President Joe Biden’s sweeping infrastructure proposal, the American Jobs Plan, is the legislation that launched a thousand gripes.
From the day it was introduced, the package spawned not only the expected debates about its cost and how to pay for it, but also a charged debate about what should and should not be classified as “infrastructure.”
The disagreement over what constitutes infrastructure is particularly perplexing considering that we generally know what we mean when we talk about infrastructure in other contexts. For example, when we speak of a company having strong infrastructure, we know what that means, and it's rare that we’re talking only about buildings and pipes.
We typically talk about people, process and technology—the necessary building blocks for the company’s financial success.
But when we talk about infrastructure in the American Jobs Plan, beyond roads and bridges, opinions diverge about investments in clean water, broadband, and especially investment in essential healthcare.
The larger problem with this debate about infrastructure is that it mostly misses a key point: the bulk of the critical foundational support for a 21st-century economy is no longer exclusively physical assets. For the Eisenhower era, interstate highways were the arteries of commerce that required massive investment to support our economy.
Today it is hard to argue that a strong digital infrastructure is not essential for American economic success. Even attracting a new manufacturing plant to a community requires high-speed internet so that the facility can run its operations.
When it comes to the infrastructure needed to support our emerging healthcare challenges the problem is similar. We do not need more physical infrastructure—building more hospitals will not help keep people any healthier or support the kind of health care jobs that we need. Instead, we should invest in the structures we lack—the people and systems that can make healthcare work better in the home and in the community.
With a rapidly aging population and more elderly Americans with complex healthcare needs, there is explosive demand for long-term care. But our current system to manage that demand is full of potholes and foundational cracks.
It needs repair because historically we spent the bulk of our infrastructure dollars on the physical assets of healthcare, like hospitals or nursing homes, while ignoring the connective tissue of the system—caregivers and systems for care to the home which allows us to meet patients where they are.
Those who say in-home care is not infrastructure have a backwards view of the future. Americans broadly prefer to heal and age in the home. In a late 2020 survey, 72% of people indicated they would prefer to recover at home, rather than a medical facility.
Asking seniors to seek more care at a hospital or long-term care facility is the equivalent of asking people to haul water from a well when they’re thirsty instead of building a pipe that delivers water directly to their home. And when people are able to get the care they need where they want, they’re much likely to get it when they need it.
The American Jobs Plan is a good start in building these ‘"pipes." We need improved wages and support for caregivers, who are some of our most essential workers. We need investments in community-based and home care resources that help lighten the load on families and loved ones who are caring for aging relatives. And we need to change payment policies to appropriately value home care as equal to or better than a trip to a skilled nursing facility.
All of that needs to be buttressed by innovative technology tools that help make the home care system smarter and seamlessly coordinated with providers, and caregivers.
Part of the basis for our disagreement over what is or is not infrastructure may be that it’s not well defined in the policy context. One way to decide whether or not something is infrastructure is to ask: Did someone have to build this, and will it crumble if it’s not maintained over time?
The answer to both those questions is certainly yes when it comes to caring for our aging population. People want care at home, and we need to invest in the infrastructure that will make it a reality. Otherwise, we’re just handing people buckets.
John Driscolll is the CEO of CareCentrix.