Healthcare workers have been lauded as heroes during the pandemic; but even as nurses and other medical employees have been praised for their service, COVID-19 has exposed many of them to long hours, dangerous working conditions, and lack of resources. Although COVID may have magnified these problems in an unprecedented way, they are hardly new challenges for laborers in the healthcare industry. Is living with these conditions expected of heroes, or are nurses allowed to ask for something better? Does a desire to serve entail vulnerability to exploitation?
This coexistence of care and exploitation is a familiar theme for historian Gabriel Winant. In his book The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America, he uses Pittsburgh as an example of the economic shift from industry to services (including healthcare), and the impact that shift has on the working class. As a Marxist, the lens Gabe turns on these issues is different than Grant’s Catholic personalism; but together they tackle the health care industry, the current state of working class jobs, and many other issues. From the political power of nurses to the meaning of women’s work, they ask what care might look like in a society where it is not work to be marketed or exploited, but an act of freedom that finds value in others.
The effects of deindustrialization began at the bottom of the working class and worked their way up; the increase in deaths of despair can be seen as white people catching up to where black people were already
As wages rose during the heyday of the steel industry, fewer jobs were available, leaving the working class with less economic security overall
As fewer steel jobs were available, families left Pittsburgh or women entered the workforce: “We think of that as feminist opportunity, and in many ways it is, but it's also economic compulsion”
The shift of women into the workforce is also tied to the shift into institutionalized care for chronic health conditions
“People lean on [hospitals] for all of these functions that the family has provided before, but are being externalized out of the family, and that causes these institutions to grow really dramatically.”
Polarization: workers’ incomes move to the edges of the scale over time; “high skill” jobs move to the top of the scale while “low skill” jobs are trapped at the bottom
Dualization: the places that employ the most people (IE hospitals) are not the companies that generate economic growth, the way they were in the industrial era (factories etc)
The healthcare industry needs many employees because of how much our society consumes it; however, because it’s profit margins are low, there’s constant pressure to reduce labor costs by intensifying the work of its employees
When healthcare is distributed through the market, there will always be motivation to depress healthcare worker wages and provide as little care as possible
From a Marxist perspective, housewives can be a form of resistance to capitalism by placing the family sphere beyond commerce
Marxism and Catholic social teaching both value the good over rights, but disagree on what the good entails
Work can be personally meaningful and done in the context of a loving relationship, while being simultaneously exploitative
“Bad” jobs can’t magically be regulated into good ones without it radically affecting the rest of the culture
Previously the middle class was defined by small property; since the industrial revolution it’s defined primarily by credentials
Nurses share characteristics with both middle class and working class
The complexity and fragmentation of the healthcare system prevents people from seeing it as an industry, as well as a humane revulsion to seeing care as for profit
“The question is how to relate to [the work of caring for others] as part of our freedom, as opposed to a source of oppression. It’s part of our freedom that we can depend on one another, and that dependence takes a form of responsibility”
“Others are the source of our freedom rather than the obstacle or obstruction of our freedom, and in our social interdependence our possibilities for self-realization are their greatest”
Links:
The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America
From Hard Hats to Scrubs: The Postwar Political Economy and Its Shifting Patterns of Inequality
Manufacturing Isn’t Coming Back. Let’s Improve These Jobs Instead.
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