A Modest Proposal for the American Healthcare Crisis
Introducing the Civic Care Labor Act of 2026
Seven hundred Americans die every day from preventable medical errors. We have decided this is acceptable, but we shouldn’t.
That works out to about 250,000 deaths per year which would make preventable death from medical error the third leading cause of death in the United States, behind only heart disease and cancer.
And a significant portion of those deaths trace directly to a single, well-documented factor: understaffing.
A landmark 2002 study in the Journal of the American Medical Association found that hospitals operating at 8:1 nurse-to-patient ratios experience five additional deaths per 1,000 patients compared to hospitals at 4:1. A separate study of 232,342 surgical discharges from Pennsylvania hospitals estimated that the difference between those staffing ratios accounted for roughly 1,000 deaths. For patients admitted with sepsis, each additional patient assigned to a nurse is associated with 12% higher odds of in-hospital mortality.
The picture in elder care is even worse. Only 11% of for-profit nursing facilities are meeting current federal staffing standards. 54% of nursing homes have been forced to limit new admissions because they cannot staff the beds. Home health providers turn away over a quarter of referred patients. By 2032, the United States will need to fill 8.9 million direct care job openings, and current projections show they will fall short by millions of workers.
Elderly Americans are dying right now because there are not enough people to care for them. They are dying of preventable infections. They are dying alone in understaffed facilities. And they are dying because nobody got to them in time.
I’d like to propose a new and novel solution to this fundamental problem.
The Civic Care Labor Act of 2026
The Civic Care Labor Act of 2026 would establish a national framework for addressing the elder care crisis through mandatory civic labor.
Its provisions are as follows:
All male citizens between the ages of 18 and 65 would be required to work 80 hours per week. The first 40 hours may be allocated to existing employment. The second 40 hours would be served as a mandatory second shift in elder care, hospice work, home health assistance, or comparable care-sector labor.
Exemptions would be granted to men whose primary employment already falls within the care sector. A man working as a registered nurse, certified home health aide, hospice worker, or equivalent would be permitted to remain at a standard 40-hour week. He has already chosen to contribute his labor toward the greater good. He would be honoured, not punished.
Men in non-care professions — finance, technology, marketing, sales, construction, law, manufacturing, hospitality, real estate, journalism, agriculture, transportation — would be subject to the full 80-hour requirement. These men made career choices, of which they are entitled to make. They are not, however, entitled to escape the consequences of those choices when the nation faces a care crisis their occupational decisions have helped create.
The framework is fundamentally one of personal responsibility. No man is being forced into care work against his will. Every man retains the freedom to enter the care sector at any time and reduce his hours. The option is always available. The choice is his.
On the Sanctity of Life
The moral foundation of the Civic Care Labor Act is straightforward. Human life is sacred. The sanctity of life does not begin at one stage and end at another. If life is sacred at all, it is sacred until everyone’s final breath. The elderly Americans currently dying in understaffed facilities are not abstractions. They are mothers, fathers, brothers, sisters, aunts, uncles, and grandparents.
Their lives have value and their deaths are preventable.
A society that genuinely believes in the sanctity of life should not stand by while thousands of its citizens die from a workforce shortage we have the power to address. The bodies required to provide adequate care must come from somewhere, and the Civic Care Labor Act simply names where.
Undoubtedly, some critics will argue that the Act represents an intrusion on individual bodily autonomy. They will say that no government has the right to conscript a man’s body, his time, his physical labor, in service of a greater good he does not agree to.
To this objection, the following responses apply:
First: the magnitude of the crisis demands proportionate response. We are speaking of vulnerable human beings whose suffering is real, present, and morally urgent. The sanctity of life cannot be used as simply a slogan. It is an obligation, and obligations, by their nature, impose costs.
Second: men have always had the option to enter care work: the career path was open to them. They chose otherwise, often for reasons of compensation, prestige, or personal preference. And while these are not invalid reasons, they are choices, and choices have consequences. A man who selected marketing over nursing must own that decision. He cannot now claim that the consequences of his choice are an unjust imposition. He should have thought much longer and harder about his career before pursuing it.
Third: bodily autonomy is not absolute. We accept many limitations on what individuals may do with their bodies in service of the collective good. We accept taxation of labor. We accept jury duty. We accept many other forms of it, and so the Civic Care Labor Act is merely an extension of this principle to a different domain of national crisis. A man’s body, in moments of civic emergency, is a national resource. To argue otherwise is to place individual preference above collective survival.
On Implementation
The Act would be administered through a national registry. All eligible men would be required to report their primary employment every 12-months. Care-sector workers would receive exemptions while all others would be assigned to regional care facilities based on geographic need.
Failure to comply would result in graduated penalties: tax surcharges, professional licensing restrictions, and in cases of sustained refusal, civil fines and even jail time.
Anyone caught helping a man evade his obligation under the Act will face equivalent penalties, up to and including jail time.
Provisions would be made for hardship cases, which will be handled on a case-by-case basis. For example, a man who is the sole caregiver for young children would receive partial exemption (20 hours instead of 40 hours). They do not, however, extend to general objections of inconvenience or career disruption.
The Act includes no opt-out for ideological objection. A man’s belief that he should not be subject to such labor does not exempt him from it. The state’s interest in addressing the elder care crisis supersedes individual disagreement with the policy.
Don’t Like It?
Every argument made above is a structural inversion of an argument currently being made about abortion in the United States.
The Civic Care Labor Act treats male bodies as a national resource in service of a “greater good.” Abortion restrictions treat female bodies as a national resource in service of a “greater good.” Both invoke the sanctity of life. Both invoke personal responsibility for prior choices. Both dismiss bodily autonomy as a secondary consideration. Both offer narrow exemptions while denying broad objections. Both insist the crisis is too severe to permit individual dissent.
Every objection that might’ve been formulated against the Civic Care Labor Act — that it violates bodily autonomy, that “just pick a different career” is glib and unjust, that the state cannot conscript individuals to solve collective problems, that the magnitude of the imposition is grotesquely disproportionate to the policy goal — is an objection that already exists. Women have been making these objections. Too many men have not been listening and believing women, or going as far as voting against women’s right to bodily autonomy.
If the Civic Care Labor Act struck you as tyrannical, your reaction is correct. The next step is to ask why the same reaction does not arise for too many men when the policy is directed at women. Because the problem I presented is real, and yet no serious person is proposing the Act – or any version of it – to solve this problem. Men choose their careers, despite their choices negatively impacting those in elder care.
As men, we understand this. We just keep “forgetting” it when the body in question belongs to a woman.
Author’s note: The Civic Care Labor Act of 2026 is not a real proposal and the author does not advocate for it. The statistics cited regarding preventable deaths, nursing staffing ratios, and elder care workforce shortages are real and drawn from peer-reviewed research and federal data sources.
My goal is to have more men look at how their own everyday behaviours either contribute to or detract from the lives of the women closest to them. I welcome everyone to subscribe, however, if you’re a man, I hope you really consider subscribing — as a free or paid subscriber — to challenge your world view and grow this community of men who care about women.
And if you’d rather not subscribe but found yourself nodding along, please consider sharing 🙏
Thanks Mike, this is exactly the jolt we need to think about what is being demanded of women. I'm currently caring for my elderly mother, after spending 20 years as a SAHM (and 5 years as a homeschool parent teacher when the schools fell apart during the pandemic) doing ALL THE CARE WORK.
Impressive Mike, thank you.