While there are many projects that require blue-collar work, there’s little reason to treat such employment as an end in itself. In the long view, it seems not to be a category of labor for which our economy generates consistent demand. Yet there are other kinds of jobs that we do seem to require, but reward with low pay and dangerous working conditions.
As Rachel Dwyer, a sociologist at the Ohio State University, has shown, the “care economy” — jobs tending to young, old, disabled and sick people, along with housekeeping, food service and domestic work — is the locus of significant employment growth. This sector generated 56 percent of growth in low-wage jobs in the 1980s, 63 percent in the 1990s, and 74 percent in the 2000s. Such workers, of course, have borne the worst of the pandemic’s dangers.
The problem with care work isn’t the lack of hard hats. The problem, rather, is that such employment is generally unregulated and nonunion, and paid for by the government (often through complex federal-state combinations) while administered by for-profit companies. Although these jobs serve a vital social need, these private employers have huge incentives to limit labor costs.
The care economy is the product of public policy, particularly Medicare and Medicaid. In 2019, these programs together accounted for 37 percent of our gigantic $3.8 trillion in spending on health care — a kind of unrecognized infrastructure bill that we pass automatically every year. The federal government could use that leverage to transform labor markets and improve care alike.
To make the best of this situation, it helps to recognize how it came about. As industrial employment contracted, it left behind populations that were poorer, sicker and older.
We have, in other words, been running for decades an industrial policy by accident out of the Center for Medicare and Medicaid Services, stimulating depressed labor markets and generating employment through federal contractors — hospitals, nursing homes and home care providers.
Yet this situation has not developed for the purpose of improving employment conditions. As a result it’s generated low-wage jobs historically already marginalized by their assignment to women, immigrants and African-Americans. Left-behind workers can’t travel back in time to a blue-collar golden age. Rather, they need policy to catch up with our work force and what it’s been asked to do.
Federal officials said they’ve conducted over 1,600 investigations since announcing the crackdown last fall focusing on residential care, nursing...