This post continues a symposium on Gabriel Winant’s The Next Shift. Read the rest of the posts here.
***
At the core of Gabriel Winant’s The Next Shift is a mid-twentieth-century vision of social citizenship: a bundle of entitlements that, together, signaled the holder’s value to society. The bundle included unemployment insurance, job security guarantees, retirement benefits, affordable healthcare, and wages that could support a family (so long as wives performed the unpaid labor of keeping house and “pinching pennies”). In other words, it was the promise of security over a life-course, channeled through a male breadwinner. The realization of this vision was a testament to the collective power of working people. Yet in a cruel twist of fate, these entitlements would also help birth a new industry, in which workers enjoyed less power, less protection, and less respect. Winant’s recounting of this trajectory offers new lessons for people who see social and economic security as the core of citizenship, and who seek to build more inclusive and resilient systems of social support.
The Divided Welfare State
This mid-twentieth-century vision of social citizenship was part and parcel of the “divided welfare state.” Over the course of the twentieth century, as scholars such as Jacob Hacker, Jennifer Klein, and Suzanne Mettler have explained, U.S. policymakers collaborated with the private sector to develop a welfare state with both a “public” and “private” side. The well-recognized “public” side consists of publicly funded, publicly administered social support programs, such as need-based food assistance, medical assistance, and income support. Historically, these programs have required claimants to navigate onerous bureaucratic procedures to access benefits; those who receive benefits often experienced stigma. The “private” side consists of arrangements between private parties—most notably, employment contracts and their attendant benefits (retirement pensions, health insurance, etc.). These benefits have, in fact, long been publicly subsidized, in the form of generous tax breaks, but neither beneficiaries nor the wider public have tended to perceive this. The steelworkers at the heart of Winant’s book occupied a particularly generous pocket of the private welfare state.
The pernicious effects of this public/private division are now well known. Perhaps most notably, people who had access to the privileged private side of the welfare state had little incentive to advocate for a more universal, more generous system of social support. Meanwhile, those who profited from providing privatized social welfare had an incentive to actively resist such measures. Our “patchwork” social welfare regime and its confusing, expensive public-private health care system are a direct result of these mid-century decisions.
The Next Shift illuminates several additional legacies of the public-private division and through them, several potential lessons for reformers. The first lesson is arguably a hopeful one: Winant shows that sometimes inequality can become so stark that policymakers must act. Steelworkers and their families were on an “island[] of social citizenship,” Winant explains, and people in the surrounding waters were worse off. They were worse off not simply because they hadn’t made it onto the “island,” but also because steelworkers’ benefits drove up healthcare costs, making access less affordable for everyone else. In other words, not only were the steelworkers and their families high and dry, but they were making the water more lethal for others. This situation helped create the political conditions that in turn gave rise to Medicare and Medicaid. National policymakers came to believe that the government had to step in, at least for the most clearly “deserving” groups of citizens: the elderly and the very poor.
In other regards, The Next Shift offers darker lessons about the “divided welfare state.” Much of the book focuses on the industries that sprung up “to service social citizenship”—to deliver, concretely, on the private welfare state’s promises. For steelworkers and their families, medical services were especially important. And, of course, services meant labor: at the top of the hierarchy, executives, administrators, and doctors; supporting them, a vast number of custodial and housekeeping workers, nurses, and other care workers, many of whom were non-White and female. In contrast to their steel-working patients, these lower-level workers did not encounter a labor market that affirmed their value. The price of their labor was not compatible with basic security. This contrast is explained, in part, by health care’s association with the intimate sphere of the family, but also by the deliberate exclusion of hospital workers from some of the most important protections of the New Deal state. Winant draws a direct link to the present status of careworkers: they “grow in numbers every year and must struggle constantly, in everyday life, with the perverse mechanisms of the health care system, which hold down wages and drive up stress and overwork.” Meanwhile, the very availability of low-wage carework jobs perpetuates a narrative that is often used to undermine the public side of the welfare state: paid labor is available to anyone who wants it; there is no reason for a working-age adult to rely on the state.
Social Citizenship and the “Alchemy” of Capitalism
The darkest legacy of the public-private welfare state, however, may be how health care generosity on the private side transmuted ill and aging bodies into rich and predictable streams of revenue. This point is somewhat unintuitive, in that from one vantage point, steelworkers and their families were consumers, not commodities: they consumed benefits and services, creating demands to which industry actors responded. But in crucial respects the steelworkers and their families were not the prototypical consumer—that is, someone who has a need or want and consciously goes to “the market” to try to satisfy it at an acceptable price. Sometimes, Winant shows, people “consumed” things that they didn’t want or need, such as an expensive surgery even when they may have preferred a non-interventionist course of treatment. He also observes that when steelworkers and their families “consumed” medical services, it was to treat problems that grew directly from circumstances they did not choose, such as poor air quality, job-related stress, and an economy that deprived them of informal care networks. Private hospitals thrived precisely because a once-powerful industrial workforce offered such a steady and predictable flow of treatable health problems.
When Winant illuminates the role of private financing in the growth of the healthcare industry, this point becomes even more troubling. A key moment in The Next Shift occurs in 1971, when private hospitals in Allegheny County (surrounding Pittsburgh) gained access to the municipal bond market. Private hospitals were hungry for the capital that the bond market provided, and bondholders recognized that patients’ Medicare and Blue Cross payments represented a guaranteed revenue stream. And thus, Winant explains, these hospitals “became machines” for turning third-party payments for care (subsidized by the welfare state) “into debt service to private bondholders—via the mechanism of mass working-class expectation of broad and deep care.” Non-profit institutions remained part of the industry, Winant is careful to note, but the big story is how “[t]he weakening of the security of the organized working class in the 1970s opened up space for private, profitable economic activity.”
This recognition opens up a different way of understanding steelworkers and their dependents—and through them, a different way of understanding social citizenship in the second half of the twentieth century. People who were among the most favored citizens were also in a sense raw material. As the industries that employed them declined, their ailing bodies became the stuff out of which other people derived a profit, at a mass scale. Through these favored citizens, moreover, private industry gained the infrastructure and know-how to profit from the bodies of less favored citizens, such as Medicaid recipients (people who by definition are economically vulnerable).
Many scholars, of course, have observed and critiqued profit-making off the backs of disfavored populations—racialized people, poor people, incarcerated people; disabled people, as the blog’s upcoming symposium on the late Marta Russell will discuss. In the words of Liat Ben-Moshe, building on Russell, we live in an era in which “people with disabilities are commodified and deemed profitable, especially when occupying insitutitonal beds”; “clever capitalist alchemy” spins “surplus populations . . . into gold.”
Winant breaks new ground in showing the role of welfarist generosity in this alchemical process, and in doing illuminates perhaps the greatest tragedy of allowing people to bargain for variegated, or tiered, social citizenship. It is not simply that some people now experience inferior forms of belonging and, through no fault of their own, are deprived of the ability it thrive. It is that the best (most expensive) forms of social citizenship have helped make everyone seem less like humans and more like bundles of monetizable needs. What does de-commodification look like? How do we create and service social citizenship in a way that eludes “clever capitalist alchemy”? These are the questions for those who would remake the welfare state in the twenty-first century.
