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The Next Shift

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The Next Shift

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

Harvard UP,

15 min read
7 take-aways
Audio & text

What's inside?

The collapse of the steel industry created a new – and worse-off – working class.

Editorial Rating



  • Analytical
  • Eye Opening
  • Hot Topic


Professor of history at the University of Chicago Gabriel Winant explores the origins of problems with the United States’ health care system that rose to the fore during the COVID-19 pandemic. Pittsburgh and its surrounding areas once were America’s manufacturing hub. Its steel mills provided security for thousands of blue-collar workers and their families. When this industry collapsed, another arose: medical and social care.


The United States’ care industry faces a “trilemma”: the choice between low wages, high unemployment or costly state intervention.

Recent years have seen increasing polarization in the US labor market: Profits accumulate in firms that don’t provide mass employment; those that do – for example, those focused on care services or education – operate at very low margins. Industries that care for people have limited options to increase productivity or efficiency.

Still, the care sector continues to grow rapidly and has become one of the largest US employers, providing one in seven jobs. Some employers in this sector seek to rid themselves of responsibility for their large workforces. For example, Pennsylvania’s largest private employer, the University of Pittsburgh Medical Center, claimed in 2013 that it had no employees. It achieved this feat through “fissuring,” which involves subcontracting work and misclassifying workers as independent contractors.

These extreme measures highlight the trilemma the care industry faces: It can keep wages as low as possible to continue high employment; increase wages and shed jobs; or rely on government...

About the Author

Assistant professor of history at the University of Chicago Gabriel Winant focuses on the social structures of inequality in modern American capitalism.

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