Gabriel Winant is an historian who studies the social structures of inequality in modern American capitalism and a professor at the University of Chicago. His first book, The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America was published in March 2021.
Miles Munkacy: Starting at the very beginning of the history presented in your recent book, can you explain the relationship between industrial workers and service workers from the 1940s to the 1970s? How did the success of one contribute to the decline of the other, and vice versa?
Gabriel Winant: What we really want to understand to approach this question is the partial and particular nature of economic security under the New Deal state. When I say New Deal state, I mean the set of institutions that were constructed between the 1930s and 1960s.
We often talk about something called a “public-private welfare state,” which is distinctive in this country. If you’re a working class person in this period of time, your best bet for achieving economic security was to either get a factory job—you’ve got a better shot at that if you’re a man, and in particular if you’re a white man—or you attach yourself through a relationship of dependency, particularly marriage to someone who has a job like that. Because the United Auto Workers and the United Steel Workers, or whoever, would have negotiated health benefits that would cover the worker in his family through their employment relationship, the retirement benefits would cover the worker and his family.
Healthcare workers, like agricultural workers and domestic workers, stood outside of the protections of the core constituency of the New Deal state. Starting in 1947 with the Taft-Hartley Act [an act passed by Congress that amended the rules governing organized labor], they weren’t covered by labor law, they were covered by what’s called “employment law,” which just covers wages and hours. This meant that people who worked in these industries were people who were more marginal in the labor market—in particular women, women of color, immigrants, and African Americans—people who did not have access to the kind of prime avenue for economic security.
However, when we look at healthcare in particular, we have to see not just the unfair stratification between these two levels of the working class, but a relationship between them. Because part of the insiders’ economic security is their access to healthcare. It is insurance.
And what does that insurance buy them? It buys them services. Who provides those services? Healthcare workers. Thus, a constituent part of the security of industrial workers is the existence of this kind of adjunct low wage workforce in the healthcare industry.
MM: Can you explain why once industries start to decline in the Rust Belt, there was a corresponding rise in healthcare and service jobs?
GW: First of all, we really need to see industrial decline as starting in the mid-1950s. Generally, the story is that it’s something that happens in the ’70s and ’80s, and that certainly is the most rapid period of industrial job loss. But Pittsburgh lost as many jobs in metal production, which was its main industrial specialty, between 1950 and 1980, as it did between 1980 and 1990. The ’80s was the worst decade,but the previous three, all totaled up, were just as bad. The relationship that this has with the healthcare industry is complicated, and it takes a few different forms.
One is that as the workforce is never fully replaced from this peak around the time of the Korean War, there’s a kind of cohort effect. There are just never going to be as many workers again in the steel industry as there were then, and that means that gradually, young men are going to not be able to follow their fathers into this kind of work. When you have one giant industry that dominates a regional labor market in the way that steel dominated Pittsburgh, or auto dominated Detroit, that industry’s decline means the young men are going to be likely to leave.
So, the population as a whole gets older over the course of the whole post-war period. All across the industrializing Northern and Midwestern cities, as young people, particularly young men realize that there’s not as much opportunity here as there used to be, they decide to head out. Not to mention that this big cohort that made the steel for the Korean War is itself getting older. By the late ’70s, early ’80s, Pittsburgh was one of the oldest places demographically in the country among big cities, and with that, it had an increasingly sick population. The older population is a sicker population for kind of obvious reasons, older people generally need more healthcare. But also, job loss itself produces bad health problems—in a society where people are dependent on work for survival, loss of work has health effects.
With this overdetermined and interlocking process at the population level—people getting older, poorer, and thus, sicker—there is a corresponding rise in demand for healthcare. This is not just because people are sicker. It’s also because the healthcare industry, for all that it is inadequate to people’s needs and irrational in many ways, does actually provide one of the main points of accessible social support.
MM: How is the argument in your book relevant to modern political discourse about reforming healthcare (for example, Obamacare)?
GW: We have this public-private welfare state that originated in the 1940s, but the basic structure of that is still with us. Health insurance is still mainly routed through employment, and healthcare provision obviously is mainly a private sector phenomenon. If we look at Obamacare, what do we see? We see—and this is also true of the Medicare reform carried out under George W. Bush—policymakers trying to figure out how they can extend some amount of health security and provisio without displacing the various private interests that structure the healthcare system as a whole; they seek to extend services and extend healthcare in such a way that some portion of the private sector will be excited.
In Obamacare’s case, that was the insurance industry. The program was designed to buy off the insurance industry and win its support. In the Medicare pharmaceutical reform under George W. Bush, that was the pharmaceutical industry. The Bush reform was a huge handout to the pharmaceutical industry. The reason for this is because we’ve stood in healthcare provision as one of the main forms of collective social response to deindustrialization and rising inequality in general.
Ironically, because the healthcare system is so fragmentary and has such perverse incentives, it was able to feed off of the dislocation of industrial workers and the social damage that accompanied that, because it could partly help manage the problems that resulted. It didn’t solve those problems, but it could help manage them. I think that’s why the moment when the United States really starts to diverge in terms of per capita healthcare spending from other developed countries is the early 1980s, because it’s when we started really relying intensely on the healthcare system to do this particular work for us of managing this dislocation.
This is why healthcare politics is so intractable. The main issue of healthcare politics is cost. We’re always talking about how to control costs to get the system under control. But your healthcare costs are someone else’s income, either in the form of actual cash income or in the form of services. So, healthcare cost increases are the footprint at the fiscal level of how the healthcare industry has grown to solve a social problem for us, which creates a really perverse dynamic where you can’t reform the healthcare system even though it doesn’t make any sense and doesn’t work at all, because it’s the thing that has grown in this vacuum to sort of solve the social problem.
MM: There’s this big push by both parties, but mainly the modern Republican Party, to bring manufacturing back to America. Is that realistic, and would it even help the Rust Belt?
GW: No, I don’t think it’s realistic. I think, on the margins, that there are factories here and there that, with the right set of incentives or subsidies, could get opened and employ 500 people here or 1,000 people there. But we’re certainly not going back to the mass employment, mass production industry world that we had for the first half of the twentieth century, even a little bit beyond.
Integrated steel mills, of the kind that they had in Pittsburgh, generally employed between 5,000 and 10,000 people, such that twenty percent of the workforce was employed just in integrated steel production, not to mention the auxiliary industries like shipping. It’s just not remotely plausible that we could ever bring something like that back, nor that we would necessarily want to.
It seems really perverse to be in the current situation of global capital surplus, in which there’s more capital than there is outlet for it in terms of productive investment, and to have the response to that be, “Let’s try to invent jobs for people to do for the sake of having them have jobs to do.” As opposed to figuring out, “Where are the opportunities for the increase of leisure and freedom from work?” What kinds of work do our economy and society actually seem to generate demand for in a real way that we could actually turn into something meaningful and emancipatory, rather than $11.00 an hour drudgery, which is what the care economy has become? That’s where the book ends up.
MM: Can you explain the relationship between industrial capitalism and people’s personal lives, and how the fall of industry affects American social fabric?
GW: One point I make in the book is that we have this reflexive idea that job loss, when it strikes American cities and towns, dissolves community, that it disconnects people from each other. Maybe, in the long term, there’s a version of that that’s true. However, in the nearer term, as shown in the ’60s and ’70s as African-Americans, who were generally the first to get displaced from secure work, were dealing with this.
People develop these elaborate networks of mutual reliance, mutual support across kinship systems, and neighborhood, and ethnic, and church type forms of social organization. There’s all these kinds of networks that actually keep working-class people alive and keep them going through a period of increasing economic displacement that were misunderstood by social policy makers as a pathological inability to form proper nuclear families. This appeared in the anxiety about welfare in the 1970s and 1980s. People were asking why the working class wasn’t forming proper nuclear families. The reason was because it was actually strategic and optimal for people to figure out these more complex strategies of coordination.
MM: As you discuss in your book, a disproportionate amount of service industry workers are women and people of color, particularly women of color. What is the significance of this statistic?
GW: Across the country, the category that the census calls “healthcare and social assistance” is now the largest category of employment. It’s fourteen percent of all jobs. In de-industrialized cities and towns, that number rises toward eighteen to twenty percent , even twenty five percent in the Bronx, which is the highest of any major urbanized center. And there are neighborhoods, in places like the Bronx, West Philadelphia, or Detroit, where thirty to forty percent of jobs are in healthcare and social assistance.
This is a quite extraordinary transformation in employment. As you suggest, it overwhelmingly implicates women.. Similarly, it remains racialized in different patterns, depending on where in the country you go. In Pittsburgh, it’s largely African-American women who work in the lower ranks of healthcare and social assistance. In coastal cities, it tends to be immigrants; there’s an enormous Filipino presence in a lot of places.
First of all, I think we have to grasp the economic dimensions of this. There’s a figure I cite from the sociologist Rachel Dwyer, that if you slice up all job growth into quintiles, fifty six percent of that bottom quintile was care jobs in the 1980s. In the 1990s, sixty three percent . And in the 2000s, seventy four percentI believe.
Low wage job creation is really overwhelmingly being driven by the care economy. And this is creating a situation, a potential political situation, of possible solidarity. I wouldn’t say it really exists yet, but there is possible solidarity between the millions of workers who have no residual claim on the forms of security and entitlement leftover by the New Deal state in the way that other groups do, and the millions of us who need this care for one thing or another. This can mean things as simple as better family leave policies, and improvement in things like that, that this country notoriously doesn’t bother with.
But I also think that can mean real social investment in more institutionalized forms of care that have more specialized workforces. To be humane and provide high quality care, we as relatives, patients, or parents, want fewer patients or fewer children per caregiver. We want our caregivers to spend more time and be less stressed with the people they take care of. So there’s a potential political alignment there that I hope can form the social core of a political coalition in much the same way that industrial workers did in their communities in the 1930s with the New Deal Coalition.
*This interview has been edited for length and clarity.