Money  /  Q&A

The Rise of Healthcare in Steel City

On deindustrialization, the care economy, and the living legacies of the industrial workers’ movement.

Serpe: You cite a RAND Corporation study from that time that shows the number of high-wage industrial jobs were going down as the number of low-wage service-sector jobs were going up. But the study doesn’t establish a relationship between these developments. This seems to be a common problem: a kind of mechanical understanding of transition from one economic order to the next. In some ways, your whole book is an exploration of how interwoven these developments are, and how drawn out and uneven the transition is. What are some of the ways that the decline of the industrial order in Pittsburgh shaped the coming postindustrial order?

Winant: First of all, you have to understand deindustrialization as a generational process, a long-term secular dynamic rather than an episode of just a few years. Industrial employment in Pittsburgh peaked in 1950 at the apex of the military-industrial cycle of investment that joins the Second World War and the Korean War. At that point, basically half of all employment in Pittsburgh was in manufacturing, mining, construction, warehousing, trucking, and other sectors that we now recognize as blue-collar work. After this massive but transitory pulse of investment, employment steadily declined.

That had severe demographic consequences. For one thing, the population shrank. The labor market was organized around seniority, and it was very heavily unionized, which meant that, as opportunity shrank, that shrinking opportunity was going to be felt unevenly by age. Young people, particularly young men, decided to leave the region entirely. Today, the population of Pittsburgh is 300,000, less than half of what it was in 1950. Some of that is suburbanization, but a lot of it is regional out-migration.

The population also, for the same reason, aged profoundly. By the 1980s, the population was old and quite sick. Because job losses create sickness—both by producing an older and thereby sicker population, and because when people who depend on work for their survival lose that work, they become housing insecure, they become stressed, their relationships become stressed, and alcoholism and domestic violence tend to increase.

People cast about for whatever economic resources they could find. And the thing that came through, more than anything else, was health insurance. Steelworkers and other industrial workers were able to carry their collectively bargained insurance with them into retirement. People who weren’t yet retired also had very good coverage for a time. Medicare and Medicaid bulked up and rounded out the system built around collective bargaining. And a massive healthcare sector grew up in correspondence with the healthcare market of industrial workers and their families. All of that outlived the job losses, and it provided people who were suffering economic dislocation a way of securing some amount of social support.