The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America

by Gabriel Winant

Overview

Winner of the Frederick Jackson Turner Award
Winner of the Isaac and Tamara Deutscher Memorial Prize
Winner of the C. L. R. James Award
A ProMarket Best Political Economy Book of the Year

Men in hardhats were once the heart of America’s working class; now it is women in scrubs. What does this shift portend for our future?

Pittsburgh was once synonymous with steel. But today most of its mills are gone. Like so many places across the United States, a city that was a center of blue-collar manufacturing is now dominated by the service economy—particularly health care, which employs more Americans than any other industry. Gabriel Winant takes us inside the Rust Belt to show how America’s cities have weathered new economic realities. In Pittsburgh’s neighborhoods, he finds that a new working class has emerged in the wake of deindustrialization.

As steelworkers and their families grew older, they required more health care. Even as the industrial economy contracted sharply, the care economy thrived. Hospitals and nursing homes went on hiring sprees. But many care jobs bear little resemblance to the manufacturing work the city lost. Unlike their blue-collar predecessors, home health aides and hospital staff work unpredictable hours for low pay. And the new working class disproportionately comprises women and people of color.

Today health care workers are on the front lines of our most pressing crises, yet we have been slow to appreciate that they are the face of our twenty-first-century workforce. The Next Shift offers unique insights into how we got here and what could happen next. If health care employees, along with other essential workers, can translate the increasing recognition of their economic value into political power, they may become a major force in the twenty-first century.

Product Details

ISBN-13:	9780674238091
Publisher:	Harvard University Press
Publication date:	03/23/2021
Pages:	368
Product dimensions:	6.50(w) x 9.30(h) x 1.40(d)

About the Author

Gabriel Winant is Assistant Professor of History at the University of Chicago. His writing about work, inequality, and capitalism in modern America has appeared in The Nation, the New Republic, Dissent, and n+1.

Table of Contents

Introduction: When Workers Disappear 1

1 Down in the Hole: Steelmaking Pittsburgh in the 1950s 25

2 Dirty Laundry: Labor and Love in the Working-Class Home 63

3 "You Are Only Poor If You Have No One to Turn To": Race, Geography, and Cooperation 98

4 Doctor New Deal: Social Rights and the Making of the Health Care Market 135

5 Enduring Disaster: The Recycling of the Working Class 179

6 "The Task of Survival": The Commodification of Care and the Transformation of Labor 218

Epilogue 259

List of In-Text Abbreviations 267

List of Bibliographical Abbreviations 269

Notes 273

Acknowledgments 337

Index 341

Editorial Reviews

01/18/2021

University of Chicago historian Winant explores in his informative debut the rise and fall of Pittsburgh’s steel industry as a microcosm of America’s shift from an industrial to a service economy. He examines the 1950s heyday of the steel industry in Pittsburgh from a labor perspective, outlining the constant conflict between workers and management as the former sought decent wages and benefits while the latter cut corners on staffing and safety to secure higher profits. The decline of the American steel industry beginning in the 1960s (due in part to global competition) affected Black workers in particular, according to Winant, as their job prospects were hindered by discriminatory hiring practices and a seniority system that limited their opportunities for advancement. He explains how the health-care industry’s expansion in the wake of steel’s decline facilitated the simultaneous “exclusion” (through segregated medical practices and high costs for care) and “exploitation” (through low wages and poor job protections) of Pittsburgh’s Black residents, and sketches how the corporatization of health care from the 1970s through the 1990s impacted patients and workers alike. Lay readers may find Winant’s academic prose and copious data points slow-going, but those with a background in labor history and economics will be rewarded by this incisive deep dive. (Mar.)

Publishers Weekly

Winant charts the rise of this new political economy and working class in his terrific new book…Offering fine-grained details of shop-floor industrial relations, the book is at once an ethnographic probe into the lives of working-class families and a comprehensive analysis of the larger dynamics of the US political economy…A useful guide to the sweeping social changes that have shaped a huge segment of the economy and created the dystopian world of contemporary service-sector work.

The Nation - Nelson Lichtenstein

How and why has the healthcare sector taken over formerly industrial cities? Why are care work jobs so important yet so undervalued? In one of the most important works of labor, economic, and policy history to appear in years, Gabriel Winant compellingly answers these questions. This is an essential book for understanding the healthcare system, its weaknesses, and the policies necessary to create a system that is equitable for both workers and patients.

Thomas J. Sugrue

Essential reading for anyone interested in Pittsburgh history, the labor movement or the economics of our health care system. It helps us to make sense of the region and the economy we inhabit today.

Pittsburgh Post-Gazette - Kate Giammarise

A deeply upsetting book. It meticulously charts the transformation of the working class to show how the destruction of workers’ unions and bodies occurred in a feedback loop, with capitalist exploitation demanding care, demanding more exploitation, demanding still more care. The demolition of state support and state protections served to speed up this feedback loop. It has long since spun out of control…Winant ably blends social and political history with conventional labor history to construct a remarkably comprehensive narrative with clear contemporary implications.

New Republic - Scott W. Stern

A thorough understanding of the political economy of the post-war United States inflected through the lenses of race, gender and class. It is a masterful book that weaves together two seemingly disparate strands—the demise of heavy industry and the rise of care work—into a single thread that traces the story of a broken society.

Spectrum Culture - Ryne Clos

Beautifully written, extensively researched, and sharply argued, The Next Shift offers a new way to think about the transformations often grouped together under the rubric of ‘neoliberalism.’ Winant sees deindustrialization not simply as a story of decline, but a story of the rise of a new kind of working class.

Kimberly Phillips-Fein

An exquisite regional economic history, The Next Shift illustrates how health care became a primary mechanism of social reproduction—allowing the American state to govern the economic and sociological consequences of deindustrialization…Offers powerful lessons for scholars of health policy and politics.

Journal of Health Politics, Policy and Law - Philip Rocco

A sophisticated, politically pointed, and beautiful crafted book, The Next Shift chronicles both the erosion of the white male industrial working class and the ascendance of a service sector run by the labor of white women and men and women of color. But unlike most stories of industrial decline, Winant’s history bristles with hope for activism for the new world of work that has emerged.

Eileen Boris

Digs deep into the stories of working people, tracing the rise and fall of two industries that, despite vast differences on the surface, have been intertwined for decades. Through stories of real people’s real lives, Winant explores the move from manufacturing to care, tracing the rise of a new working class—one that looks very different from the stereotypical blue-collar worker of the Rust Belt’s mythic past…A road map for how to think about the changing working class.

Bookforum - Sarah Jaffe

In this nuanced and powerful book, Gabriel Winant connects the slow-motion devastation of deindustrialization to the perverse political economy of care as the twin fruit of America’s compromised social bargain. Through the rusting of ‘Steel City, USA,’ Winant makes tragically concrete the ways that industrial job loss was transformed into a profit-driven market for health care—ensuring that caregivers can never afford the services they provide, and that the social exclusion on which the welfare state was built will swallow up ever greater majorities.

Bethany Moreton

The definitive account of the causes and consequences of the decline of heavy industry and the birth of the medical-industrial complex. Winant dives deeply into Pittsburgh's economic, social and cultural history to illuminate the linkages between the rise and fall of steel and the spectacular growth of health care…Essential reading for anyone wanting to understand our modern health-care industry's historical and economic foundations.

Inside Higher Ed - Joshua Kim

Charts how Pittsburgh’s declining steel industry gave rise to one of the country’s most ruthlessly corporatized health care systems, and how the ability of each to deliver on its romanticized promises rested on the exploitation of care work.

Jacobin - Natalie Shure

One of the most timely books of our era. The global pandemic has turned care workers into heroes while concealing the history that rendered them undervalued, underpaid, and precarious long before COVID struck. Winant recovers this history, revealing how the growth of the care industry was a consequence of, and response to, the decline of the industrial sector, and suggesting that the very laborers tasked with keeping the rest of the working class from an early grave may prove to be capitalism’s proverbial gravediggers.

Robin D. G. Kelley

Winant explains in fascinating detail how Pittsburgh’s working class adapted to the post-steel economy…[O]ffers a highly intelligent case study of the transformation of one key section of the working class since 1950—a vital precondition for mapping its future.

New Left Review - Tom Mertes

[An] exhaustive examination of the shifting economies of the American Rust Belt…A fascinating look at labor history and the continuing struggles of blue-collar workers, particularly in light of the pandemic and the increased burden, both personally and politically, placed on health care workers.

Pittsburgh Magazine

How the health-care industry replaced manufacturing while downgrading the quality of American middle-class life, furthering inequality, and fueling political bitter divisions is the welcome subject of Gabriel Winant’s The Next Shift…Winant weaves together a convincing argument that this downward mobility has been driven by a gendered and racist political economy that values many things—from retiree health care to CEO pay—more than care work by women and people of color…Many health-care workers on the bottom rungs now find themselves, in some ways, back where industrial workers started in the nineteenth century…[An] important book.

Democracy - John W. Miller

The replacement of blue-collar work by pink-collar work has been much discussed, but what makes this book stand out is Winant’s argument that two seemingly distinct phenomena are in fact inextricably connected…An original work of serious scholarship, but it’s also vivid and readable…[An] eye-opening book.

New York Times - Jennifer Szalai