imagine the challenges for so many others. COVID is not yet over, and yet there was this:.

[news clip] A Federal judge in Florida, striking down the federal travel mask mandate, saying the CDC overstepped its authority.

Dr. Abdul El-Sayed: A federal judge from the middle district of Florida, literally the middle of Florida, struck down the CDC transit mask mandate. The judge, Kat Kimball Mizelle, was appointed by Trump after he lost his election, and she was confirmed by the lame-duck Republican Senate. To add insult to injury, the American Bar Association was outspoken against her confirmation, calling her, quote unquote, “not qualified” because, I quote, “the short time she’s actually practiced law and her lack of meaningful trial experience.” Oof. Yet that didn’t stop her from being confirmed on a party line vote. And boy, did she deliver for the MAGA base with the doozy of a Facebook post—I mean, legal opinion. In it, she took a swipe not just at the mask mandate, but attempted to reinterpret public health law as we know it. Her ruling could spell an end to the legal foundation on which the federal government bases its interventions to protect the public’s health, not just for COVID, but beyond. Critically, the Justice Department announced it will appeal the ruling, though it won’t seek a stay of the court’s decision, meaning masks can stay off in public transit for now. There has been a unique combination of incompetence and mendacity that has been attacking public health from the jump from this pandemic. And sadly, we’ll have lost nearly a million lives, and watched public health get weaker because of it. In good news, public health keeps on doing what it does best: using science to keep us safe. The CDC launched a new public health forecasting center. The center is focused on getting ahead of the next pandemic.

I’d love to end there, but there’s one more thing I just couldn’t get away without talking about. This was Fox News host Tucker Carlson, in a conversation with a self-described “bromeopath” personal trainer.

[clip of bromeopath] Expose yourself to red light therapy.

[clip of Tucker Carlson] Yes.

[clip of bromeopath] There’s a massive amount of—

[clip of Tucker Carlson] Which is testicle tanning.

[clip of bromeopath] It’s testicle tanning, but it’s also a full-body red light therapy, which has massive amount of benefit, benefit.

Dr. Abdul El-Sayed: First, the other name for a quote unquote, “red light therapy” bromeo is talking about here is ‘low-level laser.’ It sounds a lot worse that way, right? Well, none of the claims he’s making are backed by any sound science—surprise, surprise. But you might be wondering, why does Tucker Carlson all of a sudden care about people’s testicles? Well, that clip is taken from a documentary he produced called “The End of Men.” Tucker and his friends think that women’s equality means the end of men. And let’s be clear, we’re not even close to full equality, but the very notion that we’re finally dealing with the misogyny and patriarchy that has held women back for so long is a threat to folks like him so he goes looking for some biological explanations. Surely it must be that testosterone levels are falling. To be fair, testosterone levels are in fact falling, however, that has zero to do with the end of men. Testosterone rates in men have fallen since the beginning of the 20th century because our lifestyles have changed over the last 120 years. Fewer men do physical labor. Just look at Tucker Carlson. And people on average have more body fat, which drives down testosterone levels. But Tucker doesn’t recommend you go lift heavy things or do physical labor. Instead, he brings in a crack-pot to tell you to shine a laser on, well, where the sun don’t even shine. More importantly, this is the same Tucker who’s been dogging safe and effective COVID vaccines for over a year now, COVID vaccines that, by the way, protect you from one of the most common symptoms of COVID, which is orchitis, or swollen testicles, which can result in less testosterone production—can’t even make this stuff up folks. I’m going to end my rant there.

That’s it for today. On our way out—look, I always say the same thing: rate, review the show. It really does help. I wouldn’t ask you to do it if it didn’t. Also if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some American Dissected merch. We’ve got our logo mugs and t-shirts, our Science Always Wins t-shirts, sweatshirts, and dad caps, and our Safe and Effective tees, which are on sale for $10 off while supplies last.

Dr. Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra and Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sara Geismer, Sandy Girard, Michael Martinez, and me, Dr. Abdul El-Sayed, your host. Thanks for listening.