Gabe Winant is the author of The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America. The book “traces the transformation of Pittsburgh, the archetypal industrial steel town, into a city powered by the labor of hospital workers. It offers both a finely drawn portrait of working-class life in industrial and postindustrial Pittsburgh and a vision for how care work—which has long divided workers along lines of race, gender, and generation—could become the basis for a new kind of solidarity.”

What my book is trying to say is that there was this real moment of working-class power in the New Deal that we can see clearly in a place like Pittsburgh. In 1950 half of all employment was what we would call blue collar—in the steel industry most of all, but there were still coal miners in the outskirts, and there were trucking and rail and warehousing and other kinds of machine production. This was all unionized work. In places like Pittsburgh or New York or Philadelphia or Detroit, a kind of quasi-social democracy emerged, in which workers had real power.

The American welfare state that emerged from the New Deal was distinctive in that it centered private sector employment and constructed a hierarchical relationship between the breadwinner and his dependents, particularly his wife and children. It constructed a stratified relationship between those with access to that social citizenship and those who stood outside of it and were thereby forced to survive in other ways, by servicing the people who did have access. That’s basically the relationship between the steel worker and the healthcare worker.

The book argues that we have had a dynamic for a long time in which health care routed through markets pits care workers against those for whom they care, or more broadly, between people who need care and people who get it. That can play out in the form of a generational conflict, and it often takes racialized and gendered forms, given who provides care. But there is also a basis to imagine a different kind of solidarity—between care workers fighting for different working conditions and those they take care of—given how unhappy consumers are at this point about the state of American health care. I think that is our best bet for working-class unity, on the model of the teacher strikes of the last decade, in which teachers’ working conditions and students’ learning conditions have been successfully equated in a political struggle. Hopefully it’s possible to imagine that cycle of working-class formation and activity around the principle that everyone deserves care.

We have an idea right now that there are phases of your life when you give care and phases when you receive it, or a group of people for whom care is the assigned task, and another group for whom care is an entitlement. The reality that everyone needs care is parceled out into an uneven social division of labor, around which lives are then structured unequally.

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