The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America 9780674259836
The American working class didn’t disappear with the manufacturing economy. It transformed. Instead of unionized blue-co
259 29 11MB
English Pages 352 [362] Year 2021
Polecaj historie
Citation preview
The Next Shift
The Next Shift The Fall of Industry and the Rise of Health Care in Rust B elt Americ a
Gabriel Winant
harvard university press Cambridge, Massachusetts London, E ngland 2021
Copyright © 2021 by the President and Fellows of Harvard College All rights reserved Printed in the United States of America First printing Jacket design: Monograph / Matt Avery 9780674259799 (EPUB) 9780674259836 (PDF) Publication of this book has been supported through the generous provisions of the Maurice and Lula Bradley Smith Memorial Fund The Library of Congress has cataloged the printed edition as follows: Names: Winant, Gabriel, author. Title: The next shift : the fall of industry and the rise of health care in Rust Belt America / Gabriel Winant. Description: Cambridge, Massachusetts : Harvard University Press, 2021. | Includes index. Identifiers: LCCN 2020041877 | ISBN 9780674238091 (cloth) Subjects: LCSH: Medical economics—Northeastern States. | Medical economics— Middle West. | Community health aides—Northeastern States. | Community health aides—Middle West. | Industries—Northeastern States. | Industries— Middle West. | Northeastern States—Economic conditions. | Middle West— Economic conditions. Classification: LCC RA410.54.U6 W56 2021 | DDC 338.4/736210974—dc23 LC record available at https://lccn.loc.gov/2020041877
To my parents, Debbie Rogow and Howie Winant, who have always dreamed of a better world and indeed made one for their children.
History is what hurts. —Fredric Jameson, The Political Unconscious: Narrative as a Socially Symbolic Act
Contents
Introduction: When Workers Disappear
1. Down in the Hole: Steelmaking Pittsburgh in the 1950s
1 25
2. Dirty Laundry: Labor and Love in the Working-Class Home 63 3. “You Are Only Poor If You Have No One to Turn To”: Race, Geography, and Cooperation
98
4. Doctor New Deal: Social Rights and the Making of the Health Care Market
135
5. Enduring Disaster: The Recycling of the Working Class
179
6. “The Task of Survival”: The Commodification of Care and the Transformation of L abor
218
Epilogue
259
List of In-Text Abbreviations
267
List of Bibliographical Abbreviations
269
Notes 273 Acknowledgments
337
Index 341
The Next Shift
A lle gh e ny
Rive r
North Side McKees Rocks
PITTSBURGH
Plum
Allegheny R i v er Lawrenceville Shadyside
Penn Hills
Wilkinsburg
Green Tree South Side Homestead
Braddock/ Rankin
McKeesport Bethel Park
r
Jeannette Greensburg
Clairton r
borde
Irwin
ah
ela
ounty
White Oak
Ri ve
eny C
Murrysville
Monroeville
Duquesne
Mt Lebanon
Allegh
C o u n t y b ord er
Oh io
ng no Mo
West Newton
The Pittsburgh area
0
6 miles 6 km
Introduction When Workers Disappear
I
n 2013, Pennsylvania’s largest private employer claimed before federal regulators that it “has no employees.” This institution, the University of Pittsburgh Medical Center (UPMC), added that it “conducts no operations” and “engages in no employee or industrial relations activities.” This argument surprised many because UPMC, a health care giant, dominates the regional economy. It looms over Pittsburgh from US Steel Tower, the tallest building in the skyline, on top of which the g iant letters “UPMC” have replaced “USS.” And the massive health care system today employs more than eighty-five thousand people—legal claims notwithstanding. Where did all the workers go?1 The hospital chain’s claim of having no employees, made in the context of disputes over its employment practices and tax status, rested upon a legal distinction between the parent company and its subsidiary entities. B ecause of its organizational structure, UPMC argued, it was not obligated to act in ways expected of an employer. This contention put UPMC in the growing camp of employers in all industries seeking to avoid responsibility for employment’s costs through the use of subcontracting or misclassification of workers as independent contractors—a phenomenon known as the “fissuring” of the workplace. A 2018 magazine feature on the subject used UPMC’s practices for its central example, telling the story of the outsourcing of the job of medical transcriptionist Diana Borland to a contractor that paid her per line rather than per hour. “As a UPMC employee, she had earned $19 per hour, enough to support a solidly middle-class life. Her first paycheck at the per-line rate worked out to just $6.36 per hour.”2 While UPMC’s claim was tactical chiseling at one level, at another the assertion also symbolizes a profound paradox in the American political economy:
2
The Next Shift
care workers are at once everywhere and nowhere. They are responsible for everyone, but no one is responsible for them.3 The practice of “fissuring” is only one formalized manifestation of this deeper phenomenon. In a large-scale pattern often described as the “polarization” or “dualization” of the economy, profits accrue increasingly to firms that do not generate mass employment, while labor simultaneously accumulates in low-margin industries far from profits. The accumulation of capital is more and more decoupled from employment not just by formal corporate structures but also by the mix of commodities that h uman labor is required to produce. What has changed is not just the corporate organization of labor markets but also, beneath it, the social division of l abor.4 This change has meted out severe social consequences. High-employment, low-profit industries—such as health care, education, and social services— experience constant downward pressure on their margins as a result of t hese industries’ limited opportunities for productivity gains, a problem inherent to the provision of human serv ices. The pattern even plays out inside the bounds of a given industry like health care, as pharmaceutical companies, insurers, and medical technology firms capture the profits, while hospitals, home health agencies, and nursing homes—the engines of employment— operate less profitably, further down the value chain. Unable to achieve steady advances in efficiency of production, such employers instead sustain themselves financially by increasing prices and suppressing wages. “I have not received a raise for approximately 10 to 12 years from my employer, and I pay the same price for bread as they do,” one Pittsburgh hospital worker testified in 2015.5 This category of labor-intensive, low-productivity, low-wage industries has grown rapidly in its share of overall employment. Such a possibility is intrinsic in the transition from an industrial to a serv ice economy, although specific political institutions elaborate or inhibit this possibility, leading to international variation. Everywhere across the global North, as the power of the organized working class collided with declining manufacturing profits, a sectoral transformation ensued—and the care economy expanded, within the public sector or adjacent to it.6 The choice for capitalist democracies, social scientists observe, forms a “trilemma”: a three-way choice between unemployment, low wage growth, or
I n t ro d u c t i o n
3
high public deficits. Institutional particularities at the national or subnational level, shaping the extent and contours of inequality, represent elaborations of this underlying general predicament. “There are huge areas of servicing which are labour intensive and low-skilled. The lower end of servicing society is where we must pin our hopes for mass employment,” observes Gøsta Esping-Andersen. “Unfortunately, because of their sluggish productivity, low-end serv ice jobs are threatened by a long-r un ‘cost-d isease’ problem. [Service-sector] employment is therefore likely to stagnate unless wages slide downwards.” 7 Hold wages down to encourage job creation, accept high unemployment in return for good wages, or embrace costly direct state intervention in employment—t hese are the contours of the trilemma. In the United States, through our hybrid public-private welfare state, we have selected the option of mass low-wage private-sector employment. Exploitative working conditions for some, however, enable security for others, because the millions of jobs that have proliferated at the bottom of our dual economy originate, to an astonishing degree, in the rising care economy. This category encompasses the provision of direct and indirect services to develop and sustain human capacities, including tending to the young, old, disabled, and sick and supporting daily life through housekeeping, food serv ice, and domestic work. While all t hese categories of employment have expanded markedly, health care accounts for the largest part of the care economy phenomenon.8 In the bottom quintile of the American wage structure, the care economy accounted for 56 percent of all job growth in the 1980s, 63 percent in the 1990s, and 74 percent in the 2000s. The workers who “do not exist”—whom UPMC disavowed—a re found h ere, in vast and growing numbers, in the lowest strata of the l abor market, their multiplication driving the overall increase of inequality. Insofar as this sector of employment has long been demarcated as a degraded one assigned largely to w omen, especially w omen of color, this polarization dynamic also represents the stubborn reproduction of racial and gender hierarchy in and through labor market processes. Equally, the reconstruction of labor markets since industrial decline has depended on preexisting hierarchies of race and gender.9 The extraordinary growth in the volume of this work, however, also suggests that it is meeting some demand, fulfilling some major social function
4
The Next Shift
or providing some important value. But this value is not reflected in the money paid to the workers for their role. Indeed, employers in the care economy diverge in several important ways from expected capitalist practices: the markets in which t hese employers compete are imperfect; they rely directly and intensely on public subsidy; and they do not generate sustained productivity gains.10 Focusing on care work adds a critical layer of complexity to the increasingly intense discussion in recent years over the transformation of l abor and its relationship to inequality. In one view, stable formal employment has stalled out under severe structural burdens. Unemployment, indebtedness, and precarity, in this analysis, have become the fundamental human experience of capitalism over the past several decades—whether because of a deepening crisis of growth and profitability resulting from global competitive pressures; the acceleration of automation; or both. Other observers see a more open-ended dynamic, in which the prospects of labor rise and fall without any necessary historical tendency and are amenable to collective political intervention of familiar kinds.11 Neither account, however, has a clear place for the growing care economy. If we are living through a secular decline in formal or traditional employment, how are we to explain the ascent of this sector of the labor market, as other industries have collapsed all around it? Why, specifically, did demand for institutional care increase so rapidly, driving an extreme expansion in low-wage care work? If, on the other hand, we see the process as contingent, then we do not attach major significance to the shifting sectoral pattern of employment; instead, the care economy appears as just the next growth area, one in a long sequence. This view presents a problem in that the new sector seems to be such an anomalous one in the history of capitalism, in which self-sustaining productivity growth has historically been a defining feature. Placing the rise of the care economy in historical perspective helps to reconcile t hese positions. It was not a coincidence that care labor grew as industrial employment declined. The processes w ere interwoven. The collapse of the industrial core of the economy created social problems that became translated, through the mediation of the welfare state, into the form of health problems. As their livelihoods disintegrated, working-class
I n t ro d u c t i o n
5
eople brought pressure to bear, demanding social support. This pressure p occurred to some degree as direct political agitation, but more consequentially took the form of the economic power that organized workers wielded when they acted as blocs of collective consumers, expanding the system of care provision. The resulting institutions generated employment on a massive scale. Care workers’ numbers t oday have grown to the extent that their census- designated sector of the labor market—“ health care and social assistance”— is the country’s largest, claiming about one in seven jobs nationwide and even more in places like Pittsburgh. Across the old industrial zones of the northern and midwestern United States, this figure rises today toward an enormous one in five jobs. In numerous cities similar to Pittsburgh—Milwaukee, Buffalo, Rochester, Baltimore, Detroit, Cleveland, Philadelphia—hospitals account for the majority of the largest employers. Where one institution—like Pittsburgh’s UPMC, Baltimore’s Johns Hopkins University Hospital, or the Cleveland Clinic—has managed to consolidate its market, that hospital may reach the position of the largest private employer in the entire state.12 No major urban area in the South or West rivals the Rust Belt cities in terms of health care’s share of employment (see T able I.1). At the same time, workers in the health care industry face low wages and precarious working arrangements (as do workers across the care economy in industries not studied in this book). Only months before UPMC alleged— in the context of a labor dispute—t hat it employed nobody, the hospital system was in the news for setting up a holiday food bank for its own workers to share food with one another.13 Poverty wages, understaffing, stress, precarious scheduling, and workplace disrespect often come with the job for people who wash and feed bodies, do laundry, change sheets, clean rooms, administer medic ation, run tests, provide therapies, and proffer emotional support. The paradox, then, consists in the extraordinary proliferation of this kind of employment, suggesting its increasing social importance, alongside the economic exclusion of so many who perform it. This exclusion marks a sharp contrast with the city’s celebrated working-class past. From US Steel Tower (relabeled by UPMC), the hospital giant looks down on a town still nicknamed Steel City. The local beer is Iron City; the football franchise is the Steelers;
The Next Shift
6
Table I.1. Top twenty-five urbanized counties by percentage of workforce employed in health care and social assistance, 2017
County
Largest city
Bronx County, New York Philadelphia County, Pennsylvania New Haven County, Connecticut Cuyahoga County, Ohio Kings County, New York Allegheny County, Pennsylvania Suffolk County, Massachusetts Essex County, New Jersey Monroe County, New York Worcester County, Massachusetts Essex County, Massachusetts Hartford County, Connecticut Norfolk County, Massachusetts St. Louis County, Missouri Queens County, New York Milwaukee County, Wisconsin Westchester County, New York Erie County, New York Nassau County, New York Baltimore County, Maryland Wayne County, Michigan Pinellas County, Florida Multnomah County, Oregon Hamilton County, Ohio Hidalgo County, Texas US national average
The Bronx Philadelphia New Haven Cleveland Brooklyn Pittsburgh Boston Newark Rochester Worcester Lynn Hartford Quincy St. Louis Queens Milwaukee Yonkers Buffalo Hempstead Baltimore Detroit Saint Petersburg Portland Cincinnati McAllen —
Workforce employed in health care and social assistance (%) 25 19 19 19 18 18 17 17 17 17 17 17 17 17 17 16 16 16 16 16 16 16 16 16 15 14
“Urbanized counties” are the one hundred counties nationwide with the largest workforces. Source: Data are from United States Census Bureau, 2017 American Community Survey 1-Year Estimates, Industry by Sex for the Civilian Employed Population 16 Years and Over.
the president need only invoke the city’s name to inveigh against environmental regulation; and only a few steelworkers remain (see Figure I.1.). Why does this enormous new service-sector working class not wield power or permeate public consciousness, even as the ghost of its vanished industrial pre decessor still hangs over places like Pittsburgh—and indeed over the national political culture?
I n t ro d u c t i o n
7
200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0
1950
1960
1970
1980
1990
Health care and social assistance
2000
2010
Metal industries
Figure I.1 Employment in metal production and health care and social assistance, Pittsburgh area, 1950–2010. Data source: US Census.
This mirrored historical paradox—between care workers’ absent presence and industrial workers’ present absence—is the puzzle of this book. How do the simultaneous growth of this industry and the persistent marginalization of its workers fit into the country’s changing political economy? Why did the health care industry expand so much and in this particular form? How did Steel City become a city of nursing assistants? This book shows how the industrial economy and the institutions that surrounded it created the care economy. In Pittsburgh, both the booming market for care and the huge workforce to supply care grew out of the social and po litical context of the steel mill. The factories did not just make metal goods; they made people, institutions, a way of life, and a system of relationships— a social world. As the industrial basis of this world began to collapse, its inhabitants came under worsening social and economic pressure. To manage, they drew on the resources they had, embedded in the relationships and identities they had already built—the everyday history they already had lived. Their world was melted down and recast, but it was still made from the same materials.
The Political Formation of the Postwar Working Class oday’s care economy emerged out of the economic transformation of the T 1970s. That process in turn makes sense only in light of the preceding
8
The Next Shift
institutional architecture and social history shaping the postwar working class. And this postwar history was itself determined in the great political struggles of the 1930s and 1940s. The New Deal and its aftermath, in other words, set the stage for what would come later, in the 1970s. The dramatic world events of t hose early crisis years settled into an ambiguous, fragile equilibrium in the late 1940s. Stepping onto the stage as world hegemon, the United States embarked on the reconstruction of the shattered capitalist economies of Europe and Asia and the containment of its socialist antagonist. At home, the acute social conflicts that had propelled the New Deal’s reform program froze over with the Cold War. This eventful history played out on the ground with particular intensity in urban industrial centers like Chicago, Detroit, New York, and Pittsburgh—places that lay at the heart of the New Deal political project, where g reat concentrations of the industrial working class had organized and rebelled.14 The labor movement made the greatest advances in American history during the 1930s and 1940s. Labor became a central pillar of the Democratic Party coalition, gained l egal recognition, and successfully organized the mass production industries at the economy’s core, bringing about unprecedented working-class unity across lines of race, ethnicity, and skill. In the aftermath of the strike wave of 1934, Congress passed the National Labor Relations Act (NLRA), seeking to reestablish stability in industrial relations by facilitating collective bargaining through the National Labor Relations Board (NLRB).15 When the Supreme Court constitutionalized collective bargaining in 1937, it was in a steel industry case from western Pennsylvania: National Labor Relations Board v. Jones & Laughlin Steel Corporation. The Court found that the internal operations of a vertically integrated firm like Jones & Laughlin affected and constituted interstate commerce, thus rendering constitutional the federal government’s regulation of the corporation’s labor relations. In its landmark decision, the Court quoted the NLRB’s conclusion that the steel works in western Pennsylvania “might be likened to the heart of a self-contained, highly integrated body. They draw in the raw materials from Michigan, Minnesota, West Virginia, Pennsylvania, in part through arteries and by means controlled by the respondent; they transform the materials and then pump them out to all parts of the nation.”16 To govern production, the American state cast its eye on a vast industrial geography across Appalachia and the Midwest, with the steel mills of
I n t ro d u c t i o n
9
Pittsburgh as the central focus. But if the stated purpose was the smooth flow of commerce, the specific instruments and objects of governance were human. The Court continued, “To carry on the activities of the entire steel industry, 33,000 men mine ore, 44,000 men mine coal, 4,000 men quarry limestone, 16,000 men manufacture coke, 343,000 men manufacture steel, and 83,000 men transport its product.” U nder the NLRA as upheld in Jones & Laughlin, the industrial workforce itself now appeared as an object of state knowledge and intervention, conceptualized as a bounded social unit.17 Riding a wave of militancy and enjoying this new l egal standing, the l abor movement strode ahead rapidly. Union density, scarcely above 12 percent and largely excluded from mass production when the G reat Depression began, rose above 30 percent by the end of World War II, led by the organizing of mass production workers by the militant new Congress of Industrial Organ izations (CIO). In Pittsburgh, decades of managerial domination gave way rapidly to a dynamic workers’ insurgency, unionizing the mills and ousting management’s puppets from local government. The war mobilization, and the full employment it generated, further entrenched the labor movement and extended the new administrative state into the regulation of economic life. Simultaneously empowered and constrained by this incorporation into the state from 1937 to 1945, the left wing of the New Deal coa lit ion then ran aground in the decade’s second half.18 Labor started strong after the war’s end, when an enormous strike wave shook the country. Five p ercent of the entire population joined work stoppages occurring across major industries. Along with Rochester and Oakland, Pittsburgh experienced a general strike in 1946, when tens of thousands of steelworkers, electrical workers, bus d rivers, and streetcar operators walked out in solidarity with the employees of the power utility. Of the tens of millions of person-days of work lost to strikes that year, Pennsylvania alone accounted for 17 percent. More than half of the total strike action occurred there or in Illinois, Michigan, New York, or Ohio—the geographical core of the New Deal’s mass base, resembling the industrial body anatomized in Jones & Laughlin.19 Such militant industrial action on such a narrow geog raphical basis exposed the labor movement to severe politic al backlash. Republicans retook power in the 1946 congressional elections, then promptly passed the Taft-Hartley Act. This new legal regime allowed state right-to-work laws,
10
The Next Shift
excluded new categories of workers from the protections of labor law (adding to the original NLRA’s exclusions of domestic and agricultural workers), compelled u nions to expel Communists, and forbade a number of militant tactics. Following quickly on Taft-Hartley’s heels was the failure of the l abor movement’s attempt to organize the South and escape geog raph ical confinement.20 McCarthyism capped off this reactionary cycle, purging what remained of 1930s radicalism from virtually every sphere of public life: workplaces, schools and colleges, culture industries, and state institutions. As historian David Caute observes, “The violent epicenter of the anti-Communist eruption in postwar America was the steel city of Pittsburgh, in western Pennsylvania.” Catholic priests and local officeholders, with the aid of federal agents, rallied to turn the region’s heavily southern and eastern European working class against the Soviets menacing t hese workers’ old countries. Local newspapers published the names and addresses of supposed Communists or even citizens who had signed petitions for the 1948 left-w ing presidential candidate Henry Wallace. Factory managers surveilled workers and fired t hose suspected of subversive activity. After the radical union representing thousands of workers in Pittsburgh’s large Westinghouse plants, the United Electrical Workers (UE), refused to comply with Taft-Hartley’s proscription of Communists, the CIO expelled UE and chartered a rival union to raid UE shops and pull away membership in a campaign aided by Catholic clergy, decimating the left-led union.21 This reaction against workers’ militancy in the late 1940s—i nitiated by conservatives and abetted by liberals—circumscribed and remade organized labor. Powerful unions like the United Steelworkers of America survived and remained able to grind their particular industries to a halt. But the dynamic of the previous fifteen years, in which labor had stood at the vanguard of a broad-based democratic political movement of the working class at large, ceased. Unions became more and more confined to a parochial economic project, advancing the narrow interests of their own memberships. Collective bargaining had never encompassed everyone, but from 1950 onward, it increasingly formed only insulated pools of economic security—no longer an advancing tide.22 This insulation s haped the welfare state and the longer development of America’s political economy profoundly.
I n t ro d u c t i o n
11
Collective Bargaining and the Divided Welfare State In the late 1940s and early 1950s, the New Deal was not defeated and rolled back but rather contained and compromised. Within the project of broad- based economic security, there had always been traditionalist as well as more radical tendencies. Present and powerful from the start, t hese conservative strains came to the fore as radical challenges died off. Left-led antiracist l abor organizing collapsed. Gays and lesbians faced a wave of repression. Feminist New Dealers and w omen labor activists saw their visions of gender equality fall to rising backlash, as the norm of patriarchal family-wage liberalism, already embedded in social policy from the 1930s, came into full effect. As time went on, the institutional apparatus of economic security—t he welfare state and the labor movement—continued to effect some downward re distribution of wealth, but this apparatus also simultaneously secured the shape of the broader social hierarchy.23 Collective bargaining was a central arena for this process, which elevated industrial breadwinners into the primary subjects of economic security. Unable to preserve the wartime price-control regime, labor began to negotiate for cost-of-living increases for its own members—effectively constructing a zone of privatized monetary policy. Unions, having failed in their ambition to win a national health insurance program, committed to the strategy of negotiating private welfare benefit systems—walled-off zones of security for their members and dependents. The federal judiciary sustained this practice in two more steel industry cases, which together affirmed that fringe benefit negotiations w ere a mandatory part of collective bargaining. In exchange for this privatized security, l abor abandoned its older ambitions for less work and more workplace democracy.24 This set of compromises, hashed out during the war and in the twilight of the New Deal, differentiated the organized sections of the working class from their insecure counterparts. While securing industrial workers, this arrangement disciplined them through that security. NLRB attorneys explicitly drew this link between security and discipline: “Most employers who initiate pension plans expect and, it is presumed, get improved morale and employer- employee relations, and, in turn, improved production and greater efficiency, by removing one of the basic insecurities plaguing workers t oday.”25
12
The Next Shift
nder this solidifying system, the welfare state disbursed social citizenU ship and economic security to the working class through a divided and uneven regime centered on collective bargaining. Private labor markets in the industrial sector became the key instrument of social policy for the privileged subjects of the welfare state, providing health care, unemployment insurance and job security, seniority rights, retirement benefits, and more. These forms of security rested upon collective employment relationships conducted u nder public supervision, often eased with public subsidy and transacted through nonprofit third parties.26 Indeed, in no case was the welfare state’s tiered dynamic clearer than in health care, where the emergence of the New Deal state and its penetration of industry through collective bargaining led to the proliferation of third- party nonprofit health insurance and eventually to the massive expansion of private, nonprofit hospitals. When, as in the case of Medicare, the public sector stepped in more aggressively, it did so as a consequence of the effects of the public-private regime: the rise of collectively bargained health insurance drove up the price of health care in the 1950s, pushing it out of reach for the elderly, who u nder this welfare state’s moral order w ere deserving subjects—leading to political demand for health insurance entitlements for retirees and, in second-class status, the poor.27 Even direct public intervention, in other words, positioned the state as a consumer rather than supplier of health care, rounding out the uneven and divided welfare state rather than intruding on it. Private entities, encouraged and s haped by public policy, afforded working- class people a buffer against shocks, provided they arranged themselves socially in a particular way and lived their lives along a particular course. While encouragement of long duration in industrial employment dated to the early twentieth c entury, the New Deal had solidified this project, institutionalizing a normative life course—“a ‘normal’ working life,” as Franklin Roosevelt’s Committee on Economic Security put it. Working-class p eople w ere supposed to form heterosexual nuclear families, have kids, hold down a factory job full-time and accumulate seniority if a man or marry a factory worker if a woman, buy a house and a car, go on strike during contractually specified episodes, go to the hospital when sick, and retire with a pension. Collective security depended on these collective behaviors. And while business cycles went up and down and structural pressures on employers mounted,
I n t ro d u c t i o n
13
the near-constant stimulus of Cold War military expenditure kept the orga nized core of the economy somewhat insulated, allowing intermittent but real progress through this life course for a large, select group.28 Now the new public-private welfare state constituted organized industrial workers into actuarial pools synced to this life-course sequence, securing them collectively b ecause they advanced through the world en bloc temporally—warping the fabric of time around themselves. This pattern underwrote their privileged place in the uneven welfare state. While it is widely known that the uneven distribution of the postwar working class in space gave rise to the explosive racial politics of integration in housing and schools, the uneven distribution of the working class in time shaped the stubborn postwar problem of inflation: t hose who inhabited the more coordinated pockets of the economy were less exposed to rising prices. Simultaneously, this pattern churned the rest of the economy in a worsening inflationary cycle.29 The security claimed by industrial workers, however, did offer shelter to a broader section of the working class through relationships of legal depen dency, concentrated in the family. In this sense, the male-headed household formed the elementary institution of the public-private welfare state: a private social collectivity enjoying privileged legal status and public subsidy, sustained and expanded by social policy. The subjects of this order, the persons it recognized most fully, were the heterosexual white men who held most factory jobs and headed most working-class households. African American men had a real foothold within this world, but it was small, confined, and eroding. For w omen, the main access point to security was marriage to such a breadwinner—an unlikelier prospect for Black women, as factory work eroded rapidly for Black men, in turn yielding a distinctive political orientation for Black women’s survival strategies and activism.30 The security that the public-private welfare state produced for its subjects— the insiders of the collective bargaining regime—was not just financial in form. In important ways, this security also consisted of privileged access to devalued and invisible forms of l abor. The f amily, the nucleus of the regime, provided the starkest example. Formally, the wife and c hildren of an industrial worker were his dependents; women and children accessed income and economic security through the male breadwinner, as encoded by custom and social policy alike. In practice, the industrial worker and his employer both
14
The Next Shift
depended on the heteropatriarchal nuclear f amily, which was mass-production capitalism’s instrument for obtaining and reproducing a stable workforce— although it was of course impossible to draw a distinction between affect and work in this decommodified, unquantified zone. Similarly, the increasingly comprehensive health benefits of the postwar period entitled their bearers to the insecure labor of care workers. Workers’ benefits, a transaction denominated in the economy of the becalmed insider zone, then were spent to import serv ices from the insecure outsider zone—like an unequal international trade relationship in which one currency is far stronger than the other.31 This relationship between security for the insiders of collective bargaining, and insecurity and precarity for the outsiders who provided them care, was a political effect. It represented the narrowing of the possibilities opened by the New Deal. The establishment of a perimeter around collective bargaining and the privatization of the welfare state brought this effect into force. Initially, hospital workers had held unclear status under federal labor law. Swept up in the militancy of the 1930s, however, some groups of health care workers—frequently w omen and African Americans—had pressed their case. In Pittsburgh, hospital workers revolted in 1940 over starvation wages and twelve-hour days, seeking recognition for a new CIO union at Western Pennsylvania Hospital. Management refused. In the ensuing dispute, twenty-six area hospitals sought an injunction against the union. “Hospitals,” the petitioners argued, “are not employers, nor are persons connected with them employees.” The Pennsylvania Supreme Court agreed: hospitals were a form of semipublic service, “not an industry.” To subject them to state labor law would “seriously imperil the management of the hospitals and the lives, health and safety of the patients.” Despite this battle in Pennsylvania—which presaged what was soon to come in the late 1940s—federal courts eventually affirmed in 1944 that hospital work affected interstate commerce and came u nder the 32 jurisdiction of the NLRB. The conservative reaction of the late 1940s, however, shortly gave relief to hospital administrators. As Congress was considering the Taft-Hartley Act, Senator Millard Tydings proposed an amendment to exempt hospitals from labor law, apparently prompted by the American Hospital Association. “They are not in interstate commerce. A hospital is a local institution, quite often kept up by the donations of benevolent persons,” Tydings argued; “no profit
I n t ro d u c t i o n
15
is involved in this work.” The m atter received l ittle further consideration, and Tydings’s amendment became law with Taft-Hartley.33 Thus, although hospital work was formalized employment in ways that wife-labor and domestic work w ere not, it nevertheless remained legally beyond the protections of the New Deal state in ultimately similar ways— exempt from the Fair L abor Standards Act’s wages and hours regulation as well as from the NLRA. At the cultural level, state regulation now positioned health care as an intimate sphere, more akin to the family than the factory. Health care was outside the circulatory system of commerce. Health care workers were not part of the working-class body envisioned in Jones & ere its external attendants. Laughlin—rather, they w The postwar welfare state had an inside and outside, and the boundary was the limit of collective bargaining. But exclusion did not necessarily mean detachment; the excluded w ere mobilized, and exploited, for a purpose. Altogether, this regime worked to produce the life and secure the social reproduction of the working class, albeit in differential and uneven forms demarcated by, and reinforcing of, race and gender. The system maintained people and communities, giving shape to their biological lives and molding the social realities of childhood, parenthood, marriage, sexuality, working life, old age, sickness, disability, and death. In doing so, the welfare state did not just bring about economic security or insecurity but also normalized and disciplined individual subjects. The welfare state in its various guises did all this through caregivers’ l abor but did not confer security upon their labor.34 Achieving public ends through the instrument of private and even intimate forms of social organization submerged care work beneath layers of private power, often taking racialized and patriarchal forms. This regime gendered workers as caring subjects with various degrees of racial subordination—a kin to wives or domestic servants—and appropriated the product of their work for the regime’s larger social purposes. In its governance of care, the emerging postwar welfare state—a hybrid of persistent New Deal liberalism and rising conservative reaction—t hus established its own “fissured” or “dual” labor regime, long before the phenomenon we have come to know in recent years. This arrangement, encoded in the economic organ ization of caregiving, persisted through the entire postwar period—even after labor law reform in the 1960s and 1970s—a nd thus formed the groundwork for the postindustrial labor market. The historical relationship between
16
The Next Shift
Pittsburgh hospitals’ claim not to be employers in 1940 and their repetition of this claim in 2013 was not reoccurrence—before and a fter the postwar parenthesis—but rather continuity.
The Decline of Industry and the Rise of Care Over the postwar decades, employment in manufacturing underwent a long secular decline. Workers in industry after industry fell prey to some combination of automation, disinvestment, and capital flight, beginning as soon as the 1950s. Surface mining came to coal; decentralization and automation to auto assembly, electronics, and meatpacking; runaway shops to textiles; containerization to shipping; global trade competition to steel. Across the industrial areas of the country, communities secured through their attachment to these industries came u nder intensifying economic pressure.35 This long dissolution of the industrial working class happened, however, in the context of the postwar welfare state. Across the industrial United States and the entire global North, working-class people responded to the secular crisis of manufacturing employment by making demands on state institutions, directly in political forms and indirectly through mass behavior as social service consumers. And across the entire deindustrializing world, a wave of welfare state expansion followed in the immediate aftermath, as governments responded to these demands and sought to manage the appearance of new forms of poverty amid the postwar plenty.36 In the United States, we have not understood this political phenomenon as a single event but rather know it as a sequence: the War on Poverty, the Great Society, the urban uprisings, the welfare rights and Black Power movements, the Young Lords, labor’s rank-and-file rebellion, the fiscal crisis of the state, and stagflation. As displacement widened from a phenomenon confined to African Americans and Latinos across northern cities and white people in discrete pockets during the 1950s and 1960s to a general malady of the working class in the 1970s and 1980s, the problem expanded gradually from one of impoverished areas to a full-blown macroeconomic crisis. And it mobilized increasing state responses—a lbeit not all of one kind.37 In health policy and economics, a substantial body of evidence shows that poverty, job loss and unemployment, aging populations, generous insurance policies, and well-capitalized health systems all may contribute to
I n t ro d u c t i o n
17
e ither poor population health, high rates of utilization of the health care system, or both. Th ese phenomena of course may occur separately. But t here exists a distinctive historical process that produced all of them together: deindustrialization. The social formations left b ehind by manufacturing w ere—at the level of the population—disproportionately aged, sick, unemployed, impoverished, and yet relatively well insured. This generalization does not mean that each individual in a Rust Belt town was elderly, ailing, broke, and well insured, nor that the only way t hese phenomena occur is through deindustrialization. Nor, of course, does health trouble happen only by economic mechanisms or only to working-class p eople. Neither does old age affect only the dispossessed—particularly in a society enjoying lengthening life spans. Disproportionately large pockets of p eople in all t hese categories, however, could be found in various overlapping patterns, left b ehind as the legacy of manufacturing and the industrial workers’ welfare state. As manifested at the aggregate level, this demographic and economic configuration channeled the experience of job loss into the form of patient demand, flowing through the doors of the hospitals built up to serve the market formed by the insured working class. This process coincided with rising economic pressure on single-breadwinner h ouseholds to bring in more wages, pushing women into the l abor market and decoupling the rising demand for care from the supply of nonwaged care work that once helped to manage that demand—f urther speeding its flow into institutional settings. With the secular crisis of industrial employment, the working-class population demanded more care. Women, increasingly pushed out of the nonwaged domestic sphere by economic pressure, w ere pulled into a booming labor market in care work. When women sought waged employment in the 1970s and 1980s, they entered a sector already long since cordoned off by the institutionalized racial and gendered logics of the postwar welfare state.38 As the social reproduction of the working class became an increasingly vexed question, the preexisting system of subsidized health consumption elevated health institutions, turning them into prime points of access to care beyond the household. B ecause of the health care system’s fragmented, public- private structure—linking everyday, labor-intensive care provision to the profits of insurers, drug companies, and investors—and because of the system’s access to a market in the devalued l abor of care workers, the health care
18
The Next Shift
system had the slack to accommodate rising demand for mass care. The public and privatized institutions of health provision established over the postwar years pumped income into working-class communities as other sources of security collapsed. While Medicare and collectively bargained programs were predominant, even Medicaid, the poor stepchild of health insurance, saw its budgetary footprint grow by almost half from 1981 to 1988—whereas the food stamp program, by comparison, shrank over the same period.39 Rising social need thus met a relatively obliging health care system, which grew countercyclically to absorb the shock of industrial employment’s collapse. The institutions of social policy constructed between the 1930s and the 1960s worked to shunt the social crisis of deindustrialization into the health care system. At the bottom of the labor market, waged care work proliferated, responding to the process of industrial decline. In historical perspective, the process appears in close parallel to the rise of mass incarceration. Like the expansion of the prison system in the final decades of the twentieth century, the rise of the health care industry offered an economic fix to the social crisis brought about by deindustrialization, channeling public expenditure and state power into the management of surplus population, generating employment, profits, and social stability.40 In this light, the relationship between the midcentury “egalitarian” period and our own time looks quite different. It was postwar liberalism that created the public-private welfare state that remains with us; that accepted the exclusion of huge categories of workers from social protection; that laid the groundwork for mass incarceration; that elevated the heteropatriarchal nuclear f amily into the only acceptable form of working-class household; that established widespread racial segregation in housing; that turned to financial markets to help policymakers govern through fiscal crisis; and that established a pluralist regime for labor law that could be captured by employers.41 Still traveling down this continuous historical path, we would be wrong to see the early twenty-first c entury as a return to the Gilded Age. As a general rule, t hese compromises reflected apparent political necessity. In many cases, conservatives forced the settlement on liberals. We should not read these outcomes as evidence that the postwar welfare state was essentially “good” or “bad,” “exceptional” or “normal.” The point is not to exceptionalize what was distinctive about this period of history but to provin-
I n t ro d u c t i o n
19
cialize it: to see the factory worker, and the social order built around the factory worker, as embedded within larger and ongoing historical processes. Industrial employment was the key node in the mesh of power governing and shaping a larger population, to which the formal employee was linked in hierarchical, asymmetrical relationships of interdependence through the family. But this arrangement deteriorated over time as factory workers lost their jobs, gradually turning an apparently narrow economic problem into a broadly social problem as it widened to destabilize a growing population. This later widespread instability, when deindustrialization manifested socially as a problem of populations of disposable and dependent people, allows us to look back and see how the New Deal state was always engaged in a project of securing, maintaining, reproducing, and ordering the life of the population. This project became evident when its basis eroded.42 Health care as a site of employment expanded in the United States in ways roughly parallel to what happened in other wealthy capitalist democracies. Yet, in other wealthy societies undergoing deindustrialization, while health care employment grew, health care provision did not depart markedly from other aspects of welfare states; health care provision grew as welfare states did. In the American context, in contrast, the health care system stood virtually alone, booming dramatically alongside punitive social policy. Health care, because it was so deeply enmeshed in private markets and profitable accumulation opportunities, continued to attract public expenditure—a lbeit in increasingly warped and anomalous ways, as health care departed more and more from the economic ruination that surrounded and fed it. It is in this sense no coincidence that the United States began to depart markedly from other rich democracies in terms of health care spending only in the early 1980s, when the ax swung for the rest of the American welfare state.43
Why Pittsburgh? ecause the welfare state was privatized, it was also geographically uneven, B following the patchy distribution of industrial employment. Deindustrializing places then shared similar experiences, as job loss led to crisis; crisis stimulated pressure on the institutions of social reproduction; and the industries that could attract public investment and meet political and social
20
The Next Shift
demand, answering that pressure, grew. This pattern was not limited to the United States, although it flowed through different institutional channels and produced disparate social and political outcomes in various national contexts.44 While some version of the argument here likely applies to other cities, Pittsburgh and its surrounding area exaggerate key features, revealing dimensions that might otherw ise remain invisible. The region’s social fabric was warped by steel, but in ways that amplified what was generally true of industrial centers. This book thus takes as its territory of examination Allegheny County and the surrounding counties, which formed an economic unit: the city in the center; steel mills and other factories in the inner ring of surrounding blue-collar towns; white-collar suburbs in the next layer; then coal mining and agricultural areas farther out, dotted with smaller industrial towns.45 The drama of industrial decline appeared in particularly stark and visible form in Pittsburgh. From 1930 to 1960, the local economy grew at only half the rate of the national economy.46 The simultaneous economic dominance and stagnation of steelmaking, in turn, gave shape to the rest of the metropolitan political economy. Pittsburgh strained under the weight of the decaying industrial g iant in its core, and the signs were visible throughout the region’s social fabric. For almost a century, because of the dominance of a single declining industry, the region has failed to attract major migration streams from either the South or overseas, yielding the city’s stagnating population enduring demographic makeup: approximately 70 percent white and 25 percent African-American. As a result of its economic composition, postwar Pittsburgh also developed a pronounced version of the household-workplace divide that characterized the postwar period broadly. W omen worked for wages at a far lower rate than in the country as a w hole: 30.8 percent in the city’s metropolitan area in 1960, compared with 40.2 percent nationwide.47 The economic compulsion for women to seek waged work was weaker b ecause of the large number of high- wage working-class jobs for men in the steel industry, while the demand for unwaged care was exaggerated. In Pittsburgh, the growth of the health care sector that characterized postwar America generally was also exaggerated. By the late 1970s, Pittsburgh was consuming health care at prodigious rates and, to serv ice this demand,
I n t ro d u c t i o n
21
had more health care workers per capita than any other major metropolitan area—17.3 full-time equivalent workers per thousand p eople in the population, next to a national average of 13.8 at the decade’s end.48 Accelerating this sectoral growth was the steep aging of the metropolitan population, itself an effect of long-term industrial decline. The large, youthful cohort that entered the steel mills a fter World War II was never fully replaced as the industry tended downward. U nder the rule of seniority, opportunity thus declined most strongly for young p eople, who tended increasingly to out-migrate. In 1950, 38 percent of Pittsburgh-a rea steelworkers were over the age of forty-five; in 1980, half w ere. By 1990, Pittsburgh would become the second-oldest urbanized metropolitan area in the country—behind only Florida’s Broward County.49 Dependence on steel, in other words, drove Pittsburgh to mobilize its care workforce at high levels of intensity. The maintenance and reproduction of working-class life were routed institutionally through steel production, so the decline of steel production had immediate implications for caregiving. Sites of caregiving, from the h ousehold (earlier) to the hospital (later on) developed a larger role; their footprint grew. This development, while tethered to steelmaking by social policy, also outlasted the end of steel and indeed grew further in response to deindustrialization. By following the thread of care through the transformation of Pittsburgh, we uncover the origins of t oday’s polarized economy.
What Is at Stake? This book traces an arc of transformation, as Pittsburgh’s working class endured a crisis of social reproduction and recomposed itself. The narrative expands from the claustrophobic midcentury factory and h ousehold to the broader scales of neighborhood and public institutions. As the focus widens, the book works its way outward from within the secured world of the postwar welfare state, and a narrative that begins with the largely white, unionized industrial workers of the steel mills concludes with largely African American low-wage hospital workers. Grasping the changing composition of the working class requires us to explore the real historical linkages between these social groups. Doing so, in turn, requires a historical approach that, on the one hand, takes in the structural change of corporations and institutions for
22
The Next Shift
which traditional archival sources are available and, on the other hand, enters the pores of daily life. It is not possible to understand the need for, or production, of care, without exploring intimate experience; this intimate sphere is linked h ere to larger social consequences. L abor may be imbued with feeling, even love, while still being exploitative or coercive.50 For this exploration, I have relied frequently on workplace records where available and social work studies and interview transcripts already conducted and archived. As a city made in the image of the second industrial revolution, Pittsburgh has been the subject of intense social inquiry for more than a century, although with more focus on white workers’ experience—an archival unevenness I have been only partly able to correct.51 I have also conducted a number of my own interviews, focusing in particular on health care workers, especially African Americans, to compensate for the archival gap of the later period of this study. Some interviewees shared life stories that touch on the experiences of friends or f amily who were not interviewed themselves; o thers may be at risk of employer retaliation. For this reason, I have changed the names of all of my own interviewees except those who have entered the public record on their own account or who are retired. This book is closely attuned to the rhythms, market and nonmarket alike, that rule care provision and the interplay between these rhythms. Caregiving happens in time and over time. Care habituates us to the temporal path of the life course, in whatever form that path has been institutionalized. Care raises children; binds individuals into kinship; eases the passage into old age; manages sickness, disability, and bad luck; and orients us t oward death. The need for care and the provision of care alike can be understood only in relation to the socially constructed, uneven experience of time’s passage.52 The health care industry, meeting needs not met elsewhere and attracting investment not available elsewhere, has hypertrophied, sprawling into a vast web of social intervention in the economy. Health provision took contradictory, perverse forms as a result of its baroque pattern of incentives and its fractured organizational structure. While dehumanizing and exploitative of patients, the industry also continues to represent a major form of public and semipublic support for social reproduction, inducing millions to depend on it for a strange, degraded kind of security. Despite policymakers’ constant efforts to rein in costs, health care remains a point of access to expansive so-
I n t ro d u c t i o n
23
cial expenditure, and a vast profitable industry prospers by operating this nexus. The industry’s growth represents, in other words, a paradoxical privatized socialization process within capitalism, with the residual legacy of the postwar welfare state sustaining profits and employment in this massive industry. It finds its political basis in the constituencies that it has kept alive, figuratively and, in the end, literally.53 As the cohorts that most benefited from the public-private welfare state have aged—as steelworkers retired and were not replaced—the insider- outsider dynamic established during the postwar years increasingly has taken on an intergenerational, conflictual dimension. The secured older population stands increasingly politically opposed to the insecure young, who not only experience exclusion as citizens from the top tier of social support but also, as workers, must supply at low wages the care that the elderly’s benefits procure. This is a formula for generational warfare.54 At the same time, however, the booming care economy has become a site of working-class formation. Care workers 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. Thus far, however, care workers have experienced only limited success in collective action. The key question is their ability to mobilize broader po litical support, since even the private-sector health care industry is in so many respects a delegated arm of state power, implicating the broader public in manifold ways. Over recent years, care workers have maximized their own power when they have articulated the community of interest they share with their patients and communities, who are simultaneously exploited and secured by the industry.55 The choice is thus between the politics of intergenerational conflict on the one hand—based in the trade-off between prices for care and wages for care workers—and solidarity between care workers, patients, and their communities on the other. The historical process that created the health care industry has brought about the dynamic of generational conflict and, at the same time, created a force that might transcend it by renewing class politics in the United States—on the basis of security and care for all. The final implication of this book is thus that reorganization of the working class around caregiving generates a potent political capacity. We all need care. In a more democratic and
24
The Next Shift
equal society, we would all be cared for, and we would all participate in caring for o thers.56 This book tells the story of how we have already begun to move in this direction. It is a transformation we have backed into, not quite chosen. It is happening inadvertently, unevenly, erratically, and most of all unjustly. But it is happening already. What is left for us is to right it and see it through.
1 Down in the Hole Steelmaking Pittsburgh in the 1950s
I
“
recall in high school, the warning was given to us that if we d idn’t study, do our homework, go on to college, we were g oing to end up in ‘that damn steel mill.’ That’s the terminology. ‘You’ll be a loser,’ ” remembers Howard Wickerham. “Well, I ended up g oing into the steel mill.” Fresh out of high school in 1966, Wickerham got his first job at United States Steel’s g iant Homestead Works. His father worked there too; having risen from the ranks to become a foreman, he helped his son obtain a skilled-trade apprenticeship to become a welder at the mill. A path now unrolled in front of Wickerham, unplanned but easy enough to travel. “I still wanted to be a rock singer. It was just to pay bills. I’d gotten married, had a little girl.” He could feel himself, though, being tugged into the working-class slipstream, the current of years—measured out in shifts, pay periods, and seniority—t hat could pull him all the way to old age. In his early days at Homestead, Wickerham brought his lunch in a paper bag, finding someplace to leave it u ntil his break. When lunchtime came, he went to retrieve his sandwich, only to find it torn apart by rats, which were everywhere in t hese semienclosed, filthy, hot, riverbank environments. The more senior workers, he knew, brought lunches in metal pails for this reason. But Wickerham resisted buying one. He kept bringing sandwiches in paper bags, and he kept losing his lunch to rats. The pail was expensive, but that was not the problem. The problem was that if he caved and bought one, it meant that he was staying. As a young man facing for the first time the furnaces and gas lines, the terrific heat and noise, and the weathered men whose whole lives had been spent t here, he preferred to imagine that he had a fresh choice every day.1
26
The Next Shift
Edward Salaj worked in the same department as Wickerham, also having obtained his job with the help of his steelworker f ather. Warned about rats, he opted for a lunchbox right away. His anxiety expressed itself in another way—about his f ather, whose last years at the plant overlapped with Edward’s first. The son’s first day at Homestead, April 2, 1964, was twenty-eight years after his father’s, to the day—a symbolically laden coincidence. “My father had a fear during his last days working,” wrote Salaj in an unpublished memoir. “He had a fear he would be seriously injured or killed in the mill.” It was a reasonable fear. Almost e very steelworker had some near-death experience. All could tell stories of horrible t hings they had seen.2 On his last day at Homestead, Salaj’s father was given a dangerous assignment on the mill roof, uprooting the trees that had sprouted there after a rainy period. He refused, instead accepting a discipline slip rendered meaningless by his imminent retirement. For his part, the younger Salaj soon found himself paired with an older welder, Joe Yatzko, who had been hired decades before at age thirteen, after his own f ather had been killed on the job.3 Death was in the mill’s fabric, part of its history both institutionally and personally. Mortality signaled the intergenerational continuity of class and the way that hard and dangerous work was not so much good or bad fortune but more simply fate—something passed from fathers to sons. Edward Stankowski Jr., a contemporary at Jones & Laughlin Steel, a few miles downriver from Homestead, wrote a memoir of his childhood on the city’s South Side and his life working at the mill, where he too had followed his father to work. To him, these factories seemed endowed with near- supernatural power. “I studied the mill every day of my life, wondering why the old men cursed and worshiped her,” wrote Stankowski. “What was beneath her rusty sheet-iron skirts? What caused the flashes of fire that lit up the night, the explosions that shook our house, the soot that stained laundry my mother hung in our backyard?” 4 The mill was an elemental force, like a Greek god—in fact an early union had been called the Sons of Vulcan. Impetuously, the mill might take command of your entire life and could cast you aside again easily. It demanded awe and sacrifice and instilled terror and resentment. But in return it yielded a living, and indeed a world, for its p eople and their city. Wickerham, Salaj, and Stankowski were white men, members of the mighty United Steelworkers of America (USWA), employed at the height of
D ow n i n t h e H o l e
27
the postwar boom in one of the best-paid industrial workforces the world had ever seen. Two, Wickerham and Salaj, were skilled tradesmen, at the top of that workforce’s internal hierarchy. These w ere the p eople for whom the postwar period was an exceptional moment of security. At the time, such workers did so well that observers believed social class ceased to operate as a divisive force, the so-called “postwar compact” or “labor-management accord.”5 According to more recent interpretation, experiences of men like t hese three stood at the center of a unique moment in US history, when a limited but large swathe of working-class America gained security and social enfranchisement through struggle. Naming this era “the great exception,” historian Jefferson Cowie writes, “the postwar era, the period of the ‘g reat exception’ in action, was an extraordinarily good time to be a worker. This was not simply because wages were going up to unprecedented levels and inequality was going down but because the f uture was bright, work paid off, and t here was tremendous promise for the next generation.” 6 At one level, this argument is undeniable. Jack Metzgar, in his memoir of growing up in a steelworker h ousehold in western Pennsylvania, writes, “If what we lived through in the 1950s was not liberation, then liberation never happens in real h uman lives.” This was when the New Deal order and the golden age of capitalism reached their conjoint apogee. Cowie describes the moment’s emotional fabric as “an expansive sense of possibility,” and t here can be no doubt that working-class people saw a dramatic rise in their standard of living and wielded a newfound political and social power.7 Yet something does not add up. If what they felt was an expanding sense of possibility, why did old men in Stankowski’s neighborhood curse the mill as well as worship it? Why did Salaj’s f ather go to work full of mortal fear— a fear so strong that it was nearly the first thing Salaj described when he composed his own memoirs decades later? In a world of bright futures and promise for the next generation, why w ere young men warned away from the mill? In such an exceptionally good time to be a worker, why did Wickerham dread staying so much that he let rats eat his lunch? How to make sense of the rust eating away at the postwar chrome? While historians now largely agree that management never really accepted any permanent peace with labor, this insight has only scarcely filtered down to the analytical level of daily life—as though the organized, industrial working
28
The Next Shift
class did not register the instability of its position u ntil the onslaught of the 8 1970s and 1980s. This was not so.
The World of Steel Steelmaking arose in Pittsburgh in the nineteenth century b ecause of two factors: the city’s proximity to Appalachian coalfields and its position at the point where the Allegheny and Monongahela meet to form the Ohio River. High-quality “coke”-grade coal was mined nearby in Pennsylvania. Iron ore came from the upper Midwest, around Lake Superior. (Iron generally traveled to coal.) Pittsburgh, the easternmost major port on the Mississippi River system, had access to t hese materials b ecause of the river junction. As a result, it became an entrepôt between rail and river shipment, linking the East Coast and Midwest. The first steamboats to ply the Mississippi system w ere built and launched there. Given such easy access to critical raw materials and necessary shipment routes, industrial capital began to accumulate in Pittsburgh over the course of the nineteenth century, drawing a growing stream of migrants to work.9 Mass production of steel in the twentieth c entury required an astonishing scale of operations. The mill complexes that turned out metal for America’s cars, appliances, planes, ships, weapons, skyscrapers, bridges, pipelines, and highways reached a sheer immensity that few industries rivaled. If, in 1955, you got on a boat at Pittsburgh’s Point—where the Monongahela, or “Mon,” and the Allegheny meet to form the Ohio—and traveled east and south up the Mon t oward West V irginia, you would have to go about twenty-five miles upstream before you saw anything besides steel production wherever the riverbank was flat rather than sheer (see Map 1.1). Huge barges full of coal and iron ore steamed along the river. “Hot metal bridges,” special passageways for transferring iron melted down on one riverbank to furnaces on the other side, spanned the water. Train cars rattled along both banks. Whistles and sirens sounded all around. Jets of flame shot upward. G reat plumes of smoke and dust—graphite gray, coal black, ferrous red, or sulfurous yellow—hung in the air. Heaps of slag—the waste byproduct of the smelting process—accumulated on hillsides, glowing and steaming. Tens of thousands of men moved around, busy about a vast complexity of tasks. Anne Yurcon lived in Homestead, uphill from the mill. “People always
D ow n i n t h e H o l e
Alleghe ny R iv
Alleghe ny County border
Oh io Ri ve
29
er
r
PITTSBURGH J&L Pittsburgh Works US Steel Carrie Furnace US Steel Edgar Thomson Works
Mesta Machine Co. US Steel Homestead Works US Steel Duquesne Works
US Steel National Tube Works US Steel Irvin Works
Yo
ugh
US Steel Christy Park Works
i og yR hen
eny C
US Steel Clairton Works
borde
r
M on on ga he la
ounty
Riv er
.
Allegh
0
3 miles 3 km
Map 1.1 Steelmaking in the Mon Valley
used to ask me if the noise from the trains bothered us,” she remembered. “That meant the men were working.” The whole business cycle could be mea sured out in this way, in fires and smokestack emissions, in work schedules and the level of business at the establishments on the mill town’s main street.10 What happened within this vast complex? To begin, coke-grade coal was baked in g reat ovens. Jones & Laughlin Steel did this work at its Pittsburgh Works; US Steel did it further up the Mon Valley at Clairton. This was the hottest, most noxious work in the entire steelmaking process and the department into which Black workers w ere most likely to be slotted.11 From the coke plants, coke and coke gas w ere transmitted to the blast furnaces for the first part of the smelting process. There, huge carloads of iron ore, coke, and limestone would be loaded from above in layers—“charged”— into the furnace, then heated by igniting coke gas. The furnace itself towered two hundred feet above the river, lined with special refractory brick made to
30
The Next Shift
D ow n i n t h e H o l e
Figure 1.1 Aerial view of Jones & Laughlin Pittsburgh Works, creator unknown, date unknown. Jones & Laughlin Steel Corporation Photographs, Detre Library & Archives, Heinz History Center.
31
32
The Next Shift
withstand tremendous heat. The furnace stood accompanied by g iant round tanks, feeding the fire superheated air. When lit, the coke and iron combined in the blast furnace into “hot metal,” molten iron, while the limestone absorbed impurities and formed into slag, a burning slick of byproduct. Workers drilled a hole in the furnace, letting the hot metal out, and skimmed the slag off the molten iron beneath. Through channels on the floor, the hot metal flowed out, to be poured into brick-lined vessels (“torpedo cars”), and the slag moved toward disposal. When the batch was done, workers repaired whatever parts of the furnace w ere damaged. At every step of steelmaking, a significant part of the work was the constant repair of facilities damaged by the stress of continually hosting such extreme processes. In torpedo cars, molten iron moved on rails from the blast furnace to the open hearth, which completed the smelting process. Transferred to a “ladle” that could be lifted by crane and poured into the brick-lined open hearth, the metal would cook with melted-down scrap and limestone or dolomite, losing some excess carbon. After about eight hours, workers would tap the open hearth, and out would come molten steel, again with a slick of slag. With the slag separated and impurities burned off, the steel poured into huge molds to form ingots. Maintenance crews fixed any damage, and workers readied the next “heat.” At this point, the process—more or less unitary until h ere—began to branch, depending on the product being made. Ingots underwent some combination of alloying with other materials, soaking in huge pits to maintain uniform temperature, pickling in acid baths, and reheating to be rolled, pressed, and milled into different shapes. Huge overhead cranes lifted ingots and moved them around the plant. Different plants had different specialties: National Tube in McKeesport made tubing; Homestead made plate. A huge number of different processes were necessary to make the wire, bars, plates, sheets, rails, and tubes that steel consumers required, out of which the modern world was built. A distinguishing feature of steelmaking was therefore the heterogeneity of the work. In 1950, in the Pittsburgh metropolitan area, 134,494 p eople worked in the industry. Of t hese, 6 percent w ere managers and professionals, and 8 percent were clerical staff. The remaining 86 percent, however, could be divided evenly into thirds between skilled craftsmen and foremen, semi-
D ow n i n t h e H o l e
33
skilled operatives, and unskilled laborers. Commonly in a midcentury mass production industry, skill proportions tended more t oward a bell-curve shape than steel’s flat line. Steel, lacking a single generic process, was more stratified. This stratification of skill was also a racial hierarchy: Black workers made up 14 percent of unskilled laborers, 7 percent of the semiskilled, and virtually none of the skilled trades. Recall that welders Wickerham and Salaj both got their tradesman jobs with the help of their f athers, suggesting the insularity of this work.12 In 1950, the US steel industry produced nearly one hundred million tons, more than at any previous point in its history. In the distinctive postwar American consumer landscape, steel was everywhere: in the frames of new interstate highways; in the shining appliances filling new suburban homes; in the pipelines that carried petroleum from oil fields; inside new towers rising in city centers undergoing urban renewal; and above all in the automobiles remaking American society. Beyond all t hese, however, was the enormous stimulus of the Cold War military machine, in high gear in 1950 for the Korean conflict, but in principle capable of sustaining demand for steel in peacetime.13 At the beginning of the Cold War, American steel held an enviable global position, putting out 47 percent of global product—leaving American producers generally unconcerned about international competition for most of the 1950s. Moreover, the domestic market was highly coordinated, with labor costs and product prices moving in sync across all the major firms, desensitizing steel companies to market pressure. As Gary Herrigel observes, “For most the first three decades of the postwar period, the US Steel company and the United Steelworkers Union (USWA) effectively set American steel prices.” The major firms, commanding 80 percent of the domestic market, negotiated jointly with the u nion and followed US Steel’s pricing, which in turn was synced to cost-of-living adjustments agreed upon in collective bargaining.14 Only distantly concerned about international competitors and coordinated against domestic market pressure, steelmakers accepted massive subsidies from the federal government in the 1940s and 1950s to expand capacity, which the firms pursued through extensive, not intensive, growth—more and bigger plants, rather than more technically advanced and efficient ones. Steel companies, notoriously conservative in their corporate culture and seemingly secure in their oligopoly, opted for this course of so-called “rounding out”
34
The Next Shift
instead of installing the new and far more efficient basic oxygen furnace technology coming online in new plants in Europe. Even as the technical superiority of the basic oxygen process became indisputable, management delayed installing the new furnaces through the 1950s in hopes of winning more favorable depreciation allowances from Congress. US companies were left with huge, outmoded productive capacity. In 1940, American steel capacity had stood at 81.6 million tons; over the next two decades, it grew steadily, to 148.6 million.15 The steel that built midcentury modernity was made in many places—with major concentrations in Illinois, Indiana, and Ohio. But western Pennsylvania remained foremost, if on a clear decline: in 1947, the Pittsburgh district produced about one-quarter of American steel, with Chicago the runner-up at one-fifth. (Declining Pittsburgh and rising Chicago would meet at 21.5 percent of US output in 1958.) US Steel was headquartered in Pittsburgh. So was the USWA.16 The context of a huge incumbent industry, gradually becoming obsolescent and yet shielded and sustained by powerf ul institutions, decisively shaped the entire l abor market of the Pittsburgh region. In 1950, of the 2.2 million inhabitants of the metropolitan area, 863,001 were in the civilian workforce. Of t hese, three-quarters w ere men. Among employed men, almost two-t hirds worked in manufacturing, mining, construction, rail, or trucking and warehousing. Greater Pittsburgh’s heavily male workforce, in other words, was employed at blue-collar labor to an astonishing degree; metal production led the way, with a quarter of all male employment. There existed a wide range of suppliers, shippers, and processors attached to steel, as well as parallel industries benefiting from the resources already clustered around metal: factory equipment manufacturer Mesta Machine; aluminum giant Alcoa; Pittsburgh Plate Glass; food processor Heinz; shipbuilder Dravo; and electrical manufacturer Westinghouse. The residual one-third of employed men not employed by manufacturers w ere scattered across the rest of the economy—in retail, food and hospitality, utilities, public administration, banking and insurance—with no major concentration. While Pittsburgh ranked high as the country’s fourth-largest center of corporate headquarters in the 1950s (after New York, Detroit, and Chicago), the significance of this specialization did not come from its labor market impact. Indeed, the weight of industrial production in Pittsburgh’s labor market was so g reat that manufacturing, construction, and transportation firms also
D ow n i n t h e H o l e
35
formed the largest sector of w omen’s employment—largely in clerical positions. Such employment accounted for one-fifth of working women. Beyond these jobs, smaller concentrations of working women were employed in health, education, telecommunications, hospitality, domestic serv ice, and retail.17 Bifurcated unevenly along one axis by gender, the l abor market was sliced along another by race. In 1950, the historical high point of manufacturing, the pattern of employment for African American men appears similar to that of white men: an overwhelming majority of Black wage workers were men, as with white wage workers; two-t hirds of employed Black men worked in manufacturing, construction, mining, or transportation and warehousing, as with employed white men. African American men ranked lower in t hese industries and would find them harder to live off for long—but they depended on blue-collar work for subsistence to the same degree that white male workers did at this moment of industrial high tide. The more distinctive pattern in Black employment, however, occurred for w omen. African American w omen found work in hospitals, laundries, and food and drink serv ice, but a pink- collar world of jobs as secretaries, telephone operators, saleswomen, and teachers was largely closed to them. Black w omen were driven instead into domestic work: 42 percent of employed Black w omen in 1950 worked as domestics, next to 5 percent of employed white women.18 All t hese patterns of employment, however, orbited around the predominant place of manufacturing in general and steel in particular. The region’s labor markets w ere warped by the industrial giant at the center. What happened to steel happened eventually to everyone. The early tremors for that industry in the 1950s foretold not just the crisis of industrial work, but the transformation of all work.
Steel and the Business Cycle While capacity in steel expanded steadily in the 1940s and 1950s, demand slackened after the end of the Korean War. The crisis that eventually overtook the industry began in a slow-moving form in this context. Several prob lems, each manageable on their own, began to interact with increasing intensity. First, u nionized workers bid up wages significantly. The USWA struck the entire basic steel industry in 1946, 1949, 1952, 1956, and 1959.
36
The Next Shift
Across this period, in addition to securing fringe benefits, workers also won dramatic wage gains that easily outstripped inflation. By the end of the 1950s, the union secured increases that made its members the very symbol of the postwar promise to the US working class. In his 1959 “kitchen debate” with Nikita Khrushchev, Richard Nixon made steel labor his first talking point. “Our steel workers as you know, are now on strike. But any steel worker could buy this h ouse. They earn $3 an hour.”19 Although labor costs per ton were rising fast and plant productivity was not keeping pace, the industry remained profitable b ecause labor was a relatively small proportion of all costs—but the trend was unsustainable. Steel was a component of too many products for price increases to be inconsequential. If workers won wage hikes and management passed on the cost in higher prices, then the result would be an inflationary cycle: rising steel prices caused auto prices and construction costs to increase, causing workers who were strong enough to demand higher wages to afford cars and homes. This cycle would offer relative mercy to the organized—strong unions and oligopolistic industries—a nd punish t hose in competitive markets in labor or goods.20 The prospect of such a cycle triggered policymakers’ alarm. Inflation would threaten the living standards of Americans outside the economy’s industrial core. More direly, the strength of the dollar had major geopolitical importance: US investment in postwar Europe had flooded the continent with dollars. If the dollar depreciated significantly, a major destabilization could result. This outcome, undoing the work of the Marshall Plan, was unwelcome at the height of the Cold War. The political regime of the United States was thus balanced, both domestically and internationally, on the strong dollar. Steel bargaining therefore spilled over from economic conflict and into politics.21 The federal government involved itself with steel industry bargaining and pricing throughout the postwar period. Agreements between l abor and management in steel were worked out in the Oval Office. Famously, the Truman administration attempted to nationalize the industry in 1952 to maintain wartime wage and price stability. In 1956, despite an avowed hostility to politicized collective bargaining, President Eisenhower helped broker an end to an industry-wide strike and was angered by the subsequent inevitable price increase. He issued repeated warnings in public, including in his State of the
160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0
1940 1942 1944 1946 1948 1950 1952 1954 1956 1958 1960 Total capacity (000s of tons) Total production (000s of tons)
Figure 1.2 Operations in the steel industry, 1940–1960. Data source: American Iron and Steel Institute, Annual Statistical Report, various years, as presented in Paul A. Tiffany, The Decline of American Steel: How Management, Labor, and Government Went Wrong, (New York: Oxford University Press), 1988, table 2.1.
450% 400% 350% 300% 250% 200% 150% 100% 50% 1958
1957
1956
1955
1954
1952
1953
1951
1949
1950
1948
1947
1945
1946
1944
1942
1943
1941
1940
0%
US consumer price index Employment cost per hour in steel Basic steel prices
Figure 1.3 Wage and price growth in steel, as percentage of 1940. Credit: Data source: Bureau of Labor Statistics, as presented in Paul A. Tiffany, The Decline of American Steel: How Management, Labor, and Government Went Wrong, (New York: Oxford University Press), 1988, table 2.4.
38
The Next Shift
Union address, about steel prices. Then in mid-1957, when agreed-upon cost- of-living adjustments and wage increases for the workers were set to kick in, US Steel announced another price hike. The other companies in the steel cartel quickly followed suit. At the same time, a recession set in—the worst in twenty years. Policymakers and economists w ere confounded to see inflation rise in tandem with unemployment—two variables widely held to work at odds. (Two decades letter, a more severe occurrence of this phenomenon would be called “stagflation.”)22 The conflict between policymakers and steelmakers escalated in parallel with the economic downturn. Senator Estes Kefauver, chairman of the Senate Subcommittee on Antitrust and Monopoly, opened an investigation into anticompetitive practices in industry, focusing immediately on steel. Steel management attributed inflation to excessive wage demands. As an internal US Steel memo complained, “If the steel companies had continued to charge 1946 prices and had absorbed the increased costs between then and 1957 . . . bankruptcy would have occurred and they would not have been able to continue to operate at all.”23 Steel companies w ere u nder steady pressure to yield wage hikes to the workers but had not invested in the technological upgrades that might make productivity growth pay for those raises. In the Kefauver hearings, US Steel’s general counsel had voiced the company line, arguing that the potential of the basic oxygen furnace “cannot be forecast.” Industry leaders continued in their conservative habit of financing capital improvements through retained earnings, rather than debt, which made the cost of installing the new basic oxygen furnace technology daunting, even for profitable firms. The writer Annie Dillard, who grew up in the midcentury Pittsburgh managerial elite, recalled of her father’s social world, “I knew what they hated: labor u nions, laziness, spending, wildness, loudness. They d idn’t buy God. They d idn’t buy anything if they could help it. And they didn’t work on spec.”24 To afford steady wage hikes, steel companies fell back on steady and coordinated price increases, but growing political pressure now made this strategy difficult. In the second half of the 1950s, steel companies set out to loosen this squeeze in the only way feasible. If resistance to technological investment ruled out increasing productivity, and political opposition precluded raising prices, what was left was to cut costs. This effort s haped the daily experi-
D ow n i n t h e H o l e
39
ence of the thousands of men who worked in Pittsburgh’s overgrown, semi obsolescent steel mills.25
Signs of Rust Without major investment in new technology, cost control came down to human effort. “Here then is the most basic element of the problem,” stated a 1956 “progress report” for upper management at US Steel. “It is to narrow or close the gap between an 8% rate of employment cost increase and a 2% rate of productivity gain.” What management proposed was driving fewer workers to do more. “Our industrial engineering work tells us that as an overall condition our production and maintenance workers are utilized at a rate equaling about two-t hirds of their normal capacity. This means t here is room for tremendous improvement.” Exploiting this “room for tremendous improvement,” however, was not a straightforward m atter.26 Most basically, no one even knew how to measure productivity. The material details of the processes involved were so diverse that they defied being abstracted into a single measure. The only clear gauge was man-hours per ton. Since 1940, this figure had increased at an annual average rate of 2.7 percent—a fairly impressive clip. The union cited this figure as evidence of growing productivity, meaning that the company could afford wage hikes. Such a raw output-to-hours calculation gave undue credit to labor, management retorted. The calculation mistook extensive expansion for productivity growth: “Such figures in steel mostly reflect a result which comes about largely through relatively increased volume.” That is, production was growing more efficient mainly by economies of scale, rather than improvement in methods. The more steel the company made, the more efficiently it operated. The crude output-to-hours ratio, the company argued, discounted a wide range of factors that could affect efficiency: “1. Volume and customer requirements. 2. Capital improvements of facilities. 3. Product variations as to grade of steel, size, shape, e tc. 4. Improved methods and practices. 5. Quality of raw materials. 6. Quality of purchased goods and serv ices. 7. Employee per formance rates.”27 Although US Steel had not settled on its own method for calculating productivity growth by the time of the May 1956 progress report, management
40
The Next Shift
made projections anyway: “It appears that if wage and benefit increases are to be derived only from increased productivity in its true sense, and if owners of the enterprise are to share in the benefits of increased productivity, then the annual wage and benefit increases cannot exceed an outside figure of about 2%.” Yet that figure—t he wages and benefits bill—had in fact been growing since 1941 at an average annual rate of 7.81 percent.28 How could management close the gap? The main source of savings lay in shrinking crew sizes. Smaller crews doing the same work would feel to workers like an acceleration in the intensity and rate of l abor—for which com pany leadership would require a new level of organizational solidity. The bosses had to present a front of unity and determination, not just at the bargaining t able, but every day on the shop floor. Like workers, bosses w ere organized. Considering the economic culture of Pittsburgh, economist Benjamin Chinitz saw “an environment dominated by big business. It manifests itself in many ways, such as the kinds of social clubs [someone] can belong to, the residential areas he w ill comfortably fit into, the business organizations he can join, and so forth.” Dillard remembered the cohesion of the social world that the managers had made. The urban landscape was littered with their monuments: factories, mansions, and skyscrapers. “Our classmates’ fathers worked in t hese buildings, or at nearby corporate headquarters for Westinghouse Electric, Jones & Laughlin Steel, Rockwell Manufacturing, American Standard, Allegheny Ludlum, Westing house Air Brake, and H.J. Heinz. . . . They must have known, those little boys, that they would inherit corporate Pittsburgh, as indeed they have.” In 1957 the management of Duquesne Works surveyed supervisors to generate a record of “civic activities,” which the superintendent wanted to encourage. The result was a roster of participation in the pillars of middle-class civil society: scores were involved in the Boy Scouts, the Chamber of Commerce, the Kiwanis, the Lions, and the Rotary. Through such middle-class identity groups, the Pittsburgh elite passed on its values and recruited its subordinate portions—lower and m iddle management—to t hose values. “Managers w ere required to contribute monetarily to the Boy Scouts and even donate their time to Boy Scout projects. Boiler Shop managers posted notices on a black board in their offices when contributions were due and did not attempt to hide it,” recalled Salaj. “I even knew a person that had joined the Boy Scout Troop in my neighborhood even though he lived miles away in another neigh-
D ow n i n t h e H o l e
41
borhood.” Wickerham’s father conspicuously joined the Masons to rise above the bottom rank of management—but his mobility was blocked anyway, because he was “too close to the men.”29 The mid-1950s brought an intensified campaign by company leadership to solidify its workplace hegemony, first within management, beginning from above. “We cannot assure our long-term growth and progress,” warned US Steel’s head, “unless we take steps to maintain our strength in the one area where all growth and progress must originate—in management.” The superintendents of US Steel’s Duquesne Works organized themselves into a weekly luncheon club. The club charged monthly dues, as well as fees for tardiness and unexcused absence. A member could be fined twenty-five cents for sitting in the wrong seat, complaining about the food, asking for a special meal, talking shop, or using “Forbidden Words.” It was an explicit rule that the rules be unspoken. And if the club voted on some matter, t here was a fine for being the sole vote on e ither side. The fines w ere nominal, but they communicated the point of the group: to reproduce the normative discipline, hierarchy, and consensus of industrial operations within the social life of plant management.30 When the superintendents of the plant threw a party for a larger group than their luncheon club, similarly elaborate planning was involved. The management of Duquesne Works was, at nearly all times in the late 1950s and 1960s, planning a golf outing or country club party. When supervisors did not participate, management took note and followed up with their superiors. “I was pleased to note that 87% of your supervisors were members of this organization. As you know, it is rather difficult for more than 500 supervisors in this plant to get to know each other during working hours,” one superintendent wrote to a subordinate. “I hope you will encourage all of your supervisors to participate in the affairs of the Supervisor’s Club in 1959.” Monthly parties alternated monthly between all-male “stag” affairs and family events—dances, picnics, and banquets.31 During the 1954 recession, the company launched an incentive plan for managers. Explaining the plan, leadership warned of a coming “return of the buyer’s market,” which would “separate the men from the boys” along lines of cost performance. The incentive scheme operated by calculating a base expectation of cost of operations at the level of an entire plant, then rewarding plant managers if they collectively beat the expectation. In other words, the
42
The Next Shift
scheme translated the question of managerial social cohesion from symbolism to economics. A 1956 follow-up study at National Tube Works in McKeesport revealed significant income gains for supervisors who had moved to the plant-wide incentive plan.32 Plant-level management also worked to advance the campaign. At Duquesne Works, management launched a general evaluation of “management development practices.” The program “appraised” managers for “ability to plan and to maintain maximum staff serv ices of highest quality.” Managers w ere assessed for adherence to plant and company practices. “In other words, are his actions t hose of an individual, or a member of a team. . . . Consider also the degree to which he seeks and accepts responsibility in his community, civic, political, and other outside life. . . . Consider also the extent to which he has exhibited loyalty to the company and his superiors.” Managers found wanting in some aspect went through a whole range of trainings: from study sessions with the labor contract to vocational extension classes to the “Dale Carnegie” training, a fourteen-week program in public speaking and leadership skills.33 In September 1956, US Steel launched a study of management’s working conditions at all of its plants. W ere t here up-to-date organizational charts in every department? Did individuals know their job descriptions? Did man agers have their own parking and eating facilities and air-conditioned office space? The inquiry was directed by two related purposes: to ensure the smooth functioning of the plant bureaucracy and to clarify the internal hierarchy of each factory’s social structure. Clear hierarchy, and effective representation of this hierarchy in the plant’s symbolic order, w ere necessary.34 The problem was that foremen on the shop floor might identify more closely with workers than with higher levels of management. While t here was little risk of this in departments with larger African American workforces—since Black foremen were virtually unheard of and shop-floor racism was a given— it was an everyday reality in most of the plant. This was the identification that Howard Wickerham believed prevented his f ather, a foreman who “stayed close to the men,” from being promoted. Anna Mae Lindberg remembered, “My brother Bill was active in the union. My other brother was a foreman.” For Ed Stankowski, t here was nothing unusual about the memory of sitting around in the locker room as his father—a nother wage worker—a nd his foreman, Moe, teased Ed about sex. “ ‘Are you gettin’ any mud for your turtle?’
D ow n i n t h e H o l e
43
Moe asked me, winking and poking me in the ribs with his elbow. ‘Gettin’ any mud, huh?’ My father chuckled while I turned red.” It was the same foreman who would “pat me on the back a fter a tough shift in the furnace . . . and say, ‘You put in a good day, hunky.’ ” The class barrier was not culturally impermeable. The risk that the culture of working-class men might activate shared norms of masculinity and override the culture of management was precisely management’s fear.35 Webs of tacit understandings between workers and foremen were threaded throughout e very mill. When a dangerous assignment was given to Ed Salaj’s father on his last day, part of the shock was that the foreman was “a very old friend and [countryman] of my parents.” A few days a fter the event, Salaj’s father and m other went together to confront the foreman at home. He explained to them “that the discipline slip [for refusing the work] would mean nothing to my father as he was retiring and as a foreman he was required to issue discipline slips. The slip would help him [the foreman].” Salaj himself had “once made a deal with a foreman to accept a meaningless discipline slip just to help him out.” The daily functioning of the plant in fact required that operations be woven through with such arrangements. Some of these arrangements, though, would inevitably get in the way of any cost-cutting drive.36 Bitterness between workers and foremen was probably more common than Stankowski’s unequal friendship with Moe, or the friendship between Salaj’s parents and the foreman. But it was a bitterness conditioned by intimacy— by how much was shared by the men who faced one another directly across the class divide. This antagonism was born of the inevitable rupture of tacit understandings between foreman and worker. For Wickerham, the white safety hats that men got when they joined management became a potent symbol. Cranemen, high above the shop floor, could watch for a white hat approaching and make a noise to signal to get back to work. Foremen would put their white hats in the back window of their cars, Wickerham claimed, so that when they drove around town everyone would know they w ere bosses. This strategy produced its intended distinction effect, however, only b ecause several criteria of social similarity w ere met: workers and foremen both needed safety helmets because they w ere together on the shop floor, unlike bosses in the office; workers and foremen shared neighborhoods and streets; and foremen’s cars were similar enough to workers’ cars that they could not speak for themselves as status symbols.37
44
The Next Shift
One feeling shared by workers and foremen, yet pitting them against each other, was fear of higher-ups. “We got along okay,” remembered Martin Conners of his father-in-law, a foreman. “But he was always a white hat to me, a company man. They d idn’t have a u nion to back them up, so they had to toe the company line.” Twice, foreman John Huey was injured and carried to the ambulance by workers. Huey never gave thanks or acknowledgment. “Fellas said, ‘what kinda man is he?’ ” Sometime later, a worker named Joe Payne became friendly with Huey and finally asked him, “Are you a human bein’ or what are you? . . . Those guys picked you up twice, and you came back to work and didn’t even look at ’em.” Huey replied, “When that mill goes down, Joe [when production is interrupted] who blows that whistle? I do. When I blow that whistle, my boss up the general office hears that. Then my phone rings [and] he says, ‘What’s goin’ on down t here, and how long w ill it take to fix it?’ I have a quarter mile to walk to see what’s wrong. But I d on’t even know what’s wrong yet. So when I walk through that mill, I d on’t see t hose men. I see that devil up t here. My boss.”38 The foreman had to reckon with management’s abstractions—quarterly cost and productivity goals—and the workers’ concrete experiences of heat, danger, and exhaustion. Foremen could not, like workers, make light of production objectives for their shift; neither could foremen, like the company, treat the workers as a mere input factor. Huey’s whistle translated an event in the workers’ time to management; the phone call communicated an event in the company’s time back to the workers. The foreman was the point of interchange. Maintaining and reproducing authority took continuous work, particularly if management wanted foremen in shape for a fight with the workers. In this sense, the bureaucracy of the postwar factory did not freeze the ceaseless cycle of workplace insurgency and reprisal. The bureaucracy became, rather, the terrain of this conflict—t he site of the continuous accretion of indignities.39 At Duquesne Works, management acted to shore up the symbolic unity of salaried staff and their distinction from wage earners. To keep up standards, general foremen received private offices, while the lower-ranking turn foremen—who walked the shop floor—got desk space and their own shower and locker rooms. Suddenly installing nearly two hundred desks across the plant communicated the distinction between management and l abor clearly.
D ow n i n t h e H o l e
45
Workers often had no comfortable place to sit down, much less a chance to do so. Being on one’s feet all day in heavy steel-toed boots was a core feature of the bodily experience of steel work; it was why, if “extensive standing” and “extensive walking” presented a problem for a job applicant, he was only “qualified for L IMITED placement.” Walking around was such a crucial part of the job that steel managers at various points calculated appropriate allowances of walking time for various distances within the plant and argued with the u nion over which parts of walking time counted as work time.40 Segregation of showers and locker rooms, similarly, kept foremen out of one of the few common social spaces that belonged to workers. It was no coincidence that workers’ locker rooms and bathrooms were often left unsanitary by management. “They w ere generally called shit h ouses,” wrote Salaj. The u nion had to agitate for potable w ater in drinking fountains, toilet paper in bathrooms, sufficiently large trashcans, even clean water in the sink; when the river ran high, w ater in the washroom turned brown with mud. Rather than use the bathroom, workers in the Duquesne Works open hearth at one point took to urinating in the corners of their shop floor.41 Relations of power in steelmaking, that is, gained expression in the social division of sitting and standing, cleanliness and filth, heat and cold, comfort and ache. How a body felt at the end of the day, or what it meant for the spirit to go back to work at the start of the next shift, reflected the side of t hese divisions on which a person fell. The proposed solution to the profits crunch was “tremendous improvement” in the “capacity utilization” of the waged workforce. If management could not afford to increase the productivity of capital through technological improvement, then it would have to fight labor on the shop floor to drive up workers’ productivity. This managerial offensive—which would eventually make its appearance across the entire manufacturing sector, in industry- wide bargaining in steel, and at the highest levels of the American state— showed up first in confrontations between bosses and workers, which w ere no less b itter for being so quotidian. The tensions of the postwar industrial economy reached as high as the Senate, the White House, and the global currency market, but their roots were in shouting matches over how many minutes a task needed. As a confidential 1956 US Steel memo put it, facing the productivity and cost question, “time, our most precious asset, is of the essence.” 42
46
The Next Shift
Getting through the Day In the evening of May 8, 1956, a steelworker named Pete Dohanic approached the gate of Duquesne Works from the inside. There, he asked the security guard for his gun. Dohanic, the guard later testified, “stated that he would like to shoot [gangleader] John Stawicki for m ental torture.” A little while later, Dohanic reported off work. On his way out, he again told the guard “that he would like to kill someone by the name of John Stawicki.” The guard thought he seemed drunk. An hour later, Dohanic showed up again at the plant gate, this time on the outside. Sent away once more, he went and sat in his pickup truck, across the street from the mill, visibly brandishing a rifle. Someone called the police. who arrested Dohanic and found that his gun was loaded. What brought this worker to the brink of homicide? Called as witnesses, Dohanic’s workmates took his side. Their boss, Stawicki, they agreed, was “nervous” about how production problems reflected on him. He pushed constantly and, because workers ignored his directions so often, was always embroiled in conflict. “They stated that he consequently drives to get the work done as quickly as possible without giving consideration to the cranemen or hookers. They stated that he continually complains about the slowness of the men and w ill assign them to two and three jobs at one time and yet he knows that they can only do one job at a time.” In fact, Dohanic claimed, he had not even initiated the trading of threats, though he acknowledged escalating it. The testimony got Dohanic’s termination commuted to suspension; he was rehired into the plant-w ide labor pool in October.43 Being timed, and being harried, have been major parts of work experience across the modern world.44 But the measurement and apportionment of time in daily life changes with social context. No person working for wages can be utterly unconscious of time, but how conscious and in what way changes with historical context. The cost crunch and managerial offensive of the late 1950s caused an escalation. Management’s plan to close the cost-productivity gap without new investment was to get more work out of fewer workers. From the point of view of the workers, the heart of the issue thus became the intensification of work. But its manifestations were numerous: it disrupted schedules, interfered with sleep cycles, and exposed workers to heightened discomfort and danger. Inasmuch as its central moment was the enactment of the foreman’s power, the
D ow n i n t h e H o l e
47
managerial offensive produced an experience of humiliation and always courted resistance. Sometimes resistance was individual, like Dohanic’s threat of a drunken rampage—t hough even he ultimately leaned on the solidarity of his workmates to stay employed. But workers had a repertoire of strategies for generating friction. From 1950 to 1955 at Duquesne, a total of six hundred workers engaged in a series of illegal wildcat strikes, in addition to universal participation in the official 1952 and 1956 work stoppages. The relative success of such moments of small-scale resistance, in turn, escalated the conflict. As management noted in a 1958 memo, “from past experience, we know that the Cast House and Stock House crews are extremely sensitive to any change in crew size since we w ere threatened with a work stoppage at the time of our last attempt to reduce crew size in this area. . . . We w ill, therefore, have to decide w hether or not we are willing to risk a work stoppage.” 45 Management probed for weak points in the mesh of workers’ solidarity. In March 1957, the management of Duquesne Works held a special meeting with the u nion’s grievance committee to work through a backlog of disputes. Everywhere, the stories w ere similar. In the open hearth, the repair crews had been working a new schedule that they disliked for six months. The ingot shippers claimed that their workload was too g reat. In the blooming mills, workers asked to be relieved of duties that had been piled onto their jobs. Workers in the bar mill wanted bigger work crews “due to increased work load” and a revised incentive plan.46 Across the mill, too few workers were doing too much work, or so they argued in countless grievances. “The Union witnesses said that frequently when temporary vacancies occur in the Blast Furnace Maintenance Crews because of sickness, vacations, etc., Management, in some instances, does not fill the vacancies and the crews are required to work shorthanded. . . . This is a dangerous area in which to work and any time a repairman or helper is required to work alone, he is exposed to hazards.” In the blooming mill soaking pits, “work load had increased considerably,” a June grievance reported. Management had cut crew sizes and was operating both the 38-inch and 40-i nch mills simultaneously. Meanwhile, heightened production quotas meant that the heaters w ere moving ingots through that w ere larger than the soaking pits had been designed to accommodate, requiring increased attention and involving greater h azard.47 This tightening also had important racial dimensions. Black workers, generally trapped in the worst positions, were laid off earlier and at higher rates.
48
The Next Shift
When the 1957 recession began, for example, of the first 343 people laid off from Duquesne Works, not one was in the nearly all-white skilled trades. Black workers also had the worst jobs in terms of danger and discomfort, which interacted with their experience of cost cutting to worsen both.48 In 1958, for example, a group of Black workers in the Jones & Laughlin coke ovens filed a grievance seeking the reinstatement of the position of “spellman”—an extra worker on the crew. With a spellman on hand, each worker could take periodic breaks from the “heat, gas, smoke and other extreme working conditions.” Specifically, they could pause for sixteen minutes out of every ninety-six. The company responded that, because the plant was r unning below capacity, throughput was down, and no breaks w ere required; the workers’ grievance was denied. The problem, however, was not muscular but epidermal and respiratory. From the perspective of a human body, a coke oven was not meaningfully cooler or less gaseous r unning at slightly lower capacity any more than a volcano is more hospitable than the sun. To be a Black steelworker meant one’s body would be subjected to the damage and humiliation of the job in greater concentration, more minutes per hour, more hours per day. “You talk about hell? This is hell,” said Herb Edwards of coke ovens.49 With the onset of recession in late summer of 1957, conflict over work assignments intensified. By November, almost half of the plant’s waged workforce was on layoff or reduced schedule. “Because of the soft order situation,” management explained to the u nion, “it would be necessary to have a two- week shutdown period for a sizeable portion of the plant” beginning in late December. The layoffs worsened in early 1958 and only slowly turned around thereafter. As late as January 1959—eighteen months a fter the recession’s onset and nine months a fter its official end—about 12 percent of employees at Duquesne were still on layoff.50 As economic conditions worsened t oward the end of the decade, management became more aggressive, and schedules became a prime arena of conflict. Even workers with sufficient seniority to avoid the layoff w ere unlikely to dodge disruptions in the shifts worked. In January 1958, Dan Novak, who had twenty years of seniority at US Steel’s Irvin Works, worked the schedule shown in Table 1.1. Such disturbances in a worker’s schedule were not unusual. In February, for example, up the road at Duquesne Works, management rolled out a four- week rotating schedule for workers in its Open Hearth Department (Table 1.2).
OFF 12 a.m.–8 a.m. 12 a.m.–8 a.m. OFF OFF 8 a.m.–4 p.m. 8 a.m.–4 p.m. 8 a.m.–4 p.m.
1/9/1958 1/10/1958 1/11/1958 1/12/1958 1/13/1958 1/14/1958 1/15/1958 1/16/1958
8 a.m.–4 p.m. 8 a.m.–4 p.m. OFF OFF 4 p.m.–12 a.m. 4 p.m.–12 a.m. 4 p.m.–12 a.m. 4 p.m.–12 a.m.
OFF OFF OFF OFF
7 a.m.–3 p.m. OFF 11 p.m.–7 a.m. 3 p.m.–11 p.m.
MON 7 a.m.–3 p.m. 3 p.m.–11 p.m. 11 p.m.–7 a.m. OFF
TUE 7 a.m.–3 p.m. 3 p.m.–11 p.m. 11 p.m.–7 a.m. OFF
WED
1/17/1958 1/18/1958 1/19/1958 1/20/1958 1/21/1958 1/22/1958 1/23/1958 1/24/1958
7 a.m.–3 p.m. 3 p.m.–11 p.m. OFF 11 p.m.–7 a.m.
THU
4 p.m.–12 a.m. OFF OFF 8 a.m.–4 p.m. 8 a.m.–4 p.m. 8a.m.–4 p.m. 8 a.m.–4 p.m. 8 a.m.–4 p.m.
OFF 3 p.m.–11 p.m. 3 p.m.–11 p.m. 11 p.m.–7 a.m.
FRI
1/25/1958 1/26/1958 1/27/1958 1/28/1958 1/29/1958 1/30/1958 1/31/1958
OFF OFF OFF 11–7 a.m.
SAT
OFF OFF 8 a.m.–4 p.m. 8 a.m.–4 p.m. 8 a.m.–4 p.m. 8 a.m.–4 p.m. 8 a.m.–4 p.m.
Source: Memorandum of Understanding Regarding Temporary Work Schedules for Open Hearth Department and Open Hearth Assigned and Operating Maintenance, February 9, 1958, box 15, folder 10, USSCDWIRDR.
First Week Second Week Third Week Fourth Week
SUN
Table 1.2. Four-week rotating schedule, Open Hearth, 1958
Source: Beth Novak, diary, January 1958; facsimile in author’s possession.
1/1/1958 1/2/1958 1/3/1958 1/4/1958 1/5/1958 1/6/1958 1/7/1958 1/8/1958
Table 1.1. Work schedule, Dan Novak, January 1958
50
The Next Shift
Over the space of four weeks, these workers worked all three different shifts— “turns” in steel mill parlance.51 Shift schedules held tremendous significance. On night turns, workers either had to fall out of sync with the world outside the plant or otherwise pull their social worlds into their own deviant rhythms. Queer theorist Elizabeth Freeman describes a phenomenon she calls “chrononormativity,” the ability to live in sync with the prevailing rhythms, both day to day and over the life course. For steelworkers, however, achieving the normative life course of the breadwinner meant deviating from the normative daily rhythm.52 The asynchrony produced by the turns thus both shaped and frustrated steelworkers’ desires and forms of social belonging. Working turns at the mill roiled a breadwinner’s social relationships. Stankowski remembered, “It was hard getting used to sleeping during the day. It was hard getting used to a schedule different from my friends’ schedules, getting up to go to work when they were going to sleep, having Tuesdays and Thursdays or Mondays and Wednesdays as my days off. I got mad at radio disc jockeys and TV newscasters when they heralded the coming of everyone else’s weekend. I felt disconnected, removed, on the far side of a distance money could not bridge.”53 Yet because mill work was both a force of disturbance and deeply ideologically normative, there was l ittle room in working- class culture to acknowledge the strangeness of the form of life produced by this temporality. “My mill days provided a good, stable, life with a decent living that allowed me to marry, raise a family and have a decent life style,” Salaj recalled. “Weekly work schedules w ere always a worry. Am I going to work the weekend again? 12 to 8 again!? Shift work took a physical toll and having a social life was incomplete at best. There was no stigma of being a steelworker that I noticed u ntil a fter the mills closed. I guess I just didn’t want to believe it.”54 Often, working turns meant alienation and exhaustion. Coke shoveler John Bartus got caught resting on the night turn of December 10, 1956. The next night, he had some dispute over the work that his foreman, E. R. Woodring, had assigned him. During the disciplinary hearing, “Bartus interrupted at several points to say (1) that he was not sleeping on December 10, but had just eaten and had laid his head back; (2) that he was given too much work to do in eight hours; (3) that he had not refused to do the work (Mr. Woodring interjected that Mr. Bartus had refused to do the assigned work); (4) that Mr. Woodring was always ‘riding’ him.” For Bartus, the night shift, and the
D ow n i n t h e H o l e
51
consequent lack of control over his body’s rhythms—eating, sleeping, toiling— posed a threat to his performance of normative masculinity. “Mr. Bartus was resentful toward taking orders as a laborer probably partially because he was older than many of the laborers and possibly partially because he had been a drill sergeant and used to giving o rders.”55 Mill work was alienating and exhausting not only b ecause of its hours, but also b ecause of the constant, inescapable risk of injury and death. The hotter the job, as a general rule, the greater the danger, with coke ovens, blast furnaces, and open hearths generally being the worst. At one point at Duquesne, blast furnace workers reported that inhaling dust was causing them to vomit blood. But this injury was far from the worst. Howard Wickerham’s best friend died at work. On another occasion, Wickerham remembered seeing a worker lower himself into a ladle to repair something, then hearing when the man’s anchor gave and he fell onto the interior surface of the ladle, which scorched him to death immediately. Wickerham watched an explosion split three workmates lengthwise; the image in his memory is of a cross-sectioned human body, burnt on the outside and red on the inside. These accidents were not unusual. Most who worked in a steel mill for any length of time reported some equivalent horror. At National Tube, for example, in McKeesport, e very month saw several hundred minor injuries reported—w ith as many as five hundred injuries a month not uncommon, in a facilit y with just over four thousand employees.56 To get through all this—the hours, the danger, the exhaustion—steelworkers cultivated their own habits and rituals. “Dan worked 12–8—sleeping till 4,” recorded his wife, Beth, in her diary. They ate at strange times. “A man needing to be at the mill by 4 would eat a big dinner at 2 or 3 in the afternoon. . . . Husbands getting home at midnight sat down to another home-cooked meal, or at least warmed leftovers.” For Martin Conners, who worked at Clairton, the coke oven governed what he and his peers ingested. “Spicy foods like strong coffee, kielbasa or whiskey are all you can taste because the dirt and gas from the oven cause you to lose your sense of taste and smell. But guys also drank whiskey going into work at 7 in the morning, just to make it through the day.” Jim Boland remembered, of the night turn, “You’d come out of work at 7:30 a.m. and then maybe drink u ntil one o’clock; go home, get up for supper at 5; maybe take another c ouple hours of sleep, and then leave for work around 10 o ’clock.”57
52
The Next Shift
All had to develop routines for discharging themselves of the day’s events when they finished a shift. The owner of a tavern in Duquesne remembered selling the aptly named boilermakers—a shot of whiskey and a beer—to waves of steelworkers e very day. “Men said the whiskey cleared their lungs and the beer softened the whiskey.” Workers could not just go home from the mill; its mark was still on them—in tired bodies, hacking lungs, and wounded egos. If the plant gate, the time clock, the badge and check number, the foreman, and the incentive rate all reduced them to cogs, then the tavern and shot glass undid the deed. Drink baptized a worker back into the world of the living.58 Steelworkers passed through a membrane every day. On one side, they were living l abor, p eople with unquantified needs, duties, and cares. On the other side, they were b earers of commodified labor-power. Wickerham remembered arriving at the entrance to Homestead at the beginning of his shift, only to realize he had forgotten his badge, bearing his “check number”—a workplace identification number. The guard, who had known Wickerham for years and to whom he could recite his check number, still denied him entrance, causing him to be late—a moment when Wickerham recognized the psychic violence of the daily passage through the membrane, into the mill.59 Through the late 1950s and early 1960s, US Steel’s Industrial Engineering Department was always engaged in what it called “tightening.” Specifically, Industrial Engineering maintained an “objective of 100% cost performance, together with the 2% objective in annual standards tightenings.” This goal— no waste whatsoever, with a standard of efficiency increasing e very year— meant that many kinds of resistance w ere available for workers, not all of them collective or ideological.60 For example, on one graveyard shift at 4:15 a.m., laborer Edward Harris took an unauthorized break from his job in the soaking pits because the heat was overwhelming. He refused to follow instructions to “get back down in the hole.” Instead he “cursed the pits, a fter which Foreman Dunlap told Mr. Harris that he was sending him home for refusing to perform assigned work and for directing obscene language toward him.” Harris retreated to the washroom to shower and change. “While Harris was in the act of washing up, Mr. Dunlap came to the washroom and tossed Mr. Harris’s time card on the bench. The Union claimed that the usual procedure is for employees to pick up their time cards at the office and that by Mr. Dunlap delivering the card to the washroom it further aggravated an already tense situation.”
D ow n i n t h e H o l e
53
Somehow, the two men came to blows, and Harris fled the mill by jumping the fence, rather than g oing out the gate. It is not a coincidence that the time card was the instrument of the foreman’s escalation and that leaving by means other than the main gate was the worker’s response: the boss insisted on the mill’s abstracting disciplinary mechanisms, and the worker fled them.61 Many workers defied management in this way, by drinking, fighting, and sleeping on the job or just being late. But these acts stole back time only in small, unsatisfying increments. Moreover, such defiance risked disciplinary action. To drink, fight, drag heels, or sleep constituted a form of resistance. But such practices were reactive and defensive. To really wrest back some control, workers had to interfere in a more collective way. Management—as it sought to tighten incentive rates, cut crew sizes, and speed up production in the late 1950s—courted this sort of collective defiance. In 1959, Duquesne Works management came up with a plan to spread the bar mill pipe-fitting crew more thinly across the plant, starting May 21. Pipe fitters were high- status craftsmen, who had the ethos of skilled tradesmen and felt secure in the solidarity of the union. “Everyt hing seemed normal this morning, men had changed their clothes for work and foremen were making job assignments. At about 7:15 [union officer] Vernon Sidberry came to the shop and came to the office to ask what was g oing to be done about the Bar Mill situation. It was stated nothing.” Sidberry returned to the shop, where the pipe fitters held a meeting in the bathroom. “The men grouped together started to change their clothes and left the shop.” Sidberry then brought the news to the open hearth, where the foreman soon “noticed something was wrong but kept on assigning men to jobs. He assigned 4 men to the bending of the skids and about that time he asked Joe Dvorsky if he had assigned Emil Meir to a job. As he was making no effort to go. He noticed that t here was something wrong. Then Henry Harff stated that they were not going to the job assigned.” The wildcat strike continued to spread in this way, with bathroom meetings and refusals of assignments occurring across the mill through the rest of the day. By 2 p.m., 122 workers had walked out. That night an overflow crowd gathered at the u nion hall, and by 5:50 a.m. the next morning, pickets were at their stations.62 On May 22, with an illegal picket outside the mill, 366 scheduled workers— about 7 percent of the workforce—either did not show up for the morning turn or reported in and then walked out. The wildcat was especially strong
54
The Next Shift
Figure 1.4 Workers on wildcat strike outside the gate of Duquesne Works, with management’s identifying annotations, June 11, 1959. United States Steel Corporation Duquesne Works Industrial Relations Department Records, 1904–1980, AIS.1987.03, box 17, folder 3, Archives & Special Collections, University of Pittsburgh.
among the maintenance crews, where the pipe fitters’ grievances about work rule infringements were widely shared. During the illegal picketing, management conspicuously investigated participation: “No objection to letting pickets see that we are taking pictures.” Annotating photos, managers tried to match a check number to each face. The company waited five days, then doled out the discipline. Because management understood that workers’ solidarity was an iterative phenomenon that accumulated over the course of the workday, assignment of punishment followed a part icu lar timing protocol: “The slips should not be handed out u ntil shortly a fter 12 noon. This gives the group less opportunity to grouse about this for the entire turn. . . . The slips should be handed out in such a manner that the stronger discipline slips, namely, the five-day and the one-day, would be the last ones given out on the turn.” Managers grasped that they were heading out into deeper water. Tensions that had flared up only periodically throughout the 1950s had begun to accumulate and build.63
D ow n i n t h e H o l e
55
Strike During the late 1950s, management came to understand that it could not make sufficient progress by merely chipping away at crew sizes. Workers were too ready to resist, individually and collectively. Particularly important w ere the work rules in the union contract. Section 2-B of the contract protected “local working conditions” from alteration u nless there was some change in the “basis” of the job. Arbitrators interpreted “basis” to mean “underlying circumstances”—t hat is, management was within its rights to change a job subsequent to changing technical processes. Management was not f ree, however, simply to slash manpower or cut into break time. “While the board affirmed that Management has the right at its discretion to change job content and to increase workload, its decision leads to the conclusion that such right is subject to the limitations of Section 2-B if the changes of job content or work load are inseparable from reductions in the size of an established crew or from changes in established spell time.” Far more grievances drew on Section 2-B than on any other part of the contract.64 Over the course of the decade, it became clear that management had not found a way to increase productivity growth within these constraints at a rate that could outpace the expansion of costs. Local b attles between foremen and workers were not achieving this end. The steel corporations were going to have to attack the u nion frontally.65 In November 1958, E. J. Woll, US Steel vice president for industrial relations, sent out a survey from the central office to all plant superintendents, instructing them to examine their mills to determine the costs of Section 2-B to their operations. “Although many potential cost reduction actions by Management have been prevented by Union opposition, as indicated by grievance and arbitration records, t here is no doubt that many more u nder consideration at one time or another have never reached the point of action because of the restrictions imposed by Section 2-B.” Therefore, Woll ordered, “obtain an estimate of increase of production and / or the reduction in annual cost that would be realized at normal operations . . . if the local working condition or practice were to be eliminated.” 66 Mill superintendents proposed a raft of job eliminations and adjustments toward management prerogative. “Eliminate Scrapman—#6 Mill Shear. Add duties of Scrapman to Bar Shearman Helper,” offered one. Suggested another,
56
The Next Shift
“provision should be made . . . to give Management more freedom to change schedules to meet operating needs of the business such as order performance without being limited to breakdowns and without incurring overtime.” One proposed a shortened, unpaid lunch break.67 Subsequently, industry negotiators heated up their joint talks with the union by demanding significant revision to Section 2-B in June 1959. To prepare his peers for the 1959 negotiations, a US Steel labor relations executive explained “the need for positive language in the agreement whereby the International Union would agree to crew reductions in order for the Company to get more efficient operation.” The last time the issue had come up in negotiations, in 1952, steel companies had not enjoyed sufficient consensus to press the issue. Now they did.68 Yet, while productivity had not grown fast enough to keep up with costs, it had grown. Bosses on the shop floor had not won every fight, but by keeping at the effort for years, they had sped up the workers marginally. Accordingly, when management came after Section 2-B in negotiations in mid-1959, USWA President David McDonald reacted with indignation, knowing that he spoke for members. “There are 44,000 fewer Steelworkers in the industry than t here were in 1953, and the reduced work-force is turning out 30 per cent more steel. Does this sound like Steelworkers are loafing on the job?” 69 In this sense, the attack on Section 2-B was a godsend for u nion leadership. By the late 1950s, the USWA had become a highly bureaucratic, even undemocratic, organization. In 1957, McDonald, who had never worked in a mill and seemed to prefer limousines to picket lines, had nearly lost his reelection as president to an unsophisticated but dogged intraunion insurgency, outraged over a dues increase. The rebellion, called the Dues Protest Committee (DPC), nominated for president a rank-a nd-fi ler, Donald Rarick, who worked at Irvin Works in the Mon Valley. (For vice president, the DPC ran one of the leaders of the Duquesne wildcat from several months e arlier.) If the u nion could not deliver more, why should workers pay more?70 Although the DPC and Rarick were largely apolitical in substantive orientation, they still gave expression to the frustration simmering among the steelworker rank-and-fi le. On the defensive, having even been burned in effigy at one point, McDonald tried to red-bait the DPC as Trotskyists. According to Rarick, McDonald also tried to bribe him to drop out. As the
D ow n i n t h e H o l e
57
insurgency spread to dozens of locals, a desperate McDonald sought the vein of discontent coursing through the rank and file: he proposed three- month vacations every five years, a four-day week, and a six-hour day. W hether he found that vein is hard to say; possibly aided by ballot fraud, he won reelection in 1957 by an embarrassingly small margin of 404,172 votes to 223,516. Still, the campaigns of both challenger and incumbent brought to the surface the unhappiness that permeated the life of some of the best-paid industrial workers in the world.71 This was the u nion’s recent history when the 1959 negotiations began. McDonald, inspiring no particular love in the rank and file, had been compelled to resort to 1930s-style utopian promises to beat back a no-name challenger in 1957. It was thus not obvious, when the steel companies’ negotiating committee began to make unacceptable demands in 1959, that the u nion leadership could command the loyalty from the rank and file needed to resist t hese demands successfully. Some on the employer side believed that McDonald was so weak that industry negotiators ought to take care not to undermine his position, and possibly produce a more militant union leadership, by extracting too many concessions from the union. The company’s demand to weaken work rules therefore inadvertently gave the embattled union president something that would rally the workers. “It was generally felt,” US Steel officials later reflected, “we had the battle won until the new issues [Section 2-B] were introduced; t hese new issues threw McDonald an emotional life preserver.” Jack Metzgar, reflecting on both his memory of 1959 in Johnstown, Pennsylvania, and news coverage from the time, agreed: “For two months prior to June 10, polls and informal interviews by newspaper reporters showed that steelworkers, while getting ready to strike, had little stomach for it. Younger workers had experienced long layoffs in the 1957–1958 recession, and they were just getting back on their feet.” 72 The work rules fight changed t hings. A month after the steel companies raised the issue, negotiations broke down, and the strike began. At Duquesne, “pickets first appeared at the Whitfield Street Gate at 9:47 p.m. and at the Grant Avenue Gate at 10:15 p.m., July 14, 1959.” 73 Hundreds of thousands around the country did the same. When steelworkers walked out in July 1959, they began what would become the largest strike in American history in terms of person-hours idled. They stopped America’s massive basic steel industry for nearly four months,
58
The Next Shift
bringing many families to the brink of privation. “My best friend, Denny Dishong, lived down the alley from us. His m other and father remember the strike as the absolute worst time of their lives,” writes Metzgar. For Howard Wickerham, 1959 stood out in his memory as a year of no Christmas pre sents and military rations—“government meat”—d istributed by charity. In the Novak family, of Dravosburg, Pennsylvania, two men, Dan Sr. and Dan Jr., worked at the mill. In the first week of the strike, they ate varied meals, with main courses of pork, steak, and fish. The last week, they ate sandwiches and macaroni salad. The family drew monthly relief checks of $100–$150, roughly a quarter of Dan’s monthly wages: “Needed it & it was just in time,” wrote Beth when the assistance allowed her to buy groceries on October 3. Her husband and son worked as hairdressers and janitors and did other odd jobs, while her father came to stay and attempted to hock adding machines. Other accounts echoed this experience: Joyce Henderson recalled the “welfare cheese” distributed to her family in 1959; Carol Henry remembered standing in line for “government meat.” 74 What motivated the long, b itter stand? Metzgar describes the core ethos of the strike as the steelworker’s “machismo”—the mantra “I don’t eat shit for nobody.” But others had to eat theirs. A steelworker’s wife, identified as Mrs. Mike Micklo, wrote to the chairman of US Steel in late 1959 pleading for a loan: “My husband is 48, he still has at least 15 yrs. in the mill. He is satisfied with his job, he gets good money + is treated good. He d oesn’t know of this [letter], I think he’d knock me out. Please consider this [loan].” 75 Companies tried actively to turn wives against the strike. Asked one piece of company propaganda, “What does Mrs. Steelworker think about this? Does she yearn for the new kitchen? The new clothes? The money to educate her children?” On August 28, 1959, a group of roughly one hundred women and fifty men gathered in Renziehausen Park in McKeesport to call for an immediate and transparent resumption of negotiations: the event, as reported on by a company spy, revealed the gendered tensions in the steel town world. The mayor of McKeesport opened the rally, lecturing the gathered w omen, “Don’t do anything to spoil the nice t hings we now have. . . . D on’t rock the boat.” Then, speaking over male hecklers, apparently from the u nion, a woman identified as Mrs. James Hanratty said, “Let’s get our men back to work. Our husbands hands are tied. . . . You men have read your papers and played your cards, and now it’s time to get things settled. . . . We need clothes
D ow n i n t h e H o l e
59
for our children to start to school. . . . There are families with five and six children who need to be fed.” 76 A week later, the group gathered again, this time numbering 125 w omen and 225 men. Hanratty wanted to clarify “the misquotes by the newspapers stating that we women wish to see our husbands back to work without a contract. I said no such t hing. We women wish to see our husbands back to work with a contract that is fair to all concerned.” She made an appeal for shoes and clothes for c hildren of strikers. “There was a well organized and abusive protest by both men and some w omen at this point,” reported the spy. Hanratty then introduced F ather Charles Owen Rice, a “labor priest” who had achieved notoriety for his support of the CIO in the 1930s and anticommunist activities in the McCarthy years. Rice offered a kind of gender analysis: The old man has worked a hard eight hours, stopped in for a beer on his way home and is too tired and wants to sleep when he gets home. He hasn’t taken time to tell his wife about the coming strike. Now she is asking what it is all about. She wants to help and she should help. I w ill tell you that you should hold out and not go back to work without winning this strike. . . . They (management) want as few men as they can get away with to run the mill . . . and they want those few as cheap as they can get them. If the w omen wanted to help their husbands, Rice instructed, “Support them in this strike. Make them happy at home.” Otherwise, “If your men d on’t win this strike they w on’t be able to talk to you wives. . . . They’ll be too tired from overwork.” Rarick, the defeated leader of the DPC, appeared and warned, “If you wanted to help your husbands, you’d take them home, cook them a good hot meal, and be nice to them!” 77 Management hoped in vain that consumerism would overcome the wives of steelworkers, who would scab on the home front and break the union’s re sistance. Hanratty, by convening a second mass meeting to “clarify” and by bringing a working-class hero like Rice, made clear that this strategy would not work. So did the months of Beth Novak’s diary entries in which she never complained about the strike, nor even celebrated its end, as she worked late into the night cooking and cleaning, preserving the family and pinching pennies. No less than the men who worked in the mills, the women who
60
The Next Shift
worked at home understood that everyt hing they had was a hard-won victory. Yet the membrane of misunderstanding and resentment between men and women, so vividly described by Rice, was real. The conflict first resolved into a hostile truce when President Eisenhower, contrary to all his stated principles, invoked the Taft-Hartley Act and directed the workers to return to the mills in October. Since the beginning of his presidency, Eisenhower had inveighed frequently and intensely against the politicization of collective bargaining, which he described in his first State of the Union address as “bureaucratic despotism”—with the prime example being Harry Truman’s attempted nationalization of steel in 1952, in a bid to settle a contract without adding to wartime inflation. Despite this declared position, Eisenhower had helped s ettle both the 1954 and 1956 steel strikes in f avor of the u nion: his principles proved no match for his aversion to a protracted steel shutdown in an election year. Once the 1959 stoppage began, Eisenhower hoped vainly the third time would be the charm. Chief economic adviser Raymond Saulnier insisted, however, that any settlement leading to price increases would be devastating for the White House’s anti-inflation program; the president suggested a voluntary agreement freezing wages and prices, which was of no interest to e ither management or u nion. In other words, the political necessity of controlling inflation was directly at odds, once more, with the principle of nonintervention.78 The president was in the trap again. After a board of inquiry failed to generate a workable solution, Eisenhower settled on state coercion, u nder the legal justification that resuming steel production was critical for national security. Angry workers returned to the mills under banners reading “Ike’s slaves.” And the union prepared to resume the strike in early 1960, after the required cooling-off period elapsed. Yet again, however, Republicans opted not to court the anger of the USWA during an election year. Vice President Richard Nixon, preparing his own candidacy, grasped that the militancy of the workers now had been awoken, and he became the main administration voice for a pro-u nion settlement. Together with Secretary of L abor John Mitchell, Nixon leaned on the employers to give up on the work rules question, and on January 7, 1960, management caved and signed a contract that left Section 2-B intact and granted a 40-cent pay increase. As Business Week observed wryly, the terms “were not negotiated agreements.” The u nion had imposed its position on the US government as well as management.79
D ow n i n t h e H o l e
61
The strike condensed a particular, ambivalent structure of feeling about work for men. This feeling had been shaping u nion politics for years, making Section 2-B a lightning rod as the contractual expression of the question of how tired and humiliated steelworkers would be when they got home. Decades a fter the strike, Ed Stankowski claimed, every argument between workers at Jones & Laughlin’s Pittsburgh Works climaxed in the question, “ ‘Where were you during the strike of ’59?’ As if having been t here was sufficient license for distance, superiority, respect.” This moment, it seems, was the apex of proletarian manhood for a generation of steelworkers; their ability to fight for their living was tested, and they won. The victory in the 1959 strike is the eponymous centerpiece of Metzgar’s memoir of his father. In such memories, it is easy to miss how many workers hated the jobs they defended—a hate that bound workers together and made their defense formidable.80
Distance, Superiority, Respect The strike threw into dramatic relief the bifurcation of postwar social citizenship between collective bargaining’s insiders and outsiders. The conflict posed the question of w hether a large and economically central but still limited group, in the name of their own dignity on the job, could inflict on society as a w hole the inflation that federal officials of both parties ardently wished to contain. The answer was yes. The strike, however, was not an illegal insurgency. Steelworkers’ triumph in 1959–1960 came about through the machinery of state, not against it. As had happened repeatedly since the heyday of the New Deal, Democrats and Republicans alike, whether they liked it or not and despite protesting and calling down a plague on both houses, nonetheless met their own political needs by forcing concessions on industrial employers. Islanded in their secured industrial zones, workers themselves experienced the bifurcation of social citizenship not just as their collective power but also, individually, as something darker. The collective power was emancipatory—t he reason they worshiped the mill; the individual experience was alienation and fear—the reason they cursed it. This was the phenomenon Ed Stankowski described when he wrote of feeling “disconnected, removed, on the far side of a distance money could not bridge.” All
62
The Next Shift
this was captured too in his sense of the emotional endowment bequeathed by the strike—“distance, superiority, respect.” Steel work made workers feel heroic, resentful, and embattled at once. Even a victory in a titanic strike failed to resolve this more profound contradiction, which lay deep in the structure of promises and obligations that composed the postwar working-class good life at the individual level and the national economy at the social level. To be sure, steelworkers’ strong u nion won them rights and security far in excess of what their fathers had enjoyed. But exactly b ecause organized labor enjoyed a newfound position of strength, its members were set up for a new contradiction. On the one hand, steelworkers now bore a set of material and ideological responsibilities as breadwinners: to be disciplined, reliable providers and participants in mainstream American life—to serve as the h uman core of the postwar boom. Indeed, so powerful was this norm that when the Eisenhower administration ended the strike and the US Supreme Court sustained the decision, it was on the grounds that the stoppage “imperils the national safety.”81 On the other hand, steelworkers generally feared for their lives, hated their foremen, and needed a drink. The worse the economic pressure on the industry became, the more aggravated this tension became. Beneath the layers of fetishization of industrial work that have built up over the decades, we can thus discern something e lse. Working-class men did not only love and draw strength from this work. They also dreaded spending their lives doing it, imagining all that it would require of them and all that it would do to them. This contradiction writ small s haped and damaged thousands of lives; writ large, it damned to profound instability the very structure of social citizenship that was organized around industrial labor. On the other side of the “far distance” from steelworkers, after all, was the rest of the working class, and their fates were tied up with what happened in the mills as well.
2 Dirty Laundry Labor and Love in the Working-Class Home
L
inda Novak grew up among steelworkers. Her f ather, Dan, worked at US Steel’s Irvin Works and supported the large f amily, sometimes working a few side jobs. But he died in 1961, when Linda was young. A tractor that he was riding at work caught fire, and he jumped off, hurting his leg. Several weeks later, an embolism killed him in his hospital bed. The day of his funeral, Beth, Linda’s m other and Dan’s wife, s topped writing the orderly, ledger-like diary entries she had kept e very day for years. Instead, Beth scrawled diagonally across the pages of her diary, “Dan buried today. Finished. Everyt hing no interest.”1 Linda grew up and married her own steelworker husband. He worked nights to make the payments on their h ouse. She kept the c hildren quiet and the h ouse dark during the day so he could sleep a fter he came home, slumped in front of the television. Then he was badly injured on the job. The two began to fight. When they finally split up, she kept the h ouse. As a middle-aged woman with little work history, she strugg led to live off her share of his workers’ compensation payments. Linda took up a hobby: painting Santa Claus figurines. Eventually, she lined her house with hundreds of the figurines. To her, Santa Claus meant routine happiness—he came every year and always brought joy. What else had ever been predictably joyous?2 Making each figurine represented and resolved a decades-long arc of joy, discipline, and disappointment. Even the specificity of Yuletide symbolism— often fraught for working-class people anxious about affording gifts, food, and drink—offers a glimpse of a deeper, more general problem. Another daughter of a steel family, who grew up in Pittsburgh’s Greenfield neighborhood, recalled how Christmas was an occasion for rituals of mandatory pleasure. “We’d always wash our hands with a silver dollar before we’d eat
64
The Next Shift
dinner. Once you picked up your silverware at dinner time, you weren’t allowed to put it down until you were done eating. And once you put it down, you weren’t allowed to eat. That was it.” Working-class families would, of course, save up for gifts. Steelworkers staged illegal work stoppages to get off work for Christmas.3 Women worked overtime for days beforehand to prepare; so their families had better enjoy the holiday. The ordeal of celebration—t he strugg le to have a holiday as happy as it was supposed to be—indicates a moment of compression in the normative power of family life. Christmas is “the time when all the institutions are speaking with one voice,” as Eve Kosofsky Sedgwick puts it. “The pairing ‘families / Christmas’ becomes increasingly tautological, as families more and more constitute themselves according to the schedule, and in the endlessly iterated image, of the holiday itself constituted in the image of ‘the’ family.” The loose ends of various lives are forced into “lockstep of their unanimit y in the system called ‘family.’ ” 4 The holiday rendered visible a set of general dynamics that were usually dispersed and harder to see. At Christmas, the time that had to be happy, a forcible resolution to the many contradictions of the process called “family” would be attempted. Yet the holiday’s requirements only exaggerated what working-class w omen had to do every day. Throughout childhood implicitly, but with increasing explicitness from the moment of marriage onward, the postwar norms of consumer affluence and domestic bliss spoke to working- class women in tones of obligation and menace. A promise was on the t able, but that promise carried a sanction.
The Working Class Comes Home In the postwar years, the working class was supposed to have gained a proper domestic life. Before World War II, many women at some point took in boarders or washing, were employed in labor-intensive light industry, or worked as domestics, saleswomen, telephone operators, nurses, teachers, or waitresses; when the war began, they worked in defense production. Such work formed an in-and-out cycle over the lifetime, fluctuating with economic need. A fter the war, domesticity gained new exclusivity and intensity, as consumerism ascended and norms for respectable living standards for working- class families rose.5
D i rt y L au n d ry
65
More women began to participate in waged work generally over the postwar years, but working-class w omen in places like Pittsburgh lagged the trend, thanks to their husbands’ new economic security. A blue-collar town with a dominant high-wage industrial sector and a traditionalist, heavily Catholic working-class culture produced a distinctive pattern of labor market be havior. Although Pittsburgh w omen had worked for wages at similar rates to the national average in 1920 (around 24 percent), their participation in waged work was far below the national level by the postwar period—a difference especially pronounced among married women. The relative gap between this participation in Pittsburgh and in the rest of the country, a consequence of the rise of u nionized industrial work, was greatest for married African American women (see T able 2.1). This larger gap resulted from the labor market anomaly created by manufacturing, which caused the formation of single-earner h ouseholds at higher rates for working-class p eople in general—producing an especially pronounced effect for African Americans, who nationwide had relatively less access to such work.6 Also new were the enjoyment and comfort that working-class families were supposed to derive from this arrangement, particularly women. Already in 1942, sociologist Talcott Parsons wrote that the housew ife’s work has “declined in importance to the point where it scarcely approaches a full-t ime occupation for a vigorous person.” And in the view of the official labor movement, the single-wage h ousehold constituted a g reat victory. “The American standard of living is based upon the earnings of the main breadwinner,” declared the USWA in 1945; “it rejects the concept that other members of the family have to work in order to provide the
Table 2.1. Married women’s labor market participation by race, 1960
Married white w omen Married African American women
Percentage employed in Pittsburgh
Percentage employed nationwide
19.5 26
29.7 40.7
Source: Pittsburgh Regional Planning Association, Region in Transition (Pittsburgh: University of Pittsburgh Press, 1963), 34.
66
The Next Shift
family with the necessary living essentials.” Feminism within the labor movement, too, was oriented around the protection of home life for working- class women.7 Indeed, viewed through the lens of mass consumption and homeownership, the distinction became somewhat blurred between postwar working- class and middle class families, who w ere neighbors in the subdivisions. So dramatic was the rise in the standard of living of working people in the 1950s and 1960s that, in this view, they were vanishing entirely as a class. Historian Lizabeth Cohen surveys this rhetoric: “The L abor Department [asserted]: ‘The wage-earner’s way of life is well-nigh indistinguishable from that of his salaried co-citizens’ . . . A Business Week headline blared ‘Worker Loses His nion has made the worker to Class Identity,’ while Fortune gushed that ‘the u an amazing degree a middle-class member of a middle-class society.’ ”8 While Pittsburgh’s urban history makes the sunny story of working-class emigration from confined tenements into open suburbs look a bit grittier, the contrast to this narrative is much clearer when domestic life is considered in the medium of time. In the early 1960s, after fifteen years of postwar wage growth, steelworkers earned an average hourly wage of $3.36—equivalent to $28.53 in 2020. But work was not steady enough to guarantee they stayed above what the Bureau of Labor Statistics (BLS) saw as a “modest but adequate” standard of living for a family of four in 1959.9 This budget, calculated at $6,199 annually for Pittsburgh, assumed a nuclear f amily with one male earner, a full-time housew ife, two c hildren, and no other dependents, inhabiting a rented dwelling with four rooms plus bathroom and kitchen, for an annual rent of $1,012. (Pittsburgh’s housing prices were on the cheaper end.) “The wife does all the cooking, cleaning, and laundry without paid help, and the home is equipped with the h ouse furnishings and mechanical equipment usually considered to be household necessities, such as gas or electric cook stove, mechanical refrigerator, and washing machine.” For food—for which Pittsburgh had the highest prices of any major city—BLS apportioned $1,889 annually, including one of the most significant increases of the postwar period, the near-doubling of the weekly meat budget. This family could buy a television e very fifteen years; five shirts and two pairs of pants per year for their son; and two blouses, one skirt, 3.5 dresses, and 1.5 sweaters for their d aughter. They drove a used car, which they could replace every three or four years. If steelworkers had stayed in steady employ-
D i rt y L au n d ry
67
ment, they would have come in just above this standard in the early 1960s. Counting interruptions in work, however, they fell below it on average.10 Steelworker families did not inhabit a steady state. While they had achieved high rates of homeownership in the interwar period, they used their housing stock as private group insurance to shelter extended family units against episodic distress—producing compound configurations often quite at odds with the nuclear norm. If food was expensive and housing was cheap, for example, it made sense to bring kin together u nder one relatively spacious roof, allowing for economies of scale in food purchasing and preparation. “Back then, not too many Black p eople owned their own homes,” recalled Joyce Henderson of her steelworker uncle, with whom she and her father went to live when they needed new housing. “But he owned his own home, him and my aunt.” Moreover, they kept a garden.11 In 1959, a team of academic sociologists wrote a study called Workingman’s Wife, intended to help businesses reach this ostensibly unsophisticated yet coveted market. “Before she becomes a wife and a mother,” they explained, “she regards herself as getting ready for that role decreed by society and nature; as her c hildren grow up the working class w oman is inclined to feel that her life is ‘over.’ ” The “workingman’s wife” evidently r ose to the level of an autonomous individual through marriage, parenting, and consumption. “She is heavily reliant on the external world and is oriented to what it brings to her. Another way of putting this is to say that she tends to be a psychologically passive person. . . . Mental activity is hard for her.” As the White House Conference on Effective Uses of Woman-power put it in 1955, “The structure and the substance of the lives of most w omen are fundamentally determined by their functions as wives, mothers, and homemakers.”12 Yet constructing and maintaining the postwar household was not a posture of consumerist passivity, nor was its predominance simply the result of the preferences of nonemployed women. For this group, so overrepresented in Pittsburgh, hours of domestic work did not decrease with the mechanization of household chores in the 1950s and 1960s but instead hovered above fifty hours per week. Th ese w omen w ere not simply recipients of postwar plenty, but its coproducers, generating the steady supply of labor power and regulating the valves of consumer demand.13 The working-class h ousehold was a critical social unit within postwar society, the twin of the mass-production factory. Women’s work not only
68
The Next Shift
produced and sustained living labor but also continuously forced into alignment the conflicting pressures of work and daily life through the social machinery of the f amily and its output: socially integrated individuals. Parsons grasped this fact when he wrote in 1956 (with Robert F. Bales), “it is b ecause the human personality is not ‘born’ but must be ‘made’ through the socialization process that in the first instance families are necessary. They are ‘factories’ which produce human personalities.”14 Like a factory, the household hosted a continuous collision. On one side stood the social forces that required a patriarchal structure on these families and normative gender performances of their members: male access to work and control of income; state support for the male-headed single-wage model; organized religion; intensifying norms for domestic work; stigma attached to women’s independence, enforced informally by friends, family, neighbors, and media and directly—sometimes violently—by husbands and the state. On the other side, against all of t hese forces was only the fact that, despite how earnestly many women might try to comply, they often could not do so successfully or did not want to.15
Entering Marriage Working-class w omen in Pittsburgh typically got married around age twenty. It was not so easy, at this phase of life, to form a nuclear, single-breadwinner family. The undertaking could be quite elongated—and possibly never quite complete. Present throughout their accounts is the challenge of navigating entry into multigenerational f amily units, often though not always gathered under one roof. Steel towns had disproportionately large populations over the age of 55. A growing gender gap, too, was appearing in working-age cohorts: in Homestead, where the phenomenon was already visible, men accounted for only 45 percent of the population between 25 and 54—likely due to economic out-migration. Young working-class w omen had a key role to play in this environment, helping to manage the care of the young born into the baby boom and the relatively large older generation. With the fabric of their own lives, they had to bind children and elders together around the income and needs of husbands and f athers. At the level of the f amily unit, a very high degree of gendered compliance proved economically functional and—as encoded by the familial values of Catholicism and the ethnic
D i rt y L au n d ry
69
norms of these children and grandchildren of immigrants—customarily almost mandatory.16 Mrs. C., for example, was born in 1926. She grew up the youngest of eleven children—though only eight survived childhood—in a Polish family in Homestead. Her father was a disabled millworker; her m other cooked in a restaurant and did odd jobs. The young Mrs. C. wanted to be a nurse, but her father forbade her from pursuing that career. “He went to the hospital and he figured nurses had too tough a job. He says, ‘No, y ou’re not g oing to be a nurse.’ So I didn’t.” In 1943, her father died, and her brothers returned from the army. “They came back from the serv ice and I used to take care of them. I think . . . my mother got tired of housework. Ironing all the shirts.” In 1949, Mrs. C. married her boyfriend, who worked at a beer distributor. The newlyweds lived in the house where she had grown up, just uphill from Homestead Works, with her mother and two uncles. They stayed there for eighteen years. In the meantime, her husband got a job at the mill, eventually rising to crane operator, so she never went out to work.17 Their daughter, born in 1956, remembered growing up in a three-generation household, with a structure far from nuclear: “I had so many bosses. My u ncle worked night turn so he slept during the day, so I was very quiet when I was younger. But I think it was hardest on my m other and dad, b ecause if they wanted to have an argument or something they couldn’t because what would my grandmother say. They d idn’t want to make a fuss in front of everybody.” In the late 1950s, her immediate f amily’s three members slept together in one bedroom; her u ncle and grandmother slept in the other. L ater, the h ousehold was able to afford the addition of a second floor. By this time, her father had become sick of sharing the space and moved out into a house of his own, although his marriage was otherw ise intact.18 Mrs. P., who grew up in a three-generation h ousehold in Pittsburgh’s Polish Hill neighborhood, had a similar story. She left school a fter tenth grade and worked as a messenger in downtown Pittsburgh. She met the man who would be her husband at age eighteen, at the war’s end, and they dated for several years. “When we started going together and we would talk of marriage, we never had enough money because he used to give everything to his mother.” The pair finally settled on a date, got married, and moved in with his mother, “so she wouldn’t be alone.” Mrs. P. stayed at her job downtown, her husband worked in the mill, and “his mother naturally did all the cooking. Come
70
The Next Shift
weekends I would do all my own ironing and she would do the washing and on weekends we had the arrangement made that she would clean the kitchen and her bedroom and I would clean our bedroom and the living room.” This arrangement lasted for several years, until Mrs. P. had her own child. At this point, the P. family moved out and moved the mother-in-law into her own small apartment. Then they “lived in an apartment with the landlady, who was an elderly woman. . . . Then we moved back on the hill and lived in my grandfather’s h ouse for a c ouple months and then moved into my m other’s house up on the third floor and we stayed t here until we moved across the street into a bigger apartment when we were g oing to have the third baby.”19 We may appreciate this protracted process by viewing it in comparison with the experience of an upwardly mobile woman, Dr. M., who was born to a steelworker household in a mill town, earned a PhD, and became a college dean. Already working as a teacher when she met her husband, she reflected, “I didn’t want to marry someone [like] the kinds of p eople that I saw o thers marry. . . . I w asn’t thinking about the f uture at that time or money and this is what I think had my m other concerned b ecause I wanted to be with 20 someone that I would enjoy being with.” While t here is no reason to accept the implication that middle-class marriages w ere more loving, the subjective experience of familial rupture and self-creation through companionship and new f amily formation stands out in opposition to the experience of t hose around whom Dr. M. grew up—their experience was of reproducing the past, with the f amily as a form of continuity. While mass production and then u nionization did create more stable employment than before, leading to more uniform family structures, the demand for labor never lined up with the h uman life course neatly enough for the ideal-t ypical family to become as universal in practice as it was in ide ere units of soology.21 The families that sent men to work at the steel mills w cial machinery, linking the processes of daily life to the rhythms of industry. This is the sense in which each family was, itself, a little factory. Yet members also had to live together.
Domestic Work-Discipline Like factory work, family work imposed embodied discipline on its new participants. “When I came home from work I had to cook every night, and I
D i rt y L au n d ry
71
think that was the biggest adjustment,” recalled Mrs. R. “Because at home when I would come home for supper, and mum and I would change my clothes and I would go into the kitchen and there was supper, then when I got married I had to start this, set the table and make this. I w asn’t used to that and that was a big adjustment.”22 Just like even the best jobs in the waged industrial economy, domestic work could produce alienation, even with a rising standard of living. “You get up in the morning you take care of the baby and dress her up and go up to your mother’s. Spend the morning, and have lunch t here. In the afternoon then come home and start cooking. She’d usually watch the baby when I went down the cellar to wash clothes. It was just one complete cycle, washing, ironing, cooking, and cleaning,” said Mrs. I., a millworker’s d aughter married to her high school boyfriend on her nineteenth birthday. “When you are married, they know that they got you. You’re stuck!” The shocking discipline of this “complete cycle” caused her to imagine her own life as something seen from outside. “If there was only a way you could put that on film. Just a week of somebody’s life really everything and show it. I mean a person who has prob lems especially in the first year of your marriage, this adjustment period. That is a bad time. You learn things about each other you think, ‘Oh my God if I had only had any idea.’ ” Mrs. S. moved in with her husband’s sister and brother- in-law shortly after her marriage: “We had to wash Mondays, we had to iron Tuesdays . . . her [Mrs. S’s] whole life. She was a very, very good h ousekeeper.” Or as Helen Havrilla put it, “I had to make all the foods he had had at home. And I had to make the same kind of noodles! All them noodles!”23 The purpose of the labors of women and girls in working-class h ouseholds was to produce both life and l abor power, despite the tensions between t hese two—holding in alignment the formal economy and the rhythms of the family members’ lives. Because of the era’s rising expectations of working- class affluence, such alignment required women not only to meet the material needs of the f amily—cleanliness, nourishment, health—but also to satisfy expectations of what family meant. Mrs. K.’s husband, for example, had grown up in a working-class Slovak f amily during the Depression, and he had a brush with a different gendered division of labor: “When he was young, he would help his m other to wash clothes and do everything because she would work.” He grew up and got a job at Jones & Laughlin Steel. “Then after we got married, I just did everything. So he really d idn’t do anything.”24
72
The Next Shift
omen’s work at home was routinized in its own ways. On a typical day, W Mrs. C., wife of a steelworker and m other of five c hildren, woke everyone up in shifts, made breakfast, and reminded the habitually forgetful of what they needed to do. “Then I do a routine of lightly dust, straighten up and wash, every second day of the week, b ecause t here’s so many clothes. And the same t hing with the ironing. There’s the shopping to do. I have meetings with the PTA, I’m also an officer in that.” All of this was during the workday and school day, excluding evening work and episodic work around births, illnesses, and deaths. Mrs. E., whose husband worked two jobs at two different mills and got home at 10:30 p.m. on weeknights, reported, “I always have his supper ready for him. The weekends I more or less try to save for my husband, b ecause he d oesn’t get any time thru the week. . . . The rest of the week is washing, ironing, cooking, and cleaning.”25 Because the routine of w omen’s work was not concentrated in delimited shifts, but extended around the clock and throughout the week with moments of episodic intensification, and because it encompassed quasi-voluntary activities such as church, the very existence of this routine is often missed. “Despite the fact that most of these homemakers receive little help from their husbands,” wrote midcentury sociologist Mirra Komarovsky in her book Blue-Collar Marriage, “they do not appear harried.” While Komarovsky acknowledged a “full day’s work” and “a steady stream of demands,” she argued that the rhythm of h ousewives’ work was “relaxed,” without an “eye constantly on the clock.” In his classic essay on time and work discipline, historian E. P. Thompson commented, “Despite school times and telev ision times, the rhythms of women’s work in the home are not wholly attuned to the mea surement of the clock. The mother of young c hildren has an imperfect sense of time and attends to other h uman tides. She has not yet altogether moved out of the conventions of ‘pre-industrial’ society.”26 The working-class f amily was, however, not a preindustrial remnant, but rather a live and contested social process, structurally integrated with the industrial economy—a lthough not without friction. Working-class w omen were not time-conscious in exactly the manner of factory workers, but they were nonetheless engaged in an endless struggle over the minutes, hours, and days—and, for that matter, the months and years. Working-class housewives had to maintain consciousness of their husbands’ industrial routines in addition to their own; they had to organize their labors in accordance with both
D i rt y L au n d ry
73
the factory clock and “other h uman tides.” A clue lies in the explanation given by Mrs. S., a steelworker’s widow, for why she did not remarry: “Well I think after all these years, I’m too independent. I have my job. I got my home and I cook when I want to cook. I wash clothes if I want to wash them or I can do it tomorrow.”27 Take away the steelworker husband, and the routine—and the power relation it embodied—decomposed. The rigors that sustained and constituted the family often could travel in the guise of feeling and pleasure. For African American women in partic ular, family often sharply contrasted with the world outside—in part b ecause wage work in general was more common for them than for white women and specifically meant work in other p eople’s homes. The paradox of domestic work, in these terms, was that it was explicitly subject to time discipline, unlike the work of a wife, yet still took place within informal domestic space. “You c an’t ever do enough for them,” recalled Queen E. Wright of the Pittsburgh family for whom she worked. “They want you to start in the morning, and t hey’ll set the clock back on you. If you d idn’t have you own time you looking at, you’ll be working u ntil 6 o ’clock and you’ll think it’s 4.” For Wright, owning her own watch became critical to having some control on the job. This work was exploitative and often demeaning: average annual wages for Black women in domestic work in the Pittsburgh area in 1969 totaled $1,322— the equivalent of $9,235 in 2020.28 The labor market in domestic work collapsed over the course of the 1960s, falling from 32 percent of African American women’s employment to 13 percent. In part, this decline corresponded to the spread of domestic appliances, making domestic workers among the most significant and first occupational groups to be displaced by automation in the postwar period. As this employment dried up, working-class Black women became in turn the first group to move en masse into the growing category of institutional “ser vice work,” which by 1969 accounted for 33 percent of their employment. Within this sector, health serv ice, food serv ice, and cleaning serv ice accounted for the most important growth areas, with health alone equaling domestic serv ice. All t hese easily exceeded domestic work in wages; Black women health serv ice workers’ annual wages, for example, averaged $3,559 ($24,863 in 2020 dollars). As the welfare state grew and consumed more of these services on behalf of t hose it served, it drove up wages and employment together—not beyond the realm of poverty, but enough to attract workers out
74
The Next Shift
of the home and to begin to make the functions that had once happened in homes increasingly a public affair. This waged care work was related in very concrete, practical terms to what w omen did in their own homes: cooking, cleaning, and various forms of care work. Carol Carter, for example, worked for more than a year as a ward clerk at Allegheny General Hospital in the early 1960s, quit to take care of her ailing mother, and then returned to the labor market some months later.29 As the question of who was responsible for reproducing the family over time became increasingly aggravated with the crisis of the industrial breadwinner model, Black women felt the problem first and had to figure out how to solve it first. Writ large, this meant the increasingly rapid formalization and quantification of reproductive l abor, gradually redistributing the responsibilities for sustaining life at the collective level. Collective life was always constituted out of time discipline and the struggles it engendered—whether contained within a kin unit or an employment relation; unmeasured, mismea sured, or formalized; in the supposed privacy of one’s own home, the paradoxical public privacy of someone else’s home, or the contradictory intimate public space of the h otel, restaurant, or hospital. While the necessities and pleasures of family have varied in important ways across racial lines for women, Black and white women both lived and worked along this exploitative spectrum, all across which normative gender performance manifested in the form of care work, disciplined into routines. Explained Lucille Smith, “If y ou’re a woman, you knew certain skills—how to take care of a home.” As Carol Henry, like Smith the d aughter of a Black steelworker, recalled of her mother in hard times, “My mom said, ‘He’s the man of the h ouse, but I’m the w oman in the h ouse. I’ll make t hings good.’ ” Mrs. C.’s mother, Mrs. M., a white woman, elaborated the contrast between her own extended routine and her husband’s discrete and contained one, which allowed for friendship, drinking, and leisure. For her part, she went to mass every morning, “then doing the regular housework. Do my shopping. I do everything on my own. My husband does have . . . him and his brothers are in, they have an aquarium. It’s not a money making deal. . . . So that’s how he spends his time. I get the cooking and cleaning and doing my own shopping. And if anybody needs anything, I run. So, that’s how I spend my days.” Asked what her husband did at home, she replied, “Sits. Sits.” He “would not, in no way, take part of anything connected with our work.” Her own narra-
D i rt y L au n d ry
75
tive of this routine was that it was a pleasure—what made her feel important, as she described it.30 Because of maternal and spousal work’s power of subjectivation—t he way that the work was at once oppressive and the t hing that made working-class women feel important—the women themselves often participated in making a joy of necessity. Still, the discipline of the routine is unmistakable. “You were on call twenty-four hours a day,” recalled Pat Seybert, wife and d aughter of steelworkers. “You never got any rest. Kids came home from school and you’d get them all night by yourself. Then your husband comes home at midnight and is rarin’ to go, and so you’re not asleep u ntil 2 A.M. Then y ou’re up with the kids at 6 or 7. You were more tired than he was.” Another recalled, “I went to work. I came home and I helped my mother with dinner and we had dinner. If we wanted to we went to visit someone; this depended on what time [my father] was working. He was on a shift and if he worked 4 to 12 then he wasn’t at home when I got home and if he worked 12 to 8 then that meant after dinner he’d lay down for a l ittle bit so we didn’t do too much.”31 While some parts of the routine required material production—cooking, cleaning, washing—others demanded more direct interpersonal, nurturant care, consisting of emotional and bodily attention. Mrs. V.’s husband spent thirteen months dying in the 1950s. “So I just took care of him, because I had no other ways . . . for no one to come and take care of him b ecause he didn’t want nobody but me to take care of him.” When Mrs. C.’s grandmother was dying, “I would help bathe her. She was bed-ridden. I would make sure that she had something to eat. Another t hing that I enjoyed doing with her was, she used to love to listen to operas on the radio at that time. She used to love to listen to it. So we would listen together. I enjoyed that. And I always enjoyed pitching in when t here was ever a f amily crisis.” This enjoyment was a disposition that gendered socialization worked to produce, part of what marked w omen as w omen. And it was a body of knowledge passed down, about how to behave and what to do. Another Mrs. C. had learned “the old remedies” for sick c hildren. “I neglect myself,” she reflected. “I take care of everyone else in the f amily that’s sick,” she said. “[I] enjoy it, really.”32 Some tasks, such as cooking, cleaning, and parenting work, generally had to be done during daytime, though t hese flexed with changes in steelmaking schedules. Mrs. L. might make dinner at 5 p.m., when her husband returned from his shift after 4 p.m. Or she might cook twice—once for the c hildren
76
The Next Shift
in early evening and once for the husband at shift’s end. Helen Havrilla recalled, “Cooking and cleaning was all I ever did. Whatever Steve’s schedule, I always had to work around it. And the work never got easier because it was always the same.” (Steve thought, on the other hand, that “shifts didn’t mean anything to her.”) A fter they got married and he got a steel job, she left her position at Mercy Hospital. “It was tough for me to give up working. But that was expected a fter you got married.” They moved in with her parents. Helen and her mother prepared separate dinners for their husbands in the same kitchen, because the men worked different turns at the mill. “My father worked shifts; different shifts, so, it was hard to have a set time when we sat down together.” Another steelworker’s d aughter remembered, “We w ere, 33 more or less, in and out of the kitchen all day long.” Then t here w ere jobs that women could do at night. If cooking and parenting labor w ere attached to particular events of the day, cleaning, washing, and ironing were relatively quiet and not immediately prompted by a demanding husband or child. In her diary, Beth Novak—Linda’s mother— recorded every day what hours her husband Dan worked at US Steel’s Irvin Works, before detailing her own tasks for the day, in a kind of time sheet she maintained for herself. “I finished my cupboard,” she wrote in one tally of her work, as well as “part of the stove, washed 3 tubs of clothes in the eve ning.”34 In another representative 1958 entry, she wrote, “Washed clothes all day today. [Dan] went out 4–12 for his first 4–12 in a long time. I sorted clothes + ironed till 20 a fter 1 then we both went to bed at about 1:30. Pretty tired tonite.” “I used to sleep most of the day because I’d stay up all night washing the kids’ clothes,” recalled Rose Boland. “I always cooked a meal when he came in.”35 Finally, some efforts occurred at certain concentrated moments in the life course. Pregnancy and birth stood out among t hese, although biological reproduction was the site where the disappearance of l abor into maternal love reached its most absolute. Mrs. B’s husband, who would change diapers or feed the baby only if she was not t here, did not play “as much [a part in child care] as I would like him to do. In fact, that’s a big debate now. I just told him recently he should get up for the four o ’clock feeding once on the weekend. . . . Sometimes it just seems as though I have all the burden, but he does more than, I think, a lot of husbands.”36
D i rt y L au n d ry
77
Small communities of women cooperated for such intense episodes. When Mrs. M., who had trained as a nurse, had her baby, she was joined for her labor not by her husband but by “a classmate of mine from Mercy, a little Italian girl, she was with me during the childbirth which helped a lot.” Then she took the baby not back to her own h ouse, but to her m other’s. “We didn’t have the Pampers or anything, so t here’s diapers for mom to do.”37 Other punctuations in the life course were handled similarly. “As I got older,” recalled Mrs. C., “my grandmother, she was sick, she had a terminal illness and I did help [my grandfather] with her. I used to go and help take care of her. And a fter she passed away, I used to do his h ousework for him and spend time with him then, talking to him. Then eventually he did come to live with us. I used to have to sit with him and listen to him and talk to him to keep him company.” Mrs. P. did the same: “A fter quite a few years my grandmother died and t here was no one to take care of my grandfather and he moved in with my m other. When m other left he lived 38 with us.” In steelworker h ouseholds, the domestic work routine developed in a dialogue with the mill. In general, the effect was indirect: the factory came home through the mechanisms of the husband’s hours, paycheck, and mood or, in a still more roundabout way, through the timing of pregnancy, birth, injury, sickness, unemployment, retirement, and death as they took their distinctive forms in the world of steelmaking. But in some areas of work women responded to the mill directly, rather than through t hese mediators. Laundry was foremost. When Steve Havrilla came home from the mill, Helen not only fed him but also rubbed down his overalls with lard to remove the coating of industrial grease. Every time Joyce Henderson did her steelworker husband’s laundry, she had to scrub out the basin of the washing machine and chip out accumulated dust and silt. E very wash involved a calculation of whether to use the machine and wear it out more quickly or scrub the clothes by hand. Women in the mill towns learned what different sirens and whistles from the mill meant, so they could be ready to run to their clotheslines. Recalled another Homestead resident, Ms. Takach, “We used to run to grab our clothes off the line when we saw big clouds of smoke coming from the mills!” Jean Nickeson described herself, with frustration, as “an unpaid clean-up w oman for industry.”39
78
The Next Shift
ecause of the pattern of residential segregation, such ecological domestic B labor was more intense for African American women. Black families were likelier to live at the bottom of the valleys, where air pollution collected around smokestacks. Henderson, whose family lived near Carrie Furnace and Edgar Thomson Works, recalled how the steel mills released “a big cloud of dark smoke that would just cover. And w omen who had clothes out on the line would run outside and take their clothes off the line b ecause of all the soot and the cinders and everything that would come down and just dirty their wash up.” Remembered Ray Henderson, growing up near Edgar Thomson Works, “People still tried to maintain some dignity. W omen usually got up and swept the street, picked up the garbage and put it on the side. . . . People washed their windows on a regular basis b ecause of the soot from the mill.” 40 Steel mill effluvia also endangered the appearance of a clean h ouse and its accompanying symbolic good, respectability. When Joyce Henderson’s aunt scrubbed the floor, “we had to put newspaper on the floors so p eople wouldn’t track soot and dirt into the house from all that smoke and everything.” Porches had to be swept of coal dust through the day or the week. Recalled a Homestead resident, “My grandmother used to sweep the front porch off three times a day. I mean the soot on the front porch was just incredible. I mean we were always dirty.” 41 A house formed the enduring physical carapace of the continuity of working-class life. In 1960, the populations of steel towns like Braddock, Duquesne, Homestead, and McKeesport lived in older dwellings at significantly higher rates than the national norm—modest homes often kept in families for decades. Indeed, almost one-fifth of the population in these towns still inhabited the same home as before the war, compared with one-tenth of the population in middle-class suburbs like Ross and Mt. Lebanon.42 As a clump of saved-up labor, a h ouse represented a long-term bet that a form of life would continue. Like any kind of long-term storage, preservation both assumed and attempted to sustain stability of conditions. The crowdedness of the working-class home, its dirtiness, its asynchrony from ordinary day-night rhythms, rendered it only ever partly operable as a stability machine—even for t hose who could live where they chose. The home organized reproductive labor temporally, matching it to the span of overlapping lifetimes and syncing it to punctuation in the life course—birth, mar-
D i rt y L au n d ry
79
riage, child-rearing, and old age, as well as the daily round of shift changes, mealtimes, and washes.43 Homeownership, in other words, was another way of trying to resolve the contradictory obligations and rewards of family into a coherent and continuous material reality. The logic of homeownership was not acquisitive but stabilizing. “I could care less whether you think my house is as nice as it should be or y ou’re disappointed when you walk in—I could care less!” said Mrs. E. “That d oesn’t impress me—I’m happy in it and my husband worked hard to get what we got and this suits me fine.” Acquiring a h ouse was a step toward the social recognition and subject position granted to motherhood. By staffing the house with her own labor, a working-class w oman could protect and reproduce the family that her work produced. “I didn’t go anywhere . . . because [my husband] wanted me to be around the house. And the kids were here sometimes and you c ouldn’t just pick up and go,” explained Mrs. V.44 Black families, enjoying far less access to modern and affordable housing stock than white families, found in the discriminatory pattern of the housing market a barrier not merely to the accumulation of wealth but to the stability that homeownership offered. The Black population of postwar Pittsburgh was confined to some of the oldest sections, where the housing stock was the most dilapidated. Ethel Wood Henry, for example, lived with her husband and seven children in a basement apartment in a low-lying part of Rankin, near the river and the mills. In November 1957, the sewer backed up into their kitchen, flooding the home for days with them still in it—worsened by rain leaking through the roof and coal fumes from a neighbor’s stove. “It’s so bad that we have to wait u ntil my husband comes home from work so he can cook a hot meal for us.” Two of her c hildren became sick. “I d on’t know what to do,” said an overwhelmed Henry, who then delayed a plan to check herself into the hospital.45
Pinching Pennies Consumption, we assume, offered relief from the minor miseries and monotony of working-class routines. C hildren w ere dirty, but m others could buy a washing machine; they w ere bored, but there was the television. Th ere w ere vacuum cleaners for the dust. The freezer and dishwasher eased the burden
80
The Next Shift
of cooking multiple meals. And t here was fun in this consumption—a satisfaction of desires—as well as efficiency. In this view, installment-plan consumerism relaxed the strictures of the old work ethic. The authors of Workingman’s Wife wrote of the unsuccessful efforts of blue-collar women to refrain from buying on credit—“a failure of will power when confronted with a ‘cute flower’ which can be purchased on the spur of the moment.” 46 Consumption should not be equated with pleasure. It required effort and ingenuity and always involved a negotiation of household power relations, conducted in the medium of scarcity. “Until t oday, I handle the money as far as the bills go,” recalled one steelworker’s wife. “He gives me the money and says here, take care,” explained another. Mrs. K., who worked in the laundry, held on to her job t here so she could buy furniture for her new home. “Even sometimes today, everyt hing that I’ve bought on credit, I paid right down to the penny . . . everything w e’ve bought, and during the hard times that we had, because they had a strike and all, we never lost a t hing.” Installment buying expressed not buy-now-pay-later acquisitiveness, but financial savvy. For her dining room, Mrs. K. had acquired an old t able and chairs at a second hand store and stripped and refinished them herself. “You just c ouldn’t get everything at one time.” Th ere might be ritual solemnity in the handing over of the paycheck, the movement of money out of the realm of production and into the domestic sphere. “He would never ask what I did with the money,” recalled Mrs. F. “But of course, he knew that I saved it.” 47 Strategies for thrift w ere far more common than the image of postwar consumerism suggests. “They were lean days. We had to put cardboard in our shoes,” remembered Joyce Henderson. “I had three outfits. I had a c ouple of skirts, a c ouple of blouses, and e very day I had to rotate them.” She washed her underwear every day on the washboard; her family had a washing machine, but they needed to save on electricity. Mrs. L. would bake bread every week, selling what her family did not eat to neighbors. Mrs. C. canned and made her own sausage. “I thought it was cheaper. I do that. My mother never did that.” Mrs. I., another Italian-American w oman, did the same. “I would not eat bought t hings, bought bread. I d on’t think I’ve ever eaten sliced bread in my life. I pack my own tomatoes. I grow tomatoes from the yard and pack it.” Such strategies w ere common for working-class women of all backgrounds. Earline Coburn, an African American woman who grew up in a
D i rt y L au n d ry
81
steelworker home, remembered how her grandmother would travel into the country to buy up cheap produce so she could can vegetables in anticipation of hard times. “My grandmother was going out to a farm or wherever. And she’d come back with all t hese vegetables and fruit, and she canned. She canned like greens, string beans. She made soup, she canned that. She made homemade jelly. She did all kind of stuff like that, so that when he got laid off or went on strike, all t hey’d have to worry about was the meat.” 48 Unexpected hard times w ere common, and women had to strategize. A widow of a steel mill maintenance man in difficult straits found that big-ticket consumer items could have unexpected use values. While waiting for her Social Security payments to begin, she had sought public assistance for herself and her children. The welfare worker who came to her house told her that her Hollywood bed and large telev ision w ere imprudent indulgences. Infuriated, she explained that the telev ision and bed were ways of economizing: one large bed, which she shared with her daughter, was cheaper than two; and she used the television to put her children to sleep, replacing other forms of leisure. “How I was going to raise them two?” 49 Acts of consumption, that is, often contained subtle calculations about the affective economy of the household as well as its budget. Beth Novak, for example, lost her husband’s Irvin Works paycheck when he was injured in the summer of 1961. With him in the hospital, she needed income support. For the second time in just over two years, she went on public assistance. (Her family had needed public assistance t oward the end of the long strike of 1959.) “Mrs. Dorothy Murphy took me down to the borough building to get free food got 5 lbs butter 4 lbs peanut butter 6 lbs lard 2 cases meat powdered milk—eggs—flour, large rolls.” The next day, before going to visit her husband, Dan, in the hospital, she first went to get her hair washed and set. While she did not disclose in her diary what she felt, we may h azard a guess about what taking donated food might have meant to her self-esteem, or perhaps about the image she wanted to present to the world, to her ailing husband, or to herself. A hairdo could be a tool.50 Men’s wage packets bought the inanimate supplies out of which the f amily was made, but it was overwhelmingly w omen who assembled t hese supplies and gave them life; it is a mistake to view this activity as simply consumption. In other words, consumption had to be produced. If the contrast between
82
The Next Shift
this reality and the postwar ideology of a consumerist family idyll has not stood out more sharply, part of the reason is that the participants in this cycle of endless upkeep themselves seem to have wished to give substance to appearances.51 In 1959, Richard Nixon boasted to Nikita Khrushchev in the model American kitchen in Moscow that American steelworkers, although then on strike, generally made $3 an hour, which “[made] life more easy for our housewives.” But for working people, the rewards of mass consumption w ere uncertain and hard-won. Mrs. R., for example, described growing up watching an older girl from afar with admiration: “She always looked so neat, a nice coat on, or a nice pant outfit, and her hair always looked nice, and I think I admired her because when I grew up and I got a job, that’s what I wanted to look like. Nice clothes and always make a nice appearance. I bought these and I paid for these and this is me.” The desire that took form in consumption often had a disciplinary rather than liberating power. “I have a champagne taste with a beer pocketbook. Right a fter high school, about two weeks after I graduated, I went to work, and all I could think about was you always hear about all these girls that got out of high school, getting a job, and buying everything and anything they see in sight, and I d on’t know how they do it, 52 it just doesn’t work, you just c an’t do that.” The steelworker’s wage was not enough to support the kind of family and standard of living of Nixon’s boast. One strike or downturn could easily lead to disaster, as the 1960–1961 recession did for the Brown f amily, causing them to fall b ehind on rent and be evicted from their home. The f amily numbered thirteen; they had been living for four years in a five-bedroom apartment in a largely Italian and Polish working-class area where African Americans like them w ere rare. In 1960, Brown was put on part-time at Jones & Laughlin Steel, then laid off. Shortly afterward, the Browns w ere told to vacate the apartment. The imaginary distance between such a situation and the one described by Nixon was vast; to bridge the gap took tremendous physical and emotional effort. D oing so was an achievement, and it felt like one to t hose who accomplished the effort. As Carol Henry remembered of hard times, “my mother could take a piece of bread and some flour and w ater and put stuff 53 together. She had six kids, she’d do what she had to.”
D i rt y L au n d ry
83
The Marital Encounter The working-class f amily was not a t hing but a process—a constant negotiation of necessity, doled out in unequal portions. Historian Nancy Cott quotes the midcentury legal theorist Karl Llewellyn, observing a paradox in the institution of marriage: “The curious feature of institutions is that to society at large they are a static factor, whereas to the individual they are in first instance dynamic. Society they hold steady: they are the received pattern of its organization and its functioning. The individual is moulded dynamically by and into them.” Marriage, Llewellyn wrote, was “a device for creating marital going concerns.”54 The broader social formation continued to demand that working-class people form families, but they could not do so entirely seamlessly. This contradiction came to the fore of the working-class familial process in many moments, but nowhere was the friction more intense than in the ongoing encounter between husband and wife. Working-class h ouseholds were not all the same; marriage relationships came in many forms, as they did in other classes and other times and places. Still, systemic forces worked themselves out at the conjugal level. In particular, it is clear that working-class housew ives both felt a current of resistance and tried to contain it. Mrs. L., an Italian immigrant, acknowledged “sometimes” resenting her husband because he could do what he wanted and she could not. She would get “mad, so mad” if he demanded she cook something—“ but I cook anyhow.” She resolved never to voice her anger, because sometimes “I tell one word, he no like, he say keep quiet.” So she learned: “I no say nothing.” If she talked, “it was worse for me,” but “if I keep quiet finish everything.” She did not tell herself that her anger was illegitimate. But she practiced silence.55 Mrs. V., who had married two steelworkers over the course of her life, similarly maintained a pragmatic view. A wife, she thought, “should go along with the husband. Now not all the times the husband might be right, but you have to take two persons to do that, to correct that.” She thought of this as a practical approach. “Do try to please him in any way he would want her to please him and do what he wants her to do and d on’t do nothing against his saying or words or something like that. Because once you start stepping out
84
The Next Shift
of places, that the husband says this and you say . . . a nd the wife says the opposite . . . there’s only trouble.” It was a common calculation. “I let him be the boss. It makes us all happy,” said Mrs. K.56 A thread of fear ran through t hese assessments. Asked what was most important about her husband, who worked at Jones & Laughlin, another Mrs. K. replied that he “very seldom lost his temper.” Mrs. M. recalled her husband’s threats around their c hildren’s behavior: “If they did anything wrong, he’d kill me. That was the expression he used. He said, ‘If they do anything out of the way, you’ll get murdered.’ ” When Mrs. Micklo wrote to her husband’s boss to ask for a loan at the end of the long strike of 1959, she added, “He d oesn’t know of this, I think he’d knock me out.”57 Women’s experiences of discipline often lacked an environment that was collective in any sustained way comparable to the work crew in the mill. “When he came back [from the war] and he did get a job, then he was on swing-shift again. So it made it kind of rough. Whatever I did, I did mostly with the children myself. I was always on my own.” Another, Mrs. C., recalled how her husband would strand her at home to watch the children because he refused to hire a babysitter. What was more, he would belittle her ideas, saying, “Oh she got that out of a book,” or “She got that out of a magazine.” Even Mrs. C.’s mother would tell her “he was always right and that I was wrong so I just let it go at that.” Mrs. E. had a machinist husband who “expected a good h ousekeeper, expected somebody to take care of their children—and didn’t expect somebody who would be wanting to go out a lot.” Eventually, she came to regret fighting and “accepted the fact that this is how it is.” She told no one about it. “I felt I would be betraying him—not betraying him— that’s a bad word to use. I just d idn’t feel like you should go out and talk about your husband. I just felt women who talked about their husbands, they—that bothered me.” She kept her silence “for many, many years.”58 In his memoir, Jack Metzgar describes how the unequal relationship be ousew ife Irene, interwove love, tween his parents, steelworker Johnny and h fear, and resentment. “My f ather ruled the roost in our f amily. He looked out for the rest of us, and he was more likely than any of us to know what was good for us, but he always did t hings to suit himself.” His mother’s orientation was “completely subservient,” Metzgar writes. She “had almost no self- esteem.” She “saw herself as weak,” and this quality was what drew Johnny to her. “She was thrilled with being his wife and our mother. In our child-
D i rt y L au n d ry
85
hood years, she was almost always smiling, with her eyes sparkling and with her lips pressing tightly closed, as if she w ere holding back bursts of joyous laughter. To say she loved her c hildren is too pallid; she gloried in us.” The appearance of a successful enactment of the normative model, however, was deceptive. “As almost everybody in the family bitterly remembers, he ‘abused Mom’s good nature.’ There w asn’t anything dramatic—no hitting, not even much shouting, just the kind of daily insensitivity and petty dominance for the joy of it that is both degrading and frightening if you have to live with it day a fter day.” Metzgar recollects how his father took pleasure in performing bodily dominance over Irene. In a good mood, he liked to go on a drive with the family, then reach over to the passenger’s seat to pat Irene above her breasts. She would swat him away, at first playfully—“Now, you stop that, Johnny Metzgar.” He would persist, then blow up. “He had a tough life. Unlike her, he had to work in the mill. Why did she always spoil his good humor? Why didn’t she understand him? Why d idn’t anybody appreciate him and the sacrifices he was making for his f amily?” But Irene did not remain a plaything of Johnny’s whims. In particular, the solidarity of her d aughter Marion tilted the balance of power in the h ousehold. When Johnny gave an order to Irene, Marion would ask, “Why d on’t you do it? Mom’s tired.” Irene began standing up to Johnny to preempt Marion’s rebelliousness, seeking to attract his rage away from their daughter and back onto herself. Once, in the late 1950s, Marion bit Johnny when some playful wrestling became too serious and he ignored her protests. He grounded her for two weeks, then left for a fishing trip. “The day he left, Mom got us together to announce that she was not g oing to enforce Dad’s punishment. . . . There was a look on mom’s face we had never seen before; calm and determined, the look said that we’d be alright if we stuck together.” In Johnny’s absence, Irene signed up to become a substitute teacher at Jack’s junior high school. She opened her own bank account and began wearing different clothes. “She seldom bucked him directly, she just started living a separate life. He gradually learned to do t hings for himself and, with her own bank account, so did she.” When she died, Johnny fell to pieces.59 Industrial disruption could generate conflict in the h ousehold by stressing spouses’ ability to perform their roles. Sherri Peterson’s parents had l ittle, sharing a twin bed and using a crate for a table. “My father finally found a
86
The Next Shift
job at the Duquesne mill,” reminisced Peterson. “Time passed and now my mother had two baby boys to feed. My father barely made enough money to feed all of them. My m other offered to clean h ouses for money but my father refused. He was the husband, the breadwinner, and no wife of his was going to work and share that role.” Whatever stability they achieved this way fell out during a strike year. “Hard times hit rock bottom. Our f amily now had five mouths to feed and a long steel strike was on. My m other tells me all they had to survive on for nine months was eighty-eight dollars e very two weeks. In the summer they survived off of neighbor’s vegetables they didn’t want. My f ather never asked his family or friends for anything.” 60 When industrial employment proved inadequate, in other words, women had to find other sources of provisioning despite the stigma. Mary Czap wrote to a manager at Duquesne Works in 1961 to explain to him just how the natural order of things in her family was being destabilized by the downturn of the business cycle. Since her husband had been laid off, the Czaps had been evicted from their h ouse in Dravosburg and w ere living in two rooms in her mother’s house. Ever since he was discharged from the serv ice and started back at the mill in 1955 he has not worked steady, I believe the most he worked in a single year was 6 months. So when he finally got back to work in November of 58, after a very long layoff, and then was laid-off again, the following May, I just took it in my stride, thinking he’d be back to work again in at least six months. I never expected this! 6 months went by, then 7, 8, 9 until now it’s nearly 15 months, and the pressure this has brought to bear on us, especially me, is about to lead to a nervous breakdown or worse. I have tried so hard not to be bitter, and do the best I could by my little f amily, but I just c an’t seem to cope with the situation any longer. Not only can’t we pay our many debts, & keep up with the rent, but we also c an’t buy any of the necessities of life. I myself, am badly in need of medical care, not to mention m ental care as well. I can’t even afford to buy a pair of shoes, let alone any t hing else. It was during his last long layoff, that we lost all our furniture, and I live in constant fear of that happening all over again, since we can’t make the payments on the new furniture.
D i rt y L au n d ry
87
Now that my oldest son w ill start school next month, I am r eally scared. How can I get him the clothes and supplies he needs without money? Hard times put w omen in a bind. If they tried to help, they might risk humiliating the husband.61 An interruption to a steelworker’s access to steady work could sometimes cut the opposite way, relaxing patriarchal authority in the household. Mrs. M. remembered how her father had worked at the mill until he was laid off in a recession in the 1950s and had too little seniority to get his job back quickly. Eventually he gave up and found work as a janitor. This happened while Mrs. M. was still a little girl; his personality thereafter was “liberal”—“ if we had problems, we could always talk to him.” The same happened for Mrs. P. “He had a big part in raising the kids for the simple reason that when he was working the afternoon turn he would take the kids for walks down to the playground.” She remained in the workforce for much of their marriage, because he was frequently on layoff at the mill, and he “would walk the streets with them, even in the stroller. When they were small and able to understand what stories and books were he read to them and played records with them. He watched them if I had to go anywhere. He played a big part.” 62 Here again, where an element of upward mobility did exist, it channeled t hese forces in another direction. Dr. M., the college dean born to steelworkers, also married a steelworker. But, just as she had observed that her way of choosing a spouse felt different from t hose of women around her, he himself seemed different too. “He was not an aggressive person as far as I’m a man and you’re a woman,” she had noticed, describing their relationship as a friendship. He liked to cook. And during the first year of their marriage, he went on strike from the steel mill, and “that had a g reat influence in changing patterns b ecause I was g oing to work and my husband was not.” Over time, she reflected, “I took over the role as the dominant person in our family.” She called herself in retrospect an “unconscious w omen’s libber”—a position that few wives of steelworkers would have echoed.63 Because of the way the family machine produced subject positions for husband and wife—placing them in the world, in relation to each other and their society—t he continuation of its intricate function seemed vitally important to both participants, even when its gears w ere gnashing. Often, this imperative, in combination with the stark power imbalance in many
88
The Next Shift
working-class homes, produced a climate in which communication was difficult. Frank talk risked bringing to the surface the t hings that mainly had to be avoided for the family machine to keep running smoothly. Thus the refrain: “I no say nothing.” Similarly, the Novak f amily went through many moments of duress, and Beth, in her private diary, recorded no feeling about any of it. At various times, her husband, Dan, was laid off or on strike and had to work extra hours as a janitor and hairdresser. Children got in legal trouble and fights. One of her sons got a girl pregnant, leading to a shotgun wedding. At another point, her son went missing. Several days l ater he turned up in a Florida jail. The f amily wired him money, and he returned home, but “he acted like he just did nothing wrong.” Whatever was happening in this family, nobody could speak it—not to one another, apparently not even to themselves in the privacy of a diary. “It was hush hush, everyt hing,” recalled daughter Linda. “Why?” 64 This silence appeared in many parts of f amily life but shrouded sex most of all. “Working-class wives express considerably more discomfort about what they do in the marriage bed than their middle-class s isters,” wrote Lillian Rubin in her classic study, Worlds of Pain. Sex had been almost completely forbidden as a subject of discussion for many women in adolescence and, in their telling, often remained mysterious all the way up to marriage. “I never knew about that, really, even when I was married . . . a fter I was married, because a son d idn’t come u ntil two years. We w ere strict on that at home. We never discussed anything like that. And I always went with nice p eople, that never talked . . . the girls never talked about that.” Said another, “My parents never told me anything. . . . They didn’t know what to say.” Mrs. L., who had been born in 1906 in Czechoslovak ia, told an interviewer, “Girl go with a boy and she go way with him, that’s good? No, that’s bad. No nice and no good, b ecause she think maybe he marry her. But girl crazy to listen to him, no? B ecause never no trust nobody. Whenever I was girl, I have shame.” Said Mrs. V. of raising her own c hildren, “I d idn’t tell them nothing. I was so shamed. . . . I’m still shamed.” Th ese w ere largely Catholic families with large complements of children and unreliable birth control. “All of our children were ‘rhythm babies,’ ” said Mrs. S.65 Drinking ranked alongside sex for quiet seething and shame. “It bothered me so much [when he drank],” said Mrs. T., who was married to a laborer in the mill. “I never told nobody nothing. . . . I’m all alone here.” Martha Sloan’s
D i rt y L au n d ry
89
other taught her how to say “give me your money” in Slovak, so that Martha m could run down to the tavern and speak in her mother’s voice to her father. “Otherwise, the money was spent at the bar and we couldn’t pay the [account] at the grocer’s.” Anne Pcholinsky’s husband, John, a scarfer at Jones & Laughlin, would stop at the bar by the mill a fter his shift every day. Then he would r ide the trolley home and stop at a bar in his own neighborhood. “So it was a long time before he settled down, ate, argued and then went to bed and slept all afternoon.” Summoning some understanding, Anne explained, “I don’t deny that his job was hazardous and demanding. But he always had that bottle of moonshine on the table. Had to get rid of the impurities and have a drink. ‘I deserve it.’ That’s what they always said.” 66 Sometimes, though, tension boiled over. When an interviewer asked one woman her view of whether women should stay home or have a career, she answered succinctly, “A c areer. B ecause sometimes the men beat up the wife.” While the evidence is limited, family violence appears not to have been unusual. “I saw some marriages where the men w ere rather brutal—some of the men would really beat their wives. . . . One man in particular I remember during the night he was beating his wife out between some h ouses t here, and we woke up with all this screaming and carrying on about it—about this husband being brutal. . . . A lot of people that I thought were pretty nice were not.” 67 Women fought violently too. One recalled her husband’s early morning drunken return from a night shift at the mill: “I was frying bacon and eggs for him and just threw the whole skillet against the wall.” Martha Sloan’s mother once clanged her drunk husband in the face with a skillet, breaking his nose. They agreed to pretend that he had fallen down.68 Families could be maddening or even dangerous, but they had to be produced and preserved. Without them, working-class people were adrift in the world. Silence was an indispensable tool.
Child-Rearing and the Production of Ideology Raising children consisted centrally, of course, of concrete tasks: child-rearing formed part of the round of chores for working-class women, and c hildren themselves contributed to h ousehold work. But raising c hildren was also an ideological undertaking. Children had to be raised right, to internalize the disciplined habitus that had enabled their parents and grandparents to get by.
90
The Next Shift
For this endeavor to succeed, it became imperative for adults, especially wives, that their own struggles—to get along, to make a good life—remain hidden not only to the outside world but also to their children. And just as women’s domestic work was unquantified, dissolved into the realm of love, c hildren’s work appeared only as part of their upbringing, not understood as an economic contribution—so long, anyway, as families remained within the circle of economic security. If they fell out of it, t hese rules ceased to apply. The central contradiction of child-rearing in working-class families was between the obligation to produce children and discipline them into the rules of the industrial routine on the one hand and the impulse to shield them from that routine on the other. The mother’s job was to reproduce the family form both materially and ideologically: to impart to children a sense of their family’s overall well-being and established place in the social order of patriarchal nuclear families, while at the same time enforcing rules that kids had to learn. H ere the contrast with the m iddle class was starkest. Historian Paula Fass observes that American families in the 1950s began to react to the contraction of industrial work by pushing children to study harder and climb the class structure. “Throughout the 1950s, t here was a haunting sense that American c hildren and youth w ere being prepared for a transformation in adult experience,” writes Fass. “If not e very child who went to school was preparing to become a professional, many more w ere learning that the corporate office, not the shop floor, was their likely destination.” But the conditions of self-reproduction w ere still difficult enough, even for many of the more relatively racially and economically privileged of working-class families, that they w ere not magnetized yet by this tectonic change. The lives of working-class youth, encased in ethnic tradition, religious belief, and most of all the persistence of scarcity, were still mainly organized to replicate rather than transcend the existing institutionalized life-course.69 The Mon Valley steel towns (and Pittsburgh generally) experienced fertility rates during the postwar baby boom roughly similar to the national level— approximately 2.5 c hildren per married woman. The actual numerical weight of young p eople, however, never reached anywhere near prewar levels. In 1960, only one-quarter of the population of any given steel town was u nder the age of fourteen—far less than in 1920, when this age bracket composed between one-t hird and 40 percent of the population across the steel towns.70
D i rt y L au n d ry
91
The young, far outnumbered by their elders, w ere disciplined into the world they entered; but that discipline, which was most of all the work of their parents, generally appeared as the natural effect of gender. “Nothing was ever forced upon me, but somehow, naturally, we pitched in around the house,” remembered Mrs. S. “My l ittle b rother he sort of naturally fell into d oing what men do, and that’s interesting to me, b ecause like a lot of the talk about Women’s Lib and you know, ‘Why don’t w omen fix cars’ and things like that? To me it never seemed natural to want to fix a car, I never had any interest in it, he seemed to take an interest in that stuff.” Like many mothers, Mrs. C. saw her c hildren’s work as instructional. “I taught them all that they know,” she explained of her d aughters. “Very good at it. Until this day, they go up and do their Granny’s housework.” The h ousework had to get done, of course, and her daughters in this way made a material contribution. But Mrs. C. did not see what she was d oing as getting work done, but as raising women, as her m other had raised her.71 Beyond their particular tasks, children had to learn habituation to the demands of industry. This meant, for example, keeping the house quiet and dark so fathers on the night shift could sleep during the day. Adele Vamos remembered lying in her bed and thinking of her father down at the plant when she “heard the river foghorns and the clanging of the mills at night.” The only time she saw her dad “was the week he worked daylight from 8 to 4. Other times you had to be real quiet because he was sleeping. Being quiet, oh, that was hard. But the men were so tired. They w ere never able to develop a good sleeping regimen b ecause of their schedules.” For Bonnie Harvey, her steelworker grandfather’s presence in the household meant that her mother would admonish that “we couldn’t bounce a ball on the porch because ‘Pap’s going to work tonight.” 72 As Harvey’s story suggests, it often fell to mothers to dole out discipline. Recall Mrs. M’s statement—“If they did anything wrong, he’d kill me.” Asked by an interviewer who took care of discipline, Mrs. C. replied, “Me. My boys, if they did something I d idn’t like, I’d tell my husband to talk to them and he would. But I said, I was home more than my husband.” To the same question, another steelworker’s wife explained, “I would. Yes. He would never touch them.” Said another, “Well, they got used to me, I guess. And my husband, he’s the boss.” 73
92
The Next Shift
Sometimes this division of labor was by explicit arrangement between husband and wife. Other times, the husband simply settled into benign neglect. “Sometimes I had to discipline them. He very rarely disciplined them. They got away with a lot more with their dad than they did with me. . . . Paddle once in a while, especially the boy.” In this way, the household’s internal power relations sustained the ideology of a heroic breadwinner, even as the shortcomings of this model and the compensations produced by wives determined daily routines. Jan McSorley remembered how her mother Hazel would make a grilled cheese sandwich with fried onions for her father Frank when he returned at midnight from the mill. “When I smelled the onions and cheese, I knew Dad was home and everyt hing was all right.” When Frank got home late and Hazel made him dinner, in other words, Jan responded by idolizing him: Hazel’s efforts vanished into the scene of his heroic return.74 Successful preparation of children for the discipline of the life course ahead of them meant, above all, teaching them commonsense ideology and normative practice: the nature of family, in which c hildren’s obligations prefigured their replication of their parents’ relationship. This expectation of continuity rather than mobility was a fundamental division between the working class and the middle class, and the expectation manifested itself powerfully in how parents related to their children. Placed next to middle-class families, the contrast is clear. The college dean, Dr. M., for example, said that her c hildren “were raised completely in Dr. Spock’s atmosphere. I subscribe to it completely.” She saw her son as more vulnerable and sensitive than her d aughters; she rejected the idea that c hildren “were extensions of me,” insisting on their individuality and interpreting the form of child-rearing that emphasized continuity as oppressive. She refused, therefore, to “make them little robots”—making explicit the contrast with the discipline of children in the working-class world from which she had narrowly escaped. The suburbanite Mrs. S., similarly, was a substitute teacher, married to a man in administration at a steel mill. As she saw it, what was distinctive about their family was that “my children had their father’s love and had their father with them. My husband would come home at five o’clock and we would eat. It was the time when we talked and talked t hings over. I think that was the biggest t hing, with ours is, the f ather image.” Despite the class-privileged equation of love with a stable schedule, the distinction embodied by an accessible f ather and a m other with a job—taken out of interest
D i rt y L au n d ry
93
Figure 2.1 Rochna Family in Kitchen, 1950, Sol Libsohn, American, 1914–2001, gelatin silver print, H: 14 in × W: 11 in. (35.56 × 27.94 cm). Carnegie Museum of Art, Pittsburgh. Gift of the Carneg ie Library of Pittsburgh, 86.16.134.
rather than necessity—is clear. While she hoped strongly that her daughters would marry Catholic men, she acknowledged, “Marriage i sn’t for everybody. I think [a w oman] has to figure this out for herself and figure out what’s going to, first all, be happy in and where she’s going to fulfill her goals.” While working-class w omen often supported their daughters’ career aspirations out of solidarity with the desire for personal autonomy (recall the comment that aw oman should have “a c areer . . . because sometimes the men beat up the wife”), the middle-class Mrs. S. instead endorsed the aspiration in terms of
94
The Next Shift
self-development. She urged her college-educated daughters, “Know yourself and where you’re going what your goal is.” One of her daughters remembered that even the completion of chores mimicked schooling: enough stars for doing chores successfully entitled a child to a better Christmas gift. Unsurprisingly, the d aughter studied to become a teacher herself.75 Illustrating the distinction, Mrs. K. moved socially over the course of her life, approaching the class divide from below. Her father worked for the railroad, and the family had emphasized work discipline rather than schooling. “Everybody got to work,” her father would say. “Everybody had a job. I cleaned the dishes, and the other boys . . . one would clean the porch off, one would sweep the sidewalk. Everybody had a job to do. Until every thing [was] done, nobody could loaf.” School and ambition, in contrast, did not loom so large. “I never heard [my mother] express herself to see what she expected of us. All she said, she wanted us to be good children.” As a girl, Mrs. K. had hoped to become a teacher, but her parents gave little encouragement (or opposition), and she forgot the ambition over time. The man she married, however, afforded her some upward mobility: a skilled blue-collar worker with some college u nder his belt, he made with her an environment in which they raised their c hildren differently from their own experiences. “You know, it’s going to be to the point where you’re going to need more schooling. Th ings are getting tougher,” she reflected. Both her kids went to college—t he son becoming an assistant engineer and the d aughter a teacher.76 While sometimes at odds, the possibilities of mobility and security w ere both largely trappings of whiteness and its payouts in employment and housing. By the 1960s, industrial job loss was eroding African Americans’ foothold in economic security much faster than that of white workers. Although white m others worked to conceal the manageable instabilities of their working-class world from their children while disciplining them into necessity—and thus worked to reproduce in them the normative ideology to which white working-class c hildren were subject—African American mothers more often had to explicitly instruct their children in the cautious and cooperative arts of survival. “We did t hings like most teenagers did,” recalled Earline Coburn. “No, I’m not g oing to say that. My m other was kind of strict. We could only go certain places, certain times. Most kids could go when-
D i rt y L au n d ry
95
ever, we wasn’t allowed to do that. We could go, but if we went, me and my two sisters, we had to go together, we had to come back together.” 77 Ray Henderson remembered in his memoir how his m other, a domestic worker widowed by an industrial accident, needed her sons’ help to get by. “If [she] missed that last bus to North Braddock at six o’clock, [she] had to walk the hill, and I can remember my m other having to walk that hill b ecause she never got off her work on time. She was doing day work in Squirrel Hill, and s he’d miss her bus all the time. My b rother used to run over the hill to meet her ’cause it was a pretty steep walk up the hill, and she would have bags to carry.” Henderson and his siblings had to steal breakfast from a regularly passing truck—a lmost the precise inverse of Jan McSorley’s feeling of security when she smelled her m other frying onions. In white families, wage l abor was generally hidden away elsewhere, a heroic object of distant admiration for the c hildren. For Black families like Henderson’s, in contrast, c hildren more often had to be involved explicitly in making a living. When teenaged Ray got a job sweeping floors and delivering food, he reported, “No m atter what I got, I gave her half of what I got.” 78 Surprisingly few households drawing a living from the steel industry enjoyed a complete experience of stability and comfort, although their differentiated gendered and racialized positions in housing and l abor markets produced a wide range of forms of insecurity. The contrast between norm and reality was lived out in the form of industrial work discipline for men and a perennial crisis of provider status; for women, structurally subordinated in the family, this contrast took the shape of managing that crisis—sustaining the continuity of the household despite its unstable economic basis and preparing the children to reproduce the model for themselves. If a family did succeed in holding a position in the top layer of the working class, then the relation between breadwinner and housew ife took on a somewhat different shape, and child-rearing strategies changed as well: matching Paula Fass’s analysis of the postwar years, opportunity might supplant stability as the prime goal. If, on the other hand, a h ousehold experienced too much economic turbulence—as was particularly likely to happen for African American families—the normative model became untenable. Then c hildren had to participate directly and explicitly in sustaining the group. In the large middle ground between t hese possibilities, families cycled between security
96
The Next Shift
and instability, comfort and lack, and women tried to manufacture continuity through their own disciplined efforts.
The Gift That Keeps on Taking Social citizenship was forged in the factory, then disbursed to the population through the family. The feeling of normative familial security was sensed access to this citizenship. What else was Jan McSorley’s describing in recounting her pleasure in the smell of frying onions? Dad was home from work, mom was cooking his favorite, t hings were all right. Mary Ann Eckels, a steelworker’s d aughter, liked to imagine her f ather’s fingerprints on the steel beams of New York skyscrapers; in her mind, he had literally built the country. As Edward Stankowski wrote in his memoir, Memory of Steel, “The world needed families like mine.” 79 Even when undergoing hardship and exclusion, working people had to make sense of the ways that they had been denied by a social order supposed to include them. Many working-class women thus had little choice but to try to produce households that complied, at least in part, with the norm. The result was a set of socially useful ideas: that men w ere heroic breadwinners while w omen were altruistic caregivers; that by extension, masculine industrial work was real work while feminized reproductive labor was natural, an innate labor of love. The sources of t hese commonplaces were not just policymakers and propagandists. Th ese ideas w ere embedded in the material structures of everyday life. Even for w omen whose hold was more tenuous—for systematic racial reasons or simply because of bad luck— t his ideology was powerf ul. Mrs. Joseph Price told the Pittsburgh Courier that, in the hardship of the long 1959 steel strike, her only reason for living was “the love of her husband and her children”; her shelter against racialized economic disturbance, in other words, was domestic normativity.80 Working-class women worked to deliver for their families the security they w ere promised and thus to bring them into alignment with the consensus myth of the times. Th ese w omen sensed a mainly unarticulated gap between the world as it was almost universally described in the postwar decades—safe, stable, happy, equal—a nd the world as they experienced it themselves. Feminists have long observed that oppression is often entangled with meaning and pleasure. As critic Lauren Berlant puts it, “Everyone
D i rt y L au n d ry
97
knows what the female complaint is: W omen live for love, and love is the gift 81 that keeps on taking.” This was t hese women’s own “problem that has no name.” Its ultimate origins did not lie with any individual decisions. Who was entitled to care and who was obliged to provide it was a political question, determined at a social level. Yet the problem was lived out in individual lives privately. Indeed we might say that the postwar family was a device for privatizing this social problem, so that economic and social well-being became increasingly depoliticized and detached from public life for the more secure fractions of the working class.
3 “You Are Only Poor if You Have No One to Turn To” Race, Geography, and Cooperation
A
fter being laid off from US Steel’s Clairton Works during a recession in December 1957, Prentiss Parrish and his large f amily fell b ehind on rent on their apartment in the Lower Hill neighborhood. They borrowed money from his sister-in-law and two neighbors to pay their $55 monthly rent through much of 1958. But this well ran dry over the year, and the Parrishes fell into arrears. In June, the city condemned the apartment where the Parrishes lived. It was a five-room basement, with no hot w ater or bath, stinking with bad plumbing. Given their dire economic straits, they won two extensions on the order to vacate. But trying to make rent left them unable to scrape up a deposit payment for a new place. Some listings turned out to be for whites only; another landlord told the family they had too many c hildren. Finally, in September, rather than fix the place up, the landlady evicted them.1 In a city still dominated by one major industry, within which African American men had a real but precarious foothold, only a short distance lay between economic security and disaster. E very working-class family could imagine the steep fall and the possible sequences of events that might trigger it—layoff, strike, injury, sickness, death. Everyone knew a few p eople to whom t hese had happened. Black working-class Pittsburghers knew a few more. When beginning to slip, people like the Parrishes leaned on one another for help. Economic insecurity worsened gradually and spasmodically in working- class Pittsburgh over the entire postwar period, with industrial employment in a cycle of long-term secular decline counteracted by periodic short-term upswings. The steelworker sections of the region already had begun losing population in the interwar period, a trend that did not reverse itself even
“ Yo u A re O n ly P o o r . . .”
99
during the postwar boom. This decline did not implicate steelworkers alone: extended networks of kin and community w ere involved in the daily making of life and also depended on steel work for access to social citizenship. Working-class families w ere woven together into broader social patterns of mutual reliance around steelworker nodes. The decline of industrial employment reverberated through these networks, activating collective efforts to mitigate the worsening damage. Job loss is often understood as a social solvent, but this was not its effect in these early years. B ecause the postwar welfare state disbursed economic security to the working-class population through industrial breadwinners, deindustrialization was experienced collectively. It happened not just to individuals but to communities, and they dealt with it in groups. Indeed, the gradual erosion of economic security actually fabricated working-class community, since community was a living activity, which intensified in times of duress. As a contemporary social scientist examining social ties during unemployment put it, “support buffers the effects of life stress.”2 The collective endeavor of survival, in activating local bonds of kin and community, had a specifically spatial character. Staying afloat implicated groups of people who lived together or near one another and who were thus positioned to support one another and combine effort. Watching children, sharing chores and necessities, and sustaining institutions like churches and fraternal organizations—such activities anchored groups of working-class people in space.3 In both stressing and intensifying the local bonds of working-class community, declining industrial employment also sharpened patterns of racial segregation that s haped t hese communities at the local level. Deindustrialization and the collective responses it provoked w ere a moment of racial formation. Everyday familial and collective practices reconstituted the unequal Black-white divide by throwing working-class p eople back onto the resources of their intimates and intensifying the patterns of sociality established in working-class life by both customary and institutionalized patterns of segregation. As Sharon Patricia Holland argues, race “coheres in the everyday practice of familial belonging.” 4 While elaborating practices to manage the socioeconomic problems emerging within the liberal order, working-class people also reproduced race.
100
The Next Shift
Over the 1960s and 1970s, the industrial working class began to collapse and regroup. This process did not happen all at once. Instead, the collective practices of community and mutual aid worked like a strainer, a vessel holding the unevenly dissolved population, draining it down into the low-wage labor market—with the most easily liquidated being the first to go. But the social geography of working-class Pittsburgh reinforced the community practices of white households while destabilizing t hose of African Americans, forcing them to seek alternative sources of subsistence sooner and sedimenting them at the bottom of the emerging postindustrial working class. Th ese were not the origins of the urban crisis but its consequences.
Small-Scale Segregation The social geography of Pittsburgh’s working class was racially segregated, but the pattern of segregation appeared at a very fine resolution, operating block by block. Often, only a stone’s throw separated the homes of Black workers from the homes of white workers. Gwendolyn Mitchell recalled of the African American section of New Homestead where she grew up, “the whole surrounding area around that was all white. . . . And, and this is like three minutes, you know, from our h ouse. So you cross this little line and you’re—you know it’s in segregation again.”5 The region’s hilly terrain s haped this pattern, in which vertical distance substituted for horizontal separation. “Where we lived at, it was kind of mixed,” recalled Earline Coburn, an African American. “I could remember some p eople on the street I didn’t know, I could remember them g oing up the street speaking a different [Eastern European] language.” Steep topography forbade the tract housing plans of suburban Detroit, Chicago, or Los Angeles, where new developments could spread out and attract white flight.6 Moreover, Pittsburgh’s stagnation was no match for the economic dynamism and diversity of such metropolitan economies. In Pittsburgh and the industrial towns clustered around it, t here were far fewer new housing starts in the postwar years. Th ere was l ittle space to move into, and white steelworker h ouseholds, which had enjoyed high rates of homeownership since the prewar years, were anyway too entrenched to leave quickly. Instead, to a significant extent, white working-class Pittsburgh stayed put in prewar blue- collar neighborhoods and towns u ntil the industry’s final
“ Yo u A re O n ly P o o r . . .”
101
decade—w ith emigrants moving in a trickle but not a flood toward suburbs before 1970.7 Meanwhile Black working-class Pittsburgh became organized into two types of communities. One type was found in neighborhoods known as “ghettos”—large, segregated concentrations of Black h ouseholds on the North Side, in the Hill District, and in Homewood-Brushton—neighborhoods dramatized in the two greatest fictional representations of Black Pittsburgh, August Wilson’s plays and John Edgar Wideman’s novels. In 1960, just over half of the city’s Black p eople—54,302 out of just over 101,700—lived in concentrated African American areas, wards where they w ere the majority. Th ese neighborhoods, and others of their general type across the urban North, have received significant scholarly attention.8 The other half of Pittsburgh’s Black population, along with the remaining 35,100 African Americans who lived in Allegheny County but outside Pittsburgh city limits, inhabited smaller clusters of a few hundred or thousand. These were scattered across the metropolitan area, particularly in the lower zones of the Mon Valley, near the steel mills—speckling the edges of white blue-collar areas. Altogether such areas held more of the county’s African American population than the county’s major Black concentrations did. Yet, as Joe Trotter and Jared Day point out, there exists little historical scholarship on communities of this type in the industrial North.9 A person leaving a steel mill and walking uphill from the Mon Valley floor in 1960 would, within five or ten minutes, enter and exit the Black steelworker neighborhood. A fter another twenty minutes, the white steelworker neighborhood would come and go, still displaying some internal ethnic gradations: Slovaks and Poles here on the hillside, the Italians there, the Irish a bit higher, and managers over the ridgeline. With the spasmodic decline of the steel industry, insecurity worsened for many working-class p eople but did so more severely for African Americans. A wave of layoffs, as it ground its way through the steel mill seniority list and through hierarchies of race and skill, would creep up the hillside like a rising tide.
Deindustrialization’s Onset In the 1950s, distant warnings for steel employment appeared, but few indications of serious trouble. The decade ended with metal industry employment
102
The Next Shift
in the Pittsburgh area a bit below where it had been in 1950, not yet in f ree fall. “Dad pioneered being laid off before it became fashionable,” recalled Edward Stankowski. Still, an enormous 16 percent of the region’s jobs were in the primary metals industry, and nearly an outright majority in the area’s overall industrial sector, much of which depended on steel.10 In the 1960s the decline in industrial employment began in earnest. Between 1960 and 1970, the number of workers employed in metal manufacturing declined from 162,514 to 128,142. Blue-collar work overall fell from 47 percent of the labor market to 30 percent in the space of this decade. This decline shook out unevenly: craftsmen and foremen, the nearly all-white upper echelon of blue-collar workers, numbered 138,300 in 1950 and declined only to 134,845 by 1970. The number of operatives—who made up the main rank of blue-collar employees, encompassing semiskilled machine workers— fell from 173,428 to 111,059 over the two decades, although the bulk of the decline was in the 1950s and mostly in industries other than steel. So-called unskilled manual workers lost nearly half their number, which fell from 88,953 to 47,325. In 1962, a local official of the Pennsylvania Department of L abor noted that the unemployment rate in the Mon Valley had reached 20 percent, which he attributed to automation in manufacturing.11 Through the late 1950s and early 1960s, the unemployment rate in Pittsburgh, at 9–12 percent, ran steadily twice as high as national levels. Although the labor market picked up in the mid-1960s, as the effects of the Kennedy administration tax cut carried the industry into the Vietnam War boom in steel o rders, the unemployment rate was still back at nearly 5 percent by 1967—the third-highest of all major metropolitan areas in the booming mid1960s. Even in this moment of temporary respite, Black unemployment stood at 16 percent; in 1968, Pittsburgh’s Black unemployment rate surpassed that of all other major cities, including Newark, Detroit, and St. Louis. Moreover, the region’s labor force participation rate, 54 percent, was among the lowest in the country. This figure was a combined product of the low rate of women’s workforce participation, the gradual ejection of Black men from industrial work, the overall aging of the workforce, and the departure of the young—a ll related to steel’s long-term prevalence and slow decline.12 Job loss was racialized b ecause it tracked the industrial workplace’s internal labor market hierarchy. Seniority in the mill accrued within a worker’s department rather than plant-w ide, meaning that the confinement of African
“ Yo u A re O n ly P o o r . . .”
103
Americans to undesirable departments institutionalized the pattern of who was likely to be hired last and laid off first, as well as who would be exposed to the most dangerous and difficult work. A 1968 study by the Equal Employment Opportunity Commission found Black workers “almost twofold over-represented in the lowest classification and equally disproportionately underrepresented in the most skilled blue-collar work.” As historian John Hinshaw notes, when National Tube Works in McKeesport laid off 11.5 percent of its workforce in 1967, it “furloughed 38 percent of its Black workers. For many white workers, the labor pool was a last resort in hard times, whereas for Blacks it was often the only job they would ever have.”13 A scene in August Wilson’s play Two Trains Running, set in 1969, captures this contraction in Black employment. “Go on over the steel mill. A big strong boy like you . . . if you ain’t scared of work . . . they got work over there,” restaurant owner Memphis Lee advises the younger Sterling, newly released from prison. Sterling replies, “I went over to J&L Steel and they told me I got to join the union before I could work. I went down to the union and they told me I got to be working before I could join the u nion. They told me to go back to the steel mill and t hey’d put me on a waiting list. I went and asked my landlady if I could put her on a waiting list.”14 In working-class neighborhoods, this l abor market decline was profound. A study on poverty by local urban planners found most of the region’s 161,000 poor families “within the City of Pittsburgh and along the major river corridors where the industrial towns of the region are located. H ere in the valleys of southwestern Pennsylvania are the homes of two-t hirds of the region’s poor.”15 Many Black workers laid off in this period had developed a wide range of technical skills that they could not put to use in low-rank steel jobs. Evans Smalley, for example, was a trained welder but had been employed for five years only as a laborer at a company that manufactured coke ovens for steel mills—until he was laid off. Daniel Marsh, similarly, had mechanical training but had worked as a janitor at Homestead Works until he lost his job. As the industry laid off increasing numbers of laborers, Black workers thus paid a second penalty for the discriminatory job structures of their factories.16 Their social worlds, which took shape at the neighborhood level, then absorbed this damage.
104
The Next Shift
Housing and Neighborhood in the Urban Core For much of the postwar period, many working-class families inhabited a built environment that remained dilapidated and crowded. Such conditions were especially true of Black neighborhoods, sites of underinvestment and residential exploitation. From 1930 to 1955, the city’s Black population grew by 44,970—with expansion particularly concentrated in the postwar years— while its white population shrank by a similar amount. Housing capacity did not shift or expand to accommodate.17 Few residential areas opened up to Black families. The familiar obstacles of residential exclusion—redlining, restrictive covenants, blockbusting, and direct intimidation—prevailed in existing segregated neighborhoods. A local clergy group testified to the Senate Banking Committee, “There is a strong effort to prevent Negroes from moving into white neighborhoods. Negro families encounter broad discrimination by realties, home builders, and mortgage lenders if they attempt residence in non-Negro neighborhoods. Th ere is also considerable objection on the part of white residents to Negro families moving into white neighborhoods.” Nor could private sector construction meet demand. A study of three years in the 1950s found virtually none of the new housing units built being offered “for the Negro market.” In a 1951 study of housing availability, “the highest vacancies, 14.7%, corresponds to zero negroes in the tract, 13.0% vacancies to .2% negroes; conversely the high negro percentages, 95.2% for instance, corresponds to 1.1% vacancies, 87.4% to .9% vacancies, and so on.” A 1952 report found that the entire Hill District, the cultural center of Black life in Pittsburgh, h oused 21,263 people, “jammed into 224 acres,” making it the most densely inhabited neighborhood in the city.18 Take, for example, the area of the Lower Hill bounded by Centre Avenue, Bedford Avenue, and Devilliers Street—a census tract not quite one-tenth of a square mile (see Map 3.1). The Hill rises like a ramp northeastward from downtown Pittsburgh. This tract sits near the neighborhood’s southwestern edge, closest to downtown. In 1960, 84 white people lived in the tract and 4,033 African Americans; 29.4 percent of men in the workforce were unemployed, and 27.5 percent of w omen. Of the 1,098 employed p eople, 196 worked in the metal industries, more than any other sector. Another 163 worked in personal, h ousehold, or retail serv ice. In the mid-1960s, a survey found that
“ Yo u A re O n ly P o o r . . .”
105
Al leg he ny Riv er
MILLVALE
LAWRENCEVILLE/ POLISH HILL EAST LIBERTY HOMEWOOD
NORTH SIDE THE HILL
Mo
no
ng ah
PITTSBURGH ela R
Lower Hill Census Tract WILKINSBURG
iv e r
Map 3.1 Major African American neighborhoods of Pittsburgh
a majority of households in the Hill drew income from sources other than employment—mainly public assistance and Social Security.19 In this tract, there w ere 1,568 units of housing, all but 36 occupied, overwhelmingly by renters. Almost all housing predated the war. In fact, only 159 units—10 percent—were structurally sound and equipped with all plumbing facilities. Half were in states of deterioration: per the census, “needs more repair than would be provided in the course of regular maintenance.” And a third w ere “dilapidated”—“does not provide safe and adequate shelter.” A majority of units in the tract did not have private indoor bathrooms.20 Much of Black Pittsburgh, confined to overcrowded neighborhoods and relatively unprotected by city regulation, was caught in a web of small-scale predation. Despite the state of accommodations for Black tenants, landlords still managed to extract disproportionately high rents. Half of the city’s African Americans paid at least one-quarter of their earnings for housing, compared with only 30 percent of white people. The high rents, in turn, led to frequent subletting of space within apartments to make the rent, further crowding and degrading housing stock. Tenants defended themselves against landlords however they could—by complaining to the newspaper, appealing to elected officials, and picketing outside buildings, and occasionally in violent confrontation. In just the first week of October 1959, two separate Hill District landlord-tenant disputes led to hospitalization: one for the tenant, smashed on the head with a skillet; the other for the landlord, slashed on his
106
The Next Shift
head and hand with a razor. (It is probably not a coincidence that these episodes, sparked by nonpayment of rent, occurred several months into the 1959 steel strike.)21 The city attempted to address neighborhood conditions through its urban renewal program. This effort aimed to beautify downtown, control smoke emissions, abate floods, and clear slums. The growth machine was consummated in a bipartisan alliance between David Lawrence—the Irish-Catholic Democratic Party boss, mayor, and eventually governor—and the Republican corporate executives of the city’s unusually unified business class. The program took organizational form in the Allegheny Conference on Community Development (ACCD). U nder ACCD’s guidance, the city established the Urban Redevelopment Agency (URA) to employ eminent domain widely. By the end of the 1950s, the program had demolished and rebuilt 266 acres—1 percent of the city’s buildable area—at a cost of nearly $200 million.22 Many neighborhoods resisted this program. Beginning in 1949, residents of Highland Park, a mainly white neighborhood, beat back an effort to construct a performing arts center in their section. After hundreds joined protests, two members of the city council broke with the Lawrence machine to back them. “Everyone knows,” said Councilor Edward Leonard, “that the Allegheny Conference controls both political parties.” By midsummer 1949, with lawsuits threatened, the Highland Park plan had become a major flashpoint even within the usually compliant city council, and Lawrence abandoned it. An effort to displace neighbors of Jones & Laughlin Steel so the company could absorb federal subsidies for wartime capacity growth in 1949 went more smoothly, since the United Steelworkers persuaded their members that additional jobs would be worth giving up their homes. But when the city moved in 1950 to build hundreds of units of public housing in Spring Hill and St. Clair—largely white neighborhoods on the North and South Sides inhabited by the upper layer of the working class—it encountered another wave of resistance. “Protesters, who were mainly working-class Demo crats, also staged a mass threat of withdrawal from the Democratic Party if the city did not back off its plans.” Since the program in this case did not require the input of the city council (which in any event would not have been as favorable to the protesters), these residents did not fare as well as their Highland Park neighbors. After the last judicial ruling against the protesters in 1954, construction began.23
“ Yo u A re O n ly P o o r . . .”
107
Most famously, the URA partly demolished the Lower Hill, up to the edge of the census tract described earlier. Pittsburgh’s most prominent Black politician in this period, Homer Brown, represented the area in the state assembly. He headed the African American section of Lawrence’s machine and had little interest in opposing the project. Once emptied, this historic center of Black Pittsburgh was replaced by the Civic Arena, the venue rejected by Highland Park, whose size and surrounding parking lots walled off the remains of the Hill from downtown.24 All told, urban renewal displaced at least 5,400 families by 1966, while only 1,719 new dwellings were constructed or underway. The program succeeded in driving African Americans farther from downtown, further penning them in to constricting space. Outside of the Hill itself, Homewood-Brushton received the most refugees from urban renewal, and rapid white flight followed. Homewood’s Black population rose from 13 percent in 1940 to 70 percent in 1960 and 86 percent by 1968. Homewood and the Hill were the neighborhoods that exploded in riots after the assassination of Martin Luther King Jr. in 1968. They w ere the places where disinvestment struck first and hardest. But they were not the last places to endure this process.25
Race and Class in the Steel Valley Crowding developed as a crisis initially in the concentrated Black neighborhoods of the Hill and then Homewood-Brushton, causing population to spill into existing Black footholds in steel mill neighborhoods. Th ese parts of the Mon Valley were more spacious in that they held fewer units of housing per square mile. But the homes themselves w ere packed with more p eople, a strategy for stretching steel mill security to a larger group. When displaced African Americans needed somewhere to go, they might move in with relatives who had already established such a foothold. Earline Coburn and her mother moved into the Rankin home of her h ousew ife grandmother and steelworker grandfather. “It was myself, my two sisters, and my aunt lived there, and she had two c hildren that lived t here, and my grandmother also babysat another cousin. So we was all in the same house and we grow up more like s isters and brothers than cousins.”26 Some of these communities lay inside the boundaries of Pittsburgh, others outside the city, strung along the Monongahela. Their built environment
108
The Next Shift
dated to the boom of the steel industry decades e arlier, when European immigrant steelworkers and their American-born c hildren built and purchased the homes clinging to these hillsides.27 With few exceptions, t hese local populations had peaked in the interwar period and declined steadily over the remainder of the twentieth c entury, in tandem with the steel industry’s maturity and stagnation.28 Although many such communities lay outside the city limits of Pittsburgh, it is a m istake to view them as suburbs. Their populations declined through the postwar decades; their housing stocks were old and somewhat run-down; and their racial segregation operated at a hyperlocal scale. A 1968 study by the Pittsburgh Department of City Planning comparing the city and “the suburbs” reported, with some confusion, that “the classic dichotomy of the poor, underprivileged central city contrasted with the problem-free, comfortable suburb is not revealed by t hese data.”29 African Americans increased as a percentage of the population across t hese working-class areas over the postwar period. In some communities, such as Duquesne and Homestead, Black residents left in smaller numbers than their white neighbors. In others, such as Hazelwood, new Black residents moved in, expanding the small Black foothold. Declining population in these neighborhoods was in some measure clearly white flight. However, a significant distinction persisted between the semi-integrated riverside steel towns and the middle-class suburbs of the more classic type, which sat above the ridgeline and enforced thoroughgoing racial exclusion.30 As Black people migrated into the industrial towns or stayed there in higher numbers, a contradiction opened up between the postwar dichotomous racial order and the older gradated historical pattern, which had situated African Americans at the bottom of an intricate order of white ethnics. “The Slovaks h ere and the Hungarians h ere. You could r eally tell by the clubs. Th ere was a Slovak club over here, on 5th or 6th St. Then the Hungarian club was over h ere,” recalled Sarah Andersz of Duquesne, where she grew up. “They had an Irish club on top of the hill. You know t hose Irish, they think they’re better.” Carol Henry, an African American w oman growing up in Duquesne, saw clearly how race and ethnicity both separated and joined the working- class neighborhoods. “You had the Italians and the Slovaks along the hill,” she recalled. “I remember the gardens, apple trees. A lot of times, we would get in trouble for stealing apples, they would tell our mother. Then a lot of
“ Yo u A re O n ly P o o r . . .”
109
times, the Italians would come down, they would give us stuff. And in turn, my dad and my mom gardened, they would give them tomatoes.”31 This older ethnic pattern had solidified in the durable form of the built environment, not only homes but also churches, schools, and public accommodations— giving rise to both informal interracial sociality and also customary practices of segregation rather than institutionalized ones. This contradictory mix of racial feeling and practice was the result of the durability of the region’s class structure, within which the neighborhood was a source of security for the working class. As Black families looked for places to go in the 1950s and 1960s, they sought out space in these working-class communities b ecause they already had friends and f amily there. There was room for them because the gradated prewar racial order was still there, congealed in urban space. In the postwar years, however, this pixelated social geography, concretized in enduring physical structures, had the postwar racial binary superimposed on top of it. “Where I lived on Cherry Way, they d idn’t fully accept us because that was not a section of town where we were welcome,” wrote Ray Henderson about growing up African American in Braddock. “They called us Bottom rats, and people didn’t have too much respect for us ’cause we were poor. . . . These small towns had a habit of figuring out a way of Black and white folks not associating with one another even though they were all poor.”32 This paradoxical observation—his f amily in fact did live in a place where they w ere unwelcome—describes the imprint in memory of the interspersed pattern of segregation. Neighborhoods were often more integrated residentially than they w ere commercially or in public space. Black Pittsburghers waged desegregation campaigns at restrictive sites of public accommodation within residentially integrated neighborhoods around the region. This included bowling alleys, bars, nightclubs, skating rinks, swimming pools, laundromats, and the Kennywood amusement park.33 The Hazelwood neighborhood illustrates the residential pattern (see Map 3.2). Hazelwood was essentially a mill town that happened to lie inside Pittsburgh’s municipal boundaries.34 The residential neighborhood rose on a hillside above an industrial g iant on the riverbank: Jones & Laughlin Steel. The northern half of Hazelwood formed a census tract bounded by Hazelwood Avenue, Bigelow Street, and the steel works—an area not quite a square
The Next Shift
110
PITTSBURGH
ela River ongah Mon
Hazelwood Census Tract
Mo no ng ah ela Riv er
J&L Steel Works
0
1000 ft 300 m
Map 3.2 Hazelwood census tract
mile, rising rapidly in elevation from the riverbank mill. The tract was home to about three thousand p eople. In 1950, this area had a sizable Black minority. Then came rapid reshuffling in the 1950s, with the African American presence more than doubling within a neighborhood whose population had stayed level overall (Table 3.1). In the 1960s, the neighborhood stabilized: after ten years, the population had shrunk, but its racial breakdown remained the same.35 In 1960, unemployment in this tract ran at 9.3 percent generally and 12.6 percent for Black residents—high figures, marking the area’s reliance on secularly declining industrial employment, but not approaching the ruinous levels of the Hill. Overall, one-third of Hazelwood’s population was employed in 1960. One in four African Americans in the neighborhood brought in wages (see Table 3.2). The rest were unemployed, c hildren, retirees, or not in the labor force and had to live on government support and the wages of the
“ Yo u A re O n ly P o o r . . .”
111
Table 3.1. Race and population in Hazelwood census tract, 1950–1960
African American population White population
Percentage in 1950
Percentage in 1960
17
37
83
63
Source: Census of Population, 1950, table 1—Characteristics of the Population, by Census Tracts, p. 14; Census of Population and Housing, 1960, vol. IX, t able P-1—Occupancy and Structural Characteristics of Housing Units, by Census Tract, p. 24; Census of Population and Housing, 1960, vol. IX, t able P-4—Characteristics of the Nonwhite Population, for Census Tracts with 400 or More Such Persons, p. 226.
Table 3.2. Race and l abor market in Hazelwood census tract, 1960 Total employed people Employed in metal industries Employed African American men Employed African American men in metal industries Employed African American w omen Employed African American w omen in serv ice occupations Median f amily income overall African American median family income
927 238 192 122 94 64 $5,261 $3,183
Source: Census of Population and Housing, 1960, vol. IX, table P-3—Occupancy and Structural Characteristics of Housing Units, by Census Tract, p. 178; Census of Population and Housing, 1960, vol. IX, t able P-4—Characteristics of the Nonwhite Population, for Census Tracts with 400 or More Such Persons, p. 226; Census of Population and Housing, 1960, vol. IX, t able P-1— Occupancy and Structural Characteristics of Housing Units, by Census Tract, p. 24.
breadwinning quarter—a similar pattern to that found in the Hill District. The figure for white residents, in contrast, was 36 percent, making it easier— if not entirely straightforward—to stretch the wages of breadwinners. The neighborhood’s built environment reflected this labor market situation. There were 750 units of housing for the area’s 2,787 people. (The average home thus had 3.7 p eople and 1.2 jobs.) While the housing consisted largely of small detached or row homes and was not as physically dense as in the Hill, there were more people per unit in Hazelwood in 1960 than in the Hill; population was denser per home but not per square mile. Of these 750 units, 63 percent were owner-occupied, and the rest were rented. A small majority of African American households w ere renters, while three-quarters of white
112
The Next Shift
families were homeowners. Housing stock was old: 82 percent of the homes in 1960 w ere prewar. Only 56 percent w ere judged structurally sound, with all plumbing facilities; 44 percent were deteriorating, dilapidated, or lacked hot w ater or other plumbing. Ten p ercent lacked their own indoor bathroom, using outhouses or shared facilities. Conditions w ere modest.36 The interaction between slow-moving flows of Black in-migration and white flight, on the one hand, and spasmodic and secular economic decline, on the other, shaped the racial and economic geography of all the steelmaking neighborhoods. Their demographic changes ran in parallel to t hose of Hazelwood. In Homestead, a census tract of not quite half a square mile, located a block above the town center and three blocks from Homestead Works, housed 1,661 p eople in 1950, 13 percent of them Black (see Map 3.3). Ten years later, the population was 1,425, and the African American population was up to 20 percent. By 1970, the population had fallen by a few hundred more, and the African American population had risen to 31.2 percent.37 The areas of Hazelwood and Homestead examined here indicate the classic phenomena of white flight and ghettoization. But t hese local histories also show something e lse: a slow shift in the demographic balance t oward a gradually rising Black population alongside a white ethnic population that, in large measure, stayed put into the 1970s. These w ere working-class communities of common insecurity, unevenly racialized.38 No less than in cases of racial succession in other cities, the Pittsburgh pattern of slow change in communities segregated on a fine scale led to white hostility and violence against Black neighbors. Rather than the spectacular bombings and arson in “defended” northern suburbs of Chicago or Detroit, this was the friction generated by white p eople who wanted to monopolize common space and resources that were de facto already integrated. Close quarters defined these conflicts. “Racism and exclusion policies could separate two communities from one another even though t hey’re the same community,” as Ray Henderson said of his native Braddock. As white kids in Hazelwood warned a young Black newcomer, “Go back where [you] came from, only whites live on this side of Elizabeth Street.” In Hazelwood’s Glen- Hazel housing project, the Pittsburgh Courier reported “continuing troubles, now intense, now lulled.” “Ugly attitudes, obscene language and racial epithets from both groups reportedly set the stage for present difficulties.” Asked by a sociologist how she liked living in the complex, a white w oman named
“ Yo u A re O n ly P o o r . . .”
M on on ga he la R ive r
Homestead Steel Works
113
M on on ga he la Ri ve r
Homestead Census Tract
0
1000 ft 300 m
Map 3.3 Homestead census tract
Mrs. K. “reported that she did not like living in Glen-Hazel at all, due to ‘dangerous Coloreds’, in the project which bothered her, and the ‘factory smells.’ ”39 Over the postwar years, Black footholds in steel town neighborhoods had slowly expanded. White neighbors often resented their Black neighbors but could not expel them and, in many cases, w ere unwilling to leave themselves. The result was an oscillation between coexistence—even sometimes quotidian cooperation—and bursts of vicious racism. White residents of the Glen-Hazel complex in Hazelwood reported feelings of powerlessness at rates far exceeding t hose of their Black neighbors. “He has reached the end of his resources,” as sociologist Richard Hessler described the situation of a typical white subject there. Of survey respondents in Hazelwood who said they disliked the neighborhood, 74 percent gave as their reason “too many Negroes”; Black respondents w ere significantly more optimistic.40 African American residents w ere compelled to make their lives in the very spaces enclosed by the despair of a declining white working class. Black residents were there to seek the security and pleasure of collectivity—a search necessarily involving public space. By taking up public space, however, they risked white vengeance. A 1967 incident from the steel town of McKeesport illustrates this dynamic: young African Americans, celebrating a fter a
114
The Next Shift
wedding, spilled from a restaurant into the street a fter midnight. Police appeared and ordered them to disperse. While the crowd began to break up, two women, still in “fashionable and expensive” wedding finery, did not move fast enough; policemen tackled them and squirted a tear gas pen into their eyes. Hundreds of partygoers began to protest, and police from neighboring towns quickly descended on McKeesport to patrol the city and teargas “any Negro on the street.” Black participation in an ordinary ritual of collective mill town life, tied up with social stability, cultural continuity, and economic security—a wedding—brought about furious repression.41 A slowly unfolding crisis in the community’s ability to reproduce itself turned into social conflict over the public spaces where that reproduction was enacted. Stories like that of the wedding w ere common in the late 1960s and early 1970s. In 1971, in the steel town of Aliquippa, a brawl broke out between the clienteles of a white tavern and a Black poolroom when an African American youth brushed against a white policeman on the sidewalk and was attacked by a white crowd.42 No institutions embodied these tensions more clearly than schools. A pattern of explosive racial conflict broke out across area schools in the 1960s and 1970s, describing a near-exact map of the industrial communities being drained of their livelihood: McKeesport, Homestead, Braddock, Duquesne, Hazelwood, South Side, Monessen, Donora, and Clairton—all riverbank mill communities. Each hosted very similar struggles. In Hazelwood, an altercation between students led “white toughs from Second Avenue pool halls and beer taverns” to descend on Gladstone High School, instigating a race riot on school grounds. Police followed and arrested twelve Black students, beating a fourteen-year old girl in the process. As Black students fled the school, gangs of white adults pursued them under the eyes of the police. “When the Blacks saw the gang approaching,” the New Pittsburgh Courier reported, “they started tossing rocks and bottles. The police officers did not act. They preferred to encourage the white gang with shouts of ‘throw ’em back at them;’ ‘get the n . . .’ ” The police then arrested the Black bottle-throwers, letting the white gang go. Bill Moore, the Black police commander assigned to school public safety, later resigned, saying that he no longer wanted to be used to “soothe and quiet Black people.” 43 Similar events played out up and down the Mon Valley. “Whites don’t want Blacks in school,” as one South Side student put it succinctly. In a
“ Yo u A re O n ly P o o r . . .”
115
McKeesport school, four Black students were expelled for assaulting teachers and peers, carrying a weapon (a fork), and damaging school property. The school had initially suspended thirty students before “identifying ring- leaders” and narrowing down its targets. A visitor reported that discrimination by white teachers and racist graffiti on the walls w ere ordinary in the school. In Monessen, a school guard shot a student, leading to huge student protests. In Clairton, after weeks of in-school fights, occupation by police with dogs, and attacks by white neighbors, the Black Student Union submitted sixteen demands: these included the resignations of certain administrators, a new curriculum, and the hiring of Black staff. Organized white parents unsuccessfully sought to have the school closed down in response.44
Community L abor and Collective Survival Whole communities w ere caught up in the cycles and long-term decline of the steel industry. Together, groups of people had to wring what security they could from industrial work. Working-class people continued to depend on one another—those who w ere geographically nearby or affectively close—for solidarity. Most often, such groups involved kin, but they might also involve coethnics and coreligionists, neighbors, and others connected by various forms of fictive kinship. Consider Mrs. C., whose uncle lost a leg at work: “Part of my responsibility at that time was helping to take care of his f amily because his wife was at the hospital so often with him. He was very discouraged. It was really a bad time for them. I would go to school and come home after school and I would go immediately to their home and I would take care of the c hildren and clean.” 45 These connections became especially clear under duress. A study of malnutrition in the county found the most hunger in the ghettos of the Hill and the North Side and the mill towns of Homestead, Braddock, Rankin, and McKeesport. In all t hese communities, between 40 and 50 percent of t hose surveyed reported “recently” having run out of money to buy food. In turn, 51.4 percent of t hose who ran low on money for food stated that their main recourse was to rely on f amily, friends, or neighbors.46 These ties required l abor. People worked to keep each other afloat directly and through shared institutions. Working-class women sustained t hese networks and the broader social ecology of religion, neighborhood, ethnicity,
116
The Next Shift
and kinship. Volunteerism was extremely common, in particular at institutions of ideological significance for community reproduction: the hospital, the school, and the church figured prominently. While t hese communal social support systems were largely voluntary rather than formally state- organized, they still owed their coherence to the regime of differentiated social citizenship, which constituted the economic and racial basis of neighborhoods and positioned individuals and families in relations of dependency and sometimes hostility toward one another. What was functionally a system of social support became subjectively meaningful, however, in the form of ethnic tradition, religious practice, solidarity, or love. Churches, unsurprisingly, played a key role. Generally w omen were the primary churchgoers and beyond mere attendance were actively involved in maintaining the church, tending to institutions and taking care of priests. Such patterns represented the extension of domestic femininity beyond the bounds of the home. Mrs. M. made clear how this gendered division of labor in the production of community corresponded to that in the production of the household. “If t here was anything concerning in the neighborhood and we had a meeting, I would always go. . . . Someone had to fight for the children.” The same Mrs. M. regularly cleaned her church and washed her priest’s clothes. Another Mrs. K. told an interviewer, “I went to the hairdresser’s then I go to work at the church Friday. Saturday I clean house. Sunday, it’s church, then watch the football game. Definitely that football game. And, work the Bingo on Sunday night. And this is the pattern that goes on all the time. Same t hing.” Mrs. K. estimated that she was at church “four or five days a week. Or if the priest needs something, he’ll call us, we go. We do.” On Fridays, she and her mother-in-law cooked pierogis and noodles for the church. On Sundays, Mrs. K. ran the bingo table; the game, she explained, was the only way that the small parish survived. And she cleaned the church: “You’re practically t here all the time.” “It was an honor for us, though,” said another who cleaned her church once a week.47 While the labor of community was not l imited to churches, it did tend to occur in sites of similar communitarian inflection. Mrs. K., who cleaned St. Adelbert’s, maintained an astonishingly intricate schedule of donations of her time and energy, interwoven with her domestic labor. Mondays she did laundry, made the beds, baked for bingo at the ethnic hall, made snacks for the kids, cooked dinner, went to bingo, and did the dishes when she came
“ Yo u A re O n ly P o o r . . .”
117
back. On Tuesdays, she made the beds; went to town (bus fare was discounted on Tuesdays); did the shopping for herself, her friend, and her father-in-law; made dinner; and then went to the children’s gym class to “take care of all the kids, make sure that they behave and don’t get into fights.” Every third Wednesday she went to spend the day at the lunchroom at St. Michael’s School; she did the same every third Thursday at St. Joseph’s. She spent e very first Friday at St. Thomas’s cafeteria. E very first Monday, “I go to a Tamburitzan meeting. And when t hey’re making strudel at Tamby Hall I’ll help there and sometimes we’re there from ten to four.” She helped prepare food for weddings, raised money for school needs, cooked for church events. “We make stuffed cabbages, potato salad, it’s all working in the kitchen. We had a confirmation last month so that meant extra meetings for the parents.” 48 The extent of Mrs. K.’s donations of time may have exceeded the norm, but it indicates the range of activities involved in producing and maintaining the community that gave white working-class people their security and their identities—as Poles, Italians, Hungarians, or Slovaks, and as w omen or men. The other major sites of w omen’s community labor represented other, familiar extensions of the culture of motherhood. Mrs. M.’s m other engaged in a span of voluntary labors that similarly coproduced ethnicity, neighborhood, and gender. Like many women, particularly descendants of eastern Eu ropean immigrants involved in ethno-religious organizations—t he Ladies’ Pennsylvania Slovak Union, the Polish Falcons, the Christian M others, the Sodality—her mother was “active with her fraternal organization as long as I can remember. Right now, she’s a Supreme Officer.” She was active in church, volunteered for the Red Cross, and, especially, “kept herself very, very busy, too, d oing her voluntary work over at the Veteran’s Hospital.” 49 These networks and the institutions into which they congealed would be there in moments of need and would help to socialize c hildren and raise them properly. “We lived on 13th Street,” recalled Mrs. K. “It was a very nice neighborhood. Everybody knew everybody and h ouses w ere party-walls and everybody sat out on the sidewalk. . . . When you have a date it is kind of embarrassing because you are passing everybody on the street and everybody knew when you went. . . . I can remember that my dad said, ‘Don’t you ever let me see you holding anybody’s hand g oing down.’ ”50 Yet t hese relationships embedded families deeper in the classed, typically ethnic networks whose markings postwar consumer culture demanded these
118
The Next Shift
families shed in order to achieve undifferentiated affluent whiteness. The same habits and relationships that would take care of families if wages dried up, would raise c hildren properly, and would give meaning to their years of toil also threatened to inhibit ascent into the respectable m iddle class. Mrs. R., daughter of Sicilian immigrants, grew up envying the Calabrian f amily across the street, which she saw as more assimilated. Unlike her family, the Calabrian neighbors did not cook with olive oil. “When I came home [from the Calabrian house] mother would wash my hair because she said it smelled so bad.” She grew up in her parents’ grocery store on Pittsburgh’s North Side, feeling shame at her ethnicity as an inhibition to social acceptance and potential mobility. “I never heard the term of dago or wop . . . until I was in high school,” she recalled. I was a l ittle embarrassed when we went shopping and my m other would ask for something and the clerk w ouldn’t understand her. You might say I was ashamed of my mother as I was growing up because of the language barrier. And then I resented the fact that she worked and I couldn’t bring children into the house. Even when I was too young to work because we’d dirty the h ouse and m other didn’t have time to clean it and work at the store too. So, I always felt badly about that. The grocery represented the immigrant ghetto. “I wanted to get a job. Defi ouse like nitely not working at the store all my life. Just be a woman with a h everybody else, with a porch we could sit on and not the store in front. . . . I think the embarrassment was what I disliked the most, that my friends knew I had to work when they d idn’t have to work.”51 Despite this shame, she needed her family. Married shortly after the war, she had a hard time finding a place to live. So she and her husband “moved into an apartment that my father owned and it was above a store, again.” She had always wanted a white-collar husband but instead married a steelworker. The marriage proved acceptable, however, since he took care to keep the physical markings of manual labor out of the house. “When he comes home from work he always takes a shower right away, and cleans his fingernails and shaves. I didn’t think of him as a mill worker or anything.” One form of security, the class and ethnic habits and traditions nourished over years of hardship, thus inhibited another form, which was aspirational and normative—t he
“ Yo u A re O n ly P o o r . . .”
119
security of the white middle class. This same tension manifested in the hostility and shame many white people felt relying on public assistance: in a study of food stamp usage, a majority of white respondents said that they thought people watched them when they used food stamps at the market.52 Black working-class families did not have the same set of resources to draw on. African Americans generally relied on community support more intensely, but the pool of contributors was neither as large nor as institutionalized. Black Pittsburgh was geographically scattered, gathered in small clusters and more frequently on the move. Ray Henderson wrote about the public housing complex in Braddock where he had lived: “In the late 50s a fter urban renewal destroyed housing in the Hill District, new people from Pittsburgh who had lost their neighborhood moved to Talbot Towers. Strangers to the community, they had been uprooted from everything they were used to. Their sense of community was disrupted. People no longer knew each other.”53 Accordingly, where much of the process of mutual support for white working- class people flowed through communal institutions built up over time— church, school, hospital, ethnic club—it flowed more directly from person to person and f amily to f amily in Black Pittsburgh. Recall, for example, that the Parrishes, with whom this chapter opened, kept paying rent for months a fter breadwinner Preston was laid off, thanks to his sister-in-law and two neighbors. Similarly, Sadie Adams, faced with eviction from her rented h ouse, bought it by pooling the money of her extended family to make a down payment. Her b rother’s name was on the title 54 along with hers. Ethnographic evidence suggests that such networks were common. “One can borrow clothes, ‘Pampers,’ cigarettes, and food in Belmar without apology or stigma,” wrote ethnographer Melvin Williams of an area he studied in the 1970s. Williams noted the forms of ritual that built and maintained this culture of reciprocity, pointing to visible social solidarity constructed through touching, laughing, group humiliation, and bodily expressiveness.55 Still, the system of communal social reproduction becomes apparent in the historical record most frequently in times of duress like t hose the Parrishes experienced. Present already by the late 1950s, the seriousness of this threat grew rapidly over the next decade. The Pettijohn family, for example, had prepared for a rainy day. They had ploughed breadwinner Willie’s wages from his job at Clairton Works into a
120
The Next Shift
small plot of land in Donora and built a modest h ouse on it. Though he was laid off intermittently, they grew some of their own food and had a roof over their heads, so depleted savings did not necessarily present a crisis—until a severe storm destroyed their home. Afterward, Willie slept in his truck, his wife Ella and youngest daughter Rosemary went to a neighbor’s, and their other three children stayed with Ella’s mother in the nearby mill town of Monongahela.56 The social geography of Black Pittsburgh often left communities too fragmented and economically marginal to institutionalize their communal safety nets. Even religious congregations might prove too small. Dorthea Varner, for example, was evicted in September 1973 along with her five sons from a publicly owned rowhouse in the Oakland neighborhood. The Varners had lived there for six years, but Dorthea had injured her foot recently and stopped working, reducing her to public assistance to make rent. None of her boys could get steady employment, and the Housing Authority put them out on the street. While they slept on the porch of their old house, their neighbor, Fannie Royster, spent hundreds of dollars helping to feed them. Royster stepped in when she found that none of the charitable organizations around were willing or able to help. “The t hing I d on’t understand is that Black p eople have block to block churches. But the churches when a person is sick don’t do nothin’. You jus’ be left out of doors.”57 The social organization that existed, in other words, was often tacit rather than formal and became active and cohesive in moments of need. Melvin Williams describes how, in the event of a death, older women who were not in the immediate family would step in to plan meals, the funeral and cele bration, the feeding of the bereaved, and the housing of their visiting loved ones. He observed “immediate phone calls, often to Detroit, Chicago, New York, Atlanta, Richmond, or Montgomery, to notify the entire kinship network of the death and to communicate the need for required contributions. This financial contribution is in itself a demonstration of family solidarity in a crisis that most kinship networks like to believe t here is the potential for.”58 In more segregated areas with concentrated Black communities, the fabric of community support was stronger. Lou Berry recalled growing up in the Talbot Towers project in Braddock: “It’s a two-block area with five tall apartment buildings. It’s like 210 units, 210 families in a two-block area. Every
“ Yo u A re O n ly P o o r . . .”
121
body is your mother, everybody is your father.” Eddie and Phil Saviour, an elderly married c ouple in Homewood, w ere unemployed and immobilized by bad health; a network of neighbors ran errands, did chores, and went shopping for them. Melvin Williams observed how “reciprocity takes place because, when the recipients of t hese gifts receive their own welfare income, employment income, or lottery income, they w ill also provide resources to those who formerly gave to them.” Barbara Ciara recalled of growing up in the St. Clair housing project that “it was a whole different atmosphere then, neighbors looking a fter neighbors—my mom, who unilaterally gave them permission to discipline me, if necessary.” When Ciara had a baby as a teenager, her mother and aunts took charge of raising the child. Edward Parker, who grew up in the Hill, similarly described a “village atmosphere” in the housing project where he lived. He recalled, “Everybody knew everybody. And in fact, if a person c ouldn’t pay their rent, they had rent parties so other neighbors would come and help them pay their rent.” Anna Coleman, who lived in the Arlington Heights project for the entire postwar period, recalled of community activities, “We had the help of so many p eople. Th ere were probably 40 to 50 p eople who contributed to the success of those days.” Coleman was divorced and raised her six c hildren in Arlington Heights with the help of her mother, who also lived t here, and the neighbors who held the community together. “I feel that there are so many p eople up h ere that should get credit,” she said. “Helen Littlejohn, Amy Comlerter, Blanche Scott, Ida Waring, Edith Bush, Rosetta Moses, Sylvia Scaine, Barbara Jones, and Jackie Durham.”59
Fighting for Jobs For the lower strata of the region’s working class, the 1960s saw the beginning of a downward spiral that would not level off for decades. Beset by unrelenting economic disruption, networks constructed to absorb the slow damage of layoffs and downturns faltered. Black Pittsburghers who had developed networks of mutual aid through the postwar years increasingly began to demand social and political change. The context for Black grassroots organizing was the intersection between the civil rights struggle and the local employment crisis. Out of this context came the United Negro Protest Committee (UNPC), the “action arm” of the
122
The Next Shift
local branch of the National Association for the Advancement of Colored People (NAACP). While the UNPC campaigned for better housing, sanitation, health serv ices, and legal protections, the group’s central focus was on jobs. By the mid-1960s, the campaign of pickets and boycotts had brought a wide range of employers to the table, winning hiring concessions.60 The movement encountered the most difficulty, however, in manufacturing and construction. Although Black employment in Pittsburgh’s blue-collar occupations went back decades, it had always been limited and discriminatory, including only relatively few Black workers, in the worst jobs. Unionized blue-collar labor markets were governed by seniority and connection. White fathers got their sons jobs. Resistance to further integration was, accordingly, very stiff, even as t hese industries presented the most obvious target. “Black men cannot afford to wait five more years before the promise of a decent wage materializes,” observed Diane Perry in the New Pittsburgh Courier.61 Traditionally high-wage, high-skill, u nion jobs in construction would represent a leap from the world of last-hired, first-fired dirty work that defined even many unionized Black jobs. The industry’s record, moreover, was indefensible. In Pittsburgh in the mid-1960s, according to historian Marc Linder, “no nonwhite members w ere reported in the Asbestos Workers, the Boilermakers, the Plumbers, the Sign Painters, the Steamfitters, the Stone and Marble Masons, the Tile Setters, the Elevator Constructors, the Terrazzo Helpers, the Plumbers Laborers, or Marble Polishers and Helpers locals.” The long-standing intransigence of the building trades u nions also made them more politically vulnerable than the nominally egalitarian United Steelworkers.62 Activists from multiple organizations, most significantly the UNPC, came together in the Black Construction Coa lition (BCC) to pursue this goal. A series of demonstrations in late summer and fall of 1969 targeted major building sites in downtown Pittsburgh, including the new Three Rivers Stadium; the new US Steel Building; and projects at Duquesne University, Western Psychiatric Institute, and the WQED telev ision station building. In an August action shutting down t hese sites, marchers defied an injunction limiting pickets to twenty people. Police attacked demonstrators with clubs, injuring 30 marchers and arresting 180. Action continued through the next month, and on September 20, 10,000 marchers encircled the US Steel Building
“ Yo u A re O n ly P o o r . . .”
123
Figure 3.1 Black Construction Coa lit ion Black Monday demonstration led by Byrd Brown, Rev. Jimmy Joe Robinson, Mike Desmond, photographer Coles, and police chief William “Mugsy” Moore, with man standing on van in background, Pittsburgh, Pennsylvania, September 1969. Photo by Charles “Teenie” Harris / Teenie Harris Archive / Carnegie Museum of Art / Getty Images.
site—soon to be the tallest building on the skyline—and raised their fists in a silent Black power salute.63 By this point, the issue became explosive. Mass demonstrations and a work stoppage erupted on campus at Carnegie-Mellon University. Mayor Joseph Barr appealed for help to the Nixon administration, and the Department of L abor sent a team to sit in on negotiations between the BCC, the Master Builders Association, and the Building Trades and Craft Unions. But the parties could not reach agreement, an impasse vividly illustrated when construction workers hung a large “Wallace in ’72” sign on top of the unfinished Three Rivers Stadium—drawing the connection between their defense of segregation in the trades and the larger resistance to integration in the national
124
The Next Shift
polity, as embodied by George Wallace’s anticipated presidential candidacy. Employers and u nions, maintaining a united front, proposed hiring 1,250 Black journeymen over an unspecified period of time and insisted on long training periods—a device to deter Black apprentices.64 While various agreements were signed and a plan was imposed from Washington over the next two years, the problem was never truly resolved. Compliance and enforcement were weak, goals w ere repeatedly lowered, and the construction workforce’s composition remained little changed. By 1974, the building trades had added 573 Black members, leading Nate Smith, the administrator of the program, to defend it by claiming that “the Pittsburgh Plan concentrates on quality as opposed to quantity.” 65 The struggles of the late 1960s and early 1970s opened employment for some, but not nearly enough to change the overall shape of the l abor market. Protest within the steel industry, in contrast, emerged not from outright exclusion but from marginalization. Black men worked in the mills already but were trapped in undesirable and vulnerable departments b ecause workplace seniority operated at the departmental level rather than plant-w ide. In this context, the NAACP and groups of organized Black steelworkers intensified their campaign against discrimination by both management and the union. This action, which helped lead to a 1974 federal consent decree mandating affirmative action hiring and integration of seniority lines at the plant- wide level, is generally seen as a workplace spillover of the struggle for civil rights or even a program initiated from above by liberal bureaucrats. Certainly it required the new movement context and state capacity of the 1960s. But the movement for equal employment in steel was also a form of grassroots action, which is better understood in the context of the rapid downturn in the economic fortunes of Black steelworkers over the course of the 1960s.66 It was only in the second half of the decade—a mid the steep decline in Black steel employment—t hat movement activity picked up, in the form of the national organization by Black workers of the Ad Hoc Committee, which enjoyed significant participation and leadership in Pittsburgh-a rea mills. As part of this movement, the Civil Rights Committee of USWA Local 1397 accused management at US Steel’s Homestead Works of not training Black workers hired u nder a program for the “hard core unemployed,” instead leaving them to “just sweep chips all day”—not only denying access to
“ Yo u A re O n ly P o o r . . .”
125
promotion but also leaving t hese workers vulnerable to being laid off again. The case was similar across the mills. As a protest leader at Jones & Laughlin’s Hazelwood Works explained, management had acknowledged to him off the record the existence of an “unwritten agreement” between com pany and union to move white workers out of the labor pool into steady work first. The situation of Black steelworkers caught in positions as laborers had been physically brutal and personally degrading but, to some degree, economically livable; this viability diminished as the industry wiped out laborer jobs. As in construction, the Black workers’ victory was slow to arrive, was haltingly implemented, and coincided precisely with the decline of the industry. From 1974, the year of the consent decree, to 1978, Black employment in steel in western Pennsylvania r ose only from 5,129 jobs to 5,586.67 Despite legal and political gains, the employers in construction and manufacturing e ither did not open wide enough paths for entry, w ere themselves undergoing economic decline and disinvestment, or both. Integrationist organizers and protesters faced stiff opposition. They strugg led persistently, but they strugg led for inclusion within the structure of the postwar liberal order—seeking Black men’s admission to a blue-collar breadwinner status that was itself entering crisis. Black workers’ movements were thus confined by the same material limits as the liberal state itself, requiring a healthy industrial economy generating jobs whose distribution could be contested.
Mobilizing for Survival When Pittsburgh’s War on Poverty began in 1965, it was a top-down affair. The mayor’s office had begun preparation for the program months ahead of the passage of federal legislation. As resentment about the high-handedness of the urban renewal program had grown, the influx of federal funds seemed an opportunity to rebalance but preserve the city’s Democratic machine by incorporating neighborhood-level leadership.68 Administrators selected a group of neighborhoods to target—some of them largely Black neighborhoods like the Hill and Homewood, and others more racially integrated, such as Hazelwood—and began implementing their diverse agenda: job training, day care, home and family aid, and more. By March 1, 1966, the program had put 3,262 of Pittsburgh’s young p eople to
126
The Next Shift
work through the Job Corps or the Neighborhood Youth Corps; another 429 were working in other poverty programs as teacher’s aides, as health aides, and in other subprofessional roles; and 590 had been placed in jobs outside the poverty program.69 When the War on Poverty came to Pittsburgh, it activated a vast ecosystem of voluntary organizations to reach into the city’s neighborhoods. Religious organizations, hospitals, voluntary societies, and neighborhood organizations in large numbers stepped forward to absorb federal money and turn it into programming. Although Pittsburgh’s poverty program was lauded for its inclusiveness, poor activists soon became dissatisfied when their middle-class neighbors monopolized decision-making. Poor participants’ protests swayed the citywide Board of Directors of the Community Action Agency to add to its membership one representative from each of the eight neighborhoods. Seven of the eight new representatives w ere women. The board also a dopted a rule that at least 40 percent of the membership of the neighborhood citizens’ councils had to be poor. “We now know,” wrote the Pittsburgh program’s director, David G. Hill, “that a larger role in policymaking can and must be taken by the poor themselves if the program is to be properly attuned to need and to approaches that w ill work.” 70 Black residents also generated new forms of political organization at the local level to amplify community control over programmatic resources. The Homewood-Brushton Alliance, led by Dr. Charles Greenlee and nationalist Bouie Haden, an ex-steelworker, mobilized more radical youth in the neighborhood, especially young men, to challenge middle-class authority over the poverty program. The formation of Citizens Against Slum Housing (CASH) touched off a wave of tenant organizing across the city. And Citizens Against Inadequate Resources, founded in 1966, led the fight for higher levels of public assistance and more respectful methods for its disbursement. These latter two forms of organizing—for decent housing and public assistance—were led by Black w omen.71 Where employment integration campaigns sought to draw the energy of civil rights agitation into the labor market, Black women’s organizing attempted to turn the War on Poverty, initiated from above, into a tool they could wield to secure their own survival. The spaces of community constructed and tended by Black women through hard times became seedbeds of a form of resistance that defied the assumptions of the liberal order
“ Yo u A re O n ly P o o r . . .”
127
entirely—developing a feminist analysis and seeking to detach survival from production.72 In 1968, a group of w omen formed the Welfare Rights Organization of Allegheny County (WROAC). Their leader, Frankie Mae Jeter, was a former hospital laundry worker. She became involved when, eight months pregnant, she applied for welfare and “the man told me why don’t I go out and get a job, and I just broke into tears. How in the hell was I going to get a job when I was eight months pregnant?” 73 WROAC sought to obtain through protest and direct action the economic security that the New Deal had delivered through the employment-centered public-private welfare state. In 1970, WROAC members testified to the state legislature that they could not afford “1. Educational savings. 2. Transportation to shop, go to church . . . 3. Telephone bills. 4. Furniture purchases . . . or repairs. 5. Household appliances, supplied goods, washing machines, cooking utensils, soap powder, toilet tissue, e tc. 6. Newspapers, magazines, or books. 7. Movies, concerts, ball games, or recreation of any kind. 8. Gifts, church collections, Thanksgiving, or Christmas.” Reflecting WROAC’s growing power, within the year, the county’s Health and Welfare Association, a consortium of social serv ice providers, opined that “there is almost unanimous agreement by all persons that come in contact with public assistance that as it is today it is not adequately performing its function.” The association called for “all welfare programs receiving Federal funds [to] be administered consistent with the principle of public welfare as a right.” 74 To realize this commitment, WROAC mobilized its membership of two thousand for a series of campaigns—including letter writing, in-person confrontations, and petitions—targeting the Department of Public Assistance, the Housing Authority, and the state legislature. Activists successfully applied pressure directly to welfare offices not to keep security guards on hand or delay service. The group won a lawsuit in 1969 for full welfare benefits for nonrelated guardians of dependents—a critical victory for the system of Black community labor and mutual aid, which often involved fictive kin relationships. And in 1970, amid protests against roaches in public housing and the garnishing of late rent from welfare checks, WROAC secured the ouster of the head of the Housing Authority. Indeed, WROAC activists even provoked Donald Rumsfeld, head of the federal Office of Equal Opportunity, to issue a statement deploring their tactics.75
128
The Next Shift
While much of WROAC’s focus was on securing the conditions for the social reproduction of Black families, it also fought a highly visible campaign for autonomy in sexual reproduction. In 1969, a coa lition of white Catholic clergy and Black nationalist men maneuvered Pittsburgh into becoming the only major city in the country to reject federal funding for Planned Parenthood, which they accused of genocide. “The white power structure w on’t spend a dime to kill the rats that eat up your babies, but they’ll spend thousands to make sure you c an’t have any babies,” said Dr. Greenlee, chair of the NAACP’s medical committee. Warned Haden, the nationalist leader of the United Movement for Prog ress and the Homewood-Brushton Alliance, “I’m going to take to the streets and talk to those youngsters who are not so much in love with life that t hey’re not so much afraid of dying. . . . I know they w ill bomb that center. . . . It w ill be my intention 76 to inflame them.” While Haden was not a major figure in the employment integration campaigns of the 1960s, his nationalism certainly shared with liberal integrationists an ambition to recuperate patriarchal authority as the basis of Black economic security.77 When Haden, Greenlee, and their allies succeeded in cutting Planned Parenthood’s funding, they provoked a gendered conflict between this patriarchal vision and the burgeoning Black feminism of the welfare rights movement. WROAC mobilized to send hundreds of w omen to defend Planned Parenthood at poverty program meetings. “We cannot help but notice that most of the anti-birth control pressure is coming from men,” said WROAC chair Harriet Fields. “Men who do not have to bear c hildren. We’re speaking for the women.” What they emphasized, in t hese forums and the press, was that birth control was not an imposition of the white establishment on them but a tool they required for themselves. “Some things must be left up to the woman,” said one. “Like how many c hildren you think you can feed, clothe, and send to school.” A fter two years of such campaigning, the group won the reinstatement of funding for birth control programs.78 What set limits on the welfare rights movement was the opposition of white neighbors, who coalesced into increasingly formidable political formations to constrain the War on Poverty. The rightward turn in national politics represented the apex of this process but was not the whole of it. Mobilization for survival in Black Pittsburgh represented the crisis, and possibility of tran-
“ Yo u A re O n ly P o o r . . .”
129
scendence, of the liberal order. White Pittsburgh, still wearing some of the armor of the racist liberal state, resisted this possibility.
The Politics of Whiteness As long as the white ethnic working class remained a distinct social stratum, undigested by the vast suburban white m iddle class, the security of its position in postwar society remained an open question—at least in its own members’ understanding. Although they enjoyed many of the forms of social advantage endowed by whiteness, their experiences of class-based insecurity generated a subjective narrative of deprivation and exclusion—a position that gave them a way of articulating their own paradoxical whiteness from the position of self-ascribed difference. Edward Stankowski, like many white steelworkers, went to an ethnic church in the 1960s in his neighborhood, “Hunky Hollow.” (“Hunky,” likely a contraction of “Hungarian” and the ancestor of “honky,” transformed in the postwar period from an offensive ethnic slur to a reclaimed, semi-affectionate pejorative.) Over the door of St. Matthew’s, his Polish and Slovak community’s place of worship, the words w ere written, “Come to me all who labor.” 79 Together in Hunky Hollow, worshipers defined their collectivity not just by race, nationality, and religious belief but also by labor. It is certainly true that these working-class “ethnics” were white in the most important ways by midcentury: they had access to credit and housing markets, preferences in employment, and so on. But that white racial identity animated an anxiety about achieving the desired effect: in this case, access to the privileges contained in whiteness and seemingly at risk from economic and neighborhood change. This very sensitivity about the security of their white racial status stimulated their performance of that status. Mrs. P. made the point clearly. She volunteered with the Veterans of Foreign Wars doing laundry at local hospitals, belonged to the Rosary Society, and had been president of the Parent-Teacher Association (PTA). “I just like to be helpful. My husband says; ‘You’re always helping somebody else, when’s somebody going to help you?’ And like my dad always said; ‘You get your reward, even if it’s not h ere, someplace.’ ” Her d aughter, following her m other’s lead, went to nursing school at Duquesne University, a local Catholic institution. But what appeared as an enactment of the postwar dream of upward
130
The Next Shift
mobility—a modest climb up one rung on the social ladder, into altruistic and normatively gendered work—had become, for Mrs. P., a site of racialized frustration. “This bit now where t hey’re giving everything to the negroes, is really a bunch of bull. . . . Like when my daughter was g oing to college and we d idn’t have enough aid when she was transferring to Duquesne and we looked for help . . . I was told outright that we could not get help because we were not negroes.” Apparently, Black would-be nurses had “scholarships galore.” Poles like herself, on the other hand, “because they came up the hard way through the coal mines and the hard l abor work . . . have always wanted more for their c hildren than different nationalities would.”80 This ideology began to take political form in the late 1960s. In 1966, for example, residents of the Italian and Polish Ninth Ward voted themselves out of the neighborhood poverty program, the Lawrenceville Economic Action Program (LEAP). A spokesman, housing contractor Leonard Bodak, explained that “the ward had excellent recreational and educational facilities and that its housing is 75 percent owner-occupied and compares favorably with any suburban community.” In fact, only half the homes in Bodak’s area were owner-occupied; his insistence on a favorable comparison with “any suburban community,” however, is suggestive of the anxiety of white urban dwellers about the dense neighborhoods where they lived. (Nor is it coincidence that the voice of this anxiety came from within the real estate industry.) Another resident of the ward complained, “We resent the idea that we are in slum housing. We aren’t poor and we d on’t need LEAP.” Similar grassroots mobilizations occurred in Hazelwood, South Side, Oakland, and Garfield— economically distressed, racially mixed areas where white residents tried to shut down poverty programs.81 Mrs. R., the Italian woman who had grown up embarrassed about her parents and their grocery store, made the same point about race and class more explicitly. When her family lived in the industrial town of Beaver Falls, her son had become excited about the civil rights movement in school and wanted to get involved in the NAACP. She was horrified. “Absolutely not, as long as you live with me you w ill not. I’m not going to have my house bombed.” To talk him out of it, she reminded him of another incident, when a group of his peers, including one Black girl, had come over to their house to rehearse a school play. Mrs. R. got a phone call from a neighbor, who asked, “What went on at your house last Saturday . . . t here w ere all t hose Blacks!’ ” Mrs. R.
“ Yo u A re O n ly P o o r . . .”
131
replied, “There was one colored girl and she was in the play and her boyfriend came to pick her up and he was the nicest boy.’ ” Despite defending Jimmy’s classmate and her boyfriend, Mrs. R. still lived in fear. “I didn’t want Jimmy to be involved in anything that people would not like him for or look down on him, or anything that t here might be violence with.” Once Jimmy grew up, married a woman named Cindy, and had a daughter, Melina, the same set of anxieties continued for Mrs. R., refocused on the next generation. “They live in Lawrenceville, which is inner-city, I keep telling them I’d like them to have a yard. All they have is a little courtyard in the back, which is brick. I think Melina should have grass but Cindy says that she takes her to the park everyday. They go to the pool in Lawrenceville, which is a city pool and I’m afraid s he’ll pick up a disease or something but I guess they’re clean like any other pool.” For Mrs. R., the drama of social mobility and status anxiety was spatialized onto the detached home (or its absence, for her son and granddaughter): What will the neighbors think? How clean is the pool? The fears she had about her son and granddaughter, about what the neighbors would think, appear related to her desire to “just be a woman with a house like everybody e lse, with a porch we could sit on and not the store in front.” B ehind t hese, we might find the memories of her m other scrubbing her hair to get out its smell of oil, and her expectation that her steelworker husband clean his nails and shower before entering the house. This was the anxious performance of whiteness.82 Such anxieties aggregated into conflict. In 1968 and 1969, a fight erupted around the Model Cities program, a poverty initiative run through the Housing and Urban Development Department (HUD) to channel federal redevelopment funds into designated urban cores. In Pittsburgh, the cheek- by-jowl pattern of segregation fractured the program along racial lines. The white neighborhood of Polish Hill, which adjoined the African American Hill ere being District, voted in July 1968 to withdraw from Model Cities. “We w subjugated to Black power and Black militancy,” explained a leader in the Polish Hill Civic Association. Pauline Grodecki, another local pushing the secession move, complained, “Not once has anyone from Downtown both ered to come to the residents in their homes and ask what they think.” The next year, organized residents in the Polish Hill Civic Association urged HUD to cut off funds entirely to the Pittsburgh Model Cities program, in reaction to a proposal to use federal funds to build ten homes in Polish Hill.
132
The Next Shift
“The overwhelming majority of residents in this section of Polish Hill, on Leander, Ajax, Ridgway, Bismark, and Blessing streets, vigorously object to inclusion,” wrote protestor Eugene Rudski to HUD Secretary George Romney.83 Otto von Mering, a sociologist at the University of Pittsburgh, blamed the failure of Model Cities in Polish Hill on the program’s ignorance of the social organization of the Polish community. Mering explained, “They didn’t bother to find out how the communities w ere organized in the first place. They used the wrong approaches and ignored the fraternal orders.” Moreover, the very inclusion of a white ethnic working-class neighborhood in a “poverty” program was a mistake; this group, he argued, regardless of a ctual income, did not like to be regarded as poor. “This, in Professor von Mering’s view, is b ecause of heavy reliance upon cooperative arrangements within wide-ranging family circles, each relative helping the other in time of need. ‘Poverty is not measured in real income. You are only poor if you have no one to turn to.’ ”84 Such objections at the neighborhood level grew into a populist political expression in the late 1960s and early 1970s. First in 1969, they fueled the unexpected rise of Mayor Pete Flaherty, who made a public performance of spurning the downtown Democratic machine. Flaherty, a centrist populist, promised to lower taxes and deemphasize the urban renewal program, returning power to the neighborhoods. White ethnic voters in turn understood this as a response to their frustration with poverty programs—a frustration echoed in federal policy by the new Nixon administration, which cut funding for t hese programs steeply. This political formation then developed into a more vigorously racist populism by 1972, when white steelworker sections largely lined up for George Wallace’s bid for the Democratic nomination for president. “I think the government today is giving too much to the colored. I think it’s time they get in their place,” said Marian Irwin, the West Mifflin wife of a mill policeman. “If we’re g oing to let this continue, the Blacks are going to be telling us what to do. I like Wallace b ecause he’s for people like me. He’s fair. He believes in the rich people carrying the load for a while.”85
The Uneven Web As the Pittsburgh region’s manufacturing base shrank, the underpinnings of postwar working-class life slowly disintegrated. People had to adapt but
“ Yo u A re O n ly P o o r . . .”
133
did so piecemeal, as they responded to crisis—a sickness, a death, an eviction, a layoff. They had to manage using the tools they had and to take their disasters one at a time. To do so, people relied on one another. Working-class survival was negotiated socially, often in public space. Distinctively social sites—streets, schools, hospitals, churches, and neighborhoods—thus formed the critical nodes of working-class social cohesion. The community was, at a functional level, something people needed and something they made. But ideology—religious, racial, nationalist, liberal, feminist, and patriarchal ideologies in various configurations—made this community meaningful, not merely instrumental. P eople inflected community with not only the uses but also the pleasures and fears of social connection. The ongoing process of working-class formation for white Pittsburgh was indelibly inflected by racialized anxiety about the porous border zone separating white steelworkers, construction workers, nurses, and housewives from their Black neighbors—a zone that white residents could never seal up and that they policed with erratic rather than systematic cruelty, because they also needed to coexist with African Americans. For Black Pittsburgh, this same pattern gave rise to integrationist, nationalist, patriarchal, and feminist ideological currents. Because economic disruption victimized African Americans sooner and more severely, their collective resources for managing it w ere depleted faster. Their communities were smaller and often newer. Survival depended no less on collective life—arguably more so. Yet this collectivity enjoyed fewer institutions through which it could be routed and within which it could accumulate and stabilize. White people could thus rally to defend the communal institutions and forms of social organization that already existed to secure their survival. African Americans had to fight to create new ones in a hostile political environment. Working-class p eople wove a web of collective social life around the industrial economy, which could catch their comrades when they fell out of economic security. From the late 1950s to the mid-1980s, virtually all members of the industrial working class took this fall. But they did not fall together, and the web of social support was not woven evenly. African American workers fell sooner, harder, and in greater relative numbers. Geographically fragmented and economically exposed, they depended more directly on one another rather than on institutionalized forms of mutual aid. The parts of
134
The Next Shift
the web that caught them were thinner and gave way faster—even as their collective l abor intensified to deal with worsening economic disruption. Deindustrialization thus worked its way through Pittsburgh’s social geography unevenly, producing a staged historical transition from secure social citizenship and industrial employment into what came next. These stages were racialized: industrial decline recycled the working class into a new form, starting with Black workers. The process by which people underwent this transition in turn established their position in the postindustrial economy. At the bottoms of the valleys, Black workers generally lost their minimal foothold in social citizenship over the course of the 1960s and w ere already living in the conditions we would later call neoliberalism and finding new survival strategies, while their white neighbors uphill still inhabited the safety net of the liberal state. African Americans thus proved simultaneously more available for economic conscription, more readily exploitable, and readier to fight about it.
4 Doctor New Deal Social Rights and the Making of the Health Care Market
M
rs. T. liked the hospital. “They take good care of you. They help you with everyt hing.” Mrs. T. was 78, living in the Hazelwood section of Pittsburgh in the 1970s. She had been born in 1898 in Bohemia and migrated in 1926 to Pittsburgh, where she married and then outlived a steelworker. Hospitals symbolized her inclusion in the social contract. The right to go to one, to pay l ittle or nothing, and to have skilled professionals attend to her meant something significant. As her neighbor down the street, Mrs. C., put it, the doctor was “part of the f amily.”1 This feeling was not universal. In March 1970, the Pittsburgh police arrested two women for picketing their employer, Presbyterian-University Hospital. Helen Lyles and Henrietta Goree, both African American, were charged with forcibly seeking to prevent their fellow employees from going to work.2 The picket line that Lyles and Goree walked was part of a citywide hospital u nion organizing drive launched by Local 1199, a militant u nion founded in New York in the 1930s that emerged nationwide in the late 1960s. Although hospital workers were excluded from the National Labor Relations Act (NLRA), Local 1199 aimed to mobilize the rising militancy and consciousness of Black workers to overwhelm employer resistance and win union recognition extralegally. When it reached Pittsburgh in late 1969, the union ran headlong into the sanctified, quasi-familial ideal of health care provision—expressing hospitals’ unregulated status in l abor law at the cultural level. At Mercy Hospital, fifty demonstrators marched on the office of S ister Ferdinand, the hospital administrator. Finding the door barred and guarded by police, the marchers staged a sit-in outside. While Bishop Vincent Leonard of the Pittsburgh
136
The Next Shift
Diocese endorsed in theory the right of workers to organize, he insisted that the “over-riding” concern was the Catholic hospital’s “obligation” of community service. Again and again, hospital administrators warned that workers’ self-assertion posed a threat to their altruistic mission. In an open letter, the Hospital Council of Western Pennsylvania declared that it had two concerns: patient welfare and inadequate compensation for employees. While both “are urgently important,” the Council acknowledged, “in the public interest, the second cannot be allowed to jeopardize the first.” As Chancellor Wesley Posvar of the University of Pittsburgh observed, “[Workers’] labors, in effect, have been made a part of the charitable serv ices by hospitals.”3 The hospital, then, presented a paradox. It was “part of the family”; it “helped with everyt hing.” The obverse of this same principle, however, was that the institution mirrored and extended the racial and gendered patterns of h ousehold labor, with its employees locked outside the social citizenship that secured their patients. This paradox s haped the hospital industry’s rapid growth in the postwar period, which proceeded at a fast clip between 1950 and 1965, then accelerated further between 1965 and 1983. Through this period, hospital care was a labor-intensive undertaking. What the health care dollar bought, more than anything e lse, was the attentions of the hospital worker over long stretches of time. A 1967 report to the president on health care costs observed, “Wages, which account for two-thirds of total hospital costs, are the most important factor. The wages of hospital employees, still low relative to other sectors of the economy, are rising more rapidly than other wages. This increase in wages has not been offset by any measurable increase in the ‘productivity’ of hospital employees. The number of employees per patient is rising, not falling.” 4 The administration of economic security through private-sector collective bargaining molded the hospital industry, driving its growth and shaping its inequalities. Health insurance became widespread by way of unionized industrial employment, under the regulatory supervision and encouragement of the federal government. As coverage became increasingly pervasive and comprehensive, the market grew, and the quantity and quality of health supply rose in tandem: facilities were expanded, renovated, and upgraded. In a short time, the hospital was transmogrified from a place where the poor went to die into a h ouse of science and care. As access and expectations increased, so did prices. By delivering care through public support for demand
Doctor New Deal
137
in a fragmented and privatized system, the institutional architecture of the postwar health care system locked in an inflationary dynamic.5 This dynamic, established through federal supervision of private-sector employment, then shaped the experience of insurance and hospitals for everyone else. For t hose not shielded by collective bargaining, the construction of hospital care around the collective purchasing power of u nionized blocs of private insurance subscribers—and the cost rises pursuant to this arrangement—made access increasingly forbidding. A fter only one decade of collectively bargained health insurance—the 1950s—elders in particular, who enjoyed symbolic access to social citizenship thanks to the principles of seniority now embedded in employment and Social Security, began to protest how the new system excluded them. The urban poor—denied access to industrial employment—stood on the outside too.6 Direct public intervention in the market thus came in 1965, when Congress established Medicare and Medicaid to round out the public-private system. Th ese programs continued the basic pattern established in the 1940s and 1950s: they deployed collective economic power on the demand side— to buy health care, rather than to provide it. Once Medicare and Medicaid came online, demand and price growth both accelerated further. There were notable exceptions to this pattern: the federal government took in hand the supply of care for veterans; and the state and county supplied care for several thousand disabled and elderly patients at psychiatric and old-age institutions within the Pittsburgh area.7 The growth of the hospital system was a conflictual and political process. Despite repeated efforts to assert public or social control over supply, fragmentation persisted and enabled multiple constituencies to extract what they wanted. The disorganized quality that emerged from the public-private division in combination with subsidized consumption was politically adaptive, even if it was economically and organizationa lly dysfunctional: it made the system able to meet multiple conflicting demands at once. Organized workers, retirees, hospitals, insurers, doctors—a ll benefited handsomely. And even though private employers and the public sector footed the ever-inflating bill, corporate managers and public officeholders wound up opting to maintain this system when presented with opportunities to replace it; satisfying the incumbent interests entrenched in their various fragments proved easier than moving to an alternative.8
138
The Next Shift
As the industrial workers whose organized demands had triggered this compromise faced economic decline, they turned to this system, their greatest institutional legacy, for aid. The insurance they had won and the system of supply built to meet their collective demand endured through the decline of their own industry and buffered them somewhat against that shock. In this sense, the expansion of the health care system, notorious for its economic irrationality, performed a rational political function, even if it was not one advocated by or transparent to any single actor. The health care system formed an ongoing workable site of compromise, a mechanism for channeling income into the metropolitan economy, filling the coffers of well-positioned corporate actors, shoring up the positions of local officeholders, and reproducing the social arrangements of decaying industrial Pittsburgh. Just as the hospital system kept individuals’ lives going, it also manufactured social continuity.9 This generally cozy arrangement did not include everyone. Black working- class Pittsburgh, increasingly cut off from secure industrial employment over the course of the 1960s and 1970s, could not participate freely in the hospital boom. Many African Americans lacked the health security that their white neighbors enjoyed, and they frequently experienced discrimination and neglect at the hands of hospitals. Black residents also formed a large portion of the low-wage workforce on which hospitals drew, the exploitation of which formed the basis of the bonanza for everyone else. From 1947 onward, hospital workers were excluded from the protection of labor law. Even when Congress amended the law to include t hese workers in 1974, the difference the inclusion made was limited: their ability to bargain up wages and working conditions encountered severe constraints, imposed by the institutional structure of the industry itself, constructed since the 1940s.
Steelworkers’ Welfare State, 1949–1959 The postwar welfare state and the industrial workers who formed its po litical base provided the continuous impetus powering the construction of Pittsburgh’s health care system. Workers had coalesced in the 1930s around a demand for security, with access to health care a central component. Gradually, they accumulated the market power and built up the institutional infrastructure to secure this access. The institutional result of t hese efforts, the
Doctor New Deal
139
hospital system that they sustained, proved one of organized labor’s most significant accomplishments for its members and their families. Industrial enclaves where New Deal politics w ere strongest developed robust health insurance systems early. Blue Cross of Western Pennsylvania, for example, was established in 1937, the year steelworkers won u nion repre sentation. The norms of nonprofit health insurance and “voluntary”—that is, not-for-profit and privately-owned—hospitals fitted Pittsburgh’s ideological environment of social Catholicism. Communitarian values of altruism, philanthropy, and mutual obligation prevailed. The private, altruistic provision of health reflected the widely held worldview of the workers who were its prime constituency, enacting that principle concretely. In the hospital, solidarity and social citizenship took a literally concrete form: the debts and cares that working-class p eople shared were housed in a building; they could 10 go t here. Over the course of the 1940s, federal intervention in health care enjoyed an accelerating wave of political advances. In 1943, the National War Labor Board permitted the substitution of benefits for wages under its anti-inflation program, and regulators attached a tax subsidy to this substitution. In 1946, the last New Deal Congress created the extramural research program at the National Institutes of Health and passed the Hill-Burton Act, a federal grant program to support new hospital construction, particularly in rural areas. By the end of the decade, the federal judiciary had also weighed in, ruling in a pair of steel industry cases that welfare benefits were a compulsory subject of federally supervised collective bargaining.11 Through the same years, the movement to socialize health insurance reached a high crest and then receded. Resistance from employers, the medical profession, and political conservatives stiffened a fter the end of the war. As the Catholic Hospital Association warned, socialized medicine would make patients “wards of the state as opposed to wards of society.” Finding that another avenue now was open in private-sector bargaining for winning the security of its own members, organized l abor withdrew its strength from the struggle for public health insurance. The Wagner-Murray-Dingell bill, the leading proposal for national health insurance, lost its main grassroots base of support and died with a whimper.12 Since it was the New Deal state that first created the modern insurance system, and the limits on the New Deal that contained its spread and dictated
140
The Next Shift
its structure, the health system grew in a distinctive pattern in heartlands of New Deal politics—urban industrial centers like Pittsburgh. Union members became the keystone of the entire regional health care market. A fter the steelworkers won their first nationwide health insurance plan in a 1949 strike, t here began an upward spiral of demand-d riven growth backed by public and working-class power.13 The 1949 collective bargaining agreement in steel established a single master plan for workers across the industry. Every steelworker in the country was pooled together into Blue Cross of Western Pennsylvania. At this point a relatively young and healthy group, steelworkers helped constitute a favorable actuarial pool—most of the insured population of western Pennsylvania, where Blue Cross dominated the market, plus steel employees nationwide. This way, the u nion aimed to subsidize the regional health care system in steel’s most important stronghold and thereby to stabilize its decommodification. By including nationwide membership in the regional Blue Cross, the union preserved “community rating,” in which the insurer charged all subscribers the same rate, regardless of health; this policy mobilized the good health of some subscribers to help pay for care for the poor health of others on an equal basis.14 Much of the organizational capacity of the regional Blue Cross was first developed to deal with the technical challenge posed by the steelworkers. “Virtually overnight, the data processing staff found itself dealing with the claims not only for 1.3 million Western Pennsylvanians but also for hundreds of thousands of Steelworkers across the country,” recounted James H. Lee, a Blue Cross official. “Orange crates of claims poured in . . . w ith the names of hospitals and towns [Lee] had never heard of—claims for men who worked the Mesabi Range in Minnesota or transported the iron ore on ships in the Great Lakes.” By the end of the 1950s, 5–6 percent of all Blue Cross group enrollment nationwide was affected by steel industry contract negotiations.15 Through the 1949, 1952, and 1956 contracts, the union won a generous benefit plan. Blue Cross covered up to 120 days in the hospital in a semiprivate room, 10 days for maternity benefits, and a $300 maximum surgical schedule, while Blue Shield covered doctor’s bills. The employer and the worker split the premium, costing the worker an average of $11 per month.16 Hospitals then captured tremendous new revenue. They upgraded facilities to meet demand for higher standards of comfort and care, investing in
Doctor New Deal
141
better equipment and more space—in part icu lar building the semiprivate rooms that the steelworkers’ agreement authorized. From just 1948—the year before the USWA master plan—to 1953, total annual Blue Cross payments to hospitals in western Pennsylvania increased by a factor of two and a half. Three major new institutions opened in Allegheny County in 1954, 1955, and 1958, while virtually all older institutions embarked on ambitious capital projects. By 1959, western Pennsylvania hospitals had received nearly $400 million (in 1959 dollars) from Blue Cross since its 1937 foundation.17 In 1960, it cost a total of about $5 million to construct and equip a two- hundred-bed hospital from the ground up. The total capital value of all thirty- seven of Allegheny County’s nonprofit, nongovernment hospitals was approximately $200 million, and total annual operating costs were about $65 million. The revenue stream secured by Blue Cross was thus easily large enough to transform the regional health care economy. Rufus Rorem, head of the regional Hospital Planning Association, wrote that the community hospital “has become a comprehensive health center for the entire population, and is no longer merely a custodial institution for the sick poor.” It belonged to everyone now and had to provide services commensurate to its new social base. As a 1959 promotion of the city’s medical system declared, “The community hospital is a nonprofit institution only as it regards money. It pays dividends in the form of added days of life; its market value is the ever- lengthening life span promised to each infant born today. E very man, woman and child in the community is a shareholder.” Although not properly socialized medicine, the result seemed for a moment to be a decent approximation. As Rorem put it, “The public builds the hospitals. The public uses the hospitals. The public supports the hospitals.”18 Working-class p eople thus came to understand that they had a communal claim on the health care system. In the 1950s, for example, a steelworker named Ronald Branca waged a campaign to bring a hospital to the mill town of Clairton. Branca argued that the nearest hospital, at ten miles away, did not suffice for Clairton’s needs. A member of the city’s Italian American ethnic plurality, Branca worked the town’s dense civic network, meeting with “about 97 different organizations” and lining up the support of prominent businessmen. He won over the city council, obtained city-owned land for the site, won priority for federal Hill-Burton funding from state grant allocators, polled the townspeople and “found an enthusiastic desire for a hospital,” and
142
The Next Shift
Figure 4.1 Visiting nurse and patients, ca. 1950, Sol Libsohn, American 1914–2001, gelatin silver print, H: 10 11 / 16 in × W: 10 7 / 16 in. (27.15 × 26.51 cm). Carneg ie Museum of Art, Pittsburgh. Gift of the Carneg ie Library of Pittsburgh, 85.4.53.
signed a contract with a Catholic organization to run the hypothetic al institution. In the end, the Hospital Planning Association, concerned about oversupply of hospital beds, stopped Branca’s efforts by leaning on its relationship with the u nion.19 As the quality of medical care r ose significantly and many more p eople gained access and a sense of agency, prices rose. Rising prices stressed the fragmented system on multiple sides: the growing cost of care became more burdensome for t hose outside the perimeter of security established by col-
Doctor New Deal
143
lective bargaining, while t hose within that zone of security had to pay more to sustain the system as a w hole. From just 1954 to 1958, the cost charged by a hospital per inpatient admission of a US Steel employee had climbed from $130 to $185. Insurance premiums kept pace, nearly doubling over the same period. In 1958, USWA president David McDonald warned, “If a fully employed steelworker cannot meet the continuous and insatiable costs of medical care, picture if you w ill, the plight of the retired worker who has lost two thirds of his previous income, or the unemployed worker who has, in some unfortunate cases, been totally unemployed upwards of twelve months.” Although the health care system had been largely the creation of organized labor and its state allies, McDonald identified the key problem—its public-private fragmentation. “Unlike the support of the public educational system, the public health and sanitation systems, the fire and police departments, the hospital facilities which are necessary for the life of the community are not supported by public taxation on all elements of the community.” In 1958, the USWA constitutional convention passed a resolution announcing workers’ unhappiness with their coverage and calling for a study.20 To examine the issue, the USWA hired epidemiologist and Social Security architect Isidore Falk.21 Falk began a preliminary effort in the late 1950s to pin down the nature of the immediate problem, before launching a more elaborate effort to rethink the u nion’s entire relationship to health security. What he found was a paradox, mirroring the larger contradiction of the place of the organized working class in postwar consumer society. Steelworkers and their families had won a level of access to health care that was much greater than that of the general population (see Table 4.1). At the same time, the very gap between steelworker families and everyone else made care costly and unsatisfactory even for the well-insured.
The Possibility of Reform, 1959–1964 Alongside pride in their achievement, steelworkers “expressed considerable dissatisfaction” with costs and gaps in their health care coverage in the late 1950s. A wide range of serv ices fell outside the plan, including many physician’s charges, prescriptions, and devices, as well as nonhospital forms of care. All of t hese expenses took a large bite out of pocketbooks. On average, collectively bargained insurance covered around 40 percent of total private costs
The Next Shift
144
Table 4.1. Utilization rates per one thousand p eople in a twelve-month period, 1957–1958 Steel subscribers Hospital admissions Days of care Inpatient nonobstetrical surgery
135 1,032 70
General population under sixty-five 97 764 40
Source: Data are from I. S. Falk and Joseph J. Senturia, “The Steelworkers Survey Their Health Serv ices: A Preliminary Report,” October 21, 1959, box 115, folder 1388, ISFP.
of medical care; the remaining 60 percent was paid for by other insurance or, more often, out of pocket.22 Based on these facts, the union explored two different strategies. The first was to use the ongoing 1959 strike as an opportunity to extract concessions from management. Negotiators for the USWA turned Falk’s report into a set of demands for modifications to the Blue Cross agreement: “(1) Change from 50-50 contributory to wholly non-contributory insurance; (2) extension of the benefits to laid-off, disabled and retired employees and their dependents; (3) immediate improvement of the benefits by eliminating the 120-day and similar maxima on hospital care by covering outpatient physiotherapy and laboratory benefits, in-patient medical attendance and diagnostic pathology.”23 The second approach was to exert control over supply through a comprehensive group plan for steelworkers, substituting “prepayment” for fee-for- service. The insurance buyer (the employer, the employee, or both together) would pay into a fund used to operate a system of hospitals and clinics devoted to the subscribing population. With enough subscribers in one area, such a system could replicate some advantages of socialized medicine on a private, small-scale basis, as some industrial u nions had done. In bargaining, the u nion asked management to pursue a joint study of t hese possibilities and demanded a provision allowing employees to choose such a plan where available.24 Management conceded a good deal as a result of the strike. Steel companies agreed to absorb the entire cost of premiums, which had previously been split with employees. The employers committed to maintain coverage for six months for a laid-off worker with at least two continuous years of seniority.
Doctor New Deal
145
And they set up a mechanism for retirees to continue coverage, albeit deducting the full premium from pensions.25 Steel employers, however, showed minimal willingness to budge on a group plan. They argued instead for “major medical” plans—to keep costs down by passing them on to patients, discouraging overuse. “If major medical is included in your Plan design,” argued US Steel executive R. A. Albright, “it is also important the employe share some portion of the major medical expense by means of a co-insurance f actor as a deterrent to unnecessary usage of medical care.” Albright was outraged by the USWA’s ability to resist this effort and indeed to impose “upon the basic Steel Industry a completely non-contributory plan.”26 Steel companies complained that they were subsidizing hospitals and doctors by paying rising premiums driven by medical profligacy. As the union wrung better benefits out of management, the use of medical services by steelworkers and their families soared, and fees in steelworker-heavy areas like Pittsburgh went up accordingly. Before the eruption of the 1959 strike, John Tomayko, the director of insurance for the USWA, had observed, “The very nature of our Blue Cross-Blue Shield and commercial insurance plans . . . actually encourages waste of money.”27 The disagreement over reform thus came down to who would bear the cost of greater economic efficiency. Management believed major medical could control costs by forcing steelworkers to bear more of the costs themselves, discouraging frivolous use of health care serv ices. Prepaid group practice could do it, labor argued, by abolishing the perverse incentives of fee-for- service without discouraging patients from seeking care. It was widely believed that group practice was defeated by the opposition of providers—hospitals and doctors who preferred munificent fee-for-service to prepayment. As the New York Times reported, “It is no secret that orga nized medicine would not be happy if USW decided to build its own hospitals and run complete medical care programs with ‘closed panels’ of salaried doctors, as the embattled United Mine Workers welfare fund has done.” But by the 1960s, organized medicine no longer had the strength to sustain a total embargo on a proposal as attractive as that of the steelworkers in Pittsburgh. In meetings between the joint union-management medical committee of the USWA and leaders of the American Medical Association and American Hospital Association, health care industry officials openly acknowledged
146
The Next Shift
internal conflict. Steelworkers w ere such a massive portion of the market in the Pittsburgh area that capturing a larger volume of their business could make practicing lower-priced medicine economically v iable. By the mid1960s, union officers believed that medical opposition was dissolving. Preparations got so far that the USWA earmarked $1.6 billion of its pension fund for a major capital investment in group practice facilities.28 It was not provider opposition that obstructed group practice in steel, but the doggedness of employer hostility. Discussions ran aground in the early 1960s, reaching impasse by the summer of 1964. The employers refused to agree to conditions that might attract providers. To beat back the union’s reform proposal, management even asserted that u nder the current plan, the “medical dollar is being reasonably well spent”—a sudden retreat from the position that collectively bargained benefits were driving medical inflation.29 The steelworkers were determined to take “no backward step,” in the ubiquitous motto of union leadership. If they could not have group practice, they would never accept the cuts that major medical represented. The company’s proposal was designed “to transfer costs of medical care from the insurance carrier,” which “Union Members regard as fundamentally unsound in principle.” Structural stalemate thus resulted, leading only to further increases in quality of coverage and quantity of utilization. Although the USWA proposed a range of changes to workers’ coverage in the mid-1960s, the only significant outcome was a tripling of covered hospital days u nder Blue Cross.30
Welfare State Ascendancy, 1965–1971 As organized labor consolidated benefits and constructed its private welfare system, supported by the liberal state, providers became able to deliver a higher standard of care. They expanded facilities, upgraded equipment, and incorporated more cutting-edge science into the care they provided. Prices, accordingly, r ose. Growing costs presented an immediate problem for t hose who, unlike working-age steelworkers, did not enjoy generous health coverage. As Wilbur Cohen, a major liberal policy thinker and l ater, as assistant secretary of health, education, and welfare, the architect of Medicare, explained in a 1961 speech, “People over 65 have medical costs twice as high as t hose of younger people; and they must meet t hose costs out of annual income that, on the average, is only half as large.”31
Doctor New Deal
147
While 70 percent of the population under 65 had some kind of hospitalization insurance, only 46 percent of those older than 65 did. Many of t hose plans w ere less generous and, as with the steelworker retirees—who paid the entirety of their premiums out of their pensions at this point—subscribers tended to pay far more out of pocket. During the 1962 steel contract negotiations, Donald Rarick, president of USWA Local 2227 at Irvin Works outside Pittsburgh, and former leader of the defeated Dues Protest rank-and-file movement of the mid-1950s, called for full coverage of hospitalization for retirees, “since t hese people are least able to afford the high cost of hospitalization coverage.” As a staff member of a 1959 Senate subcommittee on aging reported, “The old folks lined up by the dozen everyplace we went. And they d idn’t talk much about housing or recreational centers or part-t ime work. They talked about medical care.”32 When Congress moved t oward Medicare in the late 1950s and early 1960s, it was not only a product of direct lobbying by liberals and organized labor but also an indirect result of organized l abor’s economic power in the health care market as a whole. While it was true that the deepening commitment of organized l abor to health security through privately negotiated industrial relations worked to depoliticize u nions, labor’s gains still had an enormous, albeit inadvertent, knock-on effect in the growth of public provision by driving up prices and politicizing t hose who were now priced out—some of whom, the elderly, enjoyed significant moral standing. In a context of rising expectations of access, their exclusion constituted a serious political problem. Thus a rough consensus developed by the late 1950s that some form of federal intervention was necessary, even if the a ctual development of legislation was much more contentious.33 In industrial cities with concentrations of u nion power, rising expectations were clearest. At the same time, the early phases of industrial job loss had also begun to appear and become recognized as a new form of poverty, especially manifest during the 1957–1958 and 1960–1961 recessions. The simultaneous phenomena of expanding security and worsening poverty framed some of the most important phases of liberal politics in the 1960s—the March on Washington, the War on Poverty, and the Great Society. Medicare and Medicaid emerged from this sequence, becoming central items in the compact between the liberal state and its base, rounding out the terms of the public-private welfare state. As Vice President Hubert Humphrey put it in a speech at National Tube Steel Works in McKeesport, “Of all the blessings that
148
The Next Shift
this government has bestowed upon people, the medicare program that provides . . . medical care and nursing home care to our senior citizens is one of the finest programs that any country ever devised.”34 By producing both islands of social citizenship and surrounding forms of insecurity, the public-private welfare state and secular industrial decline together stimulated demand for federal health legislation. Once passed, the new policies then fed back into the hospital industry. The income stream gave a jolt of acceleration to the growth of the industry that already had been underway. Homestead Hospital, for example, was the main provider for a community in steep demographic decline. The town of Homestead lost more than half its population between 1940 and 1960, a serious problem operating in a regional market that was undergoing major capital expansion. The hospital had kept pace in growth with regional competitors, completing a new 29-bed maternity unit and a 117-bed building in 1959, in the wave of hospital expansion driven by the USWA and Blue Cross. Now t here was an overcapacity problem.35 As the town lost population, the remaining population skewed toward the underinsured elderly. Social insurance for retirees thus transformed the hospital’s situation. “Medicare has helped our financial situation b ecause hospitals are now paid on the basis of full, reasonable costs for serv ices to virtually all of the over-65 age group,” wrote hospital officials after their first year with the program. “In the past, care for our older citizens and the medically indigent was greatly under-financed so that full paying patients had to share the costs of t hose who could not pay. Medicare has made this problem almost non-existent.” While costs per patient-day went up with a more el derly patient population, income per patient-day rose even more under Medicare’s cost-plus reimbursement formula.36 Medicare transformed the pattern of who used the facilit y and for how long—so-called “utilization.” The average elderly patient now stayed for twenty days, compared with nine days on average for all other patients. Retirees, while only one-fifth of the hospital’s patients, accounted for more than one- third of its patient-days. Population decline driven by job loss and white flight thus did not erode the hospital’s market in the way one might expect: Medicare instead turned t hose who remained into a major revenue source. In this environment, consultants hired by the hospital recommended significant expansion: a more extensive serv ice area; a larger facilit y; a new intensive coronary care unit; more psychiatric serv ices, housed in a new
Doctor New Deal
149
community mental health center; and expanded outpatient, long-term care, and home care serv ices.37 There was one area, however, in which the Homestead administration wanted to retrench, not expand: obstetrics. Having built out its maternity unit at the end of the 1950s, the hospital was wrong-footed by declining fertility. In 1961–1962, there w ere 983 births at Homestead, amounting to a 64 percent occupancy rate of maternity beds. This rate fell steadily, reaching 41 percent in 1967–1968, and causing an uneven, irrational pattern of facilit y use. “Our labor and delivery rooms require 2,200 square feet of valuable space, yet they are used, on the average, less than twice in twenty-four hours.” At the same time, “the pressure for medical-surgical beds continues to increase. Medical surgical occupancy is running at a constant 105%. As the figure indicates, the crowding is such that between ten and sixteen patients may be placed in the halls on any given day.” Administrators therefore decided to close the obstetrical unit entirely.38 This move provoked outrage. Joseph Gaydos, the former steelworker who represented Homestead in Congress, declared, “We should not tread on those things we have come to recognize as an inherent and vital part of this community. I am sure the Hospital Planning Association may be persuaded by cold, economic facts in making this decision, but I am equally sure that it w ill heed the plea of the thousands of people in the Steel Valley.” The hospital soon faced a lawsuit from an organization called the Homestead Hospital Cot Club, an organization of working-class w omen whose volunteers raised funds for the hospital and took pictures of babies born t here. Alongside the Cot Club in the lawsuit were the Salvation Army Women, the Ladies Auxiliary of the Fraternal Order of Eagles, and the priest at St. Michael’s Church.39 The plaintiffs argued that the hospital board had been illegitimately elected and that a general hospital, by definition, had to have a maternity ward. While dismissing the first claim, the court agreed that closing the obstetrical unit would constitute a significant enough change of institutional identity to require altering the hospital charter. “This is particularly true,” the court held, “when the general hospital is in a community where it has provided t hese ser vices for many years. The removal of such serv ices would remove from the people of the community services which they could expect a general hospital to furnish.” The hospital was, the court found, required to meet community expectations.40
150
The Next Shift
The public-private welfare state, keyed to collective bargaining and therefore centered on seniority, effected the institutionalization and normalization of the working-class life course all the way through retirement. Yet this regime made the creation of life itself nonnegotiable, particularly in a heavily Catholic and densely socially organized working-class community whose family culture centered on its own intergenerational continuity rather than upward mobility. As a node in the community’s stability, the hospital had to produce babies. A 1965 Pennsylvania Supreme Court decision in Flagiello v. Pennsylvania Hospital, stripping legal charitable immunity from hospitals, made the point explicit: “The hospitals have become the birth of a nation. Every ten or fifteen years, a w hole new country comes to life in the hospitals of Amer ica.” They therefore had legally enforceable obligations to t hose they served.41 These community obligations w ere financially manageable, however, because Medicare seemed to open a faucet of limitless funds, reinforcing rather than overriding the logic already established by private health insurance. Hospitals now prospered on the beginning of the region’s demographic decline, itself a product of industrial decline. Foreseeing the passage of Medicare, the head of the Pittsburgh Visiting Nurse Association had warned in 1961 of a coming “explosion” of care needs on this basis.42 Now the explosion had arrived. Yet b ecause political action ignited and directed the explosion of demand, actors in the health care market were not free simply to capitalize however they saw fit. They had an opportunity to grow but had to weave their efforts into the institutions and expectations of organized consumer demand. Working-class Pittsburgh had rising expectations of the health care system and had the politic al power to enforce them. Indeed, the author of the 1965 Flagiello decision was none other than Justice Michael Musmanno, an Italian-A merican former coal miner turned attorney, a New Dealer and rabid anticommunist from Allegheny County who rode Pittsburgh’s Red Scare to election to the state Supreme Court.43 This power manifested in the industrial realm too. In their 1968 contract, the steelworkers won a major medical program to supplement existing benefits, rather than replacing them as the employers had proposed several years earlier. This new program, phased in partway through 1970, would pay “80% of covered medical costs not otherw ise provided,” subject to a deductible of $50 for one individual or $100 for an entire family. The new contract also sup-
Doctor New Deal
151
plemented Medicare for retirees. For retiree hospitalization, the employer now paid the full Medicare deductible ($44 in 1969), while Medicare paid the remainder of the cost of hospitalization, up to 60 days. After 60 days, Medicare would normally begin charging a coinsurance fee of $11 per day, but the new contract covered this cost as well. If a retiree remained in need, the program alone would cover 30 days of semiprivate care beyond Medicare’s limit. The retiree program kicked in 20 percent on a wide variety of specialized serv ices for which Medicare paid 80 percent. US Steel calculated that, by the third year of the contract, t hese additions would cost an additional 84.8 cents per worker per day; compare this with the $1.83 the company had spent per day on a worker’s insurance in 1967, and the extent of the gain becomes clear. The supplemented benefits translated to tens of millions of additional dollars over a year and hundreds of millions over the life of the contract. The agreement represented coverage unprecedented in its depth and extent, entitling beneficiaries to a tremendous quantity of care.44
Coercion and Rebellion Health care was a labor-intensive business. The expansionary postwar cycle generated employment rapidly, at an annual pace of about 5 percent through the late 1960s. From 1950 to 1970, the health care workforce in the Pittsburgh area almost doubled, from just shy of 30,000 to 54,000. While this expansion would be eclipsed by further acceleration in subsequent decades, the workplace environment was already transformed by the late 1960s.45 Brief and typically tiny upsurges in workers’ activity were not uncommon, often drawing on the region’s pervasive commonsense trade unionism. Five X-ray techs struck St. Francis Hospital in New C astle in 1967, for example, demanding raises, a grievance procedure, and reinstatement of a fired pregnant coworker. “They tell us that as hospital workers we should think of dedication. Well you c an’t pay bills with dedication. When we go in to a supermarket, we pay the same prices as bankers,” said striker Jane Kober. A representative of the American Federation of Technical Employees, seeking to represent the workers, admonished the hospital, “I understand l abor unions in this community have been very generous to the Sisters of St. Francis.” 46 By the end of the 1960s, however, the expansion of the health care industry intersected with the decline of African American employment elsewhere,
152
The Next Shift
turning hospital serv ice work into one of the most important labor market openings for Black workers. Regional unemployment ran at 8 percent for African Americans, even before the downward spiral of the 1970s. Among the displaced, unemployed Black men had overwhelmingly lost positions as factory workers. Unemployed Black women, on the other hand, were most likely to have worked in domestic serv ice, a shrinking category.47 Swollen with new income, expanding hospitals and nursing homes hired growing numbers of African Americans, especially women, into their lower ranks. In 1970, 10 percent of all employed African Americans in the region worked in hospitals. When Earline Coburn graduated high school and needed a job, she looked to her m other, who had moved from domestic work to a position as a licensed practical nurse, and to her new husband, who worked at West Penn Hospital—and she got herself a job at Braddock Hospital in 1969. “I just went out looking for a job, and went to Braddock Hospital. Because they was hiring what they called ‘nurse’s aides’ at the time,” she recalled. “They had classes, they trained you. It was six weeks, eight weeks, something like that.” A report for the mayor’s office found that, while 23 percent of the overall hospital workforce was Black, 70 percent of hospital serv ice workers were. Coburn recalled constant racial disrespect, a common experience in racially stratified hospital workforces. Wages, too, stood near the federal minimum—hospitals w ere only recently covered by such law. She scraped by because she still lived with her family.48 These conditions produced a nationwide uprising of Black health care workers in the late 1960s. Led by the dynamic New York–based Local 1199, this movement arrived in Pittsburgh in November 1969, fresh from a dramatic confrontation in Charleston and a victory in Baltimore. The u nion soon came to focus on the Jewish Home and Hospital for the Aged, Mercy Hospital, the Western Psychiatric Institute, and Presbyterian-University. All together, these institutions employed nearly two thousand serv ice workers. Local 1199 targeted workers at the lower end of the organizational hierarchy—orderlies; nurse’s aides; and dietary, maintenance, housekeeping, and laundry workers—a nd demanded a minimum weekly wage of $100, a $30 increase.49 Local 1199 appeared in Pittsburgh, as elsewhere, as a workplace outgrowth of the Black freedom movement. The campaign was led by Henry Nicholas, an organizer born to Mississippi sharecroppers. Its symbolic figurehead was
Doctor New Deal
153
Coretta Scott King, who had played a key role in the Charleston strike and developed a close relationship with the u nion. Locally, 1199 recruited Dr. Charles Greenlee, the head of the local medical branch of the NAACP, to serve as cochair of the Committee to Secure Justice for Hospital Workers with University of Pittsburgh labor historian David Montgomery.50 Organizing u nder the motto “union power, soul power,” the union was met with consternation from white Pittsburgh. The Pittsburgh Post-Gazette called it a “colorful, unorthodox” organization that “mingles racial and social tensions with old fashioned trade u nionism.” Based on its “colorful” approach, the campaign was quickly able to force and win an election at the Jewish Home. As a large nursing home, that institution had a workforce more concentrated in the low-wage, disrespected tier and likely more uniformly African American than a hospital workforce; as a Jewish institution, it was accountable to an unusually liberal group of community leaders.51 Pursuing the bigger quarry of the hospitals, 1199 drew several hundred workers to rallies and, Nicholas claimed, signed up a majority of workers at targeted institutions within a few months. But the union ran headlong into the discriminatory structure of American industrial relations. There existed no procedure to compel administrators to accept collective bargaining. Union vice president Elliott Godoff explained in a memo, “Board of Trustees of Presbyterian Hospital in Pittsburgh rejected our request for representation election. . . . Instead unilaterally announced wage increase of 20 cents per hour to workers. Pennsylvania Hospital Association and Mellon interests determined to deny the workers the right to organize in Presbyterian, Mercy and six other hospitals in Pittsburgh. Strike in one or more imminent.”52 The hospitals claimed to generally support collective bargaining while maintaining specific hostility to 1199. As Murray Kempton observed in the New York Review of Books, Pittsburgh’s hospital boards were full of executives of industrial corporations. “Yet u nions, whose health and welfare funds provide [t hese] institutions with their largest single revenue source, cannot show a solitary trustee. The management of Pittsburgh’s social property rests as entirely as it ever did in the hands that own its social property.”53 Welfare state provision of health security on the demand rather than supply side revealed its consequences here. James Bell, president of the board of trustees of Presbyterian-University, insisted that his institution “believes in collective bargaining.” Indeed,
154
The Next Shift
administrators invited in rival unions to fragment the organizing drive, which would have been illegal in a workplace covered by labor law. “Stop the back door deal!” implored one pamphlet from workers, accusing the employer of “collusion with Local 29 of the Service Employes International Union to force us into that union against our wishes.” Bell represented this strategy another way. Warning of “public disturbance” with 1199, he explained, “The hospital has agreed to let each employe join the u nion of his choice and have that union represent him in the grievance procedure. Th ere are currently four or five unions seeking to organize our employes from which he can choose.” In contrast to what Bell suggested w ere more responsible organ izations, 1199 made a “racial and social cause out of an economic problem,” engaging in “rioting and bullying.” The hospital’s attorney wrote in a letter to historian and union ally Montgomery that 1199 had a “tragic history of turmoil and violence,” and sought to “force a minority of our employees to be represented by people not of their choice.”54 Without a procedural path, 1199 attempted direct action. Members came to work wearing buttons reading, “1199—Keep your damn hands off me.” They staged a sit-in to demand a vote; the hospital met them with police and arrests. As hospital executive director Edward Noroian warned, the u nion made a “shameful racial appeal.” He added, “Employees have been suspended only a fter repeated warnings about disrupting the hospital and its job of producing patient care.”55 When this strategy did not succeed, the union called a strike for the beginning of 1970. “End dictatorship at Presby!” demanded one pamphlet. “This is not your plantation! We are neither your slaves nor your children!” But administrators fought back with potent weapons against the unprotected workers. Presbyterian-University secured an injunction against picketing, and thirty workers t here and at Mercy w ere suspended for strike action on the grounds that they were disturbing patients. In addition to the suspensions, police arrested a worker and a sympathizer, while the administration also promised pay raises—which would have been another violation of the NLRA, had it applied. In March, the u nion again attempted a strike at the three hospitals but quickly narrowed its focus to Presbyterian-University. Despite a rally of two thousand led by Coretta Scott King, this action withered u nder more retaliation. By the end of April, only a few dozen workers remained out on strike. The court fined ninety-one picketers—most sympa-
Doctor New Deal
155
Figure 4.2 Workers at Presbyterian University Hospital celebrating and making V signs and wearing “Local 1199 Drug and Hospital Union” caps in recognition of u nion, November–December 1969. Photo by Charles “Teenie” Harris / Teenie Harris Archive / Carnegie Museum of Art / Getty Images.
thizers rather than strikers—a nd threatened jail terms. A small group of workers was “summarily fired.”56 At one level, the employer’s triumph was a legal effect: hospitals’ 1947 exclusion from the NLRA freed the hand of administrators. At another level, this outcome was a racial and gendered effect. The hospital exemption encoded an existing l abor market hierarchy of race and gender into the neutral text of the law. Black w omen workers, excluded from full social citizenship, became m atter out of social place when they took action—a “disturbance” to the patients and an added cost to the consumer. Hospital administrators worked to divide their own workforces in this way, representing the u nion leadership as Jewish outside agitators stirring up trouble by “out-shout[ing] the Blacks on any racial matter,” manufacturing racial antagonism to maintain their leadership. As one administrator put it in a letter to employees,
156
The Next Shift
“Find out if outside organizers of this New York u nion are the type of p eople that you want to lead you.” The white workers, who represented a greater proportion in Pittsburgh’s hospitals than in New York’s, Philadelphia’s, or Baltimore’s, could be split off by such pressures.57 Although hospital workers enjoyed none of the protections that industrial workers did, the actions of 1969-1970 nonetheless changed the economic and legal situation somewhat. First, they helped frustrate efforts by Blue Cross and hospital administrators together to extract cost savings from workers. Instead, they won raises.58 They also brought about legislative change. In 1968 an unlawful Pittsburgh teachers’ strike had led Governor Raymond Shafer to convene a commission on public employee labor relations. The commission proposed legislation to establish regulated public sector collective bargaining, which was then moved through the Pennsylvania General Assembly by Speaker Leroy Irvis, a Demo crat from Pittsburgh’s Hill District. At the time of the hospital strike, it had passed the assembly but not yet the state senate.59 As the state senate weighed the bill in January 1970, fifty hospital strikers, with Irvis’s support, traveled to Harrisburg to picket the Pennsylvania State Capitol. In July, a coa lit ion of six state senators—five Democrats and one Republican—introduced an amendment extending the bill’s coverage to private nonprofit hospitals that accepted state funding. Jeanette Reibman, a Democrat from the industrial Lehigh Valley, spoke for the group: “We citizens can no longer accept the notion that hospital workers and other workers in this category should subsidize the operation of nonprofit institutions by working for less money.” The amendment passed 27–19 with l ittle debate and the support of most senate Democrats and a large minority of Republicans, and the bill as a w hole soon afterward coasted into law, powered by fear of further teachers’ strikes. This measure brought about a wave of successful hospital organizing across more rural locales in western Pennsylvania. In t hese places, employers did not enjoy access to the racial stratification of the labor market and so could not divide workplaces along lines of race in the same way.60 In Pittsburgh and its immediate environs, however, hospital workers never fully recovered from the defeat of 1970. It locked in place a dynamic in which caregiving could be offered at large volume to the insured fractions of the working class because its costs were passed on in such significant propor-
Doctor New Deal
157
tion to hospital employees via low wages. In the deindustrializing urban zones where Black labor was mobilized to meet rising demand from increasingly aged and infirm populations, u nion rights could not change the overwhelming pressure created by public-private fragmentation and subsidy on the demand side. A similar dynamic occurred at a higher level when Congress finally amended the NLRA to cover hospitals in 1974. Responding to rising workplace agitation led by Local 1199, congressional Democrats had moved to add hospitals to the NLRA wholesale, passing such a measure through the House of Representatives in 1972. In coordination with the American Hospital Association, Republican senator Robert Taft Jr. resisted and stalled the bill, aided by organized labor’s nervousness about opening up l abor law to amendments.61 In the next Congress, Taft took control of the process. More moderate than his famous father, Taft had become concerned about disruption and wanted to regulate and tranquilize labor relations in the hospital industry without treating it identically to manufacturing. “I sincerely believe that the citizens of this country should receive health care serv ices without interruption from labor disputes,” he argued. “L abor organizations representing employees in such institutions have a moral obligation to insure that the public receives such serv ices. It is important to remember that hospitals are not factories or retail establishments, and patients are not material or merchandise.” 62 In consultation with both the Nixon administration and also the Serv ice Employees International Union and Laborers’ International Union of North America, Taft crafted a compromise that extended the NLRA while imposing challenging conditions for organizing. In its final form, the bill instructed the National L abor Relations Board to limit the number of possible bargaining units in a hospital—a mandate unfavorable to u nions, which preferred to carve out smaller specialized units within hospitals for distinct occupational groups. The new law also strictly regulated bargaining and strikes, required that u nions give ten days’ notice before a walkout so that employers could find replacements, and mandated participation in mediation. “The basic conflict,” Taft observed in a note, “is public interest versus private individual’s interest in being able to bargain collectively.” 63 The consumption of care was a public concern, although its provision remained a private affair.
158
The Next Shift
Collective bargaining had marked the boundary of social citizenship. Coverage for hospitals was now tacked on as an afterthought for excluded workers who had already been conscripted into serving private actors to carry out public interests—to service social citizenship. The result was ambiguous. At a 1975 American Hospital Association conference on the issue, participants from l abor, hospitals, and government all recognized this problem. One administrator explained that collective bargaining was “all a game staged for the public, and the governor and the mayor produced the plays.” L abor too realized it had little room to move. “It can be very frustrating to negotiate with management and realize what they are offering you is contingent on funding from another source, w hether it be legislature or w hether it be a third party. It is an out for management. In fact, when we negotiate contracts, management says, ‘We would like to give it to you but it depends on the legislature.’ ” 64 The formal extension of the right did not change the institutional structure of the relationship, just as Taft had insisted it should not.
The Pattern of Care Consumption The welfare state’s administration of patient demand preserved the sanctity of the hospital as a depoliticized and decommodified space while nonetheless regulating its internal relations at a remove. This arrangement engendered a peculiar pattern of health care consumption in well-insured Pittsburgh. The peculiarity was that many patients did not have to pay much for the commodity they consumed. Indeed, they did not relate to health care as a commodity at all, nor did they consider “consuming” it as a market transaction. For the secure working class, health care stood outside the economy, in a decommodified zone whose logic more closely resembled the f amily than the market. Accordingly, this population relied on hospitals with increasing intensity in the 1970s, because they offered a serv ice these workers and their dependents did not have to buy, for which they could find many uses. By the 1970s, steelworkers and dependents departed not only from the general population in health utilization, as in the 1950s, but also from the pool of other Blue Cross subscribers. In 1974, 164.85 steel subscribers per 1,000 in western Pennsylvania were admitted to the hospital, compared with 125 per 1,000 of the rest of the Blue Cross pool; steel subscribers generated 1,169 patient-days per 1,000 subscribers, compared with 878 per 1,000 for the rest
Doctor New Deal
159
of the Blue Cross subscriber base. It was not simply the hazardous nature of steel work that drove up utilization among steel subscribers; steelworkers’ dependents exhibited high rates of utilization as well.65 Altogether, the presence of t hese industrial workers and their dependents sustained hospital utilization in Pittsburgh at a point near the national average in the early 1970s; without this presence, utilization in Pittsburgh would have fallen below it. Similar patterns obtained in Cleveland, Detroit, and other similar cities.66 In response to the demands of this group, hospitals expanded their capacity, although the most dramatic takeoff of both consumption and supply still lay in the decade ahead. Steel subscribers formed the basis of both the insurance and hospital markets. Active steelworkers and their dependents made up 17.5 percent of the entire subscriber base of Blue Cross of Western Pennsylvania. This figure, moreover, excluded many thousands of steel retirees and dependents who had Blue Cross supplementing their Medicare coverage, making that percentage a significant underestimate. People insured through steel employment thus constituted a major plurality of the subscription base of the region’s dominant insurer and a still larger share of the a ctual patients in beds.67 Considering the effects of the steelworkers on the health care system as a whole, one might see Pittsburgh as a massive company town, with Blue Cross administering its welfare scheme. The steelworkers supported Blue Cross po litically and financially and in return got a hospital system that met their standards; the hospitals gave Blue Cross, the main purchaser of hospital ser vices, a 14 percent discount, and in return got the huge business of its subscriber base; and Blue Cross captured an enormous share of the regional insurance market—w ith 62 percent of all covered patient-days in the region under its plan—to the point that the commercial insurance company Travelers brought an unsuccessful antitrust suit in 1971. Rejecting the suit, the court held that the “features of the [Blue Cross] contract which Travelers finds objectionable w ere mandated by Insurance Department guidelines designed to encourage high quality care at reasonable costs.” Monopoly was legally acceptable, since it met the political demand for widespread and intensive care provision.68 Why did steel subscribers consume so much hospital care? The only apparent biological explanation is ambient air pollution, which played some role. Average air pollution in the region stood at double the federally
160
The Next Shift
recommended level, with serious consequences for individual health. For example, 10 percent of patients in the intensive care units of local academic hospitals in 1970 had chronic lung disease. Th ese figures represented the area as a whole, concealing even worse air quality in the low-lying zones of the industrial valleys.69 But heightened use of the health care system was spread across e very medical specialty, not focused in respiratory care. This fact would seem to point toward a broader social cause. While improvements to the steelworkers’ insurance plan enabled rising rates of utilization, good insurance is a necessary but not sufficient explanation for this intensive consumption. Nor can it be attributed solely to doctors: to do so vacates the role of the patient, which we must explore to understand why steelworkers differed so markedly in their behavior from others also insured through Blue Cross. What did care mean to this group of p eople? Why did they want it? For what did they use it?70 Across the region, deepening insurance coverage combined with demographic transformation to drive expanding utilization. In 1977, 12.3 percent of southwestern Pennsylvania residents were over sixty-five, compared with 10.9 percent of US residents overall. This pattern was, as always, quite pronounced in the steel areas. In 1970, 21.5 percent of Allegheny County residents were over fifty-five; so were 41 percent of Homestead residents; 30 percent of t hose in Braddock; 31 percent of South Side residents; and 32 percent of t hose in McKeesport. Another way of grasping the extremity of the demographic shift is in the changing proportions between generations. While the elderly consumed more health care in general, the rapidly changing demographic balance intensified the effect further by overwhelming the capacity of informal care within the f amily, traditionally the site of most elder care. Already in 1950 the cohort between 65 and 84 outnumbered their children’s cohort (45 to 49), with 1.3 elders for e very child. But by 1979, the ratio between t hese cohorts was two to one.71 As demographic change and high levels of insurance interacted to stimulate health care demand, they acted as a mediating factor between the decline of the steel industry and the growth of the health care industry. The system of health care provision, the most significant external institutional outgrowth of organized labor’s demand for security, grew as the steel industry’s decline undercut the economic position of steelworkers. Their demand caused income—public and private—to flow into the system.
Doctor New Deal
161
Over the course of the 1970s, southwestern Pennsylvania overtook the national norm in hospital utilization. By 1978, the region generated 1,366 inpatient days per thousand p eople, compared with a national average of 1,192. This higher figure resulted from both a higher admissions rate (171.6 per thousand, compared to 161.1 nationwide) and a longer average length of stay (8 days, compared to 7.4 nationwide). Steel subscribers’ health care bill paid for hospital charges far more than for doctors’ fees or drugs.72 This phenomenon appeared quantitatively in utilization figures, but it also had a personal dimension. For a well-insured working-class person, receiving hospital care had a special character. Worry gnaws at anyone seeking medical attention. But at the hospital, strangers shared worries and tried to allay them. Mrs. C., for example, recalled how her parents sought “medical attention immediately for almost everyt hing.” Mrs. P. saw her encounters with hospitals as “very good experiences. I’ve never had a bad experience in a hospital. The hospitals that w e’ve gone to w ere always nice treatment. The nurses were always nice and the doctors were always t here to take care of any prob lems. I have no complaints about any of the times. . . . I don’t have any complaints, whatsoever.” When she gave birth, “one of the nurses that we became acquainted with when we were in the hospital was at that time on the maternity floor and stayed with me through the w hole t hing.” 73 Care was more than simply curative. Said Mrs. E. of her time in the hospital, “When you’re feeling the way I did everybody seems to be good. B ecause you’re not miserable and so they are nice with you. So I always had a good stay in the hospital. The food, everybody complained, I enjoyed it. Lay in bed and somebody serve you food what could be more?” When Mrs. C. became angry that her husband did too much for his relatives and not enough to take care of her, she went to her general practitioner to talk about it. “The doctor told him that his first responsibility was to his own f amily, his immediate family and then that his b rothers and sisters or whoever, they came second.” Mrs. K. had a similar relationship to her doctor: “I feel like, a fter I’ve talked to him, that he’s taken a load off my shoulders.” Her d aughter described her as “a g reat one for g oing to the hospital and seeing everybody. She likes to go maybe three or four times a week [to visit].” This dynamic was presumably what underlay the remarkable finding of a 1978 study of workers in McKeesport, Pennsylvania, which showed that a group of “employees of a medium-sized, heavy industry plant” and their families, when
162
The Next Shift
provided outpatient mental health care, decreased their use of other health ser v ices significantly.74 Utilization of the health care system overall was evidently somewhat fungible with m ental health care. Taken together with empirical evidence of high utilization across specialties, huge generational disproportion with major consequences for informal care, and qualitative evidence of what health care meant for these high-utilizing working-class patients, a conclusion presents itself: as insurance improved for t hose still covered while the economic situation of the region as a whole deteriorated, the footprint of the hospital and the doctor in daily life grew. It substituted for familial types of support and care both materially and emotionally. The growth of home care programs, too, conveyed to those with access that care providers were invested in their well-being, to the point of functioning in a role intensely associated with familial love. “They work hand to heart,” reported the Pittsburgh Press, “bathing the patients, comforting them, feeding them, perhaps d oing marketing for them, performing essential h ousekeeping tasks that boost their morale and their well being.” The article described “a pensioned steel worker who lives alone [and] has had a fractured hip. He needs some help with his meals, minor nursing care, physical therapy and help in learning to walk with crutches.” Another article several years later gave an account of an older man who lost his leg and his wife at the same time: “Crippled, largely helpless, lonely and alone with his grief—he left the hospital in deep depression. His will to live had almost sputtered out.” The visiting “homemaker,” in the words of the Press, “restored his w ill to live.” A retired steelworker, David Lindberg, extolled the “patience” and “infinite grace” of visiting nurses in a poem he wrote—lamenting, “the good they perform seldom told.” 75 At the apogee of this growth in access, health care became a source of empowerment and social support for many working-class p eople. White people—whose economic security and racial privilege protected them from medical discrimination—in particular felt this way; but members of the fraction of the Black working class who retained access to collectively bargained benefits felt much the same. Carol Henry recalled of the steelworker plan that covered her f amily when she was growing up, “They d idn’t predict [how long] you was g oing to stay. Doctors decided. . . . Insurance companies did what they needed to do, doctors did what they needed to do, and the cost wasn’t so bad.” 76
Doctor New Deal
163
Providers were almost universally voluntary, nonprofit institutions—and often religious ones. “Mission trumped margin,” as Georgine Scarpino described Catholic health care in the postwar period. “It was like a f amily,” recalled Georgeanne Koehler of the Catholic work culture at St. Francis Hospital, where she worked as a psychiatric aide. “We loved working with the poor. Just loved it. . . . If you were poor, you might not get the best bed in the hospital, but you got the best care. And probably a little bit more in the way of compassion.” Inhibiting the infiltration of market logic, the state government penalized hospitals that dumped Medicaid patients on lower- grade facilities.77 Just as this inclusion rested upon disenfranchisement of care workers, however, it was also accompanied by the exclusion of the increasingly insecure Black fraction of the working class. White working-class people frequently found it a relief and pleasure to be handled by caring strangers. Black working- class and poor p eople often had a different relation to strangers in positions of institutional power over their bodies. Some enjoyed the economic security that was more widespread among white p eople, but the institutions w ere not built for t hose who were Black in a largely white city and Protestants in a Catholic town. In a 1967 letter, a liberal priest categorized how the different institutions of white Pittsburgh related to the African American community. “The private agencies . . . have done much more than the city fathers,” he wrote. “The police have made their m istakes but they have not been out-and-out brutal. . . . The employment situation is bad. That is, it is bad for Negroes.” He closed the letter, though, with a categorical denunciation: “Medical establishment is wretched and unrepentant.” 78 This form of racism, informal yet widespread, fell beneath the purview of the formal antidiscrimination provisions encoded in federal law as part of the Great Society. Segregation and discrimination in medical practice were common, write historians Joe Trotter and Jared Day, as in the tendency of hospitals to ask white patients “if they would object to sharing a room ‘with a negro.’ ” The dignity of semiprivate rooms was one of the first accomplishments of the USWA’s collectively bargained Blue Cross plan. The hospitals renovated for this purpose viewed Black patients as a blemish on the product they sold to white patients—not just the technical curing of disease but also the desirable experience of receiving caring attention over long stretches. Mercy Hospital even a lost a bid for a government grant because of complaints from
164
The Next Shift
the hospital’s Black neighbors: “We were told we had a poor image with t hese people who alleged we discriminated against them in all aspects of our operations. One quote cited was: ‘You treated us at Mercy. But you have never accepted us.’ ” 79 Black activists challenged such practices at numerous institutions but most prominently in Homewood. Only one general hospital operated t here, Pittsburgh Hospital, run by the Sisters of Charity. Grievances against the institution ran the gamut, involving patient treatment, community relationships, and employment. According to a patient census on the morning of August 11, 1966, the patient population stood in almost exact inverse proportion to the racial composition of the neighborhood. Of the hospital’s 102 medical staff members, who held the power to admit patients, only 1 had an office in Homewood. What was more, nearly two-t hirds of the few Black patients were in wards, rather than private or semiprivate rooms.80 African American critics did not accept the hospital’s explanation that exclusion of Black patients happened for “indefinable” reasons. Th ere was not a single Black intern or resident at the hospital in 1966. The NAACP’s Dr. Charles Greenlee, who practiced in the area, explained, “There is almost no family in the area who h asn’t had a bad experience h ere.” Rev. LeRoy Patrick, who led a church in Homewood, described waiting for attention while his son bled from his wrist from a dog bite. “There were a [nun], 2 nurses, and 2 doctors in the next room. I finally heard laughter t here and exploded: ‘Isn’t anyone in charge of emergency?’ It just seemed like callousness.” In response, hospital leaders maintained a position of condescension, referring to Black activists as “you people” in meetings and dismissing criticism as “inconclusive.”81 The War on Poverty presented a potential resolution by offering federal funding for a new medical center in Homewood. In March 1967, Pittsburgh Hospital signed on to operate the center with the support of the Homewood- Brushton Citizens Renewal Council, the primary group pressuring the institution. But more militant activists used the stream of funding as leverage over the hospital’s behavior in its main facilit y. Over the course of 1967 and early 1968, the dispute widened, as militant leaders in Homewood deemed the proposed board members of the new medical center unacceptable. Bouie Haden, a Black steelworker and the leader of the radical Homewood organ ization United Movement for Progress, called the proposed board “a bunch
Doctor New Deal
165
of U ncle Toms.” He supported a new medical center—“ but not u nder t hese circumstances.” In the end, only intervention by the mayor and county officials secured the deal: Pittsburgh Hospital was instructed to choose between appointing Haden or Greenlee to the new center’s board, and selected the professional Greenlee over the blue-collar Haden two days before the deadline. By the early 1970s, residents of the area won the right to elect board members to the Homewood-Brushton Medical Center, realizing much of the initial vision of Black activists. Health policy dependent on discretionary funding from politically changeable sources, however, proved precarious. Support for the center declined slowly over the decade a fter it was established, leading to a vicious dispute over its control. The medical center represented an adjustment on the margin of the system to accommodate an excluded minority, meaningful to individuals but not sufficient to achieve a structural change.82 Pittsburgh’s other major Black neighborhood, the Hill, saw similar marginal adjustments. One, an effort to rectify the unavailability of ambulance service, mirrored the campaign in Homewood. Previously, underserved residents of the Hill had to rely on the police for emergency medical transportation; 71 percent received inappropriate emergency care in this manner. Community activists secured War on Poverty and foundation dollars to launch a new program, the Freedom House Ambulance Serv ice. Freedom House trained the local “hardcore” unemployed for work as what we now know as emergency medical technicians—a job invented for the program. Beginning operations in July 1968, Freedom House transported 4,267 patients in its first year. The serv ice lasted into the mid-1970s before the city terminated its contract and set up its own serv ice.83 The Hill, unlike Homewood, lacked a hospital entirely—hence the acute demand for ambulance serv ice. Over the course of 1969 and 1970, a group of doctors joined with Met Life Insurance to propose a solution: a group health plan with its own hospital in the Lower Hill. The organization they formed, Central Medical Health Serv ices, would be Pittsburgh’s first health maintenance organization (HMO)—a prepaid system of comprehensive group care. And the HMO would operate on a for-profit basis. In arguing for their new facility, to be called the Central Medical Pavilion (CMP), proponents emphasized the needs of the neighborhood: “All the problems of society—including health care—are magnified for those who are poor.” Care for the poor, they
166
The Next Shift
acknowledged, tended to be of lower quality. Poor p eople were afraid of hospitals yet also relied on them for social serv ices that could be delivered more cheaply in other ways. A for-profit HMO could rectify this problem through the efficiencies of market incentives, delivering savings to pay for care for the neediest.84 This proposed new $20 million facilit y, “a model of free enterprise health care in the United States,” did not sail through without opposition. Some officials approved the plan, including the Model Cities Commission, which distributed funds and permissions for development in designated zones of the city; in return, the commission had won an agreement that two Hill residents would be on the board, as well as vaguer commitments about nondiscrimination and local hiring. But o thers resisted, arguing that CMP would offer only superficial improvements to care for the poor while exploiting the most profitable cases. State insurance commissioner Herbert Denenberg weighed in against the plan, writing, “There is no such thing as ‘private money’ in a healthcare delivery system which must be supported by the public.”85 After negotiating the proposal down from 300 beds to 244, citing area overcapacity, hospital planners allowed it to proceed. By late 1974, the facility had already run into significant financial problems. By 1977, CMP was more than $5 million b ehind in mortgage payments, and a judge was contemplating putting it into receivership. Pittsburgh’s communitarian, solidaristic health care economy had no place for a for-profit hospital.86 On the other end of the spectrum, the 1970s also saw a crisis for a rare outpost of fully socialized medicine in Pittsburgh—the Veterans Administration (VA), with its three facilities in Oakland, Aspinwall, and Leech Farm. VA patients complained of long waits, poor facilit y quality, and hostile bureaucracies. George Hromi, for example, was a widower, a World War I veteran, and a retired steelworker in McKeesport. “He always told his wife that if worse came to worse, the Veterans Administration (VA) would carry him through his twilight years.” After he was widowed in May 1974, an 80-year old Hromi—described as “a lonely, confused old man”—could no longer care for himself. Hromi did not own a home, so rather than spend on rent, he moved into the hospital and then a private nursing home—paid for out of his retiree benefits. But he exhausted his resources after two months and died in July, the forty-sixth name on a waiting list for the VA nursing home in
Doctor New Deal
167
Aspinwall, while his desperate children tried to get him into the notoriously negligent county-owned Kane Hospital. Hromi’s status as a steel retiree had bought him two relatively dignified months—more than others would have enjoyed in similar straits—but the VA was of little use to him beyond a small financial allowance.87 Paradoxically, the proximate cause of t hese failures was 1973 federal legislation extending benefits to a larger group of veterans. A political outcome of the pressures of the Vietnam War on the military, which needed to manage rank-and-file discontent and attract recruits after the end of conscription, the bill formed a key part in the construction of what historian Jennifer Mittelstadt calls “the military welfare state.” Most significantly, the legislation added coverage for peacetime veterans and for dependents of “totally disabled” veterans. Patient demand then overwhelmed capacity. Unlike the privatized system that industrial workers could access securely, the public system was chronically underfunded and lacked an equivalent ability to pass on costs to insurers and the public. Although federal law required VA administrators to maintain adequate facilities and staffing, the government did not provide the funding to so—a llowing the institution instead to be crowded out by private actors. Administrators at the Aspinwall VA—where Hromi had been forty- sixth in line—lamented that they had an empty building that, with renovation, could house one hundred beds. “I’ve been talking about this for years,” said one. “But nobody seems to listen.”88
Financing the Health Care Boom As demand grew in the 1970s, hospitals began a new round of capital expansion. To finance expansion, institutions could use retained revenues, usually in combination with philanthropic support, or they could borrow. In 1971, to encourage debt-financing, the commissioners of Allegheny County formed the Allegheny County Hospital Development Authority, which could issue tax-exempt municipal bonds on behalf of hospitals and nursing homes— giving private hospitals access to the municipal bond market. As a County Commissioner Leonard Staisey observed, the legislation would allow extension of serv ices at no cost to the public.89 State power again expanded public services through private institutions— in this case the bond market. “These mechanisms, created for serv ices that
168
The Next Shift
can be financially self-supporting, have l imited ability to deliver services that are hard to shoehorn into a business model,” historian Gail Radford writes. “Their decisions have to be based, in the last analysis, on how to please the bondholders by guaranteeing a strong stream of revenue.”90 The new authority was a bid to turn the flood of incoming insurance payments into a source of creditworthiness to build more hospitals, which could then capture more insurance payments. Such bonds were generally safe and exempt from tax, lowering the cost of borrowing for hospitals. Debt-financed capital expansion then generated more supply. “Operating costs of acute care hospitals in Allegheny County more than tripled in the period 1966 through 1975,” noted a report published in 1978. “Capital expenditures are a contributing f actor to this increase, not so much in terms of the costs of financing t hese outlays, as in terms of the increases in operating costs they can impose.” From the perspective of hospital management, however, it was desirable to increase operating costs, b ecause the industry ran on profitable reimbursement for operating costs. A fter surveying regional hospitals, the report projected the continuation of this trend, with $578 million in new capital projects expected to come online from 1978 through 1983. Pittsburgh’s hospitals outstripped the national trend in debt-financing of such growth. In 1962, 12 percent of new hospital plant nationwide had been debt-financed; by 1974, the nationwide figure had risen to two-t hirds and the proportion in Pittsburgh had soared to 75 percent.91 The bigger hospitals got, the more reimbursement they soaked up— and credit to grow was cheap. Interest rates on hospital bonds w ere 1.5 to 2.5 percent lower than on comparable debt, thanks to the tax subsidy and the “substantial guarantee of revenues to serve as security for debt” represented by Medicare. Most important, hospitals could pass capital costs directly through to Medicare.92 Pittsburgh’s hospitals thus became machines for turning Medicare and Blue Cross payments into debt serv ice to private bondholders—v ia the mechanism of a mass working-class expectation of broad and deep care, taking the form of a market. Across the United States, from 1970 to 1979, the ratio of hospitals’ current assets to current liabilities fell. Although hospitals could still pay their debts without significant difficulty, their long-term indebtedness doubled, rising from 13.5 percent of net total assets to 25.3 percent. Institutions had e very incentive to incur long-term debt: total inpatient admissions rose over the
Doctor New Deal
169
1970s at a rate of about 2 percent per year, and the number of inpatient days increased at a rate of 1.2 percent a year. Medicare admissions, however, jumped 5.7 percent yearly—another boon to providers in demographically older ser vice areas.93 Hospital borrowing transformed a social and political problem into a business proposition. A worsening industrial economy threw p eople in manufacturing centers out of employment and cut them off from other sources of security. Industrial decline degraded familial support systems. It ate into tax revenue and at the same time put fiscal pressure on public serv ices, as the social instability caused by industrial slowdown sent more p eople to seek state support.94 The bargain reached a fter World War II had balanced public power with private administration. The influx of even more public money a fter 1965 tested this balance, but political forces w ere not strong enough on any side to break the bargain outright. So long as the dynamic did not tip over into outright socialized medicine, the mechanical growth of welfare provision in response to secular industrial decline attracted investment to the health care market, rather than repelling capital. The expanding industry absorbed social problems dislocated from other sectors of the economy that lacked access to such public support. A population that was increasingly aged and unemployed could rely more and more on the health care system, whose seemingly bottomless demand attracted creditors and resulted in expanded capacity—thus escalating the inflationary growth cycle further. Debt, inflation, and public subsidy worked together, stretching the political balance governing the hospital economy but fundamentally preserving it— thus expanding the overall footprint of health care in society. H. Robert Cathcart, the president of Pennsylvania Hospital, wrote, “Hospital administrators, trustees, and medical staffs are really reacting to the demands of society to provide the best possible current medical services that are available. They are not creating the demand, they are reacting to it. Failure to respond would have created a crisis causing many other problems.” The heart of the issue, Cathcart explained, was that “the consumer has been promised health services by his employers, his u nion, or his government. He w ill want to collect on these promises and in this way will continue to stimulate demand.” If adequate credit was found for hospitals, “the present health care system w ill survive. If not, there w ill be a major reorganization, which might be most
170
The Next Shift
traumatic to the system and to t hose who have supplied capital for the facilities in the system.”95 While solving some problems, hospital growth nonetheless presented a new set of challenges. As Wesley Posvar, the chancellor of the University of Pittsburgh, put it, “We are in a period of rising expectations; the p eople have Cadillac tastes without the nation having the means to pay for them. We are confronted with the possibility of spending another $50 or $100 billion a year for health care in this country.”96 While Posvar’s language represented rising quantitative demand as a qualitative appetite for luxury, he grasped the po litical essence of the problem. Securing reliable, affordable, and sustainable credit for hospitals was important exactly b ecause d oing so postponed answering a highly divisive political question. Costs would be borne by insurers, public and private, and they would distribute t hose costs to premium payers (largely employers) in the private sector and among taxpayers. This seemed the least bad option. In the near term, therefore, the tension built into the health care system— derived from the way it reconciled antagonistic constituencies—caused it to grow. Building a new wing or buying an expensive device pleased bondholders. And doing so also satisfied patients, who had access to the serv ices they desired and for which they did not pay the price. The only constituency forced to bear the cost of the bargain directly was the health care workforce, whose wage growth had to be contained if costs w ere to be managed at all.97
Expansion Even before hospitals had access to the necessary capital, they saw the possibility of expansion and began planning for it. Academic medical centers enjoyed an advantage because of the market prestige and federal funding generated by their research and training programs. At the University Health Center (UHC) of the University of Pittsburgh, officials foresaw significant growth based on this leg up, not to mention the economies of scale they could capitalize on for their affiliated hospitals by sharing serv ices. “We will face growing needs and demand for serv ice. Programs w ill expand in scope,” wrote administrator Arthur G. Hennings. He predicted that UHC would add five thousand additional students and staff over the next decade and that the center would ultimately need “probably as much as twice the present space.”
Doctor New Deal
171
This growth would mean more beds but also new equipment, expanded parking, and a vast range of other additions.98 Once the anticipated demand was met by capital markets in the 1970s, the expansion of UHC facilities began. From 1973 to 1977, for example, the UHC’s affiliated hospitals spent $49 million on capital improvements, with nearly 90 percent debt financing. In 1974, the university hired a businessman, Hallmark Cards executive Nathan Stark, to run UHC, prompting a controversy and the resignation of the dean of medicine. In 1976 and 1977, Stark succeeded in negotiating new agreements advancing the consolidation of UHC’s five hospitals, which inaugurated a new joint planning process to coordinate the hospitals’ activities, ranging from sharing parking and a blood bank to asserting university control over the appointment of medical chiefs of service.99 Stark’s appointment signaled another social transformation in the hospital system: the rise of administrators. For decades, the work of hospital administration had not been particularly prestigious, with doctors holding more status and power than administrators. But the expansion of the social scope and economic scale of hospitals demanded new administrative capacities. From the late 1950s to the mid-1960s, administration training programs changed curricular content significantly to pay more attention to forms of social medicine, such as gerontology and epidemiology. “Tomorrow’s hospital administrator,” wrote Robert M. Sigmond, executive director of the Hospital Council of Western Pennsylvania in 1966, would have to focus on “ascertaining community needs, identifying and becoming acquainted with spokesmen of community and consumer interests.”100 More plainly, the administrator’s purpose evolved to embody the tacit pact between bondholders and consumers. Through the 1970s, administrators w ere involved in near-constant complex negotiations between local communities, bondholders, and cost-cutting regulators. The first two generally wanted expansion, expressing on the local scale all the structural forces that favored rising consumption and system growth. As an administrator at Homestead Hospital defended a proposed capital program in 1973: “Investment bankers w ere willing to buy $27.5 million worth of bonds. That’s good enough for me.”101 On the other hand, the problems of overcapacity and price inflation, increasingly worrisome to health planning technocrats, w ere attracting growing
172
The Next Shift
regulatory hostility from hospital planners. This impulse first took a purely voluntary form in the Hospital Council of Western Pennsylvania, which initially could lobby for self-control but do no more. Gradually, however, the council gained more formal authority over the course of the 1960s and 1970s, beginning with 1966 legislation that assigned the organization a publicly sanctioned advisory role but little real power. As general inflation anxieties mounted in the early 1970s, Congress then revisited the Social Security Act, creating several major new entitlements, such as Medicare renal care coverage and supplemental security income, and building cost-of-living-adjustments into Social Security payments. All this represented a happy meeting point on the politics of inflation between Democratic legislators and President Nixon, who was tacking leftward for his reelection: he signed the bill at the end of October 1972.102 While expanding the fiscal footprint of t hese programs on the one hand, legislators wanly tried to contain them on the other by allowing states to opt out of Medicaid and by giving regional health planning agencies the power to review significant capital expenditures. As this regime failed to control costs, Congress moved to strengthen the regional planning councils once more. Now called “health systems agencies,” they w ere endowed by 1974 legislation with the power to cancel federal reimbursements for institutions that did not comply with agency review of capital projects.103 Every major effort to expand in the rapid growth period of the late 1970s and early 1980s now had to navigate the Health Systems Agency (HSA) of Southwestern Pennsylvania, the organized regulatory voice of restraint and rationalization, empowered by the federal government and composed of health policy experts, providers, and consumers. When consumers joined the board, they received a handbook designed to bring them over to supporting containment of hospital capital. “The oversupply of beds results in pressures that lead to unnecessary admissions and to prolonging the length of stay,” members were warned. “You and I and the rest of the taxpayers” pay for the excess. The HSA board endorsed this analysis at the general level, proposing a reduction in the overall number of beds in the region from 13,600 to 11,800 over the period between 1978 and 1985. In reviewing specific proposals, however, members of the board had to sign off on constraining the particular hospitals in their own communities, and this resolve wavered.104 In 1977, South Side Hospital provided a test. Like Homestead Hospital, South Side had long enjoyed close ties with a nearby steel mill, Jones & Laugh-
Doctor New Deal
173
lin’s Pittsburgh Works, and the social context created by declining steel employment was key to the case for the $29.5 million modernization project. “The Hospital’s service area is comprised of an aging population. . . . The older population has a higher hospitalization rate which has been estimated at four times that of the general population.” While the industry standard for total project cost funded through debt was 80 percent, South Side proposed 93 percent debt-financing.105 The HSA’s review committee rejected the project twice on grounds of area overcapacity, in an atmosphere of growing rancor. In 1978, Anne Jenneve, a member of the hospital’s board of directors, warned her community that “residents of the entire area on the south side of the Mon must patronize their local hospital, where they have a choice of doctors, and must insist on being served in their community hospital, where convenience and tender loving care are irreplaceable. Use it or we w ill lose it!”106 As the dispute over the institution escalated, local community members mobilized. The Pittsburgh Post-Gazette received dozens of letters in support of the project, asserting the right to an up-to-date hospital. Carol Conboy wrote, “The South Hills has many hard-working, tax-paying p eople who deserve the kind of good medical care that a community hospital can and does provide. I am an employee of South Side Hospital and would like to work there for many years to come.” Supporters commonly cited its economic importance to the community. Representative Gaydos again joined the fray to defend a steel town hospital, as did other elected officials.107 As usually happened in t hese cases, local officeholders w ere unanimous supporters. Allegheny County Commissioners Thomas Foerster and Robert Peirce and Pittsburgh City Councilors Robert Rade Stone and James Lally sponsored resolutions in their respective legislative bodies supporting the plan. A hospital, said Peirce, is “just as important as community churches and police and fire protection.” Hospitals could generally expect such active backing from local power brokers and officeholders, who frequently served on boards of trustees. When state health secretary Gordon MacLeod finally resolved the impasse—the review committee had twice voted against the expansion plan; the full board voted in f avor—and approved the plan, he was met with applause by state Senator James Romanelli, himself a member of the hospital board.108 When MacLeod weighed in, overruling the HSA’s review committee and letting the proposal through, he cited the opinions of local advocates. Local
174
The Next Shift
politicians could affect the allocation of hospital capital insofar as unelected bureaucrats cared what they and their constituencies thought. But elected officials had no formal procedural power, rather symbolizing and performing the communitarian solidarity of their constituencies. Their clout lay in the popular expectations of hospital care. Had HSAs enjoyed more democratic legitimacy, the project of rational planning of hospital investment might have encountered less popular resistance—as M acLeod himself came to realize, proposing unsuccessfully to the legislature in 1979 a switch to the democratic election of HSA board members.109 Absent democratic participation, popular impulses aligned behind maximal serv ice provision, generally supporting carte blanche for the ambitions of administrators playing with f ree money. The HSA process did block some proposals. The agency thwarted a $26.2 million modernization project for St. John’s Hospital in 1977—overruling the objections of virtually e very officeholder in the area, including a vocal Pittsburgh mayor Pete Flaherty and District Attorney Bob Colville. “St. John’s is the only hospital I have never received a complaint about,” fumed Allegheny County Commissioner Thomas Foerster, while state representative Robert Ravenstahl observed that the hospital’s renovation was needed to serve its heavily poor, African American, and elderly catchment area. Indeed, the HSA, thrown on the defensive, had to deny that it harbored an “anti-city” bias, pointing to all the urban projects the agency had approved, while acceding to St. John’s compromise proposal for a much smaller renovation. Allegheny County Commissioner Peirce, in retaliation for HSA’s perceived hostility and secrecy, complained to the federal Department of Health, Education, and Welfare about the agency’s practices and attempted unsuccessfully to get its funding cut.110 Fifty-four projects w ere considered by the HSA that year; St. John’s was one of only three rejected. A second large-scale proposal, Aliquippa Hospital’s $11 million renovation, was also withdrawn; the third, the UHC’s $815,300 CT-scanner acquisition, won approval on appeal. Between St. John’s and Aliquippa, then, regulators rejected $37.1 million in proposed development while approving $87.6 million.111 By the late 1970s, southwestern Pennsylvania had 5.06 hospital beds per thousand people—compared with 4.47 beds per thousand people nationwide. Accordingly, the HSA warned of an excess of 1,500 hospital beds—the equivalent of five average hospitals. The result of t hese interlocking dynamics—
Doctor New Deal
175
demand buoyed by economic and demographic change, third-party and public reimbursement, and debt-financed expansion of supply—meant that prices, the bogeyman of health policy, grew steadily despite regulators’ sporadic resistance.112 Hospital expansion benefited bondholders and administrators, but its fundamental dynamic was that it promised to manage social problems with other people’s money. Perhaps the starkest illustration of this pol itic al necessity came when the county government faced a crisis of institutional long-term care. As factory job loss intensified in the 1970s, local tax revenue dwindled, the elderly population expanded, and informal care systems based in the family deteriorated. Institutional elder care thus expanded countercyclically, as growing numbers of the older population were thrown onto public support for long-term care, particularly Medicaid. Allegheny County had a larger elderly population than the norm, and the county institutionalized its elders at a far higher rate, even as fiscal shortfalls worsened.113 This combined demographic and fiscal crisis took a toll on conditions at the region’s most important elder care institution, the enormous county- owned nursing home, John J. Kane Hospital. Despite a brief sit-down strike in 1966, Kane staff were paid very low wages and, as budgetary pressures set in, were spread thin and overworked with increasing severity. As t hese working conditions interacted with overcrowding, a disaster of patient neglect and abuse resulted. Staff immobilized patients physically and chemically because they could not manage their needs, leading to incontinence, infections, bedsores, and mental and muscular deterioration. Sometimes patients who manifested more intense need or complained about conditions were punished, as when an aide responded to a Black patient’s incontinence by spraying his genitals with cold water while bathing him, warning, “You better learn never to shit yourself again, nigger.” A woman named Dorthy, the neediest patient on her floor with both Parkinson’s and diabetes, could not move any part of her body except her mouth and eyelids. When she asked for the care she needed, “she was screamed at, slapped, and told to ‘shut-up’ many times by the staff,” and staff members rocked her bed back and forth and tilted her head below her body—practices resembling torture. The conditions at Kane Hospital represented the extreme end of a broader 1970s phenomenon. As revealed in US Senate hearings led by Utah Demo crat Frank Moss, that decade saw a series of episodes of institutional elder abuse, largely concentrated in the states that would soon be known as the
176
The Next Shift
“Rust Belt”: abuse followed from a structural pattern characteristic of industrial decline. But the exposure of Kane came thanks to three intrepid activists: Mary Lewin, Emily Eckel, and Joseph Nagy. Lewin already worked at Kane as a social worker. Upset by what she saw there, she recruited her friends Eckel and Nagy to join her t here to expose the institution from within. Together, the three authored a report, Kane Hospital: A Place to Die, which they passed to Moss’s Senate subcommittee with the help of the Gray Panthers, the elder rights organization.114 The 1975 exposure of conditions inside Kane triggered a five-year political struggle. The institution’s administration denied the allegations, as did the county government initially. But official investigation and staff testimony both bore out the accusations. The county then convened a citizen panel to weigh the institution’s f uture, giving heavy representation to supporters of privatization. Panel chair Gordon M acLeod (who would soon be elevated to serve as Pennsylvania’s health secretary) supported private-sector ownership or at least management of Kane, commenting in private correspondence that continued public control would lead to greater employee protest and “more and more adverse publicity.” Arrayed against privatization w ere the organized workers at Kane and a broad activist coa lition. Eckel and Nagy, two of the original three who exposed Kane, had belonged to the New American Movement (NAM), a socialist-feminist organization that emerged in the early 1970s from the wreckage of the student left, seeking to bridge the gap between students, professionals, and the working class. Nagy in particular, who had trained in community organizing at Chicago’s Midwest Academy, saw the possibility that the group would be able to form a broad popular alliance to fight conjointly for dignity for the elderly and power and respect for workers.115 The activists thus forged a broader coa lit ion, helping to form the Committee to Improve Kane Hospital (CIK). The CIK involved care professionals like Lewin, progressive Catholics (drawn from the Thomas Merton Center and the Association of Pittsburgh Priests), elder rights organizers (from the Action Coa lition of Elders, most prominently Mark Peterson), labor union members, patient advocates and relatives, and other unaffiliated activists. Led by Lewin, Peterson, and Nagy, the CIK brought pressure to bear through protest action and alliance with workers at Kane.116 In combination with a 1979 county workers’ strike, this effort helped stall and then defeat the drive to
Doctor New Deal
177
privatize the institution and to hold out the vision of humane and democratic elder care, in which patients and workers alike would benefit from sufficient public support. After the HSA, swayed by this movement, rejected a privatization plan, the county changed course. County officials acknowledged that the preferential Medicaid reimbursement rates from the state for a public institution obviated the logic of selling off Kane. The easiest path for local government to meet its obligations to the county’s elderly was to renovate the institution—breaking it into four smaller “mini-Kanes”—but to keep it in public hands. The social problems grinding away at Pittsburgh w ere relentless, and health policy could not control them, nor banish the popular pressure they created. What health policy could do was provide an instrument for managing t hese problems, if institutions could be arranged so as to capture as much funding as possible from insurers. As a 1976 Institute of Medicine report acknowledged of this dynamic, “powerful community interests usually favor the building of a new hospital or expanding an existing one, and oppose the curtailment of services.”117 This logic—a political logic—neither dictated the outcome of e very episode of conflict nor always worked straightforwardly. But the dynamic was inexorable.
Corporate Welfare, Social Welfare The process of relentless cost growth and capital expansion in the health care market between the end of World War II and the 1980s was political. It rested on the forms of collective life established and institutionalized by the postwar welfare state, taking first the form of the social insurance pool and then the set of providers that arose in response to it. Prices r ose more rapidly in the health care sector than in much of the rest of the economy, driving the expansion of supply. Behind this rapid price rise and corresponding expansion of supply was third-party payment for care, subsidized directly or indi ehind this expansion, in turn, was the derectly by the welfare state.118 B mand for security in working-class communities, which prized access to high-quality care as a crucial element of social inclusion and well-being. This ideology reflected mass use of the system to meet a growing portion of needs as the community aged and lost access to steel wages and informal care systems.
178
The Next Shift
Working-class power thus summoned corporate power and private capital into American medicine, as all benefited together from the system’s growth. The weakening of the security of the organized working class in the 1970s opened up space for private, profitable economic activity within a market whose structure and parameters had already been set by organized workers’ power. Yet the failure of private capital to take that industry over entirely is one measure of the persistence of strong communitarian working- class norms. Indeed, capital accumulation found its way into the system first through financial markets precisely by providing a way to continue to meet the demands of working-class security. While there is no doubt that corporate norms and practices proliferated in health care provision, they did so within the shell of nonprofit institutions that remained, in many respects, answerable to the demands of the demo cratic public, through the public’s purchasing power and the policies enacted by the public’s representatives. As with so much of the rest of the postwar welfare state, this inclusivity in turn rested on the exclusion of African Americans and the exploitation of largely Black serv ice workforces. On this basis, hospitals continued to make good on the expectations of the constituencies the hospitals served and to hold together the social bargains that the hospitals represented.
5 Enduring Disaster The Recycling of the Working Class
G
rowing up, Earline and Lou Berry thought they knew how the world worked. They lived in Braddock, Pennsylvania, and as far as Lou—t he younger of the siblings—could tell, it was booming. “In this little one-mile area, we had like three movie theaters, four, five car dealerships. It was a steel town.” The family had settled in the late 1960s in Talbot Towers, a public housing complex just uphill from US Steel’s Edgar Thomson Works. The kids grew up there, raised with the collective help of their neighbors. For African American c hildren growing up in Braddock in the late 1960s, the f uture seemed to rest on a simple question: would they be able to attach themselves to the steel industry, entering the portal into economic security through employment or marriage? Earline and Lou’s mother had not done so. Instead, unmarried, she did domestic work, then became a licensed practical nurse, toiling on the edges of social citizenship and leaning when she needed to on her extended steelworker f amily. Earline followed her m other into hospital work u ntil Earline’s high school sweetheart—soon to be her husband—got back from military serv ice and secured a job at Edgar Thomson, and she left the labor market. Younger Lou looked forward to his turn, the day he would walk down the hill to the employment office at “ET” and join the ranks of the steelworkers. “I just knew I would grow up and work in the mill one day. That’s all we wanted.” But the 1970s threw both Earline and Lou off the paths they had i magined. Under the unexpected economic pressure of t hose years, Earline reentered the labor market, first getting a job in day care, then moving through retail work and eventually back into health care. Lou found himself shut out of the steel work he had assumed was his birthright. He worked a little while at an electrical plant, then was laid off. Over the years, he drifted to the economic
180
The Next Shift
margins, doing some hustling, making some money playing guitar. He too found himself, some years later, working for a hospital.1 Lou Berry and Earline Coburn, younger brother and older s ister, both lived through the economic shocks of the 1970s and early 1980s. But their experiences w ere different. Berry was, like many African American men, driven to the edges of the labor market by the waves of layoffs and plant closures that characterized the decade from 1975 to 1985—a period in which the region lost, by one estimate, 150,000 manufacturing jobs. Coburn’s life, on the other hand, illustrates a much less examined, though no less significant, phenomenon: the very same forces causing increasing insecurity for blue- collar workers, particularly African Americans, also created both opportunity and compulsion for w omen to enter the l abor market. The process of working-class decomposition was, at the same time, a process of working- class recomposition.2 Most significantly, the division between these two processes was gendered. The market in men’s labor contracted sharply, and the market in w omen’s labor expanded. Th ese dynamics w ere also racialized. Industrial employers tended to lay off Black men sooner, and for longer, than white men. For this reason, Black women long had participated in larger numbers than white women in waged work. The workforces that grew most during this time were t hose in which Black w omen had already spent years participating, laboring in the lower strata of the hierarchy: doing the laundry, cooking and serving the food, changing the sheets, and cleaning the bodies. While it was common for observers to note the numerical replacement of high-wage industrial jobs with low-wage serv ice jobs, few perceived any connection between t hese processes. “The decline of manufacturing employment was accompanied by a steady increase of employment in ser vice industries,” observed a RAND Corporation study. “For many, the loss of manufacturing jobs meant unemployment or lower-paying jobs in new occupations.” In this typical analysis, the relationship between the two pro cesses appeared to be coincidental.3 The rapid growth in the late 1970s of the largest “new economy” sector, health care, resulted from the interaction between the existing institutions of the welfare state and the broad effects of industrial decline. As growing numbers of people fell out of the net of economic security provided by industrial employment and the social institutions that surrounded it, people
E n d u ri n g D i s as t e r
181
turned to their health care coverage to meet their changing social needs. The management of the newly insecure population became the task of the residual health security institutions of the welfare state, endowing t hose institutions with new purpose and giving them new life. Deindustrialization threw the working-class population back onto the welfare state for survival, testing its component institutions, public and private, disciplinary and emancipatory alike: the family unit, labor u nions and collective bargaining, policing and punishment, social insurance and income support systems. While many social institutions trembled under this pressure, the health care system did not. Thanks to its particular organizational structure, combining public subsidy and regulation with private administration, the health care industry instead prospered: it captured the increased demand for social serv ices with the public footing the bill, even while the industrial economy and other areas of the welfare state collapsed. Postindustrial employment growth depended upon the continuation of social intervention in the economy: keeping the distressed population alive required massive countercyclical public expenditure, which in turn created new investment and a new l abor market.
Deepening Crisis, 1965–1977 Blue-collar Pittsburgh was used to being out of work. A fter the long 1959 strike, steel consumers had begun to stock up or look overseas in anticipation of interruption in domestic steel supply. Although t here was no strike in 1965, this pattern led to steel gluts, slack markets, and layoffs, especially for Black steelworkers disfavored by internal segregation of seniority lists— while eating away at the workforce as a w hole. As a result, US Steel began lobbying the u nion for a deal swapping guaranteed annual wage increases for the u nion’s promise not to strike for new contracts—the so-called Experimental Negotiating Agreement (ENA).4 Employment security, however, proved illusory. Overall employment in the Pittsburgh-a rea labor market reached a peak in 1967, when US Steel first conceived the ENA. Beneath the temporary bounce, technological upgrades and global competition were eating away at steel employment from within and without. In 1965, for example, US Steel finally caught up with competitors and installed a basic oxygen furnace at Duquesne Works, laying off scores
182
The Next Shift
of workers from the obsolete open hearth furnace. Fitting the classic racialized pattern, only a handful of t hese layoffs w ere in the all-white skilled trades, while dozens were general laborers and second and third helpers—positions likely held by African Americans. Overall, the workforce fell from 671 hourly employees in the open hearth to 304 working in the new basic oxygen furnace.5 By the second half of the 1960s, a rising sense of instability was creeping into steel work, intensifying its daily dissatisfactions, especially for Black workers. In 1968, Pittsburgh saw a worse unemployment rate for African Americans than any other major city in the country, surpassing runners-up St. Louis, Detroit, and Newark. At the same time, though, many had a hard time imagining that the unemployment rate reflected anything worse than the ordinary cycle of layoffs, callbacks, injuries, and strikes.6 Although management began denying the possibility of plant shutdowns as early as the 1960s, the shuffling and downsizing of workers sent a clear signal otherw ise. “We have been told that many of you have heard a rumor that Jones & Laughlin management has decided to phase out or abandon the Pittsburgh Works. This rumor is not true,” explained the president of Jones & Laughlin to employees in 1969. Management had invested $100 million in upgrades over the course of the 1960s. “Would we have done this if we planned to abandon the Pittsburgh Works?” But the company was losing money on the plant. “Let’s face the realities of life. Regardless of management’s intention, regardless of the facts related here, our customers can phase out the Pittsburgh Works by placing their steel o rders with our competitors, and they w ill do so if our quality and serv ice continue downhill.” 7 This confusing, turbulent pattern was the puzzling situation as layoffs sped up in the early 1970s. In recessionary 1971, almost as soon as the ink was dry on the new industry-w ide contract, steel management announced massive layoffs. In western Pennsylvania, forty-seven thousand steelworkers w ere out of work in August. Blithely, a union representative described the situation as an extra vacation—“a second bonus.” The industry seemed to recover over the next several years, only to sink again in 1974–1975. Coming off that recession, the jobless rate in the area spiked up to almost 9 percent and stayed t here for several years. Even then a state labor administrator commented, “Steel is in a temporary decline. Once steel comes back unemployment w ill
E n d u ri n g D i s as t e r
183
drop here.” Half the time, steelworkers could explain this as the ordinary cycle of boom and bust.8 Other times, something worse seemed to be afoot. For Black workers especially, the situation grew increasingly dire. When US Steel responded to civil rights protests and a lawsuit by auditing its National Tube plant in Mc Keesport in 1972 for racial patterns of employment, it found almost no Black workers. Because of weak demand, the blast furnace was shut down, which meant that most African Americans had been furloughed. The confinement of Black workers to seniority lines in the hottest, dirtiest departments led to a set of lawsuits aggregated and settled in a 1974 consent decree. U nder this settlement, steel mills and the union began affirmative action hiring of women and African Americans and to shift to a plant-wide rather than departmental seniority system. In theory, this gave Black workers the chance to rise out of the coke ovens, blast furnaces, and open hearths.9 In retrospect, the consent decree appears more as a diagnosis of the industry’s discriminatory practices than a prescription to correct them. The consent decree emerged from protests driven by unequal employment practices in the slowly worsening 1960s; it addressed some such practices just in time for the entire industry to begin its downward spiral. Moreover, many who gained brief access to new jobs faced daily harassment. LaJuana Deanda, for example, hired at Homestead Works in 1974, once had to punch a foreman who tried to grope her: “You got to stop the men before they get started.” Many in similar positions spent weeks “on probation” before being failed on physical tests designed to show they could not do jobs they had been doing already. Women employed at Duquesne Works protested, “We have gotten special ‘attentions’ from foremen and fellow workers. . . . We have to put up with super-tests and super-harassment to try to prove that we c an’t do the work.”10 At the same time as tension was growing on the shop floor, the companies prevailed on the union to agree to the ENA. By trading the right to strike for guaranteed wage increases, the union deprived members of their most potent tool for resisting the worsening economic situation. Three large Pittsburgh-a rea u nion locals, at Aliquippa, Edgar Thomson, and Clairton, soon voted to condemn the agreement.11 Out of t hese dilemmas, rank-and-fi le insurgency boiled up once again in the United Steelworkers of America. In September 1976, Edward Sadlowski Jr.,
184
The Next Shift
director of the union’s Chicago district, announced his intention to challenge favorite son Lloyd McBride for the presidency of the international u nion. “Our wages have slipped way b ehind. Unemployment has thousands of our union brothers and sisters out on the streets,” argued a pro-Sadlowski pamphlet. “One out of five steelworkers is without a job. In the last twenty years, we have lost 100,000 jobs.”12 Sadlowski’s campaign, with its slogan “Fight Back,” targeted u nion bureaucracy over the sense that work slipping out of control. Grievances took months to resolve, jobs w ere becoming insecure, and an undemocratic u nion had traded away the right to strike. “We know what it is like to buy groceries at ever rising prices and to try to balance the f amily budget. We know what it is like to be laid off or to try to survive on short work weeks. We’ve seen too many of our neighbors and fellow workers unemployed, trying to keep their kids in school and put food on the t able without a regular income,” argued Sadlowski’s slate. “While the problems are not new, they are getting worse.”13 Reflecting rising uncertainty about the very f uture of industrial work, Sadlowski gave an interview to Penthouse magazine in which he oddly seemed to endorse layoffs. “We have already benefited from what our brains have produced technologically. We’ve reduced labor forces (in basic steel) from 520,000, fifteen years ago, to 400,000. Let’s reduce them to 100,000.” The left- wing challenger put a proletarian spin on the postindustrial discourse of the time: “There are workers right now who are full of poems and doctors who are operating cranes.” A doctor, he suggested, “is more useful than a man with the capacity to be a doctor spending his life on a crane.”14 Correctly perceiving that labor was being reallocated between sectors by powerful forces—if not quite grasping the dimensions of this process in terms of education, race, and gender—Sadlowski still saw far. Nobody, he acknowledged, loved working in a steel mill. Perhaps structural economic change could bring greater human freedom—t he true purpose of the labor movement. Advancing a critique of l abor’s productivism, Sadlowski proposed that the “ultimate goal of organized labor is for no man to have to go down into the bowels of the earth and dig coal. No man w ill have to be subjected to the blast furnace. We have already benefited from what our brains have produced technologically. Let’s have the steel industry, by virtue of what it is capable of producing, subsidize education.” Th ose displaced from steel work could “find employment somewhere else,” he argued. “Society absorbs it [surplus
E n d u ri n g D i s as t e r
185
labor].” This proved a difficult position when such brutal work now seemed precious and scarce, and Sadlowski’s opponents made much of his statements, especially since outgoing president I. W. Abel had proposed a “lifetime job security” plan at the u nion’s convention to weaken Sadlowski.15 Despite the fracas, the challenger managed to win the majority of votes in basic steel—t he g reat integrated mill complexes in places like Pittsburgh, Youngstown, and Chicago. His own ambivalence about the industry’s f uture seemed, at least, to match that of the largest bloc of workers. The same issue of a local militant newsletter declaring Sadlowski’s victory at Clairton Works, for example, also reported the closure of several of the plant’s coke oven batteries: “Many ask, w ill these closures be a sign of the future of Clairton Coke Works? Rumors run rampant around mill.” Despite his ability to tap such anxieties and carry the industry’s core, Sadlowski lost narrowly overall, after overwhelming defeat—whose fairness many questioned—in the vast constellation of small shops outside basic steel.16 Sadlowski’s candidacy indexed rising nervousness in the blue-collar world. He saw and acknowledged what was happening to the industry. Despite some ambivalence, he grasped the reality of deindustrialization, which many in the ranks of labor continued to ignore, and he searched for egalitarian possibilities within it. He managed to identify a relationship between the displacement of industrial workers and the growth of the new serv ice economy, although, like most observers, he did not yet apprehend just how little that new economy would provide for his working-class brothers and sisters. The rank-and-fi le organizations that formed Sadlowski’s grassroots base remained important sources of working-class solidarity, fighting for safety, nondiscrimination, and democracy on the job. They captured the leadership of Local 1397 at Homestead Works and turned it into a regional base of working-class radicalism in steel’s final decade. Resembling Sadlowski himself, this milieu formed a creative and radical subculture, full of autodidacts, poets, musicians, cartoonists, and activists.17 The crisis of steel caught many by surprise, but groups of militant workers had their eyes open. It was not within their power to stop what was happening in the industry. Nor—despite their best efforts—could they find a way to translate that disaster into widespread resistance on the scale of the 1930s, as they had hoped to do. But this defeat is no discredit to their creativity and determination.
186
The Next Shift
The Bottom Falls Out, 1978–1985 At the end of the 1970s, steel’s long, slow decline accelerated. Steel mills w ere operating at 78 percent capacity in 1977, the year of Sadlowski’s defeat; imports had risen to 20 percent of the domestic market. On “Black Monday,” September 19, 1977, Youngstown Sheet and Tube closed and laid off five thousand workers—the first major plant closure in basic steel. When Paul Volcker’s Federal Reserve began deflating the economy in 1979, credit-sensitive sectors like real estate and the automotive industry absorbed the immediate shock, which they passed up the supply chain to steel. That year, LTV Steel, which had acquired Jones & Laughlin Steel, shut down the Eliza Furnaces— huge blast furnaces in the heart of Pittsburgh. By 1980, American steel was running at only 50 percent capacity.18 The severe downturn that closed out the 1970s ended the cycle known as “stagflation.” Manufacturers feeling the sting of declining profitability, driven by the resurgence of global competition in manufacturing and inflating input costs, had delayed a major conflict with l abor by assenting to wage increases and passing along the cost to customers as price hikes. Although the two phenomena had been believed to work at odds, a simultaneous increase of unemployment and inflation—stagflation—ensued. This dynamic was the target of new Federal Reserve chairman Paul Volcker when he observed that, for some number of Americans, living standards would have to fall. Steelworkers were just the kind of Americans he had in mind.19 At the level of macroeconomic governance, the phenomenon often called neoliberalism arose in immediate response to the structural crisis of stagflation. Its most dramatic manifestation came in the action of the Federal Reserve in 1979 to contract the money supply—the so-called “Volcker shock.” Because the old industrial centers lay at the heart of the stagflationary dynamic—kept afloat amid sinking profitability by inflation—they were dealt the harshest blow by the Fed’s action. The ensuing recession was most acute for blue-collar workers. In the Pittsburgh area, most of the big mills entered the final phases of their shutdown cycles, zeroing out employment within a few years. A member of the Federal Reserve Open Markets Committee warned Volcker in June 1980, “The steel industry is very much in a state of panic.”20 In Pittsburgh, the downturn was ruinous.
E n d u ri n g D i s as t e r
187
It was thus at the end of the 1970s that the working-class communities of southwestern Pennsylvania tipped from cyclical, gradually worsening distress into general social crisis. Investigating the situation in the steelmaking areas, a group of scholars noted that unemployment had run between 16 and 25 percent above the Allegheny County average before the 1979–1980 recession. Once the downturn began in the middle of 1979, the regional labor market lost more than half of the jobs in the steel industry, with unemployment rates rising in some mill towns almost half again higher than in the county at large. “Until 1980 the decline of the milltowns had been a gradual process marked by a steady out-migration of steelworkers to worker suburbs and by shrinking employment in the mills,” wrote the authors. “The current recession has seriously undermined the already weakened steel industry and speeded the decay of the mill towns. This phenomenon has exacted substantial h uman and economic costs from both the towns and the region and has raised serious concerns that existing development and revitalization strategies w ill be unable to reverse the trend.” There had been a long, slow pro cess of intensifying social and racial segregation in the region: it suddenly came sharply into focus with the 1979 shock. For the region as a whole, unemployment hit 9.7 percent by July 1981—while the United States stood at 7.8 percent.21 Those still hoping for renewed investment and employment in obsolescent steel mills were soon disappointed. In 1982, US Steel went heavily into debt to acquire Marathon Oil for $6.6 billion. Despite denials, the steel g iant was cannibalizing its massive industrial plant—even changing its name to “USX.” CEO David Roderick brushed off complaints, explaining that the company “is not in the business of making steel. It is in the business of making profits.” Shortly a fter the purchase, USX scrapped its plan to construct a continuous caster at its Edgar Thomson Works. By withholding investment in the most significant new technology in integrated steelmaking, the industry’s largest player signaled that it was beginning to extricate itself from production in the Pittsburgh area. By the end of 1983, US Steel mothballed parts of seven mills in the Pittsburgh area. At the same time, LTV began slowly shutting down the remnants of the old Jones & Laughlin complexes in Pittsburgh and Aliquippa. In 1983, steelworker Ed Stankowski was laid off permanently after a series of transfers between LTV worksites: “I was mad. Mad at myself for
188
The Next Shift
having nothing but a beat-up Chevy to show for 25 years of living; mad at someone else, anonymous and distant, for taking away my job, birthright and heritage; and mad at myself again for having bought into it all, for having allowed myself to believe that steel was my birthright and heritage.” By 1983, unemployment reached 17.1 percent—next to 10.8 percent nationwide.22 In 1984, the first outright plant closure came from USX: Duquesne Works, one of the giant facilities on the Monongahela River, which had employed up to six thousand workers at its height. “We’re not making any money in the Mon Valley, so the Mon Valley i sn’t getting any cash to spend for its capital projects,” commented Roderick. The mammoth Homestead Works, almost twice as large as Duquesne by employment, came to the end of a long gradual closure in 1986. Across the river in McKeesport, US Steel’s National Tube Works went down the next year, a fter a similar long decline from six thousand employees at the decade’s beginning. Charles Tice, one of the last workers to go, told the Pittsburgh Post-Gazette that, with their seniority totaled, members of his family had worked one thousand years at the plant. The collapse of an industry of such great historical weight and scope damaged the w hole social structure surrounding and resting on it.23 Existing patterns of social reproduction and community formation gave way, and the population, cut loose, needed to find new modes of survival.
The Multiplication of Poverty From the late 1970s into the mid-1980s, unemployment in the Pittsburgh labor market ratcheted upward steadily, with the number of jobless and insecure accumulating rather than rising and falling as in an ordinary cycle. Twice as many w ere unemployed in 1980 as had been in 1970, which had itself been a recession year. Twice as many again were jobless by 1983 as had been in 1980. As an Urban Institute study put it, “The Allegheny County economy was in recession before the national recession began and remained in recession after the national recession ended.” In 1976, the poverty rate in the Pittsburgh area was 6.7 percent; by 1983, it had more than doubled to 13.8 percent. When the unemployment rate in 1983 for the Pittsburgh metropolitan area peaked at 17 percent overall, it reached a Depression-like 25.6 percent for Black workers. Men were unemployed at a rate of 18 percent, women at 11 percent. These numbers included only t hose looking for work.
E n d u ri n g D i s as t e r
189
abor force participation, however, also lagged well below national levels, L meaning that the balance in Pittsburgh was, in relative terms, tilted away from work and toward forms of collective dependency for working-class survival—on f amily and state support or illicit and informal means of survival. Even those lucky thousands still working in what was left of the steel mills by 1983 found themselves forced to accept outright wage reductions in the new contract, after initially rejecting a concessionary agreement at the end of 1982. In the steel town of Aliquippa, social workers observed a 55 percent decline in earned income from 1981–1982 to 1983–1984. “Falls of this magnitude inevitably set in motion a struggle for individual and collective survival.”24 Because the postwar welfare state had used industrial employment to disburse security to a population far beyond workers themselves, the crisis of industrial employment evolved into a crisis of reproduction: the population lost much of its means for securing the care and support it needed to survive. Laid-off steelworkers could retain benefits for some months or up to two years depending on seniority—but then they were dropped if they had not transitioned to retiree status. Although the majority of steelworker families borrowed from f amily and friends and did odd jobs to get by, in 1983 Pennsylvania’s unemployment fund nonetheless carried more debt than that of any other state in the country—followed by Rust B elt g iants Illinois, Ohio, and 25 Michigan. Many local governments drew as much as half their tax revenue from industrial property, so the idling of the factories was a fiscal catastrophe, causing sharp cutbacks in almost all basic serv ices. At the same time, fiscal austerity at higher levels of government become more severe in the early 1980s. A Pittsburgh-area study found that the 1981 federal budget, which transformed Title XX of the Social Security Act into a block grant program, reduced funding for social serv ices by 25 percent. Attempting to manage the gap blown open in its finances, even Pittsburgh proper—which enjoyed a more diverse tax base than the surrounding mill towns—passed its largest-ever tax hike in 1981, followed by an even larger one in 1982.26 Through the early 1980s, a vicious interaction thus developed between social need and fiscal austerity. A weakening economy drove both greater demand for support and, especially in the context of rising political conservatism at the state and national levels, smaller budgets. In 1982, for example,
190
The Next Shift
358,147 people received social services of some kind from Allegheny County, at a cost of $71.8 million. The next year, 451,103 people—one-t hird of the entire county population—received county social serv ices, at a cost of $70.3 million. In other words, the county served nearly 100,000 additional people on the same budget. Precisely when the need was growing, social support contracted. “We have about 750 people laid off. Those p eople had been laid off a very long time. Most of them have been laid off for a year and a half, to two years,” said Barney Oursler, who had worked at US Steel’s Irvin Works. Oursler had become involved in organizing relief efforts. “We’ve explored most of the social agencies. We’ve looked at all the kinds of groups that are out t here to help p eople. We discovered a c ouple of years ago that t here is not much out t here that is r eally able to h andle that type of disaster, thousands and thousands of people with no income.”27 In the face of the inadequacy of public support for displaced industrial workers, a new radicalism grew up in the Steel Valley. One group, the Denominational Ministry Strategy, consisting of community organizers and a few radical mill town clergymen, staged aggressive confrontations with Pittsburgh’s elites—stuffing dead fish in deposit boxes at banks and interrupting services at elite churches. Another organization, the Tri-State Conference on Manufacturing, taking its cue from radical lawyer Staughton Lynd’s efforts in Youngstown, Ohio, attempted to gain public ownership over idled steel mills. A third, the Mon Valley Unemployed Committee, gave direct support to t hose out of work and engaged in protests and lobbying for support for the unemployed. Still others, clustered around the radical leadership of USWA Local 1397 at Homestead Works, campaigned for Jesse Jackson for president in 1984 and engaged in direct action against US Steel management. All came together periodically, as when Ronald Reagan visited to Pittsburgh in 1983. “I’m h ere to protest against Reagan,” said Andrew Sopko, president of USWA Local 1270 at Ambridge. “This is the worst I’ve seen it in 40 years. Right now, we’ve got 15 people working in the plant. In 1947, we had 4,000.” Protesters demanded an end to cutbacks to social services, accusing Reagan of “turn[ing] his back.”28 The thousands thrown onto public assistance navigated a social policy environment that was increasingly punitive, albeit to different degrees depending on the claims they could make. Unemployment insurance proved more generous than other income support, staying ahead of inflation. But un-
E n d u ri n g D i s as t e r
191
employment compensation had a time limit for individual beneficiaries: Pennsylvania lowered the state’s maximum duration of benefits in 1983 from thirty weeks to twenty-six, even though joblessness typically lasted longer. Supplemental security income, meanwhile, also stayed steady, albeit with tightening eligibility. The federal government cut back Aid to Families with Dependent Children (AFDC) in 1981: 10 percent of Pennsylvania recipients lost eligibility; another 7 percent saw grants shrink. Donna Gonzalez, a single mother with a young child on Pittsburgh’s South Side, was working part-time at a home-care company, earning $498 per month, when the new policy lowered the cutoff for a family of two to $393 and left her ineligible. “They (the government) want you to better yourself,” she observed. “But they slam the door in your face.” Similar to AFDC, both eligibility for food aid and the dollar value of aid contracted.29 The state followed up in early 1982 with further “welfare reform.” Led by Republican governor Richard Thornburgh, a bill called Act 75 established a “workfare” program in 1982, designed to drive recipients of general assistance—“employed, intact families meeting income guidelines, temporarily disabled workers and single, unemployed p eople”—back into the l abor market. By 1983, the reform had removed 10,000–30,000 people in the Pittsburgh area from the assistance rolls—up to one-third of local beneficiaries.30 Meanwhile, services for the most desperate, such as shelter care, w ere even more woeful. In 1981, for example, 17,000 county residents competed for 11,000 places in shelters. Th ese figures represented a sharp increase in demand but not supply from 1979, when 7,000 residents had competed for 8,000 places. Although a 1983 county study predicted that 1,500 p eople w ere at risk of being on the street during the 1983–1984 winter, a follow-up the next year warned, “Current estimates put that figure much higher—over 4,000. The problem is likely to persist and perhaps escalate due to the depression in the smokestack industries and stringent cutbacks in welfare entitlement programs.” Pressure on shelters was overdetermined: some was caused directly by economic calamity; some by fiscal austerity’s aggravation of that calamity; some by the m ental health consequences of the downturn; and some by the deinstitutionalization of the mentally ill population. Th ese forces magnified 31 each other. For policymakers, it was attractive to imagine managing this misery by retraining workers . In his 1983 visit to the city, Reagan visited a local training
192
The Next Shift
center, describing it as “such an example of hope and effort and self-help.” Training, the president suggested, offered a permanent solution to economic displacement, in contrast to “the quick fix” of monetary policy. For years, corporate and policy mandarins in Pittsburgh had imagined high technology and an educated workforce as the answer to the city’s employment problems. “Left alone, our region’s research and development activities w ill continue to employ tens of thousands of Pittsburghers and w ill spin off economic growth in various forms. Yet the potential for something much greater exists,” wrote the Allegheny Conference on Community Development in a 1984 report. To achieve this goal, the Conference called for the “cultivation of the entrepreneurial environment.”32 Steelworkers’ skills, however, remained stubbornly rooted in the old economy. Volunteers at Homestead’s Rainbow Kitchen food bank who collected information from job seekers, for example, discovered a vast repertoire of skills built up by decades of blue-collar life and rendered suddenly worthless. Jim Nowak wrote “Carpenter (Very Good!)” on his job card. Mike Wozniak, who had been a rigger at Homestead Works for twenty-nine years, listed “Burning—Handling Heavy Machinery and Equipment—Crane Repair— High Work—Dismantling.” For work, he was looking for “anything pertaining to above.” Almost invariably, the men had skills in forms of manual labor for which demand was low: plumbing, painting, carpentry, electrical work, roofing, machine operation, and auto repair were common. African American steelworkers often had t hese same skills but had even poorer chances of breaking into these segregated labor markets. Many had acquiesced already to low-wage work: Hank Brown listed his skills as “janitor,” “kitchen help,” “yard work”; Carly Davis wrote, “Security Guard, Child Care.” To retrain this workforce and find it employment in anything other than minimum-wage work—g iven the advanced age of many of the workers— would require massive social investment.33 Here too, the austerity of the early 1980s l imited possibilities. Federal appropriations for job training were halved when the Job Training and Partnership Act replaced the old Comprehensive Employment and Training Act (CETA) in 1982. From 1982 to 1983, the number of people in the area served by public training and job counseling programs collapsed from 24,453 to 7,346. Oursler, now a local unemployed organizer, observed, “There i sn’t any
E n d u ri n g D i s as t e r
193
money to give you training right now and once your benefits run out t here’s no way to support yourself to get training.”34 The unemployed were under few illusions. Monte Lester, for example, laid off from a steel mill in 1982, knew full well that computers were supposed to be the f uture. But he also knew he could not afford retraining, so he got in line for unemployment, despite hating the feeling that “I can’t take care of myself anymore.” Linda Ganczak echoed him, saying of her laid-off husband, “Nobody wants to hire someone that’s fifty years old.” One survey of households in Duquesne stricken by job loss found that only 5 percent sought retraining. “One possible explanation would be pride and a tradition of self- reliance,” suggested the social workers behind the study. “Another would be the possibility that unemployed h ousehold members do not have faith in retraining to help them secure a job.”35 Even the program earmarked for displaced industrial workers—t he benefits provided u nder the 1975 Trade Readjustment Act (TRA)—proved woefully underfunded. The program was designed to pay for retraining, provide basic living support to the unemployed during school, and help them find jobs afterward. In 1983, seventeen thousand people in western Pennsylvania became eligible for TRA benefits; 97 percent were laid-off steelworkers. But, reported the Pittsburgh Press, “the state Department of Labor and Industry, which channels the federal [TRA] money, got only $3.3 million this year— enough to provide training for only 576 applicants.” When the Mon Valley Unemployed Committee surveyed laid-off workers that year, the committee asked workers w hether they planned to go back to school. “TRA—nothing back” was a common reply. Dozens gave responses recorded as “TRA— hoping” or “TRA—waiting.” “I’m seven weeks behind in getting my [TRA] money,” said William Griffiths, laid off from Duquesne Works. “It’s cutting things real close. I’m lucky I can get help from relatives.”36 In different ways, all programs for the unemployed contained assumptions inadequate to the moment. Unemployment compensation was designed for cyclical downturns, rather than the permanent collapse of a century-old dominant sector of the labor market. Direct aid—general assistance and AFDC—was too meager to do much good. And training programs, in addition to being underfunded, contemplated a labor market that would never have room for the displaced steelworkers.
194
The Next Shift
One “social service” for the poor boomed in this period. As industrial collapse reduced tens of thousands of people to labor market surplus and conservative administrations slashed the welfare state, punishment became an attractive strategy for managing poverty. While mass incarceration’s roots were deep and complex, it accelerated in the context of a collapsing labor market. In 1981, the Pennsylvania General Assembly flouted a blue-ribbon commission’s recommendation of reduced and rationalized sentencing. The next year, the state passed a mandatory minimum sentence law. A 1985 state commission reported, “The past five years have been marked by major and continuing increases in Pennsylvania’s county and state incarcerated populations.” Between 1979 and 1984, average daily population of jails and prisons grew by 58 and 60 percent, respectively—additionally swollen by the deinstitutionalization of mental health care and the cutting of welfare support, as historian Anne E. Parsons points out. The Allegheny County jail, like many Pennsylvania carceral institutions, experienced “severe overcrowding prob lems,” incurring a court order “to remedy unconstitutional conditions.” The jail saw its worst overcrowding in 1983, the same year economic conditions in Pittsburgh hit their lowest point. In Homestead, 1984 and 1985 data from the borough police showed that nine out of ten arrestees for misdemeanors, felonies, and outstanding warrants were unemployed. For Black men, 95 percent of those arrested in t hese categories w ere unemployed. Unlike the austerity that struck other institutions that regulated poverty, however, prisons prospered. Over the 1980s, the state went on a $300 million prison construction binge.37
The Demography of Crisis In a city dominated by one industry, the shape of the population itself was molded around steel’s employment patterns, and life courses were normalized to its rhythms. The age structure and patterns of family formation developed in a kind of negotiation with the industry’s whims. Its collapse reshaped the pattern of social life at this basic level. Given steel’s seniority-based structure of security, the downturn meted out harsh punishment on the young, many of whom pulled up stakes. Sharon Browning, who grew up in a steelworker home in McKeesport, watched her cohort leave while still young for the South and Southwest: “Mine’s a gen-
E n d u ri n g D i s as t e r
195
eration that, half of us are gone. Particularly the guys.” Empirical research bears out Browning’s observation. “We note a massive macro-shift from this region to the South and West (states such as Florida, Texas, Arizona and California are the major destinations, very often with a one-way flow),” observed a report for Pittsburgh’s City Planning Department.38 Between 1980 and 1990, the metropolitan population shrank by 176,725, an enormous 6.7 percent loss. As economist Christopher Briem notes, Detroit—the next-largest source of domestic emigration—lost half as many people in the same time, out of a population 70 percent larger than Pittsburgh’s. This was overwhelmingly a youthful phenomenon: from 1980 to 1985, more than 70 percent of net migration was among t hose u nder 29. And it was a phenomenon of unattached men—or a way that men became unattached. A 1984 Princeton University study found that Pittsburgh had the country’s second-lowest proportion of single men between 20 and 59, with only 52 single men per 100 single w omen in this bracket.39 While there was a widespread concern that working-class families were falling apart in the early 1980s, Pittsburgh still remained one of the more married and least divorced cities in the country. When a w oman identified in the newspaper by the pseudonym Ann Hunter left her husband in 1982, after he lost his job and began to drink, she embodied political anxieties about single motherhood and social welfare: she had seven c hildren and was living on public support. In fact, however, divorce was economically risky. Survival now required two incomes where possible, binding women into marriages and causing “expanding [women’s] caretaker roles,” social workers found. “Sub-group variations by age show the younger women spending increased family time trying to pull members closer together and avoiding or smoothing over internal strife,” reported one study. “The older w omen, by contrast, made efforts to affirm solidarity and retain the closeness that had been built in family life even though their households had undergone considerable change. Black h ouseholds especially weathered powerf ul storms, but the women had emerged with a new closeness to their children through f amily time investment.” Closeness, of course, did not preclude conflict. “There were times I couldn’t stand everyone standing around watching me do everyt hing,” reported one w oman married to a laid-off steelworker. Still, as another in a similar situation explained, despite tension with her husband, “I had to keep it as normal as possible.” 40
The Next Shift
196
Summing up the age profile of families fixed in place by necessity, the attainment of retirement (often early) by the large cohort that entered the labor market in the military-procurement steel boom lasting from 1940 to 1955, and the out-migration of the young, we see an extraordinarily rapid overall aging of the population. In 1970, 11 percent of the regional population was older than sixty-five. By 1980, the elderly population—growing fast in both absolute and relative terms—had reached 13.8 percent of the regional population. And in 1990, the elderly made up more than 17 percent of the population (Table 5.1). This expansion of the cohort of t hose over sixty- five was occurring twice as fast as in the country as a whole. Among counties in the nation with at least one million people, Allegheny County ranked second in the relative size of its elderly population by 1990; only Florida’s Broward County was older.41 The absolute number of the extremely old—older than eighty-five—a lso nearly doubled from 1970 to 1990. This segment of the population had the most intense care needs, with thousands requiring assistance completing basic tasks such as eating, dressing, bathing, and walking. And the growth of this population segment was, once again, pronounced in the steelmaking areas.42 The aging of the population put intense pressure on elder care systems, particularly as the fiscal health of local government declined. Th ere were more old people, with fewer young people to support the elderly—d irectly, as unwaged household labor, and indirectly through economic contributions to institutional care. As a 1981 health policy paper put it, “Women are traditionally the caretakers for disabled aged parents. But inflation has forced
Table 5.1. Percentage of population over age sixty-five
Pittsburgh area United States
1970
1980
1990
11 9.90
13.80 11.30
17.33 12.56
Source: Regional age structure data are from “A Time for Concern: The Status of Elderly and Handicapped in Western Pennsylvania,” box 1, Reports on Allegheny County, Archives & Special Collections, University Library System, University of Pittsburgh, Pittsburgh, PA. National comparison comes from Beaufort B. Longest, “The Pattern of Utilization of Inpatient Hospital Serv ices in Southwestern Pennsylvania: Report of a Study,” Health Policy Institute, Policy Series no. 1, November 1980, box 136, folder 8, RHWPA; “Background Information, Long Term Care,” box 88, folder 2, RHWPA; Census of Population, 1990, t able 12, t able 14.
E n d u ri n g D i s as t e r
197
many women to return to work, leaving less time for caretaking.” Extended family clusters, which had long helped households manage caregiving responsibilities, also had contracted: in 1970, 100,665 people in the area lived in households of five or more; this figure fell steeply to 62,699 in 1980. Moreover, those elderly who had pensions and savings found their unemployed family members turning to them. “When they started r unning out of money, they went on to their parents,” described Bob Macey, a mill maintenance worker and u nion officer. “Now the parents of course they worked there, they saved money and they were ready for retirement. Lo and behold this comes along, so it reached a lot deeper than just the employee. It went on into families. And even those people who had saved and were ready for retirement, now were helping their kids. Now everybody is out of money.” Tellingly, a study of a downtown men’s shelter found twice as many boarders over sixty-five as there had been in a 1955 study.43 In a 1978 report, the Health Systems Agency of Southwestern Pennsylvania warned of a shortage of more than five thousand long-term care beds in the Pittsburgh region. In any given week in 1977, social workers reported, many patients in need of placement in long-term care beds w ere waiting for spots; many took up hospital beds while they waited, while others sat at home, demanding the energy of h ouse hold members who might other w ise be working. In 1979, the county commission issued a report on local capacity for elder care needs. The commission found massive shortfalls across the board (Table 5.2). More elders were thus thrown onto the mercy of local and state government just when t hose administrative bodies were buffeted by fiscal crisis and their capacity for meeting the needs of the elderly plummeted.44 The economic decline of the region, while an acute problem for elder care, created dilemmas surrounding all forms of socially produced dependency. The young, although shrinking in numbers, w ere not spared. Between 1960 and 1980, the number of c hildren u nder five fell by half in Allegheny County, from 172,477 to 79,326. Yet this decline did not simply alleviate pressure on services for the young, b ecause of the sharp uptick in the number of working mothers. Among women with children u nder six, only one in seven worked outside the home in 1970. By 1980, this number had risen to one in three. Here, too, the diminution of extended family networks took a toll on informal care systems.45
The Next Shift
198
Table 5.2. Allegheny County needs for persons over sixty, current and projected, 1978–1985 Serv ice required Group meals Center ser v ices Assistance in getting out of h ouse Housecleaning Washing / bathing Maintaining home repairs, heavy chores Transportation Subsidized housing Supervised residence Intermediate nursing care Skilled nursing care Sub-acute care
Needs met, 1978
Total need, 1978
Projected need, 1985
13,000 25,000 4,000
30,000 60,000 25,000
35,000 75,000 30,000
4,600 1,000 1,100
25,000 5,000 35,000
30,000 8,000 40,000
12,600 4,000 3,500 2,000
55,000 45,000 7,500 10,000
65,000 75,000 10,000 15,000
3,500 500
7,500 2,500
10,000 3,500
Source: Planning Committee on Long Term Care for the Elderly, Final Report, June 1979, box 26, item 2, PELR.
Since President Richard Nixon vetoed a bill to establish a national day care program in 1972, childcare had remained a public m atter only for t hose on the economic margins. As Pittsburgh’s Louise Child Care Center put it in a 1976 report, “Who are the c hildren we serve? They are c hildren from single parent families. They are from families in which chronic illness c auses prob lems with care during the day. They are children of working parents. They are children of parents who are training or studying to improve their life situations, or to become independent from public assistance.” The boundary between economic margins and the mainstream, however, blurred as the industrial economy collapsed. While the availability of w omen’s unwaged parenting labor was decreasing, fiscal austerity was constricting childcare options. Under pressure from federal budget cuts and governed by a conservative state administration, the Pennsylvania welfare department reduced its contracts with childcare providers by 10 percent in 1981; simultaneously, the state tightened eligibility requirements and eliminated free care. “Providers report that the elimination of free day care has resulted in a significant in-
E n d u ri n g D i s as t e r
199
crease in terminations at the lower income levels due to parental inability to pay the weekly fee,” found a study of the Pittsburgh area.46 Head Start programs at both the city and county level became similarly stretched. Their budgets remained the same size, while economic stress caused the eligible population of c hildren to balloon. “The target population growth is attributed to higher levels of unemployment and, therefore, more low-income-eligible families. Programs report longer waiting lists than a year ago.” Administrators, while spared direct budget slashing, nonetheless felt both the relative cuts of growing demand and the knock-on effects of budget decreases to related programs, such as in child nutrition. Meanwhile, in the devastated mill towns, deep cuts fell on school systems, slicing into discretionary school activities such as extracurriculars.47 Precisely in the moment that economic and social change began to compel new family economies into being, public policy conspired to obstruct the change. The result was not so much the conservation of old family structures as it was aggravation of the difficulty of transition to two-earner h ouseholds. Working-class women had to deal with increasingly contradictory demands on their time and energy and had to do so using scarcer resources.48 Young p eople—especially African Americans—raised in this environment entered a brutal l abor market. The RAND Corporation study of Pittsburgh’s education system and labor market, for example, had expected to find rising wages for entry-level jobs, since a diminishing pool of young potential hires should have driven up the price of labor in that age cohort. But downward pressure on the higher tiers of the labor market instead cascaded into and swamped the entry-level labor market. Employers, the analysts observed, had no trouble attracting such workers, “because they could draw on a pool of underemployed workers displaced during the massive shifts from manufacturing to service employment e arlier in the decade.” 49
Sickness and Health Such a calamity was bound to inscribe itself on the bodies of t hose subjected to it. “Studies of the effects of economic recession on the health care system,” warned a group of Pittsburgh scholars at the time, “have shown that unemployment is linked to poorer health status and increased mortality in the long term.” In capitalist societies, where survival is linked to market employment,
200
The Next Shift
job loss wreaks havoc on working-class p eople’s physical and mental health— an effect powerf ul enough that social scientists and epidemiologists have measured it in one form or another across widely disparate capitalist socie ties in different historical moments. This effect clearly appeared in Pittsburgh. In their 2009 study, for example, economists Daniel Sullivan and Till von Wachter find a huge initial mortality increase for Pennsylvania workers laid off between 1980 and 1986: “Our estimates suggest a 50%–100% increase in the mortality hazard during the years immediately following job loss. The estimated impact of displacement on annual mortality rates declines substantially over time, but appears to converge to a 10%–15% increase in the hazard rate.”50 While it is not possible to fully reconstruct historical epidemiological data from this episode to scientific standards, t here is no reason to believe that the common pattern would not apply—particularly given that the people in the midst of this crisis saw it for themselves. “The first year that Carrie Furnace was down and out, I think there was 14 heart attacks,” recalled Pee Wee Veri, a laid-off boilermaker. Michele McMills, who was hired in forge repair after the 1974 consent decree, described seeing “a lot of real physical illness, people in their thirties dying of cancer from the stress, a lot of suicides. A number of people that I worked with were suicides. A lot of premature heart attacks.” Indeed, Lloyd McBride himself, the president of the USWA, dropped dead of heart disease in the early 1980s—a death journalist John Hoerr attributed to the stress of trying to serve a membership undergoing crisis. Low birth weight rates for African American newborns rose steadily in the early 1980s, reaching a peak concurrent with the l abor market trough of 1983. “We are seeing more sick infants now than we ever have before,” announced Dr. Ian Holzman, a specialist in acute infant care at Magee-Women’s Hospital. “I am disturbed that infant mortality increases when unemployment increases.”51 A major part of the public health impact was affective. As public health scholar M. Harvey Brenner warned in a report for Congress, mass joblessness would drive increases in the rates of schizophrenia, alcoholism, and depression. In 1982, the director of the Allegheny County M ental Health / Mental Retardation Program reported a major uptick in waiting lists for admission to alcohol treatment. A 1984 study confirmed this warning, finding elevated alcohol-related offenses and domestic violence incidents following plant closures. One study found that 82 percent of the unemployed of the Mon Valley
E n d u ri n g D i s as t e r
201
ere suffering depression; the suicide rate in a selected group of valley w towns in 1984, 2.75 per ten thousand, was more than double the national rate. Longer-term comparisons in the suicide rate are possible only at the level of Allegheny County as a whole, so that the acute spike in this rate seen in the steel towns is somewhat diluted. Nonetheless, Allegheny County saw its suicide rate rise from parity with the national rate in 1979—at around 1.2 per 10,000—to 1.34 per 10,000 in 1983, while nationally the rate remained flat.52 Ron McMunn, a Homestead steelworker, was laid off in 1983. “I worked all them years at the plant and I have nothing now. I feel all tied up. I feel like I’ve been all balled up tight for so long now,” he lamented. “I lost my wife and my f amily. I used to get very angry. All the time I was filled up with hatred.” Harry Rhodes, a millwright, hanged himself May 17, 1985, a week after he relented to early retirement. “I can’t go on without working,” read his suicide note. Georgeanne Koehler, a psychiatric aide at St. Francis Hospital, remembered “a lot more people thinking about suicide, I would say. So you spent a lot of time making sure that they knew that somebody loved them, whether or not they worked.”53 The early 1980s saw rapid increases in the number of women and children seeking shelter from domestic violence. In 1983, the director of the W omen’s Center and Shelter of Greater Pittsburgh reported surging need over the previous two years. “More and more of the women we see are reporting that the stress of unemployment is causing their problem,” she observed—noting also that the recession made leaving male partners a more daunting prospect. It appears that from this point t here was further increase: a 37 percent rise in “victims served” from just 1983 to 1985. “Leaving the home, in most cases, is not considered an option b ecause the w omen feel they just c an’t break up the home when employment prospects are dim and financial problems severe for their husbands,” observed Shirl Quay of the W omen’s Center and Shelter in Aliquippa.54 The crisis of manufacturing employment thus remade the population. Bodies were older and more worn, carrying more damage and more needs. At a conference at St. Francis Hospital titled “Unemployment—t he Epidemic Nobody Treats,” sociologist Ann Mooney warned that cardiovascular disorders “typically start increasing about three years a fter the recession.” Cirrhosis, suicide, homicide, admissions to mental hospitals, and infant mortality were all predictable consequences. “Hard times,” Mooney warned,
202
The Next Shift
“make for hard arteries and hard livers.” In 1982, St. Francis proposed an $83-m illion improvement of its psychiatric care capacity. Local regulators weighing the proposal hired consultants from Massachusetts to advise them. One consultant, Bertram Brown, initially observed that “t here is no good method for determining how many psychiatric beds an area needs.” However, “when southwestern Pennsylvania’s mill closings and high unemployment were mentioned to the consultants, Brown said the need for psychiatric serv ices probably w ill increase. A strong connection has been established between increased unemployment and m ental illness, 55 he said.”
The Medical Shock Absorber The health crisis did not go untreated. Disinvestment and austerity made the population sick, but that fact increased, rather than decreased, how much care flowed through the health system. As health policy scholar Buz Cooper observes (in a study of Milwaukee), “High utilization rates are a manifestation of . . . [the] long march toward racial and economic segregation; the painful loss of both its industrial prowess and the low-skill jobs that many of its largest businesses offer.”56 In the moment, many believed that massive industrial job loss would inevitably mean equivalent loss of health care access, since insurance coverage was so intertwined with employment. And layoffs of course did have this result, often ruinously, in individual lives.57 Nonetheless, the aggregate effect was not so straightforward, since it was the health care system—of all social services—that suffered the least from the disinvestment and austerity of t hese years. Ultimately, the health care system and the public support on which it relied came to shelter the economically displaced somewhat. Care for the poor was undoubtedly worse in quality and hard to access. But as an aggregate phenomenon, this care still exceeded the assistance offered elsewhere. Even at the individual level, many of the newly unemployed found themselves able to access care, albeit in stigmatized ways. Avis Smith, for example, laid off from Carrie Furnaces, lost her insurance, could not afford interim coverage, and then accrued some daunting hospital bills for her daughter. At this point, however, she became eligible for state medical assistance. She still
E n d u ri n g D i s as t e r
203
suffered a feeling of vulnerability and dependency b ecause she no longer earned her coverage through her l abor—but she was covered. “It feels miserable when you’re used to paying your own way. Now, your hands are tied.” Another laid-off worker, Bernie Spiewak, echoed Smith, saying, “It’s hard for me to accept anything from anybody else. I’m so used to going out and getting what I need.” When McKeesport Hospital and South Hills Health System partnered to offer free care to the unemployed, the institutions were surprised to find little demand for the program. Those likeliest to be uninsured and without care, it appeared, were also the youngest and healthiest, who were least likely to need care urgently. “We believe people who need care are seeking it,” explained the president of the hospital council.58 Many health providers, still following the logic of communitarian and philanthropic care provision, stepped forward to fill in the gap. In Aliquippa, another steel town, social workers observed, “Members of the unemployed committee issue their needy peers a card that admits them for free health ser vices at the Aliquippa Hospital.” The hospital established extended payment plans for the unemployed—in other words, the hospital used its own relative financial stability in a capital-starved community to generate credit redeemable only at the hospital. In the steel town of Sharon, the general hospital negotiated a monthly lump-sum payment with Sharon Steel Corporation, so that the hospital could offer a free “Emergicare” program to laid-off workers. Nationwide, hospitals generally expanded free care in the hardest-hit places, although not enough to keep up with demand.59 Contracts with the federal government required many hospitals to offer so-called “uncompensated services.” Between 1982 and 1985, the region’s hospitals more than doubled the volume of uncompensated care they provided (in dollar costs). Halfway through the 1983 fiscal year, western Pennsylvania hospitals reported that they had already provided two-thirds of their required yearly quota of uncompensated care and were preparing to dip into the next year’s funds. Additionally, Blue Cross and the region’s hospitals together subsidized an emergency insurance program, offering a year of insurance to the unemployed of western Pennsylvania at a rate 40 percent below cost. “A lot of p eople are not g oing back to work,” observed Blue Cross’s president. “You’ve got to admit t hese are not normal times.” 60 Still, the hospitals in the region remained essentially financially stable in the early 1980s. They could impose markups on private payors and could
204
The Next Shift
extract enough to cover costs from employees by holding down wages and staffing. When faced with limits to Medicaid reimbursement, hospitals made clear they would make the costs up elsewhere.61 After all, Medicaid was expanding in coverage b ecause it worked countercyclically, its enrollment increasing with unemployment—good news for hospitals that might otherw ise care for these patients for less. “Right now we feel the hospitals can and will be able to provide this care,” commented the vice president for finance of the Hospital Council of Western Pennsylvania— though he made ominous noises about the f uture, in line with the industry’s ambitions to reclaim more funds from the state. Recalled psychiatric aide Koehler of this time, “We started taking in more and more people that went from middle class to working poor. But at that time, everyone had a right to a bed.” 62 Although Pennsylvania had cut state welfare programs in 1982, health coverage remained intact for many in the recently displaced population. While being on the AFDC rolls qualified someone for medical assistance, those who fell through the cracks but remained on general assistance also had a chance at coverage. This two-track system distinguished the “transitionally needy” from the “chronically needy,” who w ere eligible for indefinite benefits. To qualify as chronically needy and eligible for indefinite benefits, an individual had to establish a recent history of steady employment, be over forty-five, show a disability, or seek addiction treatment. By meeting one of t hese criteria as well as the means test, an individual could maintain full medical assistance coverage. In this way, while the reform was procyclical, bringing austerity to bear on a recession-battered economy, it also carved out modest shelter for the displaced industrial worker. Forty-five was the age when steelworkers with twenty years of seniority became eligible for early retirement if the employer could not offer work. Many steelworkers might be able to show a disability or might seek addiction treatment. Even t hose failing to meet t hese qualifications, however, maintained limited medical assistance coverage. In total, in a given year in the early 1980s, nearly three hundred thousand p eople in Allegheny County made use of some kind of public health assistance (excluding ordinary Medicare usage by the elderly); this figure thus totaled a quarter of the entire population u nder age 65.63 The huge over-65 population, obviously, used much more public health assistance, in the form of Medicare.
E n d u ri n g D i s as t e r
205
In turn, this coverage appeared as a market for providers. For example, Braddock General Hospital, an institution serving a devastated steel community, became the largest detoxification center in the county. Eighty-six percent of the hospital’s patient population was covered by Medicare or Medicaid.64 Statewide, Medicaid grew by one-third over the early 1980s (see Table 5.3). The welfare state, diminished by cutbacks, thus proved more generous with health care than with other serv ices. Health care also remained an arena where organized labor continued to wield some power. Although Republicans in the US Senate defeated a House bill to extend additional funding to states for maintaining health insurance for the unemployed in 1984—a sign of labor’s weakening position nationwide—many of labor’s gains persisted in significant residual form. Even when the union conceded on wages, the USWA had stood resolute on medical and retiree benefits in 1983 contract negotiations. Then in the b itter 1986 USX strike, labor reporter John Hoerr observes, the workforce’s age composition meant that the “steelworkers w ere willing to sacrifice practically anything except pension and health insurance coverage.” In part icu lar, t here were many steel retirees aged 45–65 who would be in a vulnerable position if something happened to their private benefits before they qualified for Medicare.65 Yet this economic vulnerability was still a point of political power. The union successfully resisted cuts to retiree benefits at the bargaining table with USX and through political clout at the other major regional steel company, LTV. When it declared bankruptcy in July 1986, LTV terminated retiree coverage unilaterally, complaining that its insurance program covered more than two retirees for e very active worker. Immediately, Rust Belt political
Table 5.3. Pennsylvania Medicaid expenditures (state and federal), 1979–1983 Year
Expenditures ($)
1979–1980 1980–1981 1981–1982 1982–1983
1.21 billion 1.34 billion 1.44 billion 1.62 billion
Source: Lawrence J. Haas, “Medicaid Cut May Save State $110 Million,” PPG, February 19, 1983.
206
The Next Shift
representatives of both parties sprang into action. Pittsburgh’s own Senator John Heinz, along with Ohio’s Howard Metzenbaum, quickly introduced a bill in the US Senate to restore benefits, while workers at a still-operational LTV plant walked off just after settling a contract. As retirees protested for union leadership to take further action, Heinz convened Senate hearings, beginning with the story of a worker whose benefits w ere cut while he was in the hospital: “When Henry learned that his policy had been cancelled, he told me he felt like taking a dive right out the fifth-story window of his hospital room.” Management backtracked, extending benefits for six months, and the next year the federal government assumed responsibility for LTV’s liabilities. In 1988, Congress took further action, passing the Retiree Benefits Protection Act to add additional security for such liabilities in the future. At LTV, retirees managed to hang on to their insurance u ntil 2002, when the company was acquired and pushed into bankruptcy again by financier Wilbur Ross.66 Repeatedly, then, threats to retiree benefits were turned back, at least in the near term, and t hese forms of security in turn produced significant income for local economies. A 1985 study found that the US Steel retiree benefits program injected $123 million into the steel towns of the Monongahela Valley that year. “If t hose payments had not been t here, the distress in the Mon Valley would have been infinitely worse than what it is now,” reflected Lefty Palm, the u nion’s regional director.67 Tallied together with Medicare and Medicaid, the benefits represented a major countercyclical inflow of income. As social programs carried by the beneficiary to the point of service, health benefits differed from other forms of social welfare, often disbursed through grants to providers, which then served a fixed quota of clients. The entitlement model secured the insuree against absolute exclusion, although it neither guaranteed sufficient or affordable medical service nor, of course, offered the best means to produce good public health. Still, serv ice to the insured got bodies into beds and circulated dollars into the local economy. The pattern obtained across deindustrializing America: in 1981, of the country’s one hundred largest cities, Pittsburgh ranked twenty-fourth in average hospital length of stay; ahead of it were New York, Omaha, Jersey City, Cleveland, Buffalo, Philadelphia, Boston, Baltimore, Yonkers, Detroit, Chicago, Indianapolis, Syracuse, Kansas City, Fort Wayne, Akron, Providence,
E n d u ri n g D i s as t e r
207
Dayton, St. Louis, Worcester, Rochester, Washington, DC, and Milwaukee.68 Of these, only Washington, DC was not a major center of industrial job loss. A major health care market thus prospered even a fter its original industrial basis eroded. Medicare, especially, proved immune to austerity in this time. Even as total Blue Cross coverage in Pittsburgh-area hospitals declined from 37 to 32 percent of patients from 1982 to 1984, Medicare coverage increased from 31 to 35 percent. According to a study of the devastated mill town of Duquesne, “91% of seekers obtained prescription medicine, 93% got hospital care, and 88% obtained other health serv ices.” 69 While fiscal retrenchment caused services to shrink in many sectors, it did not have the same effect with health care provision. As a 1985 Urban Institute report put it, “Federal, state, and local government spending combined declined by 4 percent in Allegheny County. . . . between LFY [local fiscal year] 1982 and LFY 1983 a fter adjusting for inflation.” This was a significantly steeper decrease than what most localities underwent at the time. Yet “the decline in government spending . . . in Allegheny County would have been much sharper had it not been for the growth in spending for the federal Medicare program. If Medicare is excluded, government spending in Allegheny County in these program areas dropped 8 percent.” Medicare alone, in other words, cut the bite of fiscal austerity in half. Over the course of the early 1980s recession, public insurance programs for the first time accounted for more than half of the revenue of Pittsburgh-area hospitals. Considered as a w hole, the regional hospital industry saw its revenues rise dramatically and its margins improve from 1979 to 1982, while the number of hospitals running deficits declined.70 Health care’s unique place in the postwar political economy elevated it above the reach of the recession and accompanying fiscal austerity. Although individuals still often struggled to get sufficient care, the recession left health care in aggregate almost completely unharmed. In fact, investment, which collapsed across the board in other industries, accelerated in the health care sector. In the second half of the 1970s, capital investment in the regional hospital industry had hovered around $85 million annually. In 1979—t he year the Fed tightened the money supply, choking off borrowing and investment in general—i nvestment in Pittsburgh hospitals tripled to $230 million. It grew again to $280 million in 1980–1981. When the state Health Department approved a $127 million project to build a new thirteen-story building
208
The Next Shift
at Pittsburgh’s C hildren’s Hospital in 1981, Governor Richard Thornburgh observed, “The project is expected to provide 200 jobs during the construction and renovation phase, and an eventual 278 additional permanent hospital staff jobs.” The new building, and jobs, sprouted from the ruins of steel.71 This sector was shielded from, and indeed feeding off, the larger socioeconomic disruption. With interest rates high and demand for care soaring, tax- exempt hospital bonds offered a guaranteed safe yield. For hospitals, t here was no reason not to borrow and build. They could pass through the costs of borrowing to the insurer, and demand, undergirded by the public-private welfare state, persisted. A health policy study reported, “The recession accelerated the decline in what has been a long term underlying trend in the older manufacturing industries and halted, at least temporarily, the growth in wholesale and retail trade. During this recent period, the strongest sector of Pittsburgh’s economy has been health and other serv ices.” From 1979 to 1982, “community-w ide hospital utilization and serv ice intensity increased” sharply.72 So secured, the population consumed care prodigiously. Rates of hospital utilization soared. By 1979, the Pittsburgh region generated 1,614 hospital patient-days per one thousand people in the general population—in other words, an average 1.6 days per person. This rate of utilization outstripped t hose of comparable industrial cities, which in turn generally equaled or ran ahead of the national mean of 1.2. Pittsburgh generated 23 percent more hospitalization per capita than the United States in 1979. By 1981, this figure was 35 percent above the national mean (Table 5.4). For this reason, there were more health workers per capita in the Pittsburgh region in the early 1980s than in any other major metropolitan area in the United States—17.3 full- time equivalent hospital employees for every one thousand people in the region, compared with a national average of 13.8.73 Pittsburgh also experienced very high health care costs, although the effect was mainly explained by volume of use rather than higher prices. From 1976 to 1981, the region’s hospitals had plowed $763 million into new capital investments. Over the same period, per-capita health care expenses rose rapidly. Already at 121 percent of the national average in 1976, t hese expenses reached 139 percent by 1981. Capital expansion and more intensive use rose together, underwritten by this sector of the welfare state, which absorbed some of the shock of the downturn. Hospitals could pass through their costs—
E n d u ri n g D i s as t e r
209
Table 5.4. Health utilization statistics, Pittsburgh metropolitan area compared with United States, 1981 Variable Per capita expenses Expenses / day Expenses / admission Patient care physicians / 1,000 population Admissions / 1,000 population Average length of stay Surgical operations / 1,000 population Inpatient days / 1,000 population Outpatient visits / 1,000 population Days / 1,000 population
Percentage of US rate 139 101.6 112.1 109.7 122.3 109.2 138.1 135.2 167.3 136.9
Source: Draft Application for a Stage One Planning Grant to the Robert Wood Johnson Foundation, June 17, 1982, p. 5, box 41, folder 4, ACCDR.
including capital investments—to the third parties that footed the bills, Blue Cross and the federal government most significantly. The existence of a larger and more advanced hospital plant, in turn, encouraged more use. The result was massive provision of hospital care and spiraling costs. In 1980, Pittsburgh had five beds per one thousand people, well ahead of the national average of 4.5. By 1990, a fter $2 billion in debt-financed investment over fifteen years, Pittsburgh would have seven beds per one thousand p eople.74
The New Labor Market For years before the downturn, elite voices in Pittsburgh had called for a more diverse regional economy. The mills darkened the city’s reputation and, many believed, frightened investment away. “We are perceived as an area with high wage costs,” warned the Allegheny Conference on Community Development in a report on regional economic prospects. With the collapse of steel, the transition finally materialized. “In retrospect, while the 1982–1983 recession was wrenching in its effects on the area, it forced important changes in our economy and the way we do business,” the report declared. Creative destruction had done its work.75 The fall of steel had made room for the replacement of manufacturing with “services.” “The most remarkable growth has occurred in the category which
210
The Next Shift
for government data gathering purposes is described as ‘private services’, and which includes such major employers as health care facilities, business support services . . . and educational institutions,” the conference report exulted. “As the employer of more than 85,000 workers, the health care system directly assists the Pittsburgh region’s economic well-being. At the same time, it is an integral element in the community’s quality of life.” 76 Boosters of an economy organized around health care, education, and high technology often seemed to imagine that everyone involved would be a professional. Echoing optimistic predictions over the previous decade, the forecasters at the Allegheny Conference extolled the health care industry for its promise of creating “middle-income service employment with skilled jobs in hospitals, financial serv ice firms, universities, and other places.” As one analyst testified to Congress in 1984, “Only about 2 percent of serv ice employment is in the personal serv ice category. The g reat majority of serv ice jobs are white collar and half of these are found in upper white collar occupations such as professional, technical, administrative and sales functions.” 77 Health care, prospering in the hard early 1980s, did grow remarkably as a source of employment. A later report noted, “Employment in health serv ices in the Southwestern Pennsylvania region during the 1980s was consistently strong through two general economic recessions, and it grew at rates that equalled or surpassed t hose of other service-t ype industries.” Between 1976 and 1982, hospital employment in the Pittsburgh area rose from 39,500 to 51,700—dramatic expansion in a period of such intense economic contraction (see Figure 5.1). Public health scholars took note of this aberrant trend— “the pattern of the early 1980s, in which budget constraints tended to increase hospital staffing needs.” 78 Yet such growth was hardly concentrated in the “middle-income” bracket of the highly skilled professionals. Rather, the rising care economy contributed tremendously to the emerging polarization of the labor market. Nationwide, more than half of all new jobs in the bottom quintile of the wage structure in the 1980s were care jobs of one kind or another.79 Health industry employment grew through the 1980s at a steady clip, ranging between 3 and 5 percent per year. By the end of the 1980s, one in nine jobs in the region was in health care. With time, however, it would become clear that the dream of a city of professionals had not come to pass. Hospital and especially nursing home work required tens of thousands of new
E n d u ri n g D i s as t e r
211
80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 1976
1977
Hospitals
1978
1979
Nursing facilities
1980
1981
1982
Other health
Total
Figure 5.1 Health care employment in Pittsburgh metropolitan area, 1976–1982. Data source: Health Policy Institute, “The Implications of a Changing Economy for the Hospital System in Southwestern Pennsylvania,” p. 54, Box 136, Folder 8, RHWPA.
employees in altogether less prestigious positions. In 1990, average annual income across all occupations in Allegheny County stood at $26,842. Some near the lower bounds of the professional stratum earned more than this: general-duty registered nurses, for example, averaged $33,800 a year (Table 5.5); some categories of technologist averaged around $28,000. But many of the largest categories of work in the health industry received much smaller paychecks. For example, nursing aides averaged $15,500 a year; even licensed practical nurses earned only $22,500. Accounting for inflation, these numbers represented minimal wage gains in the bottom strata of this labor market over the period since the mid-1970s.80 While the negative shock of the early 1980s was quite rapid, the adjustment in some parts of the labor market was overall gradual and somewhat conflictual. Health care attained its leading position over the course of the de cade, and w omen’s presence in the Allegheny County labor market by 1990 had nearly caught up with men’s, but blue-collar employment—still dominated by men—was not wiped out completely. Of employed men, 29 percent still worked in construction, manufacturing, trucking, and warehousing; among t hese, construction—which along with work like auto repair attracted many displaced steelworkers seeking to use their skills—employed the most
The Next Shift
212
Table 5.5. Distribution of health serv ice employment by occupation category in Pittsburgh metropolitan area, 1992 Occupation category Diagnostic and treatment Administration Registered nurses Health and other paraprofessionals and technicians Clerical Health and other serv ice workers Housekeeping, laundry, food, and maintenance
Number of employees
Percentage
Approximate average annual wages ($)
9,830
8.7
90,000
7,647 23,012 17,134
6.9 20.5 15.2
38,000 33,800 24,000
22,456 20,052
20 18
18,400 18,000
12,080
10.7
14,000
Source: Ralph L. Bangs and Thomas Soltis, “The Job Growth Centers of Allegheny County: Interim Report for the Project: Linking the Unemployed to Growth Centers in Allegheny County,” June 1989, p. 19, box 124, folder 3, RHWPA; Margaret A. Potter and Allison G. Leak, Health Care System Change and Its Employment Impacts in Southwestern Pennsylvania (Pittsburgh: Health Policy Institute, University of Pittsburgh, 1995), 24-25.
men. Metal production remained the largest area of industrial employment, although it was down to only 11,934 workers. Three of the region’s large mills—Edgar Thomson, Irvin, and Clairton—remained in operation, with workforces drastically reduced. Food serv ice, wholesale trade, retail, and building serv ice stood out as the other major sites absorbing working-class men’s labor power—a long with hospitals, although men were hired t here in much smaller numbers than women.81 Employers greeted this labor market surplus by seeking to press down wages and destroy u nions. In a 1983–1984 strike, management at a large restaurant, a tourist attraction in a former train station, hired permanent replacements in a strike, who then voted for u nion decertification. In 1985, three locations of Kauffman’s department store decertified the United Food and Commercial Workers a fter a b itter work stoppage. School strikes that year across the suburbs saw would-be substitutes lining up to cross picket lines. “Strikers are crazy if they think people won’t cross a picket line with
E n d u ri n g D i s as t e r
213
unemployment being like it is,” said one replacement worker. “With so many industries closing down, people need work.” And at the end of 1985, the Office Buildings Association of Pittsburgh demanded a 15 percent wage and benefit cut from hundreds of unionized custodial staff, locking them out after they went on strike.82 In the near term, the assault by employers signaled that the low-wage workplaces into which the displaced might move would offer little reprieve. In the building services strike, the union managed to stave off the absolute worst, settling a contract in January that merely froze rather than cut wages while increasing workers’ insurance premiums $46 per month. In the longer view, the confrontation eventually played a key role in the conception of the nationwide Justice for Janitors campaign, a rare labor success story of the 1990s.83 As a general rule, the struggles of the postindustrial working class originated in such defensive episodes, as the labor market surplus brought about by the collapse of manufacturing worsened competition for work, drove down wages, and emboldened employers. This was the economic minefield individual workers had to cross. Mary Washington graduated from Steel Valley High in 1976. Soon thereafter she got a job at US Steel hooking structural steel beams to cranes—thanks, no doubt, to the 1974 affirmative action consent decree. But she lost the job in 1982. A fter a few years without work, she got hired as a nurse’s aide—near minimum-wage work. From her work history, it is clear that she had no formal experience in the field, but the racial and gender structures of the labor market knew where to put her.84 Sharon Browning, a white woman, was the daughter of a steelworker, and she had not anticipated a wage-earning life. “I just thought I was going to get married and I was going to have babies and I was going to stay home like my mom did,” Browning said. After graduating from high school in 1975, she earned an associate’s degree in community m ental health and worked for a couple years in the field. She liked the job, but it paid badly. Once she got married to a steelworker, she quit. But the security that once came with these arrangements was not to be found: “The steel mill industry was already starting to down turn by that time.” Her husband rotated through layoffs for some years. “That was a huge stress financially.”85 In the meantime, in 1986, Browning’s disabled older s ister was diagnosed with terminal cancer. As the family struggled to care for the dying sister in
214
The Next Shift
their home, “I wasn’t working, I was helping my f amily care for her. . . . I was always the one g oing, okay, show me what to do.” A fter she died, Browning realized, “My life’s falling apart. I need to somehow support my f amily, b ecause we d on’t have enough money to get by. . . . I thought, I could do this, I could be a nurse.” She went back to community college. “My spouse was not terribly supportive, but I did it anyway.” She got her m other to watch her kids while she was in class. “There was a good number of women just like myself.”86 There were two paths into the health care industry, and they were racially divided. Hospital and nursing home jobs had already been part of the world of work for African Americans for many years. When Washington went seeking this work, she followed a well-worn route through the l abor market. This had been Earline Coburn’s path back in the late 1960s, when she was newly married and her husband did not yet have his job in the steel mill. She in turn had followed her m other, who had been a nurse’s aide. This had been Joyce Henderson’s path in the early 1970s, when she and her husband Ray found themselves struggling to get by on his steelworker’s wages, so she got a job at a nursing home, then a hospital. African American women took t hese jobs because they needed work and could get it scrubbing bodies, taking vitals, preparing food, and changing sheets. Thea Jackson graduated high school in 1972 but had no work u ntil 1985, when she got an associate’s degree in nursing from the Community College of Allegheny County. In 1985, degree in hand, she sought her first job—in “anything—a lmost.” Much the same was true for Carol Henry, whose husband worked in the mill five years. Then, as times got harder, they got divorced in the early 1980s. “I was divorced, had two kids, and I was like, I am not g oing to be on welfare. . . . Finally I said well, I’ll just go to nursing school.”87 White women, on the other hand, generally wound up in health care work through a process more inflected with religious and gendered ideology—as in Browning’s realization that her familial caregiving could extend to being a nurse. So it was, for example, with Mrs. K., who did “a little help with this one lady that’s been sick, help her out with her h ouse and help her that way to take care of things for her.” The world of such activities was vast, stretching from small-scale family and neighborhood care work to more formal volunteering.88 If circumstances—a downturn, a divorce, a layoff—pointed a woman toward the labor market, health care work was the obvious door to open.
E n d u ri n g D i s as t e r
215
Figure 5.2 Nurse training, ca. 1970. Photo by John L. Alexandrowicz. Allegheny Conference on Community Development Photog raphs, Detre Library & Archives, Heinz History Center.
Terry Chalich, a longtime registered nurse, believed that western Pennsylvania was one of the few parts of the country not suffering from a nursing shortage in the 1980s. “Because a lot of the wives of steel workers . . . were working as nurses” as a result of steel layoffs. Linda Ganczak was one such woman. When her husband was laid off from his crane operator job at the mill, she got a job at a nursing home. “One day I just went into the counselor’s office and said, ‘I think I want to go to nursing school,’ ” remembered Mrs. M. Until that moment, she had never thought about it. But under pressure to come up with a plan, “nursing” was what came out of her mouth. Another steelworker’s daughter—a lso “Mrs. M.”—remembered how her mother “kept herself very, very busy, too, doing her voluntary work over at the Veteran’s Hospital.” The children went to church every morning and the family participated in a range of Catholic and Slovak fraternal organizations. “We always used to talk about being a nun,” she remembered. “We belonged to the Junior Red Cross at that time, and Clara Barton [Society].” For her to wind up training to be a nurse at Mercy Hospital, then, was somewhat overdetermined.
216
The Next Shift
So too with Pearl DaPra, who “devoted her teenage years to the Hospital as a volunteer” before getting a job t here as a licensed practical nurse.89 Two sets of compulsions thus created the new working class in health care. The first, the gendering of care work and the constitution of w omen as caring subjects, ran on a longer time line, operating throughout the course of the lifetime. Working-class w omen were produced as caring subjects in their schools, their churches, their neighborhoods, and especially their families. In the world of the single-wage h ousehold, this care served its purpose in relation to the rhythms of the industrial economy: women cooked for tired steelworkers, disciplined c hildren into the industrial routine, cleaned up the soot from their houses, and scrimped and saved during layoffs and strikes; women tended to their people when they got old or sick. With the decline of the steel industry, however, the gendering of care work intersected with another equally powerful compulsion: economic need. While the long, slow decline of steel employment had taken a steady toll on Black working-class families for decades—creating a well-established pattern of labor force participation for Black women—t hings had gotten dire enough to push large numbers of displaced white women into work only in the final spasm of the steel industry. As a 1986 proposal for recruiting home health aides put it, “The displaced homemaker is tailor-made for the homemaker / home health aide position and could be said to have been in training for the position for years. Many older women have been out of the work force for anywhere from ten to twenty-five years or have never been a part of it. They have brought up and cared for their children and / or nursed elderly parents through illnesses while attending to the numerous duties of running a household. Now, b ecause of either freedom from some of t hese duties, or, more likely, economic need, t hese p eople are joining the workforce.”90
Deciding the Trilemma In postindustrial societies, policymakers must choose two of three desirable outcomes, forming a “trilemma”: low unemployment; rising wages; and fiscal restraint. This choice emerges from the low-productivity and nontradable characteristics of serv ice work. To achieve low unemployment, wages must be driven down for the private sector to create jobs. Or the public sector can absorb the service economy, increasing wages but inflating public deficits. In
E n d u ri n g D i s as t e r
217
the American context, this question was decided already, in advance, by the structure of the public-private welfare state. The institutions of social solidarity from the postwar era became an inertial force, selecting the low-wage, low-unemployment, private-sector path for the postindustrial labor market in the United States in a later moment, when manufacturing collapsed.91 The social fabric of Pittsburgh had been woven around the steel industry. For this reason, the collapse of the industrial workforce did not simply coincide in time with the emergence of the health care workforce. The decline of the one accelerated the growth of the other. The conditions for emergence of health care work w ere embedded in the unraveling of the industrial economy. That is where the market came from, in the form of the aging, ailing, well- insured city; and that is where the workforce came from, as old forms of care provision failed, old survival strategies fell apart, and care became increasingly an institutional question. As a team of social workers found, in a study of the mill towns Aliquippa and Duquesne, “compared with the period before unemployment, the proportions of women who were caring for c hildren outside their own homes, caring for older persons, and participating in community activities had all decreased. The study w omen who had terminated or cut back on t hese outside activities explained that they simply no longer had the time.”92 In other words, what had once been a nonmarket system for social reproduction—conditioned by social policy and communitarian values and practices—became subsumed into formal care institutions in the spasm of the late 1970s and early 1980s. The public-private welfare state activated. Its mechanisms for absorbing the shock into the health system sprang into action as one fraction of the working class crumbled and thereby produced a new industry—w ith a vast new workforce.
6 “The Task of Survival” The Commodification of Care and the Transformation of Labor
T
he patient had come to Henry Clay Frick Community Hospital for work on her pacemaker. While t here, she was advised to have a tumor removed from her right index finger. But the surgical wound became infected, and a month later she was back at Frick to have the finger amputated. As she recovered, a longtime nursing assistant named Elfreida Murray admonished her that these procedures had been m istakes. The patient asked Murray whether she didn’t “think the doctors had done everyt hing they could before amputating the finger?” Murray did not answer the question but “looked at her and smiled.” The patient then appealed to the Murray’s supervisor for comfort. “Proper reassurance was given,” and Murray was punished for undermining the “confidence and trust that [the patient] had placed in the hospital and her physicians.”1 The year before, Congress had enacted the most significant change to Medicare since the program’s creation in 1965. The new “prospective payment system” (PPS) aimed to control costs by restructuring how the program paid hospitals. Since 1965, Medicare had reimbursed hospitals on a “cost-plus” basis: the federal government repaid whatever expenses a hospital had incurred treating a Medicare patient, plus an additional percentage. This system allowed a massive increase in the quantity and cost of care given, since costs were—f rom the hospital’s perspective—i ncome. Hospitals spent the 1970s growing fast, as more beds meant more patients and more revenue. Prices soared and the Medicare budget ballooned, a process that led to concern in Congress and the 1983 reform.2 The new payment system exerted central control over Medicare billing. Hospitals now worked off a fixed price sheet, with each diagnosis worth a certain reimbursement regardless of treatment cost (allowing for regional vari-
“ T h e Tas k o f S u rv i va l ”
219
ation in labor costs). Private insurers, following Medicare’s lead, also generally shifted to prospective payment, but with negotiated rather than administrative prices. PPS thus brought about commodification by bundling hospital services into priced goods. The new system discouraged long hospital stays but inadvertently promoted more aggressive medical interventions, which carried higher reimbursement rates. From 1965 to 1983, hospitals had been rewarded for volume of care—t he greatest component of which was labor. A fter action by Congress in 1983, the reward structure shifted to encourage intensity of intervention. The doctors at Frick Hospital, in other words, w ere newly incentivized to tell their patient that she should get that tumor removed and that finger amputated. Nursing assistant Murray, accustomed to a model in which care moved more slowly, had her doubts. Embodied in the disagreement between Murray and her supervisor, then, was the difference between the decommodified health care that had prevailed in postwar Pittsburgh and the corporate health care that subdued, absorbed, and replaced it. Murray had started work at Frick in 1965. She was an experienced participant in a health care system that she had known for decades as a site of care provision and that was subject to democratic pressure by patients and communities. What she became caught up in, beginning with this 1984 incident, was the transition of the hospital from a labor-intensive, durational model of care to a capital-intensive, interventionist model of treatment. This transition induced a shakeout, with far-reaching effects across the health care system. Smaller and poorer hospitals faded while larger, richer ones grew, leading to a process of industry consolidation. The old communitarian health care system was not so much dissolved as enclosed by emergent corporate giants in the field. Commodification, corporatization, and consolidation brought about new inequalities. One was the inequality among patients created by an uneven health care economy: corporate health empires emerged from prestigious academic medical centers. Such centers cut back caregiving on their economic peripheries, where they inherited community obligations, while offering cutting-edge procedures in the metropolitan core. Equally significant, however, was the workplace inequality brought about by this restructuring. The marginal status of the health care worker, established in the industrial period when the hospital was an institutional adjunct of the factory, persisted
220
The Next Shift
beyond the demise of manufacturing and the extension of legal protections to hospital workers. This marginality was manifest in wages and benefits but also along less tangible dimensions. Corporate hospital systems sought to absorb and mobilize not only the capital of the old community hospitals but also their sentimental, communitarian ideology. At the same time, demand for health care remained insatiable. Adjustment of the financial and corporate structures of health care delivery could change who provided and received care and u nder what conditions, shifting around costs and benefits. While adjustment of the system in the 1980s was designed to diminish consumption, in this way, the baseline need persisted: institutional health care had become too central to the survival and social reproduction of the population. The workforce that produced it, too, proved collectively indispensable—even if internally stratified and individually precarious.
Care and Work Culture Pittsburgh’s health care system in the late 1970s and early 1980s remained the institutional product of the postwar welfare state, stamped by the social power and communitarian values of the organized industrial working class. The system had been swollen by the inflow of income in the 1970s, extending the logic of postwar liberalism into the 1980s virtually unaltered. Health policymakers and economists criticized the system as “overbedded”—afflicted with overcapacity—which encouraged excessive care and drove inflation. Steelworkers’ insurance and Medicare had created a broad social right to care and had stimulated a culture of mass health care consumerism. Working- class people used the system to get their needs met as other forms of security fell away—a v iable strategy for an aging, ailing, well-insured population. Through the 1970s and early 1980s, the decline of steel and the aging of the population had expanded this market, and, in a concrete continuation of the gendered division of labor and caregiving culture in the postwar working class, the w omen who staffed t hese services had been pulled into the labor market by the loss of steel wages and the growth of hospitals. The postwar f amily form h ere functioned as a resource on which employers could draw, mobilizing labor trained and socialized in t hose h ouseholds. As the employee handbook at Columbia Hospital put it, “There is something very special about working in a hospital. W hether or not you are directly
“ T h e Tas k o f S u rv i va l ”
221
concerned with patient care, you get a very special feeling which comes only from working for an organization which cares for the ill or handicapped.” Frick Hospital employee Pauline Oravetz attributed her own work ethic to her upbringing: “We carried w ater and we scrubbed clothes on the board by hand. Th ere’s nothing like the good old days. Let’s face it. We d idn’t say, ‘Mother, what’s t here to do?’ We knew what to do, and we have brought up our c hildren in the same way.” Sally Pearman, an X-ray tech, similarly explained, “I like working with people and helping p eople. Compassion, sensitivity. There’s a religious aspect to it and that’s not to be corny or anything like that. It’s a true feeling I have.” Cecilia Kravice, a nurse’s aide, described an unadulterated pleasure: “I just love going to work and seeing new people and seeing what you can do for them. I get a big kick out of the satisfaction of doing something for somebody.” Regina Horvat named this feeling as her knowledge, since a young age, that she was “good with people,” a quality that she learned from her m other and that her nursing work both drew on and 3 extended. This feeling sustained exploitation. Oravetz, for example, was a ward clerk—a desk job. “But, hey, if Mr. Jones is falling out of bed, I’m not going to let him fall. I’ll do all I can to prevent it. I’m not g oing to yell, ‘Hey nurse, Mr. Jones is falling out of bed.’ I’m going to help him. You’re t here for the good of the patient, regardless of w hether it’s your job or not.” In a labor dispute at Monsour Medical Center, a nurse “testified after 11 years of employment that u ntil very recently she was unaware that she was exceeding the purview of her responsibilities.” As observed by no less than Senator Richard Schweiker, many who worked in health care “would do voluntarily what we could not ask them to do otherw ise.” 4 By weakening the boundary between home and work, this work culture tended to generate everyday tensions between the two spheres and chaos in the lives of women workers. Gale Ridenour, for example, began work as a nurse in spring 1976. While management initially thought she was a slow learner, by midsummer her performance had improved. “Although Gale displayed some hesitance about assuming 3-11 charge, she has done well and has not needed to rely on Ms Hall,” wrote a supervisor in late summer. Then in early autumn, she was in trouble again. “Ms Ridenour has been ill 2 days since our last conference; illness being caused by pregnancy. Ms Ridenour states that her doctor is concerned about her persistent illness, loss of appetite,
222
The Next Shift
weight loss. She is also unable to take vitamins, iron medication e tc. I am placing Ms Ridenour on a three day / week part time basis in an attempt to correct her chronic absenteeism,” wrote the nursing administrator. In October, citing her initial unsteadiness on the job, her bosses fired her. It was not Ridenour’s skill level, then, but her pregnancy that was the reason she missed twenty days over the course of her six months on the job. While the supposed identification between domestic caregiving and workplace caregiving had been a key labor market avenue by which new workers entered t hese jobs, caring on the clock often created turmoil in home lives.5 Workers’ family structures had not adjusted nearly as dramatically as the labor market had done. “Only about 10% of the w omen have husbands who don’t belong to a union,” guessed a worker at Frick. Domestic responsibilities, accordingly, w ere still distributed akin to how they had been in the years of the single-family wage. “While men described themselves as d oing more housework” during the period of unemployment, observed a group of social workers, “women’s assessments of the fathers’ involvement in such chores changed very little over the years.” Said one hospital worker, “The men call us female chauvinists, liberated women. They say, ‘Hey, they think we should be at home in the kitchen.’ ” Another agreed, “A lot of w omen’s husbands don’t like them working around men or around naked p eople. That bothers them. It sounds crazy but a lot of husbands feel threatened.” 6 In the twilight of the single-wage h ousehold, w omen moved into breadwinning roles as h ousehold budgets required, but generally without the enthusiasm of husbands. “In the hospital, t here’s no dignity whatsoever,” explained one worker. “They don’t respect you, and they strip you of everything. You’re put down for everyt hing you do up t here. When I went into nursing, my husband was very proud. I don’t let him know half the stuff that happens in there. If he knew, he’d make me quit no m atter how much we needed the money.” Sondra Bisher lamented, “We had a doctor one time that talked on stress and he said, ‘If your body is tired, you’re sick.’ I work 7 days and I have to come home and clean my h ouse. I’m physically exhausted. My husband’s to the point where he washes clothes b ecause I’m too tired at times. H e’ll pitch in and do t hings, which a lot of them w on’t. A lot of husbands would just say, ‘That’s your job.’ ” Still, Bisher counted herself lucky. “A lot of the girls I work with are divorced, separated, widowed. How do they put in their 8 hours there and go home and take care of a h ouse? I’ve had them say, ‘You have a won-
“ T h e Tas k o f S u rv i va l ”
223
derful husband’ because I’ve come home from work and supper’s on the table when he isn’t working. They have to go home and do it. You put in 8 hours and then go home and run a daughter here and a son t here. How do you get anything done?” 7 Since the health care industry had subsumed care functions and labor supply from the postwar family, care work appeared on a continuum with unwaged domestic work. Workplace conflict in hospitals thus often took on themes of obligation, duty, and guilt. At Frick, for example, workers voted for a u nion in June 1977. But the administration refused to bargain a contract, leading to a strike the next summer. “It was hard,” explained a striker, “standing out t here and wondering what’s going on with the patients. . . . There were stories going around that they were getting better care than before the strike. They w ere acting like the best t hing that ever happened to the hospital was our going on strike.” The strike interrupted the “real” emotional experience of care work—it made workers feel both disruptive and dispensable at once. “They acted like they didn’t really need us. I know they weren’t getting good care. Only the nurses and supervisors stayed in to do the work, and volunteers g oing in once in a while.” One worker told a reporter he went back to work because “he felt guilty.” Charlene Bierer remembered the strike as “a big farce. All they did was make a fool out of us. Th ere were girls from the union going in, hiding in trunks of cars. The union did nothing to them. They w eren’t fined or anything for it. They w ere g oing in and working. And the volunteers. They’d run you down. They were worse.”8
Struggle for the Health Care Dollar As the Reagan era dawned, the health care system remained a welfare state stronghold, particularly in industrial centers like Pittsburgh. Unharmed, even expanded, by the recession and austerity of the early 1980s, its growth could hardly have made a sharper contrast with the deflation and contraction in the rest of the economy. Richard Schweiker, elevated from representing Pennsylvania in the Senate to running the Department of Health and Human Serv ices (HHS) for the Reagan administration, observed in October 1982, “We have just seen hospital costs, many of which Medicare pays, jump another 15.5 percent over the past 12 months—three times the rate of inflation, which has come down considerably in the past year and a half.”9
224
The Next Shift
Blue Cross and Medicare were by far the most important buyers of health care in Pittsburgh, followed by Medicaid. Blue Cross, anchored for years by the enrollment of the vast population of steelworkers and dependents, still held near-monopoly privileges in the private health insurance market. The aging population bulked out Medicare’s role as a buyer of care, while Medicaid too had grown countercyclically through the economic devastation of steel’s collapse. The three insurers—one a nonprofit moored to industrial collective bargaining, two public—together covered 86 percent of patients in the average Pittsburgh hospital. “The style of health care delivery characteristic of the Pittsburgh area is a direct response to the demands of unions for extensive employer-paid health insurance benefits,” wrote a group of health economists in an HHS study. “This historical relationship between cost- paying insurers, hospitals, employers, and unions helps explain . . . why nontraditional forms of health serv ices delivery, notably HMOs and PPOs, have been slow to take root and flourish in Pittsburgh. Such programs are more often sponsored by commercial insurers and by design restrict enrollees’ freedom of choice of provider.” In Pittsburgh, groups of patients, constituted by unions and the welfare state, still defined the market.10 As the example of Pittsburgh suggests—as with 1970s stagflation generally— health inflation as a national economic problem was fed significantly by the industrial urban crisis. While the w hole country felt the effects, it was especially powerful in places with intense patterns of health care consumption and well-capitalized systems geared for those markets. In 1982, the Health Policy Institute at the University of Pittsburgh proposed a drastic local solution: “an annual reduction of 450,000 days of inpatient hospital care in the region.” In parallel, New Jersey, New York, Maryland, Massachusetts, Connecticut, and Washington all had launched experimental efforts in cost control.11 The class relations of the postwar period were undergoing dramatic disintegration and recomposition in deindustrializing cities, a process that manifested itself in expanding social reliance on the health care system. As an expert witness observed at the US Senate Committee on Aging in 1983 (chaired by Pittsburgh Republican John Heinz), the problem of health inflation appeared to be connected to industrial society in general. “The key to the entire reform,” explained a political scientist testifying about the New Jersey approach, “remains the problem of urban hospitals.” Caregiving in the
“ T h e Tas k o f S u rv i va l ”
225
cities was the heart of the m atter because the cities were where the crisis of working-class social reproduction was most intense—t he so-called urban crisis.12 Through the late 1970s and early 1980s, efforts to contain costs at the federal level had proved politically toxic, as too many constituencies remained invested in the expansionary status quo. At the local level, such entrenchment had manifested in vigorous community defenses of particular institutions. Federally, the Carter administration’s feeble price control plan offended the left, center, and right all at once: the proposal did not assert muscular federal power over the insurance industry, as Carter’s challenger from the left Ted Kennedy demanded; it did not satisfy powerful congressional Democrats from the Rust B elt (such as Chicago’s Dan Rostenkowski and St. Louis’s Richard Gephardt), who represented the interests of the expansive and contented hospital industry; and it appeared too invasive and friendly to labor for Republicans. Still a senator in the late 1970s, Pennsylvania’s Schweiker was a leading conservative voice on health care. He detested the price control mechanism and observed what he thought to be another fatal flaw: the bill’s attempt to implement such controls without suppressing hospital wages. “It is simply not fair to exclude from a system of price controls an item of a hospital’s budget which accounts for up to 60% of its costs. . . . Workers w ill have e very incentive to increase their wage demands when they know wages are the only segment of the hospital budget that is not controlled.”13 Opposed on all sides, Carter’s bill was defeated by the Democratic House of Representatives 234–166 in November 1979. Then, under the new Reagan administration, another false start was made in the form of the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982, which authorized reimbursements for average costs rather than costs by individual cases. TEFRA was nonviable by design: hospitals warned that its implementation for any length of time would ruin them. But as intended, the law forced consideration of a second reform. Only after TEFRA was signed into law did Congress and HHS move again for reform in 1983.14 In the end, a version of New Jersey’s system—t he prospective payment system—wound up being a dopted by Congress in the early 1980s. Pennsylvania’s Schweiker, now HHS secretary, midwifed it. The intellectual basis of PPS had been developed at Yale University in the 1970s as an internal accounting device for hospitals: e very patient was classified by “diagnosis
226
The Next Shift
related group” (DRG), enabling the hospital to identify a unitary “product” rather than the bundle of discrete serv ices.15 Schweiker’s staff at HHS combined the experiences from Yale and New Jersey and adjusted them to fit the aims of federal reform. HHS proposed paying hospitals a fixed amount per “product” (that is, by diagnosis) rather than for the total costs of all the serv ices they rendered. The federal Health Care Financing Administration would maintain a list of 467 “diagnostic related groups” (DRGs)—i llness categories within which patients displayed common sets of symptoms requiring commensurable kinds of treatment.16 Under this system, the government affixed prices to DRGs: the amount that Medicare would pay the hospital, regardless of how it went about providing the treatment. Hospitals would be forced to take responsibility for their own costs, shifting the burden from the public to the hospital and implicitly to the overconsuming patient. As Schweiker argued to the Senate in 1983, the proposed system would “establish the federal government as a prudent buyer of services” and provide “incentives for hospital management flexibility, innovation, planning, control and efficient use of resources.”17 Congress proved deferential to Schweiker and the Reagan administration’s agenda, passing the reform with a supermajority and little debate. The widening disjuncture between extreme health inflation and an overall sharp deflationary contraction had created an atmosphere of fiscal emergency and a consensus on the need for reform, while the previous year’s TEFRA had set a time bomb to force further legislative action. Hospitals now understood reform as inevitable and sought only to steer it in their favor. In particular, teaching hospitals extracted what policymakers saw as a “bribe, pure and simple”: legislators proposed to increase their reimbursement rates to compensate them for teaching costs. Moreover, the proposal did not threaten the capital cost pass-t hrough—under which Medicare reimbursed hospitals for the costs of borrowing—t hat had allowed so much expansion.18 Although the reimbursement reform rewired the social compromise of the postwar years, which had linked the interests of patients, hospitals, and doctors in an inflationary cycle, the reform did not attract committed opposition. A year after it came into effect, the American Medical Association found that 63 percent of its members thought care had become worse. Some of the loudest complaints came from Pittsburgh. Senator John Heinz, the Pittsburgh Republican, used his perch as chairman of the Senate Special Committee on Old Age to launch an investigation. Heinz warned that many patients,
“ T h e Tas k o f S u rv i va l ”
227
particularly the infirm elderly, had complex etiologies that eluded a single diagnosis: “The issue is w hether or not, when there are hospital-initiated denials [of care], there is any protection to the patient, and whether given the incentives u nder PPS which, you know, if you are a hospital and you are operating at 50-to 60-percent capacity, it is even more important to be able to make money on the patients that you do get, the incentives can get pretty strong.” In other words, hospitals might both deny admission to patients who needed unremunerative forms of care and, as beds thus emptied out, also try to run up the bill on the patients that they did have.19 Heinz h ere echoed the most influential health policy scholarship opposing DRGs, which had been conducted by Blue Cross of Western Pennsylvania. In this work, researchers found that patients in Pittsburgh-area hospitals did not conform to the diagnosis categories established in the initial Yale program and eventually adopted by Congress. Sounding like nursing assistant Elfreida Murray at Frick Hospital—who got in trouble for advising a patient against excessive intervention—these researchers called for an approach that traced the individual path of the patient rather than fixating on a diagnosis. “Patients who are similar or even exactly the same with respect to their discharge diagnoses can have a number of diverse reasons for hospitalization. Since diagnosis and treatment are determined by the condition of the patient upon admission in conjunction with the differential diagnoses, the use of hospital resources w ill differ accordingly.”20 But the reform promised a rationalization and consolidation that favored powerful actors inside the hospital industry. Under the new instrument of rationing, Medicare paid a fixed price for any given diagnosis. If costs came in below this price, the hospital kept the difference; if costs came in above the price, the hospital ate the overrun. In concept, hospitals would then specialize in the services they provided the best. “Thus,” wrote Pittsburgh health policy analysts, “the incentives facing hospitals were to shorten patients’ length of stay, to reduce inpatient expenses by streamlining staffing to increase productivity, and to avoid [prospective payment] constraints altogether by shifting minor surgical procedures and some other serv ices to the outpatient setting.” Where t here had been communitarian solidarity, PPS would enforce market discipline.21 Reform changed whom hospitals treated, how, and for how long. Lengths of stay shortened, diminishing preoperative and recuperative days. Before the reform, recalled Maryann Johnson, a registered nurse, “People weren’t sent
228
The Next Shift
out of the hospital a fter a day or two.” Stays frequently exceeded a week, even for minor procedures. “The nurses took care of you, prepped you. . . . We didn’t do outpatient surgery back then.” A fter the reform, however, the a ctual mix of patients in a hospital at any given time shifted toward needing more acute care. Inpatient populations became sicker and older. This, in turn, triggered adjustment in the daily round of what hospital workers actually did.22 In the year a fter prospective payment came into force, hospitals began removing beds, shortening stays, and slowing price hikes. Through “utilization review,” they pressured physicians to hold down lengths of stay. The average annual rate of hospital inflation had been 15 percent from 1978 to 1982 but, beginning in mid-1984, fell to 2.4 percent—its lowest level in two decades. Annual patient-days per capita in the Pittsburgh region—the figure that had stood at an astronomical 1.6 in 1979—fell to 1.1 by 1985.23 The Medicare reform thus represented the health policy equivalent of the Volcker shock: the new policy squeezed consumer demand and punished overcapacity in industrial centers, which had manifested through inflation. In aggregate, the reform was financially punishing. Average net operating margins for Pittsburgh-area hospitals stood at 5.1 percent in 1984–1985 but fell by half over the next several years. “Structures built u nder one set of environmental circumstances are not usually well suited to a drastically dif ferent set of conditions,” commented Beaufort Longest, the head of the University of Pittsburgh’s Health Policy Institute in 1988. “The hospital system simply cannot be sustained intact for the indefinite future.” Some hospitals would have to shrink, specialize, or fail.24 Averages, however, w ere deceiving. The hospital industry was not failing overall but rather becoming economically polarized. In 1988, Longest observed, “Sixteen hospitals in the region have had occupancy rates of fifty percent or less . . . while eleven others w ere occupied at more than eighty percent.” The eight metropolitan teaching hospitals enjoyed an average net operating margin of 4.6 percent, compared with the twenty-two nonurban, nonteaching hospitals, averaging –1.9 percent. “Those hospitals that were doing well before PPS report they are doing even better,” noted health economists surveying the Pittsburgh market. Smaller community hospitals in aging postindustrial areas, on the other hand, had prospered on the old payment system. Now cut off from this stream, they suffered. As Longest put it, hospitals could no longer rely on “mere geography”—t hat is, the ties of class
“ T h e Tas k o f S u rv i va l ”
229
and community that had bound working-class Pittsburghers to their local providers in reliable captive markets. As Longest explained, “The system of voluntary hospitals is comprised of individual units with rich and sustained histories of strong, and very specific, community support. In some ways, this can be counted among the greatest assets of t hese institutions.” This asset was grounded in the sense that hospitals genuinely served their communities— that hospitals were, in some emotional if not literal way, owned by their communities. Financial necessities, such as layoffs or cessation of certain ser vices, “may run headlong into the community’s expectations for ‘their’ hospital.” A shakeout was now on the way.25 While struggling hospitals found no resolution to this challenge, the larger, more profitable ones had an opportunity. They invested their profits in “the acquisition of new technologies, equipment replacement, facility renovation . . . and management information systems.” By pushing less acute patients out of the hospital and into outpatient care, the 1983 change led to overall higher rates of inpatient acuity. Whoever was left in the hospital now required more intense intervention. “Acutely ill patients required more diagnostic tests, more medications, more respiratory therapy, and use more high-tech monitoring equipment. Discharging inpatients sooner meant the need to provide more intensive physical therapy, patient teaching, and more careful oversight using sophisticated computer technology,” explained the Health Policy Institute. “More efficient utilization of professional staff required more professional support serv ices.”26 For those institutions that could afford it, the new regime presented an opportunity to grow, not a compulsion to shrink. As economists Daron Acemoglu and Amy Finkelstein observe, the reform had the effect of increasing the cost of hospital labor relative to hospital capital, incentivizing institutions to invest in more advanced technology—if they could afford it. For example, Presbyterian-University Hospital (PUH), the flagship institution affiliated with the University of Pittsburgh, pushed through a $211 million expansion program in the mid-1980s, including two new buildings for medical care and research, a “multi-level addition to its center wing” to house a centralized intensive care unit, and expanded cardiac care and cancer centers. PUH anticipated, for example, a rise from 1,100 cases at its oncology center in 1987 to 1,759 by 1994. Justifying the expansion plan, hospital administrators wrote, “while it is recognized that the region is overbedded by 1034 beds (July, 1986),
230
The Next Shift
it must be understood that the role of PUH goes well beyond the region. It is the nature of PUH’s business to provide cutting edge technology to a type of patient who is more acutely ill.”27 The resulting unevenness within the hospital industry meant that profitable institutions could sell costly services—often on national or global markets—while marginal institutions dispensed care only to their impoverished local communities. “Back in the day, we didn’t get no transplant patients,” remembered Carol Henry, an LPN who started work in 1981. As her career went on, the increasingly marginal hospital where she worked was absorbed by Presbyterian-University, and recovery from transplants—high-cost, capital-intensive interventions—came to occupy more and more of her work.28 Medical intervention and care provision thus became increasingly distinct endeavors—one capital-intensive, the other labor-intensive. On the one hand, t here existed massive opportunity for t hose providers that could afford new investment. On the other hand, marginal institutions now had to ration care for t hose who needed it and enjoyed only residual welfare state entitlement. The separation was spatialized onto the metropolitan geography, distinguishing hospitals in the urban core from those on the deindustrialized periphery. For example, in Aliquippa, a devastated riverbank steel town, an insurance company accused the local community hospital of checking patients in on Fridays to begin tests on Mondays. While denying the charge, an administrator acknowledged, Aliquippa Hospital was proud of having retained its “family atmosphere.”29 This “atmosphere” and what it entailed materially—the access to care maintained by remaindered working-class people in the teeth of tightening austerity—became a site of everyday conflict in health care workplaces.
Hospital Work and the Political Economy of Stress The new environment caused a rapid economic disintegration for the community hospitals serving declining working-class areas. After several years u nder the new system, for example, the administration of Braddock Hospital—serving one of the hardest-hit steel towns—reported “financial deterioration.” The causes: “decline in the steel industry and resultant poor payor mix”; “prospective payment”; “increasing cost of technology”; “industry shift to outpatient serv ices”; “competition in traditional hospital markets”;
“ T h e Tas k o f S u rv i va l ”
231
“shift of admissions to competitor institutions.” Medicare and Medicaid covered 85 percent of the hospital’s patient load. The institution averaged an 8 percent decline in admissions each year from 1984 through 1988. Braddock’s cost per case began to fall steeply by the late 1980s, a sign that expensive—a nd lucrative—cases w ere being taken elsewhere. At the same time, Medicaid cases—some of the least profitable—rose from 11 percent of the hospital’s total patient-days in 1983–1984 to 28 percent by 1991 and eventually were triple the regional norm.30 This intensification of unevenness in the hospital system in turn reshaped health care l abor markets. In aggregate, the regional hospital workforce grew for a decade a fter the 1983 reform—t he counterintuitive result of the increasing acuity of inpatient populations and the corresponding demand for more intensive forms of health care. But this effect, too, was uneven—in fact doubly so. It was uneven within institutions, as more technically specialized job categories expanded to accommodate the rising acuity of patient populations and the financial preference for more intensive interventions, leading to workforces more stratified by skill. And employment growth was uneven across institutions. Economists evaluating the impact of prospective payment observed that “the large, tertiary care facilities, which are doing well financially, have instituted minimal [employment cutback] policies. None of these hospitals have resorted to layoffs or cut wages. . . . The smaller, primary care institutions, however, are cutting back.” From 1984 to 1990, regional hospital employment in aggregate increased by 11.1 percent. But at Braddock, for example, total staff fell off by 14.6 percent over this period. By decade’s end, Braddock Hospital employed only 3 full-time-equivalent employees per occupied bed, compared with 5.8 for Allegheny County hospitals overall.31 This pattern in the hospitals serving destabilized industrial areas stimulated a new form of workplace strugg le for workers: conflicts over staffing levels, hours, and schedules moved to the fore. For example, at Frick, in the declining coal mining area southeast of Pittsburgh, workers had organized and struck in the late 1970s primarily over wages. This was a workforce largely constituted out of the 1970s expansion of health care labor; supplementing lost industrial wages had been the goal for many. Then austerity came in 1983. At the end of the year, in reaction to TEFRA and anticipation of the prospective payment system’s effects, Frick announced massive layoffs and reductions from full-t ime to part-t ime status. “One registered nurse
232
The Next Shift
with seven years’ serv ice was reduced to part-t ime status,” reported a local paper. “She is 5-1 / 2 months pregnant and her husband, a steelworker laid off for two years, is working at a minimum-wage job stocking shelves in the store.” Commented a union official, “She’s g oing to have her baby on medical assistance—an RN.” As Frick shuffled around remaining staff, it produced an emotional jolt. “I never saw so many tears,” said one worker. “I wouldn’t send my dog over t here now. We’ve been shifted so much we d on’t know what we’re doing.” Overall, the number of part-time employees doubled, while full-time staff fell by a quarter.32 Workers began protesting immediately. The move, u nion officials argued, was a violation of the contract, and moreover was only even possible because of the hospital’s use of volunteer l abor. Fifty-t hree workers turned out for an organizing committee meeting on December 18 to plan a response. The next day, they held a candlelight vigil in the cold outside the hospital entrance. Exclaimed a leaflet, “We want to work! We want to serve you, our patients!”33 From employees’ perspective, the new regime intensified temporal precarity, generating asynchrony between work schedules and concrete events in the lives of both workers and patients. While this situation was not new, prospective payment intensified it. On the one hand, work schedules themselves became more erratic with the sudden and dramatic growth of part- time employment. On the other hand, patient needs became more acute. As u nion officer Anne Brumfield pointed out to a Frick administrator, housekeeping employees reduced to part-time “are being told by their supervisor and now their department head, that they must be always available, seven days per week at home for a telephone call to come to work. It has also been reportedly told to these same housekeeping employees that if they cannot be at home for a telephone call they are to call the Hospital each day to check and see if they are needed to come to work.”34 Such conditions might conflict with other imperatives in a worker’s life— particularly for the women in t hese jobs who continued to bear the brunt of domestic obligations. As Joanne Warrick complained after being disciplined for suspiciously calling off work around her normal days off, “The sick and absent days I took for taking my daughter to Children’s Hosp. cannot be helped. I have been having a health problem which will hopefully be corrected with surgery in a few weeks. There are times a person can’t help being sick even if it is before or a fter days off.”35
“ T h e Tas k o f S u rv i va l ”
233
Frick was not unusual. McKeesport Hospital, a steel town institution, went through much the same. “McKeesport Hospital is at 5.0 FTEs [full-time equivalents] per occupied bed. . . . It is a ratio which we cannot afford to maintain,” wrote the hospital’s executive director to the union local president. “The coming year with our anticipated declining statistics and workload, decreased revenues, and increase in competition, requires for the success of McKeesport Hospital a cooperative attitude between the facilit y and the unions.” Total patient-days had fallen from 175,287 in 1972 to 105,325 in 1985. Total staff had peaked in 1982 at 1,851 full-time equivalents and was down to 1,326 by 1987—and the hospital insisted further cuts w ere needed.36 As hospitals shifted toward more acute care and the economically marginal institutions struggled to keep up while revenue plummeted, they passed the cost onto workers in the form of precarious schedules, which manifested as stress. According to The 9to5 National Survey on Women and Stress, conducted in 1984, “The industry which stands out as very stressful is the health care industry. Health care jobs—nurses, health care workers (professional and technical workers overwhelmingly) and social workers—rate their jobs as very stressful more often than the norm.” This survey found that among w omen rating their jobs as “very stressful,” 30 percent reported having headaches “always” or “often,” and 30 percent “sometimes.” Those described as very stressed also reported suffering often or always from “exhaustion,” “anger,” “pain,” and “nerves,” in numbers around and above 50 percent.37 This production of stress is historically observable in everyday life but often only indirectly. For example, a rash of violations of parking policy at Frick in late 1983 and 1984 is a trace of some small-scale rebellion. The worst offender, kitchen worker Phylis Frock, flouted the rules twice in five days. On the first reprimand, “she became very belligerent” and mocked her supervisor’s authority. Four days later, Frock parked in the prohibited zone once more. Again, her supervisor reprimanded her. “[Frock] became very belligerent and loud and said she thought her shift should be allowed to park in the back lot.” As her manager wrote her up, Frock “raised her voice and said she w asn’t going to sign anything. . . . ‘I’m not looking at anything and you can shove it up your ass.’ ”38 Clearly, Frock viewed her supervisor’s authority as illegitimate. But the reason that friction occurred specifically over parking was that she was
234
The Next Shift
r unning b ehind and wanted to park closer. We can only guess why she was late repeatedly: sleeping in b ecause she was tired or sick; dreading leaving for work; lingering too long over a shower or breakfast; or, likelier, hustling family out the door or children to school. Lateness only means selling more time than one has.
Nursing Homes and Home Care In the period from 1965 to 1983, hospitals had served as shock absorbers for disruption in the working-class life cycle. Particularly in aging blue-collar areas, hospitals played an informal role somewhat akin to nursing homes, substituting for unwaged family labor. Industrial decline precipitated out a displaced, surplus population. Management of that surplus was where women’s unwaged family labor and health care labor overlapped most thoroughly. As a report for the regional Health and Welfare Planning Association put it bluntly in 1985, “Long term care is largely a family responsibility. Between 60% to 80% of all care received by the impaired elderly is provided by family and friends, who are not compensated and receive few or no other support serv ices.” But demand for such labor was growing fast. As a home health agency noted, projected need for “homemaker / home health aide serv ices” was expected to double from 1984 to 1990: “Where w ill t hose people come from?”39 With communities aging and unwaged family care increasingly unavailable as women went to work, the pressure to warehouse the huge elderly population intensified. When Congress tightened the valve on the funding stream that had encouraged hospitals to serve this purpose, pressure flowed into adjacent industries. Such care work—everyday life support below the level of acuity hospitals now required—was displaced into nursing homes or onto home-based care. A host of corporate actors—ranging from nonprofit hospitals to for-profit nursing home chains and home care agencies—followed. Medicaid, the only public source of indefinite support for long-term care, fueled this shift. In Pennsylvania, Medicaid expenditures for long-term care rose from $496 million in 1981 to $650 million five years l ater. Through Medicaid, Pennsylvania spent more than any other state except New York on long-term care.40
“ T h e Tas k o f S u rv i va l ”
235
With hospitals incentivized to discharge patients sooner, home care agencies and nursing homes found themselves loaded with a larger and sicker patient population than they w ere used to. “More patients have serious decubiti [bedsores], and require more acute care in general. They find that many more post-surgical patients need visits twice daily, IV antibiotics, hyperalimentation, naso-gastro feedings, tracheotomy, or are ventilator dependent,” commented health economists studying six area home care agencies. The same phenomena appeared among nursing homes. A 1985 study found that approximately 90 percent of Allegheny County’s long-term care beds were occupied, and supply was particularly scarce for the rising number of medically indigent elderly. “There is cause for concern about what is happening to t hose individuals who need nursing care and are not getting it. Too low Medicaid reimbursement rates ($50.14 per day for skilled care, $44.11 per day intermediate care) undoubtedly contribute to the shortage of Medicaid beds.” 41 These economic conditions created restraints but also opportunities. If providers could hold down costs, the demand for more beds was t here. Nursing homes that kept costs low received “efficiency incentive” bonuses from the cash-strapped state. With inpatient hospitalization no longer a viable offering in this market, even some hospitals began angling to get into the nursing and home care business. McKeesport Hospital, suffering financially a fter the Medicare reform, signed a deal in 1984 to construct a 120-bed long-term care facility in its home area. Across the river in Duquesne, the union hall of Local 1256 of the United Steelworkers, which had once represented the thousands employed at Duquesne Works, reopened as a personal-care boarding home—t he same day that USX announced the permanent closure of four more steel mills in the region.42 Bigger players entered the market too. National chain Beverly Enterprises expanded from 4 nursing homes in Pennsylvania to more than 40—several in the vicinity of Pittsburgh. In 1984, the nursing home industry nationwide received 45 percent of its income from Medicaid and Medicare; the giant Beverly, operating 1,025 homes with 115,003 beds around the country, took in 65 percent of its revenue from t hese sources. Almost all of the chain’s capital investment was financed through publicly subsidized debt.43 The key expense in a nursing home is, of course, labor. As was happening in home care simultaneously, time spent by care workers with patients—
236
The Next Shift
measured in frequency of visits and length of stay—decreased as caseloads grew. These life-maintaining forms of care—slower-moving from the perspective of patients—were expanding in volume and, at the same time, intensifying in the pace demanded from caregivers. While caseloads grew in volume and intensity, providers u nder budgetary constraints cut back on care’s substantive content. Researchers for the Serv ice Employees International Union (SEIU), which fought a major campaign against Beverly, noted examples including “neglecting to call back off-duty staff to cover for t hose who call in sick, skimping on food and linens and tightly controlling the use of disposable medical supplies.” Although the state would reimburse for more than one social worker, “in 1984, most Beverly homes in Pennsylvania employed only one.” 44 Like the declining hospitals that they succeeded in the elder-care market, nursing homes created precarity systematically. In a Department of Welfare office case study of five Beverly workers in western Pennsylvania, one was working 103 hours per month at $3.44 an hour, supporting a household of three—including an unemployed man; another in exactly the same conditions worked only 85 hours per month; a third worked 98 hours at $3.96; a fourth worked 85 hours at $3.44; and the fifth, 94 hours at $3.44. None, that is, came close to full-time employment. Accordingly, nursing homes saw extraordinary turnover, with annual rates over 100 percent not uncommon.45 As in hospitals, the work routine in nursing homes apportioned stress. A string of events might reveal the points of strain, as befell a h ousekeeper in autumn 1986 at the Beverly-owned Murray Manor Convalescent Center. Although she did not write her name on her account of how she lost her job, she did record the story meticulously: “I had a lot of family problems the week of Nov 16th with members of my family in the hospital & my daughter in law being operated on in Pitts. Hospital also I was sick & the death of my nephew—I was a nervous wreck.” She called off work to visit her daughter- in-law on November 20, returning two days later, on Saturday. But at seven in the morning on November 23rd, she received a phone call with the bad news that her nephew had died. “I just went to pieces, Arlene Shultz called our Supervisor Elnora Bankosh & told her about it & told her I was g oing home, E Bankosh said ok.” Between her ordinary one day off and the two from which she absented herself with a doctor’s slip, she stayed home for three days. “I still wasnt feeling good but I went to work on Nov 27, 1986 b ecause
“ T h e Tas k o f S u rv i va l ”
237
their was only 2 h ousekeepers (We each had 30 rooms, 38 baths, 7 halls 2 stations Front Lounge station Plus all the other extras).” On her way back to work after her absence, she got a flat tire and had to walk to the house of her son-in-law, whose phone she used to call the laundry at Murray Manor and tell a coworker, Eileen Zeliech, that she would be late. She asked Zeliech to “tell anyone if they ask I got to work at 745.” When she finally arrived, she “got a cup of coffee & went to the dinning room (to try calm down).” A coworker sat with her to help her collect herself, until a man ager, Don, came by. “I got up & went to work it was 5 till 8. But I was so worked up I sign in 700 instead of eight.” Coworker Zeliech noticed the error on the timesheet later and warned the unfortunate h ousekeeper, who corrected it and told her supervisor. A week after the flat tire, however, manager Don summoned her to his office and told the housekeeper that she was suspended u ntil further notice. “I said for what he said falsyfing record. I said what he then said get her out of this room now & escort her out of the bilding.” In the narrative she recorded, the outraged housekeeper enumerated the falsehoods that management itself had inscribed in the records. Some were personal offenses to her, others more hygienic in nature: “Papers falsyfied for state for the soil linen bins”; “Falsyfy records for dryers clean 10:00 + 300 they only clean them at 300.” Other staff observed pervasive shortages of incontinence pads, diapers, and isolation gloves. At one point, scabies broke out, affecting several patients and at least one nurse’s aide, apparently caused by absent supplies and the refusal of the administration to isolate patients. As a worker observed, “Its too costly to keep pts in isolation for the whole week during [treatment] periods.” 46 The consequences of cost-cutting were illustrated starkly when a patient at the home died after routine respiratory suctioning. The nurse, Karen Akers, was experienced and had an “excellent record,” but she and respiratory technician Elizabeth Petrulak failed to turn the respirator back on when they “left to attend to other patients.” A fter the incident, Murray Manor terminated its respirator project—“ for lack of funds”—a nd laid off the workers assigned to it.47 Nursing home and home care workers w ere the most disposable of the health care workforce, even as their work was to manage the slow disposal of o thers. This shared disposability could manifest in negligence or even conflict and violence between caregivers and patients, but it could also produce
238
The Next Shift
conflict between workers and management over conditions of care. In 1985, the o wners of two Pittsburgh nursing homes, Shadyside Manor and Negley House, sold them to a larger for-profit operator. The buyer then laid off about half of each facilit y’s staff, replacing them easily in Pittsburgh’s collapsed labor market. In response, workers picketed the two homes, engaged in civil disobedience, and submitted complaints about patient conditions, arguing that both facilities w ere understaffed and negligent. Two employees at Negley House, Pearl Thomas and Frances Jones, described a steep deterioration in the quality of care after the layoffs. “Patients were excoriated, rough and raw in the groin and buttocks area, fecal matter caked and dried on patient skin, beds not made by 2:30 in the afternoon.” At Shadyside Manor, the African Americans who made up the bulk of the staff alleged that management practiced systematic racial discrimination against both staff and patients.48 Management dismissed the lost skills of the laid-off workers as irrelevant to patient conditions. Administrators argued that long-term care was unskilled and easily performed by interchangeable individuals, citing the threeday orientation for new staff as sufficient replacement for the lost experience of the laid-off workers. Workers’ account of the web of time linking them to the patients—a concept of care as a collective, cumulative, skilled, and social process rather than a bureaucratic and interchangeable routine—did not register. As the administrator of another nursing home wrote, when abuse or negligence happened, it was “generally an isolated act committed by a single individual.” 49 The time-disciplined body of the woman worker in such workplaces became synonymous with the caring subject. In the summer of 1986 at Beverly- owned Murray Manor, management terminated cook JoAnn Ariondo for repeated “poor performance”: specifically, she did not mop the floor often enough. As her manager put it, her work performance “clearly indicates: a) She does not take pride in herself or her job. b) She does not take pride in the facility or her department. c) She does not care about her fellow employees.”50 “Pride” was the affective reward for a proper performance of “care.” Management mobilized the skills and feelings generated by the living experience of w omen in the disintegrating working-class social world—skills and feelings, manifested into labor, by which t hese women held that world together. The employer disciplined and enclosed this living experience into a time-bound regime. Workers felt the offense of this discipline as stress, as
“ T h e Tas k o f S u rv i va l ”
239
disrespect, and often as racism. They responded by arguing for the ethic of care, mobilizing the gendered communitarian ideology that had produced them as caring subjects eligible for such employment in the first place.51 The schedule thus appears frequently as both instrument of power and site of conflict. Such a conflict occurred when Jennifer Lis, a Murray Manor employee, was disciplined for using the Xerox machine to copy the schedule for the 3–11 p.m. shift. Her supervisor acknowledged that staff had a right to the schedule but insisted that they could only copy it by hand. Workers wanted printed copies, however, because a printed copy was more binding, helping to establish predictability. Asked Lis, “Can you guarantee that such a hand- copied schedule w ill be recognized as valid?” Care was impossible to routinize completely—t he quality that made it resistant to automation. Unable to choreograph workers’ movements precisely, management had to enforce work discipline at the level of scheduling, in the abstract measure of time. Even when management budgeted specific quantities of time per task, h uman initiative often altered the schematic. The routine only functioned b ecause workers adjusted it, using their own skill and creativity; management needed them to do so, but punished them for it. This represented the mobilization of gender by the employer. As Lis had to point out, she was not a h ousew ife: “I am not asking to copy r ecipes, but pertinent information to help ensure that staffing at the facilit y runs smoothly.”52 This conflict was endemic to health care work. At St. Joseph Nursing and Health Care Center, which was controlled by Mercy Hospital, workers formed a u nion in the early 1990s. These workers were largely middle-aged black women, many of them heads of their households. Their wages ran between $5 and $6 per hour, and it was not unheard of for one nursing assistant to be responsible for “up to 52 patients—an impossible task,” as an organizer with Local 1199 explained. “The result of short-staffing is that nursing homes have become the most dangerous workplaces in our society, with incidences of employee injury running as high as 40%. Nursing home workers suffer serious injury rates higher than coal miners and construction workers.” At St. Joseph, workers reported for duty “in casts or on crutches b ecause management would rather have them perform light duty than let them collect compensation.” Administrators, whose profit margin required low l abor costs, resisted the union aggressively. Dietary aide Esther Jefferson recorded an illegal interrogation. “On Wednesday, September 30, 1992, I went to the office of Terry
240
The Next Shift
Schiebel, the Director of Dietary, for him to give me my evaluation of my job performance, & I signed it. He then told me he was afraid that the home couldn’t function with a union, & asked me if I had signed a card. Then he said he I know I’m not supposed to ask you that. I said ‘no, you’re not.’ He said ‘The home is afraid, & that you can save somebody . . .’ I just sat t here.”53 As the care workforce became more stratified not just within institutions but across them, this precarity grew. Carol Henry was laid off from Montefiore Hospital in the period a fter PPS, so she found agency work, getting placed on a temporary basis in nursing homes and private residences. “Rough,” she called it. Her ex-husband, a laid-off steelworker, was d ying, and she had to care for him and raise their c hildren while trying to make ends meet. “You need 80 hours in two weeks, but the agency d idn’t guarantee you that. You might work two days, you might work three days. Y ou’re different places, it a in’t guaranteed for you to be [in the same place] the next day.” She was a single mother, but her own mother was able to watch her children while she worked. “I sit back and I think, if it w ouldn’t be for her, I d on’t know if I could’ve done it,” said Henry. “She had to help me. And she did. She practically raised them, as far as the way I was working.” Henry’s precarity became literal a fter bus service in her town was cut back. In winters, she took to sledding on a flattened box down the steep hillside by her house to catch the bus. “I’d catch myself before I’d fly out on that highway,” she remembered. “I did that for years.”54 Such risky routines illustrate the point made by feminist critic Neferti Tadiar about how care labor turns w omen’s laboring bodies into “media” for the making of other lives. W omen working in the service sector, Tadiar points out, “are working all the time, as producers of time.”55 Race and gender worked through women in this industry—Carol Henry and secondarily her mother, St. Joseph’s workers coming in on crutches, and thousands more—to mobilize them as producers of time for their family, for employers, and for their patients, creating profit and lengthening biological life. Th ese women produced time continuously, but as they traversed the boundaries between commodified and decommodified segments of this continuity, they found it, as Henry said, “rough.” Workers’ organization in much of the health care industry, especially hospitals, had mainly fallen into abeyance since the upsurge of u nionism in the 1960s and 1970s. All through the 1980s, unions were mainly on the defen-
“ T h e Tas k o f S u rv i va l ”
241
sive. Yet the proliferation of precarious employment in the industry’s lower tiers was so great that institutional care work and the problems it posed still made themselves apparent in unexpected ways. Care workers intruded into political philosophy in an incongruous musing in Michael Walzer’s 1983 classic Spheres of Justice on “the hardest work, the dirty work, the most intimate serv ice.” “Doctors and nurses, defending their place in the social hierarchy, shift it onto the shoulders of aides, orderlies, and attendants—who do for strangers, day in and day out, what we can only just conceive of d oing in emergencies for the people we love.” Feminist thinkers, meanwhile, engaged the question of care more systematically: sociologist Arlie Hochschild developed the idea of “emotional labor” in the early 1980s; political theorist Joan Tronto asked in 1987, “Where does caring come from? Is it learned in the family? If so, does an ethic of care mandate something about the need for, or the nature of, families? Who determines who can be a member of the caring society? What should be the role of the market in a caring society?”56 These questions w ere not only anecdotal or abstract. Their material dimensions, the everyday conflicts and agonies they implied, w ere developing all around. In her 1985 classic “Manifesto for Cyborgs,” for example, feminist theorist Donna Haraway observed, “Work is being redefined as both literally female and feminized, w hether performed by men or w omen. To be feminized means to be made extremely vulnerable; able to be disassembled, reassembled, exploited as a reserve labor force; seen less as workers than as servers; subjected to time arrangements on and off the paid job that make a mockery of a limited workday; leading an existence that always borders on being obscene, out of place, and reducible to sex.” Haraway saw a relationship between industrial restructuring and “the collapsing welfare state and the ensuing intensification of demands on women to sustain daily life for themselves as well as for men, c hildren, and old p eople.” Similarly, in his speech at the 1988 Democratic National Convention, Jesse Jackson delivered a paean to the supposedly voiceless working poor whom his unexpectedly strong presidential campaign had sought to represent: “No, no, they are not lazy! Someone must defend them because it’s right, and they cannot speak for themselves. They work in hospitals. I know they do. They wipe the bodies of those who are sick with fever and pain. They empty their bedpans. They clean out their commodes. No job is beneath them, and yet when they get sick they cannot lie in the bed they made up e very day.”57
242
The Next Shift
Corporate Consolidation The economic polarization of the health care industry destabilized not just employment within individual institutions but also the organization of the industry at large. An accelerating wave of corporate consolidation crashed over the weakened community hospitals, while prestigious academic hospitals expanded. At the center of the new order stood the cluster of academic hospitals and clinics attached to the University of Pittsburgh. Presbyterian- University was the largest and most prestigious of t hese, although its leadership personnel came from the administration of the affiliated Western Psychiatric Institute and Clinic (WPIC), an institution transformed in the 1970s from an outmoded psychoanalytic facilit y into a money-drawing center for medicalized psychiatry. Emboldened by growing academic revenue and the prices and prestige t hese institutions commanded, their administrators had managed to expand and invest during the mid-1980s when poorer institutions went into steep decline. The centerpiece initiative was a multi-institution university cancer center, which paid off handsomely as a mechanism for pooling revenue from affiliated academic hospitals and attracting additional federal funding.58 The path toward consolidation now lay open. In 1985 and 1986, WPIC’s management established greater control over the specialty Eye & Ear Hospital and, more significantly, Presbyterian-University through formation of a consolidated Medical and Health Care Division (MHCD) of the University of Pittsburgh. Eye & Ear had fallen into disuse thanks to laser eye surgery. Presbyterian-University, in contrast, had become a global leader in specialized treatments, particularly transplants. “When you say medicine, I think transplant,” commented the executive director of the American Council of Transplant Physicians to the New York Times. “When you say transplant, I think Pittsburgh.” Half the country’s liver transplants happened in Pittsburgh. “The hospital’s list of patients reads like an international Who’s Who,” reported the Times, “including several members of the Saudi royal family and other Middle Eastern leaders.” Once WPIC and university administrators were able to get control of both Presbyterian-University and Eye & Ear in 1986, the two hospitals w ere merged, allowing the remunerative transplantation work to expand into the space of the moribund institution.59
“ T h e Tas k o f S u rv i va l ”
243
MHCD thus consolidated control over several major revenue streams. From the time of the consolidation in 1986, MHCD management anticipated that the flagship Presbyterian-University’s revenue base would continue to shift away from the old social insurance sources—Medicare, Medicaid, and Blue Cross. Other streams would rise from 23 percent of income in the mid1980s to 37 percent by 1994—becoming, for the first time, the largest source of Presbyterian-University’s income. The institution could borrow cheaply on this anticipated market share, invest, and expand.60 In this way, MHCD emerged as the medical and economic powerhouse at the center of the regional hospital industry. While high-prestige institutions like Presbyterian-University Hospital prospered, the working-class community hospitals approached collapse. With demand declining, the cost of a bed in community hospitals fell to 70 or 80 percent of what it cost to stay in the more in-demand prestigious institutions, adding to the difficulties posed by t hese institutions’ high vacancy levels and l imited ability to offer costly services. As the journal Health Care reported in a 1989 article, “A Tale of Two Pittsburgh Hospitals,” a mixture of declining reimbursement and occupancy rates, oversupply of beds in the area market, and general rise in the cost of care “have put many hospitals in precarious financial positions just as health care’s importance in the local economy has expanded.” The article compared St. John’s Hospital, which served a “declining and aging population base” on the working-class North Side, with Shadyside Hospital, an institution in an affluent neighborhood. “Not only has our volume increased but our financial viability has increased,” commented a Shadyside administrator. “We’ll be one of the survivors when the shakingout period is over.” The prediction proved half right: St. John’s, the financially weaker of the compared hospitals, was in the process of a merger. Several years later, however, even Shadyside would join the University of Pittsburgh system.61 The unevenness in the overall industry was so dramatic that, at the top end, the nonprofit institutions encountered a semantic and accounting problem: they w ere climbing above the level of respectable revenue for their tax status. “So I asked my boss, is that where the profit is,” explained an accountant at Allegheny General Hospital. “He said no, that’s not profit, we don’t talk about profit h ere. I said OK, what is it? He said ‘Net operating
244
The Next Shift
revenue less expenditures.’ ” Allegheny General, the largest single hospital in the region, posted a positive margin of 14.9 percent in the fiscal year ending June 1988, even after investing millions in new equipment. Its top competitor, Presbyterian-University, ran a healthy 9.6 percent, and in the late 1980s began the process of acquiring its weaker neighbor, Montefiore Hospital.62 The hospitals that did not come out on top, meanwhile, took desperate measures. Before its acquisition, Montefiore had lent money to its doctors to keep them from leaving for other institutions. Similarly, the battered Braddock Hospital attempted to reinvent itself as a for-profit institution through a joint venture with medical staff in 1989. The alternatives w ere conversion to a nursing home or specialty treatment center, or sale to a larger competitor. “Even well-funded institutions have reason to be wary of the future,” editorialized the Pittsburgh Post-Gazette. “Imagine then the task of survival before Braddock General Hospital, which serves a particularly hard-pressed portion of the Mon Valley.” 63 The venture failed. An enormous 86 percent of Braddock’s patients w ere covered by Medicare and Medicaid. Indicating social conditions, psychiatric patients and the chemically dependent formed a huge portion of the patient population. Braddock, in fact, was the largest provider of detoxification ser vices in the county. Such patients were disproportionately covered by Medicaid, making this market a poor financial fulcrum on which to leverage new investment, particularly with cuts to Medicaid accelerating.64 Detoxification and psychiatric care exemplified the slow-moving, unremunerative care demanded late in a steel town’s life-cycle. Within three years of the venture, Braddock’s board acknowledged that “a very substantial number of the patients served by Braddock Medical Center are Medicare and Medicaid insured. The Medicare and Medicaid reimbursement process is currently making it increasingly difficult to obtain the funds necessary to operate the Medical Center. The long range prognosis for substantial financial improvement is not encouraging.” In 1993 the directors began exploring the possibility of a merger as the only alternative to closure. Despite the hospital’s unworkable economics, they did not want to abandon it entirely. After all, Braddock had a base of devoted—if unprofitable—patients who maintained an old attachment. “Anytime I’m not feeling good, my family takes me over to Braddock Hospital and they take care of me,” said 84-year-old
“ T h e Tas k o f S u rv i va l ”
245
Mary Hunter. “All the doctors over t here know me by name. I don’t know what I’d do if they wasn’t around.” 65 The social decline of steel town life had been lucrative, but only up to a certain point. Health care austerity, enacted federally in 1983 and reinforced through cuts to Medicaid for another decade, reversed the dynamic and gradually made economic disinvestment costly for the freestanding community hospitals dealing with the brunt of its consequences. The social pain of deindustrialization, once partly buffered, was now felt in full force. By the mid1990s, the results revealed themselves starkly. Dorothy and Paul Brooks of Vanport, Pennsylvania, had enjoyed a modest but secure blue-collar living. He had been a trucker, hauling steel from the mills. She had worked as a clerk part-time. Paul was laid off in 1982 and spent twelve years in and out of work. In the mid-1990s, in a stroke of bad luck, he developed a lump on his larynx, and she tore her rotator cuff. They were covered by Medicaid u ntil a new round of cuts at the state level hit the program. “It’s a form of euthanasia,” said Dorothy. “If we lose that benefit, and my husband’s cancer of the larynx recurs in the next two years, we w on’t be able to afford to pay the medical 66 bills.” The forces making community hospital care uneconomical were not limited to Braddock. Institutions once swollen by social insurance dollars were starving for funds by the early 1990s. Averaging out their operating costs and revenues, the region’s hospitals in aggregate dipped into the red in 1995 for the first time in years. “We’ll still care for the poor,” said S ister Rosita Wellinger, president of St. Francis Health Center, which lost a federal lawsuit over declining reimbursement rates that year. “But our losses will be terrific. I don’t know how we’ll make it up.” 67 The new powerhouse of MHCD was ready to step in and take advantage. Observed its chief, psychiatrist Thomas Detre, “I thought t hese hospitals eventually should merge into a single entity. I knew this was going to be a long and painstaking process. So we swallowed up little pieces one by one.” In 1990, the University of Pittsburgh administration took more unified control, renaming the division the University of Pittsburgh Medical Center (UPMC). Wesley Posvar, the chancellor of the university, explained, “UPMC is prospering while the University faces a period of austerity. Some readjustment is necessary and fair.” 68
246
The Next Shift
With greater university control, UPMC was able to recycle clinical profits into academic operations. This funding stream enabled the institution to recruit more effectively on the academic labor market, attracting star faculty who could translate research back into greater clinical and research revenue, in turn augmenting the institution’s ability to compete in national and global medical markets. As a direct result, the medical school added twenty endowed chairs between 1990 and 1993. “Our guiding principle,” explained Detre to the joint boards of Presbyterian-University and Montefiore, “has been to create as many linkages as possible among our Medical Center hospitals and affiliated hospitals, the various Health Sciences schools, and other schools and centers of the University of Pittsburgh.” As of 1990, UPMC boasted twentytwo research and clinical centers on the model of its foundational Cancer Institute, with fifteen more in formation. “In addition to providing state-of- the-art care, centers also serve the added advantage of offering comfortable, one-stop serv ice to patients who need a multidisciplinary team to attend to the often complicated medical problems they bring to our Medical Center.” The Sports and Preventive Medicine Institute, for example, included a specialized pain clinic, which in turn provided seed money “for the recruitment of an internationally known biomechanical engineer who will serve as vice chairman for research of the Department of Orthopaedic Surgery,” Detre explained.69 When Detre retired in 1992, the UPMC board appointed his deputy, Jeffrey Romoff—a businessman, not a doctor—to succeed him, despite the overwhelming preference of health sciences faculty for an external search. Romoff represented unabashed embrace of corporate transformation. “We are witnessing the conversion of health care from a social good to a commodity,” he would tell the Pittsburgh Post-Gazette.70 Although Medicare reform had depoliticized health care somewhat in the 1980s, this corporate transformation pushed the issue back onto the national agenda—in a process beginning in Pennsylvania. In 1991, a fter the sudden death of Senator John Heinz, Governor Bob Casey appointed an unknown Democratic policy intellectual and bureaucrat named Harris Wofford to fill the vacancy. Wofford then unexpectedly trounced Republican Richard Thornburgh, the former Pennsylvania governor and current attorney general of the United States, in a special election. Wofford’s surprising strength, all agreed, came from his campaign’s recognition that health care was once more
“ T h e Tas k o f S u rv i va l ”
247
a major issue. Through summer 1991, the issue rose to the top in focus groups and opinion polling and Wofford began campaigning on a demand for national health insurance plan. His victory in the fall sealed the new consensus: health care was at the top of the national political agenda.71 After Bill Clinton was elected president the next year with a campaign run by Wofford staffers Paul Begala and James Carville, this momentum ran disastrously off course. Wofford himself spent 1993 and 1994 backing away from his apparent support for a federal insurance program, busying himself instead trying to strengthen legal protections for retiree health benefits and eventually fighting in favor of the component of the Clinton proposal that called for the federal government to absorb 80 percent of insurance costs for early retirees—a sop to both industrial employers and their u nions. The failure of this proposal in the face of fiscal concerns in the summer marked one of several moments when momentum for Clinton’s plan began to stall: labor was unable to update its vision of employer-based health coverage, and industrial employers w ere now too weak to counterbalance insurance companies.72 Insurers, meanwhile, stood firm against the entire package. While the commercial insurers campaigned savagely against it, their resistance was joined by traditional nonprofits like Blue Cross of Western Pennsylvania, which warned Wofford that Clinton’s plan would be harmful for “high cost” plans and those with “higher risk subscribers” such as itself. Across the country, as Theda Skocpol emphasizes, the idea that reform would endanger Medicare became a central feature of opposition. In other words, the defense of incumbent forms of social insurance paralyzed the effort to reform health care as a whole. The popularity of remaking the system in the abstract deteriorated once it took specific form and encountered the deep roots sunk by the health care industry in multiple sectors of society, aided by the welfare state. To be sure, a vicious propaganda campaign devastated the proposal while its advocates dithered. Nonetheless, the proposal’s defeat had a real material basis in the existing, parcelized institutional structure of health security. Symbolizing the debacle, in 1994 Wofford himself went down to defeat to Rick Santorum, a congressman from the Pittsburgh suburbs who, despite his right-w ing politics, had opposed the North American Free Trade Agreement, voted to prohibit permanent replacement of strikers, and assailed Wofford for voting in f avor of diminished Medicare reimbursements.73
248
The Next Shift
Without state intervention to limit costs, insurers would attempt to do so themselves—an outcome Detre and Romoff had predicted in a 1988 position paper. “The basic premise is that the best and most needed [hospitals] w ill prevail,” they wrote. As a UPMC vice president later observed, “People were very frightened in 1993 to 1995.” He diagnosed the situation in simple terms of market control. “We had to gather power. Against whom? Against what we thought was the insurer. It was critically important that we, the university, needed to have friends.” 74 Gathering power meant, above all, consolidation. An arms race now began. Insurers sought to control prices by recruiting hospitals and doctors to their own networks and directing patients to providers in return for favorable rates. Blue Cross of Western Pennsylvania, still the dominant player in the regional market, moved rapidly in this direction. Providers then came under ferocious pressure to cut costs. The only hope for a hospital to defy pressure on its rates was to command a stronger negotiating position with the insurer by accumulating market share. “The biggest challenge facing hospital administrators today is survival and I mean that literally,” said the administrator of a small hospital in a suburb southwest of Pittsburgh.75 UPMC emerged from its late 1980s consolidation ready for this struggle. Rather than take on Blue Cross directly, the university reached a temporary understanding with the insurer, making Blue Cross the exclusive carrier for university employees. In return, Blue Cross agreed to subsidize some of UPMC’s academic activities. This arrangement bought UPMC time, which it used for further dramatic acquisitions: at a 1996 meeting of hospital CEOs, the g iant warned its smaller rivals, “the window of opportunity is closing quickly.” The prestigious medical center promised significant administrative savings and market advantages to any institution that joined it—and tacitly, bankruptcy for t hose that refused.76 In September 1996, UPMC acquired Braddock Hospital after that institution’s twelve-year decline, promising to maintain service in the area through 1999. This nominal concession recognized the deep attachments still held by the Braddock community to what the Philadelphia Tribune called one of its “few functioning institutions.” Braddock Hospital sent doctors and nurses to treat senior citizens for free. Alcoholics Anonymous used its meeting rooms. It had paid to renovate an old h ouse across the street for addicted
“ T h e Tas k o f S u rv i va l ”
249
Allegheny Valley Hospital r ve
Allegheny
Ri
Aliquippa Hospital
Passavant Hospital
Oh io R iver
St. Margaret’s Hospital St. Francis Hospital
Shadyside Hospital
Mercy Hospital South Side Hospital
borde
a
on
on
g
he
r M
6 km
McKeesport hio Hospital gh e
l a R i v er
Jefferson Hospital
6 miles
unt y border
ug
. ny R
0
ounty
Homestead Hospital
Yo
eny C
West Penn Hospital Columbia Hospital
Braddock Hospital
University of Pittsburgh Medical Center main campus (Children’s Hospital, Montefiore Hospital, Presbyterian-University Hospital, Eye & Ear Hospital, Magee Women’s Hospital, Western Psychiatric Institute and Clinic)
Allegh
Pittsburgh Hospital
Allegh eny Co
Allegheny St. John’s Hospital General Hospital Divine Providence Hospital Central Medical Pavilion
Map 6.1 Hospitals in the Pittsburgh region
others and children. A group called the Mothers’ Community Hope Chest, m which gave away f ree c hildren’s clothing and strollers, worked out of Braddock Hospital. “I c an’t imagine this place without a hospital,” said Albina Zinza, a 71-year old who had volunteered t here for nine years. UPMC’s tentative commitment—a promise of three years’ operation plus minor investments in renovations—represented the twitches of the weakening but not vanished power of communitarian ideology. UPMC assumed Braddock’s $12.9 million in liabilities and its $26.7 million in assets, as well as acquiring its market share.77 The next month came the acquisition of McKeesport Hospital—not a moment too soon for that institution. The year before, Moody’s had threatened to downgrade the hospital’s debt. Moreover, the institution was in an escalating dispute with its nurses’ u nion, which had worked without a contract
250
The Next Shift
for two years. “Management wants the nurses to assume all the risks of ‘same day health care,’ ” said the u nion president at a 1995 rally. “If they don’t schedule enough nurses for a particular shift, they can force them to doubleout regardless of personal circumstances. If they schedule too many nurses, they can call the nurses up an hour and a half before the shift and cancel the day’s wages. Nursing is stressful enough without adding family budgeting and stranded kids to the day’s demands.” A fter two years of delay, McKeesport settled the contract with the nurses’ u nion the month a fter the merger plan was announced.78 In this first wave of acquisitions outside of its Oakland home base, UPMC bought up not only McKeesport Hospital and Braddock Hospital, but also South Side Hospital, Aliquippa Hospital, and St. Margaret’s Hospital. All five institutions served former steel towns or blue-collar neighborhoods. Indeed, all but St. Margaret’s had a direct historical link to a particu lar steel mill. These communities shared resonant memories of contributing to hospital construction with payroll deductions from steel mill wage packets. Several generations of steel town families had used their high- quality Blue Cross insurance to birth their babies and tend to their elders at t hese hospitals. Now, the assets built up and embodied in t hese institutions could be profitably depreciated by the acquirer, the debts written down, and the market share engrossed—t heir long communal history devoured and metabolized. In this same phase, UPMC snatched up Shadyside Hospital—a major prize.79 As consolidation took hold in one sector of the industry, other sectors w ere compelled to follow. In 1995, Blue Cross of Western Pennsylvania began the process of merging with Blue Shield, which covered medical (as opposed to hospital) bills. In 1996, the merger was announced, forming a new firm, Highmark. Doctors, after legal resistance to this consolidation, were soon crushed between t hese two huge, organized players. Now facing a consolidated insurer, hospital giant UPMC in turn invaded the insurance market, launching its own insurance company subsidiary to compete with Highmark.80 The market-power arms race between Highmark and UPMC made other freestanding institutions nervous, driving t hose that could to imitate the two goliaths. On Pittsburgh’s North Side, Allegheny General, the major competitor to UPMC in the hospital market, had also flourished since the early 1980s. Yet this institution watched with alarm as its higher-status university-
“ T h e Tas k o f S u rv i va l ”
251
affiliated rival expanded dramatically and the larger insurers consolidated. To bolster its position and rectify its lack of academic revenue and prestige, Allegheny General had incorporated a larger parent company, the Allegheny Health Education and Research Foundation (AHERF). From 1988 to 1996, AHERF went on an acquisition binge, buying up hospitals and medical schools across the state. Seeking to gain market share, AHERF overextended itself disastrously, particularly by diving into the competitive Philadelphia market. Over little more than a decade, AHERF grew from 3,610 employees to 29,500, and from $329 million in assets to $2.6 billion. Then, hugely overleveraged, it collapsed in 1998 in the largest nonprofit health care bankruptcy in history.81 Eventually, insurance giant Highmark (the former Blue Cross) acquired AHERF’s remnants in Pittsburgh. The insurer bought up AHERF’s hospitals to compete with UPMC in the hospital market, just as UPMC had launched an insurance subsidiary to compete with Highmark in the insurance business. The Pittsburgh health care industry thus became consolidated into two warring vertically integrated firms, one a hospital company with an insurance subsidiary, the other an insurance company with a hospital subsidiary, each seeking leverage against the other. The period of competition and market revolution, in the end, proved short. Less than twenty years a fter federal legislation to introduce market discipline to health care, UPMC controlled 42 percent of the hospital beds in Allegheny County, and its growth was far from complete. Through its expansion, UPMC became the largest regional employer by the late 1990s, having doubled its number of employees from 11,900 to 23,000 in the middle of the decade.82 Oligopolistic market structure in health care emerged in the 1990s in the distinctive context of a disintegrating decommodified system made up of community hospitals, public and nonprofit insurance, and the mass health care provision they enabled. It was thanks to the weakening of these institutions that UPMC was able to emerge and consolidate the market under its control, forcing competitors to join the same pursuit. The assets that community hospitals had built up incrementally—through decades of working people’s contributions of dollars and care, with their own bodies, out of their pockets, and through third parties—became fodder for the emerging corporate empire. Health care had been a kind of constructed commons—a decommodified network of social relationships of collective obligation. Th ese relationships,
252
The Next Shift
while solidaristic, w ere not equal. W omen, particularly black w omen, maintained them at their own expense, while black patients had only partial and diminishing access. Indeed, this system’s fundamental principle was a gendered ethic, in which the work of social reproduction occurred out of the bounds of commerce, as well as within racially segregated compartments. To become the dominant actor in the regional labor and health care markets, UPMC enclosed this commons. Health care was commodified and engrossed into the economy, although quickly consolidated into a noncompetitive form of distribution through corporate integration. Yet, while UPMC needed the residual assets—both material and ideological—of decommodified health care, corporate administrators did not long maintain reciprocal commitment toward the norms of the institutions that they disinherited. UPMC closed down Aliquippa Hospital in 2008, downgraded South Side Hospital to an outpatient clinic in 2009, and shuttered Braddock Hospital, in the face of vociferous local protest, in 2010—finishing off three of the steel town institutions that had been key to UPMC’s growth.83
Working in the New Health Empire The commodification, consolidation, and stratification of the industry in the 1980s and 1990s broke down health care labor and reassembled it in new forms. This transformation in turn became central to the regional labor market writ large, as health care grew across the board. In 1980, 8.7 percent of the labor force in the Pittsburgh area worked in health care. By 1990, this number had climbed to 11.5 percent.84 While hospitals saw dramatic employment growth through the early 1990s, this pattern shifted with the emergence of market oligopoly. Hospital employment peaked in 1993, the inflection point in the corporate consolidation process. But even as hospital work leveled off, health care labor markets in general kept up their expansion, spreading out into other types of institutions; ambulatory facilities, nursing homes, physicians’ offices, and home care agencies all continued rapid employment growth. A fter another decade, health care work overall accounted for 14 percent of the regional l abor force, making it easily the largest industry in the labor market, approaching the direct imprint of the steel industry in its heyday.85
“ T h e Tas k o f S u rv i va l ”
253
Figure 6.1 LaToya Ruby Frazier, Rally to Protest UPMC East, July 2 2012, 2012, gelatin silver print. Courtesy the artist and Gavin Brown’s enterprise, New York / Rome.
Yet precisely because the health care industry had originated in social policy and political conflict rather than profitable investment, health care’s growth and commodification processes continued to produce a daily struggle over the nature of health care work. Was it governed by economic logic or something else? What values underlay the rules? Hospitals, seeking to contain costs in their labor-intensive industry, faced a compulsion to maximize workers’ productivity by limiting their numbers, in the expectation that they would deliver sufficient output regardless. This expectation rested on the inherited care ethic, the cultural substrate left over from the dissolving decommodified system. Management enjoyed leverage in the fact that workers themselves would not allow the vital elements of care work to go undone.86 Much of the output in health care was immaterial, some even immeasur able. Even as health care became increasingly commodified, its intangible
254
The Next Shift
qualities made it difficult to identify a bounded, priced care good for purposes other than reimbursement accounting. Cost-conscious health economists and hospital administrators saw no easy way to increase productivity in direct caregiving jobs. This dilemma even extended somewhat to types of health care work that could be more clearly measured and accelerated: doing laundry, making beds, washing floors, serving meals. In t hese cases too, certain standards of care constituted a quality minimum that management risked violating if it pushed too hard for productivity.87 Yet the only straightforward way for management to increase productivity was to limit how many people it hired or how many hours it gave employees. At McKeesport Hospital, for example, the administration implemented a “labor productivity monitoring system” (LPMS) in 1994, instructing man agers that “the clinical manager’s goal is to manage staffing such that at the end of the pay period have staffed at or below the LPMS recommended staffing.” The system was a downward ratchet on staffing levels. This approach, management conceded, could calculate only the total amount of staffing needed over a two-week period and was not fine-grained enough to anticipate the needs on any given day. Staffing the clinic at or below average need over a two-week cycle subordinated the actual daily round of the hospital to a principle of productivity that could be achieved only through the abstract reduction of working hours.88 The period of corporate consolidation, driven by the struggle with insurers over rates, brought to the wealthy hospitals the same conflicts over scheduling and staffing that had played out inside the declining community institutions over the previous decade and that characterized nursing and home care systematically. “They got rid of p eople, and they never, ever replaced them,” said Earline Coburn. The change was easy for her to see, because she had worked two different stints in hospitals in very different periods. As a young woman in the 1970s, she had worked as a nurse’s aide at Braddock Hospital, near where she grew up. She changed sheets, took temperatures, washed bodies, and cleaned rooms. The wages had been low, but the work “wasn’t too bad, it r eally w asn’t,” she remembered.89 Then, after years in other kinds of jobs, Coburn got hired at Presbyterian- University as a housekeeper in 1997, earning about $9 an hour. “I guess I was taking too long. B ecause they wanted you to turn the bed over in a certain amount of time. What happened was, I had to work my first weekend. I’ll
“ T h e Tas k o f S u rv i va l ”
255
never forget. They did not train me for an ICU. I literally said, they threw me to the dogs. . . . It was so hectic.” In her areas, she had thirty rooms to clean per shift. “There was ten rooms per floor. I would have to go into each room, and pull the trash, and the linen, and if t here was any debris on the floor, whatever, straighten that up. Empty the trash in the nurse’s station and in the kitchen. That’s basically what I did on each floor u ntil they called me for a bed.” Some days, if t here was no demand for fresh beds, she could handle the load. Other days, “it was off the chain.”90 To manage, Coburn often had to do the job her own way. Starting her shift at 3 p.m., she found that the overworked staff on the prior shift sometimes held over patients who were supposed to have been checked out already in order to avoid the extra work of the discharge. “They would just put it off and put it off. And then the [administrator on duty] would call the bed in stat. And then they want you to hurry up and come in t here and do this room. And they waited so long that sometimes the patient would be in the hallway, and y ou’re cleaning the room!” Coburn “never did clean the rooms the way they taught me to clean them. Because the way they taught me to clean it, the patient w ouldn’t have the bed u ntil later.” By cutting staff, the hospital stressed workers. In this way, the institution mobilized the resource of caring affect. “I wouldn’t want my mother sitting out in the hallway,” she observed. Coburn did not like what was happening—but she figured out how to make the situation work.91 Joyce Henderson too spent long enough working in the hospital system to see it change. A fter a brief stint at a nursing home in the 1970s, she worked for several decades at Presbyterian-University, beginning as a nurse’s aide. “The whole atmosphere changed when leadership did. Like I said, it was the hospital that cares,” she remembered of the transition of the late 1980s. “Then it turned into the hospital that you couldn’t live without. If you didn’t go to their hospital, you w ere definitely g oing to die. So they w ere trying to push 92 their transplant programs.” Henderson was trained as an electrocardiogram (EKG) technician. While she felt racialized disrespect from her employer through her entire c areer, something shifted in the late 1980s. “I mean they constantly wanted you to put out, put out, put out, put out, put out. They were just like tyrants. And they scrutinized everyt hing that you did. If somebody left a job, they didn’t fill that job. Whoever was working at the time would have to pick up the slack
256
The Next Shift
of that person.” Henderson gave the same account as Coburn: “And they figured as long as you were doing a job, you didn’t need the help. So you were doing your job, and somebody else’s job. And that’s how they did. Somebody left, they d idn’t replace them. You just had to do more, and you had to work more hours, and it was just really much.”93 Despite common experiences of overwork and understaffing, the landscape of health care work was increasingly uneven. Over the period of corporate consolidation in the 1990s, fragmentation in hospital occupations intensified. In 1990, half of the regional health care workforce—56,665 people—consisted of professional and technical workers, who were the upper half of the occupational hierarchy ranging from technicians through physicians. By 2005, this number had increased to 77,537. The vast majority of workers in professional and technical job categories w ere found in hospitals—where they w ere needed for technologically intensive interventions—rather than in nursing homes, ambulatory clinics, or home health care, where “low-skill” workers remained closer to the old model of slow, life-sustaining care. This rapid growth thus marked a dramatic occupational stratification of the hospital workforce 94 While the numbers of professional and technical workers increased in absolute terms, and dramatically as a relative portion of the flatlining hospital workforce, they shrank as a percentage of the booming overall health care workforce. Much faster employment growth was occurring in the “unskilled” fragments of the workforce, concentrated in nursing homes, home care, and ambulatory care. The result was a twofold fragmentation: first, within hospitals, as the institutional hierarchy became vertically stretched, subdivided into finer gradations of credential and skill; and, second, between hospitals and the rest of the health care industry, as “unskilled” labor pooled in outpatient worksites.95 This occupational hierarchy was racialized. Joyce Henderson, a rare African American worker in a technical position, observed of Presbyterian- University, “You have all these black p eople working in these positions, lower positions like in housekeeping, the kitchen, all t hese different t hings. But when it came to wanting to be trained to be an X-ray tech or some other kind of tech or whatever, they just made it almost impossible for you.” Lou Berry, starting in housekeeping at the same institution, came in optimistic about his chances of c areer advancement. But after asking around, he wised up.
“ T h e Tas k o f S u rv i va l ”
257
“Some of [my coworkers] been t here fifteen, twenty years, and t hey’re still doing the same jobs. And I c ouldn’t understand. Like, I just came from orientation and they talked about all this opportunity to move up and grow in the company. Why you still d oing the same t hings after all t hese years?” A fter a little time, Berry developed an analysis: “It’s almost like a class system in that place. Housekeepers, dietary workers, all what we call the serv ice workers—it’s hard to get out of that tier and transfer to like, techs. So mostly what I saw is serv ice workers transferring to lateral positions.” Among t hese service positions, hourly wages averaged $12.94.96
The Waning of the Romance of Care Commodification and consolidation did not reduce the outright demand for care, which proved insatiable: too much social weight now rested on the supply of health care. Reform simply moved this demand around, causing providers to capitalize on demand where it was remunerative and to offload it where it was not—most often, onto the shoulders of the new army of low- wage workers. The structural transformation of the health industry in the 1980s and 1990s produced a vast, marginalized workforce concentrated at the bottom of the hospital hierarchy and outside hospitals entirely, in nursing homes and private residences. This workforce, partly demarcated by race and partly by gender, was responsible for delivering a growing portion of the care that sustained the everyday survival of the patient population—as opposed to the intensive interventions that sustained hospital profits. The new fragmentation of hospital work tended to reallocate direct patient care. Maryann Johnson, a highly skilled white nurse-a nesthetist at UPMC, explained, “The nurse’s aides go in, the patient care technicians go in [to the rooms]. They go in, t hey’re the ones that do the vital signs, t hey’re the ones that are t here with the patients, giving the path, being t here with the patients. So what you have the nurse doing is going and gathering the data, the information, and putting it in the computer.” The skilled interactive labor of the registered nurse, Johnson complained, had been reduced to insignificant key-tapping. “What you see is the nurses at the nurse’s station is recording, recording, entering data. And they’re taking it from the clipboards, they’re taking it from everybody e lse’s work.” Her view is widely shared in nursing scholarship. “In practice the work of the most educated
258
The Next Shift
nurses is becoming less concerned with the patient’s body,” write Sanchia Aranda and Rosie Brown.97 At the bottom of the hierarchy, things had changed too. Lou Berry, for example, gave little credence to any admonitions from the administration about work discipline and patient care. “I could see right through that. To me, part of patient care is adequate staffing,” he observed, pointing to a deadly mold outbreak at UPMC. “You run t hese places so understaffed, you d on’t give a damn about the patients.” Pamela Banks, a medical assistant, detected how the “atmosphere [that] was more personable and f amily like” at her hospital went away when UPMC acquired it. While she saw it as “important for patients to feel like they are more than just a number,” “with the way things are set up now it’s difficult to really get to know” them. “Since I’ve been at Children’s Hospital, my workload has quadrupled and it h asn’t been reflected 98 in my raises,” testified Alia Rawls. Commodification and deskilling, by stressing the workforce, assaulted the meaningful dimensions of care work. Where t here had once been a serv ice ethic—exploitative but also with real resonance—there was now something more like servitude, for a social purpose unrecognized by the employer itself. A contradiction now yawned between the social good that workers produced and what the work felt like.99
Epilogue
H
ealth care has remained a site of ongoing dispute in US politics since the early 1990s, and the pattern of conflict has been repetitive. Each attempted reform fails to disrupt, and eventually deepens, the basic orga nizational structure by which provision of social insurance is delegated to private actors. This fragmentary arrangement then allows costs to rise, prompting the next round of reform, which then encounters further enriched and empowered private-sector forces blocking the way to systemic change. After Bill Clinton’s effort to reform health care failed in the 1990s b ecause of the entrenchment of too many social constituencies in their respective fractions of the health system, the next two presidents drew the lesson that any proposal with a chance of success had to buy off rather than rebuke major industries. The extension of Medicare coverage to prescription drugs in 2003 and then the Patient Protection and Affordable Care Act (ACA) of 2010 both incorporated this lesson centrally. In the latter case, grassroots opposition to Barack Obama’s plan took the form, as it had in 1994, of a defense of social insurance. “Keep your government hands off my Medicare,” a much-derided slogan, bespoke not irrational false consciousness but rather the generational defense of social policy incumbency.1 Needless to say, neither Medicare Part D nor the ACA put to rest the basic dysfunctions of American health care. While significant improvements on the margins occurred—particularly the extension of Medicaid and protection for patients with “preexisting conditions”—the approach of recuperating the existing regime by mending its frayed edges and further enlisting industry cooperation is fundamentally inadequate to resolve the pathologies of health care as it is organized and institutionalized in the United States. Th ese pathologies can be grasped in two basic and interlocking categories. The first is
260
The Next Shift
the organizational fragmentation of the industry and the delegation of provision to private actors, subsidized by public consumption.2 The second is the social determination of poor health outcomes at a structural level: social in equality itself makes Americans sicker and more reliant on the health care industry. This second process appears to manifest through phenomena as varied as disability claims, addiction epidemics, mortality rates, and much more. In deindustrialized Pittsburgh, the connection is easy enough to draw. “There is no sense of community here,” one heroin overdose survivor in post-steel McKeesport explained in an addiction study. “Left to your own devices, somebody that’s drinking and drugging is gonna continue drinking and drugging. Nothing e lse, cause t here a in’t shit e lse to do.”3 The paradox of health politics is that the organizational fragmentation of the industry has allowed health care provision to stand in as a social response to rising inequality. While ever-rising health care costs appear within public debate almost exclusively as a fiscal problem, health care inflation represented, ironically, a political solution to the ravages of deindustrialization—helping to explain why systemic dysfunction has proven so politically difficult to resolve. As the fragmentary health care system presented one of the only sites with the institutional capacity to expand and respond to such social prob lems at scale—because it linked public resources with private profits—health policy processed economic dislocation into an epidemiology. In many cases, this dynamic brought stigma onto subject populations, but sometimes also care or comfort, and often all these at once.4 The postwar liberal state made it possible for public intervention in social reproduction to expand through health care, as through punishment, to manage the social and economic consequences of industrial decline. Institutions dependent on state largesse and s haped fundamentally by public power grew steadily through the supposed renascence of laissez-faire, b ecause t hese institutions could manage social problems that, despite many efforts, generally resisted other solutions.5 As larger portions of populations became patients, they could claim a share of this income in the form of serv ices; the institutions that served t hose patients could as well, as insurance reimbursements. Along the way, the public-private welfare state helped select a low-wage path for the American labor market.
E pi l o g u e
261
This state of affairs should not be taken as e ither complete or stable. B ecause this regime effects a continuous transfer of income into and through the health care system, it engenders political conflict more or less constantly. The system’s extreme inefficiency is a correlate of its expansive capacity, which has enabled it to rise to the occasion presented by spiraling social need. Under unyielding pressure to contain costs and mainly unable to do so through productivity increases, health institutions instead suppress labor costs, by holding down wages and levels of employment. And, of course, t hese institutions dehumanize patients and gouge payers wherever possible through the chaos of the health care marketplace.6 In the health care industry, then, two opposed forces collide. The bottomless demand for care serv ices begotten by the unequal transformation of American society grinds against the political and economic resistance to the expenditure of ever more resources on care, especially care for the poor. The conflict works itself out at three levels: at the politic al level, where state managers seek to secure the population in whatever ways are politically imperative while managing the ensuing cost; at the institutional level, where hospitals and insurers seek to consolidate markets, inflate prices, and offload costly or risky cases—producing the patient experience of a cruel and dysfunctional health system; and in the daily lives of health care workers, whose services are demanded to accomplish the social and political functions of the industry, while the workers, with the patients, must bear the costs; workers thus become collectively indispensable yet individually disposable. This contradiction is the reason that the health care industry must be understood fundamentally as a site of class formation. As Chicago nursing assistant Shantonia Jackson puts it, “We come a dime a dozen. I told my [director of nursing] quite a few times, ‘You a in’t gonna scare me. I am a CNA [certified nursing assistant]. I’m certified to clean ass all over Illinois.’ ” 7
Essential Workers When the University of Pittsburgh Medical Center moved to close Braddock Hospital in 2009, the rationale was lack of demand for the institution’s ser vices in a town that had lost so much population. Only one line of serv ices was still in heavy use: the program in behavioral health, drug and alcohol
262
The Next Shift
detoxification, and rehabilitation. “Braddock [Hospital] was one of the few remaining parts of the community safety net for behavioral care and that safety net just got a lot smaller,” commented one local expert. Said another, “It w ill be interesti ng to see what the jail does a fter [the hospital] closes. I think the warden just got a larger job.”8 The hospital closure, however, reverberated in more than one way. For Lou Berry, a UPMC worker who had been born at Braddock Hospital, it came as a deep shock. “They kept talking about how this hospital d oesn’t make money,” he noted, disclosing the institution’s transgression of the boundary between care and profit. “They were supposed to be a charity hospital. What place in the world needed charity worse than Braddock? It’s absolutely the poorest borough in Allegheny County. Charity starts at home.” Berry began talking to his coworkers about forming a u nion.9 The transfer of the costs of health care provision onto health care workers has formed a community of interest between them and the disposable surplus population created by neoliberalism and industrial decline. The stress on their bodies from the work and the stress on patients’ bodies from their social environments echo each other increasingly. A patient relying on the health care system to sustain her w ill be one of thirty for a nurse’s aide like Katrina Rectenwald, receiving little attention. “Answering call bells, taking vitals, bathing patients, changing sheets and toileting—a ll of t hese are the responsibility of aides and each aide is taking care of up to 30 patients,” says Rectenwald. “When our aides get to work they are already stressed out. They are stressed out about their transportation—I don’t know any aides who have cars. They are stressed out about their bills. Recently, one aide on our floor actually asked the nurses for money. You can imagine what that does to a person’s dignity and the dynamics of our care team.”10 For Nila Payton, a medical secretary in a pathology office at UPMC since 2006, the main source of stress is that her phone constantly rings, and she cannot miss a call. Th ose calling in are mainly dealing with mesothelioma and black lung—both environmental diseases characteristic of deindustrialized places. Since everyone else on the unit is overworked too, she finds it difficult to find someone to spell her while she goes to the bathroom. Consequently, every time she needs to pee, she must beg. She believes she has incurred damage to her bladder. On her twenty-sixth birthday, “because I was holding my pee so long, I actually peed myself.” Payton finds fulfillment in
E pi l o g u e
263
“helping the p eople that call me crying, b ecause they c an’t get answers to certain t hings. . . . I w ill go above and beyond the call of duty,” she explains. “I love what I do. I just honestly don’t like who I work for.” “I haven’t gotten more than a 15 cent raise in the 9 years I’ve worked for UPMC. For a while I was working two jobs within Magee Hospital just to make it,” testified Carl Blue. “It’s very stressful on your body, but I had to do what I had to do to make it. I did this to make it, to survive, to pay my bills, keep my kids, given the money that’s needed to get them what they need for school and t hings. Just for all of us to be able to survive and eat food, that’s why I did it.” Hospital housekeeper Janet Dickerson’s high workload—“you’re cleaning 30 rooms by yourself”—takes a toll on her body too. “You go in you wash the bed down, you do all the surfaces. You clean the bathroom and you mop that floor and dress that bed and put in the supplies that it needs. You know, to keep it stocked, to stock it, okay . . . I’ve had two shoulder operations, rotator cuffs and mine just aren’t 100% you know to do that all night long.”11 Like many patients, Payton is now in medical debt—t hough in her case it is to her own employer. Geneva Davis, who works in radiology, has diabetes, high blood pressure, and a thyroid disorder. “I work for a world renowned hospital and t here are days when I have to choose between buying food or paying for my medications.” Linda Thomas, a nursing assistant for twenty- five years, “can’t even afford to be able to take the medication I need every day. I take it every other day to make it last as long as possible.” Leslie Poston, who works two jobs—secretary for UPMC and home health aide—has no disposable income. “If I do have extra money, I pay it to UPMC—because I have thousands of dollars in healthcare debt.”12 Workers’ collective action began to rebound in the late 2010s, and it was these kinds of experiences that underlay it. The year 2018 saw the highest level of strike participation in the American economy since the mid-1980s; of t hose who did walk off the job, 90 percent worked in e ither education or health care—the major care industries. A small one-day strike at UPMC contributed to these numbers. And over the previous decade, health care accounted for more strike activity than any other industry.13 This dynamic appeared to speed up rapidly as I finished this book in spring 2020, while COVID-19 raged. Like a flash of lightning, the pandemic illuminated our society, revealing who is valued and who is dispensable. The thousands left to die in nursing homes and prisons marked one such
264
The Next Shift
revelation—social disposability made plain. The unequal racial toll of the disease was another—one related to who had to continue to work. As for the workers in harm’s way, they formed a paradoxical case. Windows and bridges festooned with banners thanking “frontline heroes” did not make up for weeks with insufficient protective gear, insufficient staffing and training, or refusal of hazard pay. Continuing to work out of a sense of duty or lack of any real choice, thousands became sick and died. Seventy-t hree percent of health care workers infected in the first two months of the pandemic were women. Teachers had revealed their power and demonstrated what happened when they stopped working in the strike wave of 2018 and 2019, but health care workers had somewhat less choice about establishing their critical role.14 What do we mean when we as a society call t hese workers “essential”? We evidently do not mean that they are owed substantive recognition or power, money or status, for their efforts. We mean, rather, that whether they like it or not, they owe us something—possibly everyt hing. Those invested in the current unequal social order may come to regret acknowledging how much depends on t hese workers, demanding so much from them while offering them so little. Even before the pandemic, health care workers had grasped this contradiction. “In addition to being a very loving m other, I’m a very determined woman, which is why I constantly talk to my coworkers about the importance of forming a u nion and standing up for better pay and affordable healthcare,” testified Latasha Tabb in 2015 to a Pittsburgh commission. “This industry is heavily dominated by working m others, some of them single mothers, all of us d oing everyt hing we can to build a good life for ourselves and our families. We are the m others and the caretakers in the hospitals but it seems like t here’s no one taking of us or looking out for our wellbeing.” Given its structural basis, we should expect that her sentiment is widely shared. “I am an integral part of patient care—from bathing them to emptying bed pans, to being a friendly face when they need one. It’s incredibly hard, but I’ve been at this for thirty years, so I’m obviously not afraid of hard work. I’ve come to accept the back pain and knee problems I have from lifting patients and being on my feet all day,” acknowledged Arlena Hill. “What I c an’t accept is the low wages. I am scheduled for thirty six hours a week, but if I only worked that much, the only t hing I would be able to pay is my rent. Th ere w ouldn’t be anything for bills, gas, food, or even a new pair of shoes that are on sale.”15
E pi l o g u e
265
For these workers, the value of what they do is clear. To o thers, they may still be invisible, or disposable, or objects of sentiment—but they see themselves with clarity. “Healthcare workers like me are taking care of people with serious diseases and chronic illnesses—lifting them, emptying catheters, giving them baths. For that, I am only making $13.32 an hour. Is that really all I am worth?”16
List of In-text Abbreviations
ACA Patient Protection and Affordable Care Act ACCD Allegheny Conference on Community Development AFDC Aid to Families with Dependent Children AHERF Allegheny Health Education and Research Foundation BCC Black Construction Coa lition BLS Bureau of L abor Statistics CIK Committee to Improve Kane CIO Congress of Industrial Organizations CMP Central Medical Pavilion CNA certified nursing assistant DPC Dues Protest Committee DRG diagnostic related group ENA Experimental Negotiating Agreement ET Edgar Thomson Works FTE full-time equivalent HCFA Health Care Financing Administration HHS Department of Health and Human Serv ices HMO health management organization HSA health systems agency HUD Department of Housing and Urban Development J&L Jones & Laughlin Steel LPN licensed practical nurse LTV Ling-Temco-Voight Steel MHCD Medical and Health Care Division of the University of Pittsburgh NAACP National Association for the Advancement of Colored People NAM New American Movement NLRA National Labor Relations Act NLRB National L abor Relations Board PUH Presbyterian-University Hospital PPO preferred provider organization
268
L i s t o f I n - T e x t A b b re v iat i o n s
PPS prospective payment system RN registered nurse SEIU Service Employees International Union TEFRA Tax Equity and Fiscal Responsibility Act TRA Trade Readjustment Act UE United Electrical Workers UNPC United Negro Protest Committee UPMC University of Pittsburgh Medical Center URA Urban Redevelopment Agency USWA United Steelworkers of Americ a USS United States Steel Corporation USX United States Steel Corporation’s new name in 1986 WPIC Western Psychiatric Institute and Clinic WROAC Welfare Rights Organization of Allegheny County
List of Bibliographical Abbreviations
1199 AF National Union of Hospital and Health Care Employees Local 1199 Additional Files, 1955–1986, Kheel Center for Labor- Management Documentation and Archives, Catherwood Library, Cornell University. ACCDC Allegheny Conference on Community Development Collection, 1944–1993, AIS.1973.04, Archives & Special Collections, University of Pittsburgh Library System. ACCDR Allegheny Conference on Community Development (Pittsburgh, Pa.), Records, 1920–1993, MSS 285, Library and Archives Division, Senator John Heinz History Center. BGC Bernard Greenberg Collection, 1951–1988, AIS.2010.09, Archives & Special Collections, University of Pittsburgh Library System. CORP Charles Owen Rice Papers, 1935–1998, AIS.1976.11, Archives & Special Collections, University of Pittsburgh Library System. CUPDHKAF Chancellor of the University of Pittsburgh, David H. Kurtzman (Acting), Administrative Files, 1966–1967, UA.2.10.1966–1967, University Archives, Archives & Special Collections, University of Pittsburgh Library System. CUPWWPAF Chancellor of the University of Pittsburgh, Wesley W. Posvar, Administrative Files, 1967–1991, UA.2.10.1967–1991, University Archives, Archives & Special Collections, University of Pittsburgh Library System. DTP Dick Thornburgh Papers, 1932–, AIS.1998.30, Archives & Special Collections, University of Pittsburgh Library System. EESP Edward E. Smuts Papers, 1945–1981, AIS.2012.07, Archives Serv ice Center, University of Pittsburgh Library System.
270
L i s t o f B i b l i o g r a ph i c a l A b b re v iat i o n s
GASPR Group Against Smog and Pollution (GASP) Records, 1968–2002, AIS.1979.21, Archives & Special Collections, University of Pittsburgh Library System. HAOHPR Homestead A lbum Oral History Project Records, 1975–1977, AIS.1980.06, Archives & Special Collections, University of Pittsburgh Library System. HSASPR Health Systems Agency of Southwestern Pennsylvania Records, 1971–1987, AIS.1987.02, Archives & Special Collections, University of Pittsburgh. HWP Harris Wofford Papers, Bryn Mawr Special Collections, Bryn Mawr College. ISFP Isidore Sydney Falk Papers (MS 1039). Manuscripts and Archives, Yale University Library. JFP James Ferlo Papers, 1963–2015, AIS.1998.02, Archives & Special Collections, University of Pittsburgh Library System. MFR Local 1199 Executive Secretary Moe Foner Records #5206-S, Kheel Center for Labor-Management Documentation and Archives, Cornell University Library. MMDP Michael M. Dawida Papers, 1984–1995, AIS.2000.02, Archives & Special Collections, University of Pittsburgh Library System. MSP Melvin Seidenberg Papers, c. 1840–2002, MSS#566, Library and Archives Division, Senator John Heinz History Center. MVUCC Mon Valley Unemployed Committee Collection, 1973–1998, AIS.2002.02, Archives & Special Collections, University of Pittsburgh Library System. NAACPPBR National Association for the Advancement of Colored People, Pittsburgh Branch Records, 1964–1966, 1974, AIS.1964.38, Archives & Special Collections, University of Pittsburgh Library System. NPC New Pittsburgh Courier. NYT New York Times. POHP Pittsburgh Oral History Project, Manuscript Group 409, Pennsylvania State Archives. PBT Pittsburgh Business-Times. PC Pittsburgh Courier. PELR Pennsylvania Economy League Records, 1929–1985, AIS.1978.06, Archives & Special Collections, University of Pittsburgh Library System. PP Pittsburgh Press. PPG Pittsburgh Post-Gazette.
L i s t o f B i b l i o g r a ph i c a l A b b re v iat i o n s
271
RCCP R. Conrad Cooper Papers, 1927–1980, AIS.1991.01, Archives & Special Collections, University of Pittsburgh Library System. RHWPA Records of the Health and Welfare Planning Association, 1908–1980, MSS #158, Library and Archives Division, Senator John Heinz History Center. RKR Rainbow Kitchen Records, 1974–1992, AIS.1991.10, Archives & Special Collections, University of Pittsburgh Library System. RSSP Richard S. Schweiker Papers (1771), Historical Collections and Labor Archives, Special Collections Library, Pennsylvania State University. RTJP Robert Taft, Jr. Papers, Library of Congress. SDP Steffi Domike Papers, 1946–2009, AIS.1997.20, Archives & Special Collections, University of Pittsburgh Library System. SEIU 585 Service Employees International Union Local 585 Records, 1966–1989, AIS.1982.14, Archives & Special Collections, University of Pittsburgh Library System. SLC Steelworker Lore Collection, Rivers of Steel Foundation, Homestead, PA. SOHP Steelworker Oral History Project, Rivers of Steel Museum, Homestead, PA. TAMP Thomas A. Michlovic Papers, 1978–2002, AIS.2002.04, Archives & Special Collections, University of Pittsburgh Library System. USSCDWIRDR United States Steel Corporation Duquesne Works Industrial Relations Department Records, 1904–1980, AIS.1987.03, Archives & Special Collections, University of Pittsburgh Library System. USSCNDWR United States Steel Corporation National-Duquesne Works Records, 1890–1985, AIS.1991.06, Archives & Special Collections, University of Pittsburgh Library System. USWA 1397 United Steelworkers of America Local 1397 (Homestead, Pa.) Records, 1937–1972, AIS.1993.17, Archives & Special Collections, University of Pittsburgh Library System. USWA 1843 United Steelworkers of America Local 1843 Records, 1937– 1999, AIS.2000.05, Archives & Special Collections, University of Pittsburgh Library System. USWADPCS United Steelworkers of America Dues Protest Committee Scrapbook, 1956–1957, AIS.1997.43, Archives & Special Collections, University of Pittsburgh Library System.
272
L i s t o f B i b l i o g r a ph i c a l A b b re v iat i o n s
VNAACR Visiting Nurse Association of Allegheny County Records, Inc., 1918–2000, AIS.2000.13, Archives & Special Collections, University of Pittsburgh Library System. WCWP Walter C. Worthington Papers, 1940–1993, MSS 905, Library and Archives Division, Senator John Heinz History Center. WEMHOHPR Women, Ethnicity and M ental Health Oral History Project Records, 1975–1977, AIS.1978.11, Archives & Special Collections, University of Pittsburgh Library System. WHWSR Women Hospital Workers Study Records WAG.195, Tamiment Library and Robert F. Wagner L abor Archives, New York University. WOR Washington Observer-Reporter. WUCR Women in the Urban Crisis Records, 1969–1984, AIS.1985.03, Archives & Special Collections, University of Pittsburgh Library System.
Notes
Epigraph Fredric Jameson, The Political Unconscious: Narrative as a Socially Symbolic Act (Ithaca, NY: Cornell University Press, 1981), 102.
Introduction 1. Charlie Deitch, “No Help Wanted: In Filing to L abor Board, UPMC Claims It Has No Employees,” Pittsburgh City Paper, January 30, 2013; “UPMC to Invest $2 Billion To Create 3 New Specialty Hospitals in Pittsburgh,” Pittsburgh Post- Gazette, November 3, 2017. 2. David Weil, The Fissured Workplace: Why Work Became So Bad for So Many and What Can Be Done to Improve It (Cambridge, MA: Harvard University Press, 2014); Danny Vinik, “The Real Future of Work,” Politico Magazine, January– February 2018. See also Louis Hyman, Temp: How American Work, American Business, and the American Dream Became Temporary (New York: Viking, 2018). 3. See Eileen Boris and Jennifer Klein, “We W ere the Invisible Workforce: Unionizing Home Care,” in The Sex of Class: Women Transforming American Labor, ed. Dorothy Sue Cobble (Ithaca: Cornell University Press, 2007), 177–193; Tamara Draut, Sleeping G iant: How the New Working Class Will Transform Amer ica (New York: Doubleday, 2016). 4. William D. Nordhaus, “Baumol’s Diseases: A Macroeconomic Perspective,” The B.E. Journal of Macroeconomics 8, no. 1 (February 2008), 1–39; David H. Autor, Lawrence F. Katz, and Melissa S. Kearney, “The Polarization of the U.S. Labor Market,” American Economic Review 96, no. 2 (May 2006), 189–194; William J. Baumol, The Cost Disease: Why Computers Get Cheaper and Health Care Doesn’t (New Haven, CT: Yale University Press, 2013); Jochen Hartwig, “Structural Change, Aggregate Demand, and Employment Dynamics in the OECD, 1970–2010,” Structural Change and Economic Dynamics 34 (September 2015), 36–45; Peter Temin, The Vanishing Middle Class: Prejudice and Power in a Dual Economy (Cambridge, MA: MIT Press, 2017); Servaas Storm, “The New Normal:
274
N o t e s t o Pag e s 2 – 4
Demand, Secular Stagnation, and the Vanishing Middle Class,” International Journal of Political Economy 46, no. 4 (2018), 169–210. 5. See Teresa Leste, Yakir Siegal, and Maulesh Shukla, “Return on Capital Perfor mance in Life Sciences and Health Care,” Deloitte Insights, April 30, 2019, available at https://w ww2.deloitte.com/us/en/i nsights/industry/health-care/r eturn -on-c apital-health-care.html; Lawton R. Burns and Wharton School Colleagues, The Health Care Value Chain: Producers, Purchasers, and Providers (San Francisco: Jossey-Bass, 2002); City of Pittsburgh Wage Review Committee, Report on the Impact of Raising Wages for Service Workers at Pittsburgh’s Anchor Institutions (December 8, 2015), 131. 6. Richard Rose, Public Employment in Western Nations (Cambridge: Cambridge University Press, 1985); Torben Iversen and Thomas R. Cusack, “The Causes of Welfare State Expansion: Deindustrialization or Globalization?” World Politics 52, no. 3 (April 2000), 313–349; Francesca Bettio and Janneke Plantenga, “Comparing Care Regimes in Europe,” Feminist Economics, 10, no. 1 (2008), 85–113; Linda McDowell, Working Bodies: Interactive Service Employment and Workplace Identities (London: Wiley-Blackwell, 2009); Andrea Muehlebach, The Moral Neoliberal: Welfare and Citizenship in Italy (Chicago: University of Chicago Press, 2013); Anne Wren, ed., The Political Economy of the Service Transition (Oxford: Oxford University Press, 2013); Sophie Mathieu, “From the Defamilialization to the ‘Demotherization’ of Care Work,” Social Politics 23, no. 4 (Winter 2016), 576–591. 7. Torben Iversen and Anne Wren, “Equality, Employment, and Budgetary Restraint: The Trilemma of the Serv ice Economy,” World Politics 50, no. 4 (July 1998), 507–546; Gøsta Esping-Andersen, Social Foundations of Postindustrial Economies (Oxford: Oxford University Press, 1999), 96. 8. Rachel E. Dwyer, “The Care Economy? Gender, Economic Restructuring, and Job Polarization in the U.S. L abor Market,” American Sociological Review 78, no. 3 (June 2013), 398. On debates over definitions of care and their significance, see Paula E ngland, “Emerging Theories of Care Work,” Annual Review of Sociology 31 (2005), 381–399. 9. Dwyer, “The Care Economy?” 404; Evelyn Nakano Glenn, “From Servitude to Serv ice Work: Historical Continuities in the Racial Division of Paid Reproductive L abor,” Signs 18, no. 1 (Autumn 1992), 1–43; Mignon Duffy, Making Care Count: A C entury of Gender, Race, and Paid Care Work (New Brunswick: Rutgers University Press, 2011). 10. See Kenneth J. Arrow, “Uncertainty and the Welfare Dynamics of Medical Care,” American Economic Review 53, no. 5 (December 1963), 941–973; see also Baumol, The Cost Disease. 11. For the first view, see Moishe Postone, Time, Labor, and Social Domination: A Reinterpretation of Marx’s Critical Theory (Cambridge: Cambridge University Press, 1993); Michael Denning, “Wageless Life,” New Left Review 66 (November–December 2010), 79–97; Kathi Weeks, The Problem with Work: Feminism, Marxism, Antiwork
N o t e s t o Pag e s 5 – 9
275
Politics, and Post-Work Imaginaries (Durham, NC: Duke University Press, 2011); Aaron Benanav, “Automation and the Future of Work—1,” New Left Review 119 (September–October 2019), 5–38; Aaron Benanav, “Automation and the F uture of Work—2,” New Left Review 120 (November–December 2019), 117–146. For more mainstream approaches, see Erik Brynjolfsson and Andrew McAfee, The Second Machine Age: Work, Progress, and Prosperity in a Time of Brilliant Technologies (New York: Norton, 2014); Richard Baldwin, The Globotics Upheaval: Globalization, Robotics, and the Future of Work (New York: Oxford University Press, 2019). For the second view, see Arne L. Kalleberg, Good Jobs, Bad Jobs: The Rise of Polarized and Precarious Employment Systems in the United States, 1970s to 2000s (New York: Russell Sage Foundation, 2011); Draut, Sleeping Giant; Kim Moody, On New Terrain: How Capital is Reshaping the Battleground of Class War (Chicago: Haymarket, 2017). 12. See “A Union Aims at Pittsburgh’s Largest Employer,” New York Times, April 2, 2014; Rich Exner, “Ohio’s 100 Largest Employers,” Cleveland.com, June 17, 2019, https://w ww.c leveland.com/news/g 66l-2 019/0 6/929ccb3d1d2274/ohios-100 -largest-employers-2019-rankings-led-by-cleveland-clinic-walmart-others.html (accessed September 2020); Metropolitan Milwaukee Association of Commerce, “Major Employers List,” available at https://w ww.m mac.org /major-employers-in -metro-milwaukee.html; Johns Hopkins Medicine, “Fast Facts: Johns Hopkins Medicine,” January 2020, available at https://w ww.hopkinsmedicine.org/a bout /downloads/J HM-Fast-Facts.p df. 13. Charlie Deitch, “UPMC Opens Food Bank for Struggling Employees, Misses Point Completely,” Pittsburgh City Paper, December 11, 2012. 14. Lizabeth Cohen, Making a New Deal: Industrial Workers in Chicago, 1919–1939 (New York: Cambridge University Press, 1990); Joshua B. Freeman, Working-Class New York: Life and Labor Since World War II (New York: New Press, 2000), 3–71. 15. Christopher Tomlins, The State and the Unions: Labor Relations, Law, and the Organized Labor Movement in Americ a, 1880–1960 (New York: Cambridge University Press, 1985); Cohen, Making a New Deal. 16. National L abor Relations Board v. Jones and Laughlin Steel Corporation, 301 U.S. 1 (1937), 27. 17. National L abor Relations Board v. Jones and Laughlin Steel Corporation, 301 U.S. 27. 18. Mike Davis, Prisoners of the American Dream: Politics and Economy in the History of the US Working Class (New York: Verso, 1986), 52–101; Nelson Lichtenstein, “From Corporatism to Collective Bargaining: Organized Labor and the Eclipse of Social Democracy in the Postwar Era,” in The Rise and Fall of the New Deal Order, 1930–1980, ed. Steve Fraser and Gary Gerstle (Princeton, NJ: Princeton University Press, 1989), 122–152; Steve Fraser, Labor W ill Rule: Sidney Hillman and the Rise of American L abor (Ithaca, NY: Cornell University Press, 1993); John H. Hinshaw, Steel and Steelworkers: Race and Class Struggle in Twentieth-Century Pittsburgh (Albany: SUNY Press, 2002), 65–104; Nelson Lichtenstein, L abor’s
276
N o t e s t o Pag e s 9 – 1 1
War at Home: The CIO in World War II (Philadelphia: Temple University Press, 2003); Meg Jacobs, Pocketbook Politics: Economic Citizenship in Twentieth-Century America (Princeton, NJ: Princeton University Press, 2005), 179–220; Eric Leif Davin, Crucible of Freedom: Workers’ Democracy in the Industrial Heartland, 1914–1960 (Lanham, MD: Lexington Books, 2010); James T. Sparrow, Warfare State: World War II Americans and the Age of Big Government (New York: Oxford University Press, 2011), 160–200; Jefferson Cowie, The Great Exception: The New Deal and the Limits of American Politics (Princeton, NJ: Princeton University Press, 2016), 10–11. 19. George Lipsitz, Rainbow at Midnight: L abor and Culture in the 1940s (Urbana: University of Illinois Press, 1994), 142–148; Jack Metzgar, “The 1945–1946 Strike Wave,” in The Encyclopedia of Strikes in American History, eds. Aaron Brenner, Benjamin Day, and Immanuel Ness (Armonk, NY: M.E. Sharpe, 2009), 216–217. 20. Howell John Harris, The Right to Manage: Industrial Relations Policies of American Business in the 1940s (Madison: University of Wisconsin Press, 1982), 105–158; Barbara S. Griffith, The Crisis of American Labor: Operation Dixie and the Defeat of the CIO (Philadelphia: T emple University Press, 1988). 21. Ellen Schrecker, Many Are the Crimes: McCarthyism in America (New York: Little, Brown, 1998); Landon Storrs, The Second Red Scare and the Unmaking of the New Deal Left (Princeton: Princeton University Press, 2013); David Caute, The Great Fear: The Anti-Communist Purge U nder Truman and Eisenhower (New York: Simon & Schuster, 1978), 216–217; Philip Jenkins, The Cold War at Home: The Red Scare in Pennsylvania, 1945–1960 (Chapel Hill: University of North Carolina Press, 1999); Ronald W. Schatz, The Electrical Workers: A History of L abor at General Electric and Westinghouse, 1923–1960 (Urbana: University of Illinois Press, 1987), 188–224. 22. Katherine Van Wezel Stone, “The Post-War Paradigm in American Labor Law,” Yale Law Journal 90, no. 7 (June 1981), 1511–1580; Jennifer Klein, For All These Rights: Business, Labor, and the Shaping of America’s Public-Private Welfare State (Princeton, NJ: Princeton University Press, 2003), 15, 257. 23. Ruth Milkman, Gender at Work: The Dynamics of Job Segregation by Sex during World War II (Urbana: University of Illinois Press, 1987), 99–160; Robert Korstad and Nelson Lichtenstein, “Opportunities Found and Lost: Labor, Radicals, and the Early Civil Rights Movement,” Journal of American History 75, no. 3 (December 1988), 786–811; Alice Kessler-Harris, In Pursuit of Equity: W omen, Men, and the Quest for Economic Citizenship in Twentieth-Century America (New York: Oxford University Press, 2001); David K. Johnson, The Lavender Scare: The Cold War Persecution of Gays and Lesbians in the Federal Government (Chicago: University of Chicago Press, 2004); Ira Katznelson, When Affirmative Action Was White: An Untold History of Racial Inequality in America (New York: Norton, 2005); Margot Canaday, The Straight State: Sexuality and Citizenship in Twentieth-
N o t e s t o Pag e s 1 1 – 1 3
277
Century America (Princeton, NJ: Princeton University Press, 2009), 137–254; Robert O. Self, All in the Family: The Realignment of American Democracy Since the 1960s (New York: Hill and Wang, 2012); Storrs, The Second Red Scare. 24. Alan Derickson, “Health Security for All?: Social Unionism and Universal Health Insurance, 1935–1958,” Journal of American History 80, no. 4 (March 1994), 1333–1356; Nelson Lichtenstein, The Most Dangerous Man in Detroit: Walter Reuther and the Fate of American L abor (New York: Basic Books, 1995), 271–298; Jacobs, Pocketbook Politics, 179–261; Marie Gottschalk, The Shadow Welfare State: Labor, Business, and the Politics of Health Care in the United States (Ithaca, NY: Cornell University Press, 2000); Colin Gordon, Dead on Arrival: The Politics of Health Care in Twentieth-Century America (Princeton, NJ: Princeton University Press, 2003); Klein, For All Th ese Rights; Jonathan Cutler, Labor’s Time: Shorter Hours, the UAW, and the Struggle for American Unionism (Philadelphia: T emple University Press, 2004); Thomas A. Stapleford, The Cost of Living in America: A Political History of Economic Statistics, 1880–2000 (New York: Cambridge University Press, 2009), 253–295. 25. Jill Quadagno, One Nation, Uninsured: Why the U.S. Has No National Health Insurance (New York: Oxford University Press, 2005), 50; A. Norman Somers and Louis Schwartz, “Pension and Welfare Plans: Gratuities or Compensation?” Industrial and Labor Relations Review 4, no. 1 (October 1950), 81. 26. Jacob Hacker, The Divided Welfare State: The Battle over Public and Private Social Benefits in the United States (New York: Cambridge University Press, 2002; Klein, For All These Rights; Lane Windham, Knocking on L abor’s Door: Union Organizing in the 1970s and the Roots of the New Economic Divide (Chapel Hill: University of North Carolina Press, 2017). See also Jonathan Levy, “From Fiscal Triangle to Passing Through: Rise of the Nonprofit Corporation,” in Corporations and American Democracy, ed. Naomi R. Lamoreaux and William J. Novak (Cambridge, MA: Harvard University Press, 2017), 213–244. 27. Theodore R. Marmor, The Politics of Medicare (Chicago: Aldine, 1970), 14– 38; Lauri Perman and Beth Stevens, “Industrial Segregation and Gender Distribution of Fringe Benefits,” Gender and Society 3, no. 3 (September 1989), 388–404; Klein, For All These Rights; Beatrix Hoffman, Health Care for Some: Rights and Rationing in the United States Since 1930 (Chicago: University of Chicago Press, 2012). 28. Sanford Jacoby, Employing Bureaucracy: Managers, Unions, and the Transformation of Work in American Industry, 1900–1945 (New York: Columbia University Press, 1985); Carl Gersuny and Gladis Kaufman, “Seniority and the Moral Economy of U.S. Automobile Workers, 1934–1946,” Journal of Social History 18, no. 3 (Spring 1985), 463–475. For the Committee on Economic Security, see Committee on Economic Security, Old Age Security Staff Report, 38, https://w ww.s sa.g ov /history/reports/ces/ces2armstaff.html. On social insurance and “normalization,” see François Ewald, The Birth of Solidarity: The History of the French Welfare
278
N o t e s t o Pag e s 1 3 – 1 4
State, ed. Melinda Cooper and trans. Timothy Scott Johnson (Durham, NC: Duke University Press, 2020). On military spending, see Larry J. Griffin, Joel A. Devine, and Michael Wallace, “Monopoly Capital, Organized L abor, and Military Expenditures in the United States, 1949–1976,” in “Marxist Inquiries: Studies of Labor, Class, and States,” supplement, American Journal of Sociology 88 (1982), S113–S153; Tim Barker, “Cold War Capitalism: The Political Economy of American Military Spending, 1949–1989” (PhD diss., Harvard University, forthcoming). 29. On employment and the life course, see Martin Kohli, “The Institutionalization of the Life Course: Looking Back to Look Ahead,” Research in Human Development 4, nos. 3–4 (2007), 253–271. On the postwar industrial working class and social space, see Thomas J. Sugrue, The Origins of the Urban Crisis: Race and Inequality in Postwar Detroit (Princeton, NJ: Princeton University Press, 1996); Robert O. Self, American Babylon: Race and the Struggle for Postwar Oakland (Princeton, NJ: Princeton University Press, 2003). On inflation, see Jacobs, Pocket book Politics; Samir Sonti, “The Price of Prosperity: Inflation and the Limits of the New Deal Order” (PhD diss., University of California, Santa Barbara, 2017); Melinda Cooper, Family Values: between Neoliberalism and the New Social Conservatism (Cambridge, MA: Zone Books, 2017). 30. Ann Shola Orloff, “Gender and the Social Rights of Citizenship: The Comparative Analysis of Gender Relations and Welfare States,” American Sociological Review 58, no. 3 (June 1993), 303–328; Linda Gordon, Pitied But Not Entitled: Single Mothers and the History of Welfare (New York: F ree Press, 1994); Sonya Michel, “A Tale of Two States: Race, Gender, and Public / Private Welfare Provision in Postwar America,” Yale Journal of Law and Feminism 9, no. 1 (1997), 123–156; Kessler-Harris, In Pursuit of Equity; Bruce Nelson, Divided We Stand: American Workers and the Struggle for Black Equality (Princeton, NJ: Princeton University Press, 2001); Canaday, The Straight State; Self, All in the F amily. On Black feminism, survival, and activism, see Carol B. Stack, All Our Kin: Strategies for Survival in a Black Community (New York: Basic Books, 1974); Patricia Hill Collins, “Shifting the Center: Race, Class, and Feminist Theorizing about Motherhood,” in Mothering: Ideology, Experience, and Agency, ed. Evelyn Nakano Glenn, Grace Chang, and Linda Rennie Forcey (New York: Routledge, 1994), 45–66; Premilla Nadasen, “Expanding the Bounda ries of the Women’s Movement: Black Feminism and the Strugg le for Welfare Rights,” Feminist Studies 28, no. 2 (Summer 2002), 270–301. 31. See Martha May, “The Historical Problem of the Family Wage: The Ford Motor Company and the Five-Dollar Day,” Feminist Studies 8, no. 2 (Summer 1982), 399–424; Elizabeth Faue, Community of Suffering and Struggle: Women, Men, and the Labor Movement in Minneapolis, 1915–1945 (Chapel Hill: University of North Carolina Press, 1991); Dorothy Sue Cobble, The Other Women’s Movement: Workplace Justice and Social Rights in Modern America (Princeton, NJ: Princeton University Press, 2004); Tithi Bhattacharya, ed., Social Reproduction
N o t e s t o Pag e s 1 4 – 1 6
279
Theory: Remapping Class, Recentering Oppression (London: Pluto, 2017). See Self, All in the Family; Kessler-Harris, In Pursuit of Equity, 170–202. 32. Leon Fink and Brian Greenberg, Upheaval in the Quiet Zone: A History of the Hospital Workers’ Union, Local 1199 (Urbana: University of Illinois Press, 1989), 1–27; “Who Is Responsible for the ‘Disturbance’ at West Penn Hospital?” Hospital Workers Organizer 1, no. 12 (July 1940), 6, box 7, folder 36, CORP; “Slave Conditions Exposed by West Penn Picket Line,” Pennsylvania Reporter, July– August 1940, box 7, folder 36, CORP; Hospital Workers’ Local No. 255, State, County, and Municipal Workers of America (CIO), “A Statement to the Public on Hospital Conditions in Allegheny County,” July 1, 1940, box 7, folder 36, CORP; “Hospitals Gain Injunction in Labor Fight,” PPG, July 2, 1940; Western Pennsylvania Hospital v. Lichliter, 340 Pa. 382 (1941), 209; William C. Scott and Donald W. Smith, “The Taft-Hartley Act and the Nurse,” American Journal of Nursing 56, no. 12 (December 1956), 1557. 33. Unsigned Note, “Exemption of Non-profit Hospital Employees from the National L abor Relations Act: A Violation of Equal Protection,” Iowa Law Review 57, no. 2 (December 1971), 417n24. 34. See Nancy Folbre, “ ‘Holding Hands at Midnight’: The Paradox of Caring L abor,” Feminist Economics 1, no. 1 (1995), 73–92; Paula England and Nancy Folbre, “The Cost of Caring,” Annals of the American Academy of Political and Social Science 561, no. 1 (January 1999), 39–51; Fink and Greenberg, Upheaval in the Quiet Zone; Eileen Boris and Jennifer Klein, Caring for America: Home Health Workers in the Shadow of the Welfare State (New York: Oxford University Press, 2012). 35. Paul A. Tiffany, The Decline of American Steel: How Management, L abor, and Government Went Wrong (New York: Oxford University Press, 1988); John T. Cumbler, A Social History of Economic Decline: Business, Politics, and Work in Trenton (New Brunswick, NJ: Rutgers University Press, 1989); Sugrue, The Origins of the Urban Crisis; Roger Horow itz, “Negro and White, Unite and Fight!”: A Social History of Industrial Unionism in Meatpacking, 1930–1990 (Urbana: University of Illinois Press, 1997), 245–280; Jefferson R. Cowie, Capital Moves: RCA’s Seventy-Year Quest for Cheap Labor (Ithaca, NY: Cornell University Press, 2001); Thomas Dublin and Walter Licht, The Face of Decline: The Pennsylvania Anthracite Region in the Twentieth Century (Ithaca, NY: Cornell University Press, 2005); Robert Brenner, The Economics of Global Turbulence (London: Verso, 2006); Ronald D. Eller, Uneven Ground: Appalachia since 1945 (Lexington: University of Kentucky Press, 2008); Tami J. Friedman, “Exploiting the North-South Differential: Corporate Power, Southern Politics, and the Decline of Organized Labor after World War II,” Journal of American History 95, no. 2 (September 2008), 323–348; David Koistinen, Confronting Decline: The Political Economy of Deindustrialization in Twentieth-Century New England (Gainesville: University of Florida Press, 2013).
280
N o t e s t o Pag e s 1 6 – 1 8
36. Iversen and Cusack, “The C auses of Welfare State Expansion”; Wren, The Political Economy of the Service Transition. 37. Frances Fox Piven and Richard Cloward, Regulating the Poor: The Functions of Public Welfare (New York: Vintage, 1971); James O’Connor, The Fiscal Crisis of the State (New York: St. Martin’s, 1973); Lisa Levenstein, A Movement Without Marches: African American Women and the Politics of Poverty in Postwar Philadelphia (Chapel Hill: University of North Carolina Press, 2005); Jefferson Cowie, Stayin’ Alive: The 1970s and the Last Days of the Working Class (New York: New Press, 2010); William P. Jones, “The Unknown Origins of the March on Washington: Civil Rights Politics and the Black Working Class,” Labor 7, no. 3 (September 2010), 33–52; Judith Stein, Pivotal Decade: How the United States Traded Factories for Finance in the 1970s (New Haven, CT: Yale University Press, 2010); Cal Winslow, Aaron Brenner, and Robert Brenner, eds., Rebel Rank-and-File: Labor Militancy and Revolt from Below in the Long 1970s (New York: Verso, 2010); Julilly Kohler-Hausmann, Getting Tough: Welfare and Imprisonment in 1970s America (Princeton, NJ: Princeton University Press, 2017); Jessica Wilkerson, To Live H ere, You Have to Fight: How Women Led Appalachian Movements for Social Justice (Urbana: University of Illinois Press, 2019); David Stein, “Containing Keynesianism in an Age of Civil Rights: Jim Crow Monetary Policy and the Struggle for Guaranteed Jobs, 1956–1979,” in Beyond the New Deal Order: U.S. Politics from the G reat Depression to the Great Recession, ed. Gary Gerstle, Nelson Lichtenstein, and Alice O’Connor (Philadelphia: University of Pennsylvania Press, 2019), 124–140; Johanna Fernández, The Young Lords: A Radical History (Chapel Hill: University of North Carolina Press, 2019). 38. Duffy, Making Care Count. 39. Theodore R. Marmor, Jerry L. Mashaw, and Philip L. Harvey, America’s Misunderstood Welfare State: Persistent Myths, Enduring Realities (New York: Basic Books, 1990), 92. 40. Ruth Wilson Gilmore, Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California (Berkeley: University of California Press, 2007). On care and control, see Barbara Ehrenreich and John Ehrenreich, “Health Care as Social Control,” Social Policy 5, no. 1 (May-June 1974), 26–40; Peter Conrad, “Medicalization and Social Control,” Annual Review of Sociology 18 (August 1992), 209–232. 41. See Jefferson Cowie, The Great Exception: The New Deal and the Limits of American Politics (Princeton, NJ: Princeton University Press, 2016). In contrast see Sugrue, The Origins of the Urban Crisis; Klein, For All Th ese Rights; Kessler- Harris, In Pursuit of Equity; Canaday, The Straight State; Jennifer Mittelstadt, From Welfare to Workfare: The Unintended Consequences of Liberal Reform, 1945–1965 (Chapel Hill: University of North Carolina Press, 2005); Greta R. Krippner, Capitalizing on Crisis: The Political Origins of the Rise of Finance
N o t e s t o Pag e s 1 9 – 2 0
281
(Cambridge, MA: Harvard University Press, 2011); Self, All in the Family; Elizabeth Hinton, From the War on Poverty to the War on Crime: The Making of Mass Incarceration in America (Cambridge, MA: Harvard University Press, 2016); Kim Phillips-Fein, Fear City: New York’s Fiscal Crisis and the Rise of Austerity Politics (New York: Metropolitan Books, 2017); Windham, Knocking on Labor’s Door; Keeanga-Yamahtta Taylor, Race for Profit: How Banks and the Real Estate Industry Undermined Black Homeownership (Chapel Hill: University of North Carolina Press, 2019). For general analysis of postwar liberalism in t hese terms, see Cooper, Family Values; Amy C. Offner, Sorting Out the Mixed Economy: The Rise and Fall of Welfare and Developmental States in the Americas (Princeton, NJ: Princeton University Press, 2019). 42. See Michel Foucault, “The Mesh of Power,” trans. Christopher Chitty, Viewpoint Magazine 2 (September 2012); David H. Autor and Mark G. Duggan, “The Growth in the Social Security Disability Rolls: A Fiscal Crisis Unfolding,” Journal of Economic Perspectives 20, no. 3 (Summer 2006), 71–96; Gilmore, Golden Gulag; Anne Case and Angus Deaton, “Rising Morbidity and Mortality in Midlife among White Non-Hispanic Americans in the 21st Century,” Proceedings of the National Academy of Science 112, no. 49 (December 2015), 15078–15083; Gabriel Winant, “A Place to Die: Nursing Home Abuse and the Political Economy of the 1970s,” Journal of American History 105, no. 1 (June 2018), 96–120; Nathan Seltzer, “The Economic Underpinnings of the Drug Epidemic,” SocArXiv (2019), accessible at https://osf.io/preprints/socarxiv/cdwap/. 43. Michael Moran, “Understanding the Welfare State: The Case of Health Care,” British Journal of Politics and International Relations 2, no. 2 (June 2000), 135–160; Jacob S. Hacker, “Dismantling the Health Care State? Political Institutions, Public Policies and the Comparative Politics of Health Reform,” British Journal of Political Science 34, no. 4 (October 2004), 693–724; Austin Frakt, “Medical Mystery: Something Happened to U.S. Health Spending A fter 1980,” New York Times, May 14, 2018. 44. J. Mohan, “Spatial Aspects of Health-C are Employment in Britain: 1—Aggregate Trends,” Environment and Planning A 20, no. 1 (1988), 19. For more evidence on the British experience, see McDowell, Working Bodies; Margaret Whitehead, Due North: Report of the Inquiry on Health Equity for the North (Liverpool: University of Liverpool and Centre for Local Strategies, 2014). 45. See Allen Dieterich-Ward, Beyond Rust: Metropolitan Pittsburgh and the Fate of Industrial America (Philadelphia: University of Pennsylvania Press, 2015). 46. Benjamin Chinitz, “Contrasts in Agglomeration: New York and Pittsburgh,” American Economic Review 51, no. 2 (May 1961), 279–289. 47. Nora Faires, “Immigrants and Industry: Peopling the ‘Iron City,’ ” in City at the Point: Essays on the Social History of Pittsburgh, ed. Samuel P. Hays (Pittsburgh: University of Pittsburgh Press, 1989), 17–18; Joe W. Trotter and Jared N.
282
N o t e s t o Pag e s 2 1 – 2 3
Day, Race and Renaissance: African Americans in Pittsburgh Since World War II (Pittsburgh: University of Pittsburgh Press, 2010); University Center for Social and Urban Research, University of Pittsburgh, “Pittsburgh Women Close Labor Force Gap,” Pittsburgh Economic Quarterly (Summer 2003), 1. 48. “Health care and related data,” ca. 1981, box 41, folder 3, ACCDR. 49. Christopher Briem and Peter A. Morrison, “How Migration Flows Shape the Elderly Population of Pittsburgh,” paper presented at the Southern Demographic Association (2004), available at http://citeseerx.ist.psu.edu/v iewdoc/download ?doi=10.1.1.572.4 299&rep=rep1&type=pdf; United States Census, Census of Population: 1950, table 82; United States Census, 1980 Census of Population, table 230; “Allegheny Still Second Oldest Big County in United States,” Pittsburgh Post-Gazette, May 24, 2001. 50. Arlie Russell Hochschild, The Managed Heart: Commercialization of H uman Feeling (Berkeley: University of California Press, 1983); Clare Ungerson, “Cash in Care,” in Care Work: Gender, Labor, and the Welfare State, ed. Madonna Harrington Meyer (New York: Routledge, 2000), 68–88; Clare L. Stacey, The Caring Self: The Work Experiences of Home Care Aides (Ithaca, NY: Cornell University Press, 2011); Federici, Revolution at Point Zero; Kathi Weeks, Constituting Feminist Subjects (New York: Verso, 2018). 51. Maurine W. Greenwald and Margo Anderson, eds., Pittsburgh Surveyed: Social Science and Social Reform in the Early Twentieth C entury (Pittsburgh: University of Pittsburgh Press, 1996). 52. Emily K. Abel and Margaret K. Nelson, eds., Circles of Care: Work and Identity in Women’s Lives (Albany: State University of New York Press, 1990); Eva Feder Kittay, Love’s Labor: Essays on Women, Equality, and Dependency (New York: Routledge, 1999). 53. For a discussion of this general phenomenon, see Paul Pierson, “Irresistible Forces, Immovable Objects: Post-Industrial Welfare States Confront Permanent Austerity,” Journal of European Public Policy 5, no. 4 (December 1998), 539–560. See also James K. Galbraith, The Predator State: How Conservatives Abandoned the Free Market and Why Liberals Should Too (New York: F ree Press, 2008), 105–113. 54. Esping-Andersen, Social Foundations of Postindustrial Economies, 148. For this argument, see Malcolm Harris, Kids Th ese Days: Human Capital and the Making of Millennials (New York: L ittle, Brown, 2017). 55. Steven Henry Lopez, Reorganizing the Rust Belt: An Inside Study of the American Labor Movement (Berkeley: University of California Press, 2004); Dana Beth Weinberg, Code Green: Money-Driven Hospitals and the Dismantling of Nursing (Ithaca, NY: Cornell University Press, 2009); Andrea Louise Campbell and Kimberly J. Morgan, The Delegated Welfare State: Medicare, Markets, and the Governance of Social Policy (New York: Oxford University Press, 2011); Ariel Ducey, Never Good Enough: Health Care Workers and the False Promise of Job Training (Ithaca, NY: Cornell University Press, 2009); Dan Clawson and Naomi Gerstel, Un-
N o t e s t o Pag e s 2 4 – 2 8
283
equal Time: Gender, Class, and Family in Employment Schedules (New York: Russell Sage Foundation, 2014); Mignon Duffy, Amy Armenia, and Clare L. Stacey, eds., Caring on the Clock: The Complexities and Contradictions of Paid Care Work (New Brunswick, NJ: Rutgers University Press, 2015); Rebecca Kolins Givan, The Challenge to Change: Reforming Health Care on the Front Line in the United States and the United Kingdom (Ithaca, NY: Cornell University Press, 2016); Jane Mc Alevey, A Collective Bargain: Unions, Organizing, and the Fight for Democracy (New York: HarperCollins, 2020). 56. Joan C. Tronto, Who Cares?: How to Reshape a Democratic Politics (Ithaca, NY: Cornell University Press, 2015); Nancy Fraser, “Contradictions of Capital and Care,” New Left Review 100 (July–August 2016), 99–117.
1. Down in the Hole 1. Howard Wickerham, interview with Gabriel Winant, June 5, 2013. 2. Edward A. Salaj, “Blue Collar Memories of the Homestead Works, By Edward A. Salaj, A Former Worker,” box 2, folder 72, SOHP. 3. Salaj, “Blue Collar Memories.” 4. Edward F. Stankowki Jr., Memory of Steel (Lima, OH: Wyndham Hall Press, 2004), 3. 5. On the economic boom, see Claudia Goldin and Robert A. Margo, “The Great Compression: The Wage Structure of the United States at Mid-century,” Quarterly Journal of Economics 107, no. 1 (1992), 1–34; Stephen A. Marglin and Juliet B. Schor, eds., The Golden Age of Capitalism: Reinterpreting the Postwar Experience (New York: Oxford University Press, 1992); Thomas Piketty, Capital in the Twenty-First C entury, trans. Arthur Goldhammer (Cambridge, MA: Harvard University Press, 2014). An excellent example of the contemporary belief in the postwar industrial compact is Clark Kerr, John T. Dunlop, Frederick Harbison, and Charles A. Myers, Industrialism and Industrial Man (Cambridge, MA: Harvard University Press, 1960). 6. Jefferson Cowie, The G reat Exception: The New Deal and the Limits of American Politics (Princeton, NJ: Princeton University Press, 2016), 153. 7. Jack Metzgar, Striking Steel: Solidarity Remembered (Philadelphia: T emple University Press, 2000), 39. 8. See Mike Davis, Prisoners of the American Dream: Politics and Economy in the History of the US Working Class (London: Verso, 1986), 121–124; David L. Stebenne, Arthur J. Goldberg: New Deal Liberal (New York: Oxford University Press, 1996), 154–232; Nelson Lichtenstein, State of the Union: A Century of American Labor (Princeton, NJ: Princeton University Press, 2002), 98–140; Kim Phillips- Fein, Invisible Hands: The Businessmen’s Crusade Against the New Deal (New York: Norton, 2009). See also Jefferson R. Cowie, Capital Moves: RCA’s Seventy- Year Quest for Cheap Labor (New York: New Press, 2001); Thomas J. Sugrue, The
284
N o t e s t o Pag e s 2 8 – 3 4
Origins of the Urban Crisis: Race and Inequality in Postwar Detroit, 2nd ed. (Princeton, NJ: Princeton University Press, 2005); Jeremy Milloy, Blood, Sweat, and Fear: Violence at Work in the North American Auto Industry, 1960–1980 (Urbana: University of Illinois Press, 2017); Daniel J. Clark, Disruption in Detroit: Autoworkers and the Elusive Postwar Boom (Urbana: University of Illinois Press, 2018). 9. Richard Hartshorne, “Location Factors in the Iron and Steel Industry,” Economic Geography 4, no. 3 (July 1928), 241. On the city’s industrial history, see Kenneth J. Kobus, City of Steel: How Pittsburgh Became the World’s Steelmaking Capital during the Carnegie Era (Lanham, MD: Rowman & Littlefield, 2015). 10. Herb Edwards, interview, box 2, folder 16, SOHP; Anne Yurcon, interview with James R. Barrett, May 12, 1976, HAOHPR. On the built environment in cultures of production generally, see Tim Ingold, “The Temporality of the Landscape,” World Archaeology 25, vol. 2 (1993), 152–174; Andrew Herod, Labor Geographies: Workers and the Landscapes of Capitalism (New York: Guilford Press, 2001); Thomas G. Andrews, Killing for Coal: America’s Deadliest L abor War (Cambridge, MA: Harvard University Press, 2010). For steel in particu lar, see Robert Bruno, Steelworker Alley: How Class Works in Youngstown (Ithaca, NY: Cornell University Press, 1999); Sherry Lee Linkon and John Russo, Steeltown U.S.A.: Work and Memory in Youngstown (Lawrence: University of Kansas Press, 2002). 11. Douglas A. Fisher, Steel Making in America (Pittsburgh: US Steel, 1949); Kenneth Warren, Big Steel: The First Century of the United States Steel Corporation (Pittsburgh: University of Pittsburgh Press, 2001). 12. John Hinshaw, Steel and Steelworkers: Race and Class Struggle in Twentieth- Century Pittsburgh (Albany, NY: SUNY Press, 2002), 169–170. See also Harry Braverman, Labor and Monopoly Capital: The Degradation of L abor in the Twentieth Century (New York: Monthly Review Books, 1974), 294–300. 13. Data from American Iron and Steel Institute, Annual Statistical Report, qtd. in Paul A. Tiffany, The Decline of American Steel: How Management, L abor, and Government Went Wrong (New York: Oxford University Press, 1988), 27. 14. Tiffany, The Decline of American Steel. See 103–127, especially 117, on international competition, and 128–152 on domestic coordination; Gary Herrigel, Manufacturing Possibilities: Creative Action and Industrial Recomposition in the United States, Germany, and Japan (New York: Oxford University Press, 2010), 87. 15. Hinshaw, Steel and Steelworkers, 109–110; Judith Stein, Running Steel, Running America: Race, Economic Policy, and the Decline of Liberalism (Chapel Hill, NC: University of North Carolina Press, 1998), 11–36; Tiffany, The Decline of American Steel, 21–41; Kristoffer Smemo, Samir Sonti, and Gabriel Winant, “Conflict and Consensus and the Anatomy of the New Deal Order,” Critical Historical Studies 4, no. 1 (Spring 2017), 54. 16. Warren, Big Steel, 275. Data from American Iron and Steel Institute, Annual Statistical Report, qtd. in Tiffany, The Decline of American Steel, 27.
N o t e s t o Pag e s 35 – 4 1
285
17. Census of Population, 1950, table 35; John D. Stephens and Brian P. Holly, “City System Behaviour and Corporate Influence: The Headquarters Location of US Industrial Firms, 1955–75,” Urban Studies 18, no. 3 (October 1981), 296. 18. Census of Population, 1950, table 83. 19. “The Kitchen Debate—Transcript,” July 24, 1959, available at http://w ww .foia.cia.g ov/sites/d efault/fi les/document_conversions/1 6/1959-07-24.pdf. 20. Stein, Running Steel, 7–36; Lichtenstein, State of the Union, 122–25; Meg Jacobs, Pocketbook Politics: Economic Citizenship in Twentieth-Century America (Princeton, NJ: Princeton University Press, 2004), 179–261. 21. Charles Maier, In Search of Stability: Explorations in Historical Political Economy (Cambridge: Cambridge University Press, 1988), 121–152. 22. Smemo, Sonti, and Winant, “Conflict and Consensus.” 23. United States Steel Corporation, “Economic Trends in the Iron and Steel Industry: Facts for Management,” May 1959, p. 18, 1959 Negotiations Folder, box 54, USSCNDWR. 24. Hearings of the Subcommittee on Antitrust and Monopoly, Administered Prices: Steel, Part 3, 80th Congress, 1st Session, 1958, p. 1059, qtd. in Walter Adams and Joel B. Dirlam, “Big Steel, Invention, and Innovation,” Quarterly Journal of Economics 80, no. 2 (1966), 175; “Supervisors Connected with Civic Activities,” April 16, 1957, box 30, folder 8, USSCDWIRDR; Annie Dillard, An American Childhood (New York: Harper & Row, 1987), 198. 25. Robert Brenner, The Economics of Global Turbulence (London: Verso, 2006), 56. 26. Memorandum, pp. 5–6, October 16, 1956, box 3, series IV, RCCP. 27. “Prog ress Report Regarding Development of a Measure and Index of Productivity,” pp. 4–5, May 8, 1956, box 3, folder 3, RCCP. 28. “Prog ress Report Regarding Development of a Measure and Index of Productivity,” p. 25. See also Metzgar, Striking Steel, 120–127. 29. Benjamin Chinitz, “Contrasts in Agglomeration: New York and Pittsburgh,” American Economic Review 51, no. 2 (May 1961), 285; Dillard, An American Childhood, 75, 92, 134; “Supervisors Connected with Civic Activities,” April 16, 1957, box 30, folder 8, USSCDWIRDR; Salaj, “Blue Collar Memories”; Wickerham, interview. Deborah Rudacille, Roots of Steel: Boom and Bust in an American Mill Town (New York: Pantheon, 2010), 18. See Nelson Lichtenstein, “The Man in the M iddle: A Social History of Automobile Industry Foremen,” in On the Line: Essays in the History of Auto Work, ed. Nelson Lichtenstein and Stephen Meyer (Urbana: University of Illinois Press, 1989). 30. “Rules and Regulations Governing the Operations of the Duquesne Luncheon Club,” ca. 1957, box 27, USSCDWIRDR. 31. Superintendents’ Club Parties, 1957–1961, box 27, USSCDWIRDR; Supervisors Club Participation, February 27, 1959, box 27, folder 3, USSCDWIRDR; see,
286
N o t e s t o Pag e s 4 2 – 4 7
for example, Duquesne Works Supervisors Club Tentative Program, February 2, 1960, box 27, folder 3, USSCDWIRDR. 32. Works Management Incentive Plan, May 1954, box 261, USSCNDWR; W. J. McShane to T. H. Kennedy, May 29, 1956, box 260, folder 3, USSCNDWR. 33. Duquesne Works Management Development Program, April 1959, box 30, folder 8, USSCDWIRDR. 34. Task Force Questionnaires, September 20, 1957, box 30, folder 8, USSCDWIRDR. 35. Anna Mae Lindberg, interview with Nora Faires, May 5, 1976, HAOHPR; Stankowki, Memory of Steel, 13. 36. Salaj, “Blue Collar Memories.” 37. Interview, Wickerham. 38. Ellie Wymard, Talking Steel Towns: The Men and W omen of America’s Steel Valley (Pittsburgh: Carnegie Mellon University Press, 2007), 24–25. See also Bruno, Steelworker Alley, 116–122; Metzgar, Striking Steel, 50, 199–201. 39. See Michael Burawoy, Manufacturing Consent: Changes in the Labor Pro cess Under Monopoly Capitalism (Chicago: University of Chicago Press, 1979). 40. Action on Providing Supervisory Desks, April 22, 1957, box 30, folder 8, USSCDWIRDR; Report, Industrial Relations Conference, Medical Evaluations, December 26, 1962, box 8, folder 5, United States Steel Duquesne Works Industrial Relations Records; Supplemental Agreement Attached to Agreement of April 29, 1947, “Portal to Portal,” USWA 1843; Official Walking Time, September 14, 1939, box 15, “Walking Time,” USWA 1843. 41. Salaj, “Blue Collar Memories.” Minutes of Meeting with Grievance Committee, May 19, 1953, box 4, folder 6, USSCDWIRDR; Minutes of Meeting with Grievance Committee, January 19, 1954, box 4, folder 6, USSCDWIRDR; Minutes of Meeting with Grievance Committee, September 21, 1954, box 4, folder 6, USSCDWIRDR; Minutes of Meeting with Grievance Committee, September 19, 1956, box 4, folder 7, USSCDWIRDR; Employee Suggestion Plan Investigation Form, July 11, 1957, box 26, folder 2, USSCDWIRDR; Cost Reduction Project Report, November 1957, box 32, folder 2, USSCDWIRDR; Employee Request, June 18, 1957, box 29, USSCDWIRDR. 42. Memorandum, p. 5, October 16, 1956, box 3, series IV, RCCP. On the managerial offensive of the late 1950s, see Davis, Prisoners of the American Dream, 121–124; Stebenne, Arthur J. Goldberg, 154–232; Phillips-Fein, Invisible Hands, 87–114. 43. Memorandum of Special Third-Step Meeting Concerning Unanswered Grievance—Discharge of Pete Dohanic Jr., May 25, 1956, box 9, folder 2, USSCDWIRDR. On violence of this kind, see Milloy, Blood, Sweat, and Fear. 44. E. P. Thompson, “Time, Work-Discipline, and Industrial Capitalism,” Past and Present 38 (December 1967), 56–97. 45. Work Stoppages at Duquesne, from April, 1947 to February 21, 1956, box 22, USSCDWIRDR; “Potential Sources of L abor Relations Trouble,” May 23, 1958, box 2, folder 7, USSCDWIRDR.
N o t e s t o Pag e s 4 7 – 5 2
287
46. Minutes of Special Third-Step Meeting between Local #1256 Grievance Committee Chairman and Management of Duquesne Works, March 14, 1957, box 22, folder 2, USSCDWIRDR. 47. Minutes of Meeting with Grievance Committee, May 15, 1957, box 22, folder 2, USSCDWIRDR; Minutes of Meeting Grievance Committee, June 19, 1957, box 29, USSCDWIRDR. 48. “Number of Employees to Be Laid Off for Minimum Four-Day Work Week,” August 29, 1957, box 2, folder 12, USSCDWIRDR. 49. Board of Arbitration, Docket No. 259-C-60, November 28, 1958, box 59, folder 2, USWA 1843; Grievance Report, August 25, 1958, box 59, folder 1, USWA 1843; Herb Edwards, interview, box 2, folder 16, SOHP. Workers in dirty shops or low-status jobs who did not have southern or eastern European last names were likely, though not certain, to be African American. 50. R. A. Brumbaugh to A. L. Norman, November 12, 1957, box 2, folder 8, USSCDWIRDR; United States Steel Corporation Meeting with Grievance Committee, December 17, 1957, box 32, folder 7, USSCDWIRDR; Relief of Congestion in Employment Office by SUB Applicants, December 1, 1957, box 26, folder 2, USSCDWIRDR; Employment Statistics, January 23, 1959, box 8, folder 3, USSCDWIRDR. For the dating of recessions, see “US Business Cycle Expansions and Contractions,” National Bureau of Economic Research, available at http://w ww .nber.org/cycles.html. 51. Beth Novak, diary, January 1958, in possession of Linda Novak, facsimile in author’s possession; Memorandum of Understanding Regarding Temporary Work Schedules for Open Hearth Department and Open Hearth Assigned and Operating Maintenance, February 9, 1958, box 15, folder 10, USSCDWIRDR. 52. Elizabeth Freeman, Time Binds: Queer Temporalities, Queer Histories (Durham, NC: Duke University Press, 2010), 1–19. 53. Stankowski, Memory of Steel, 31. 54. Salaj, “Blue Collar Memories.” 55. Second Step Meeting—Grievance 57-2, January 28, 1957, box 8, folder 2, USSCDWIRDR; Memorandum of Understanding, John White, #16505, October 25, 1961, box 15, folder 4, USSCDWIRDR. Grievance form, HD-65-166, September 19, 1965, box 10, folder 5, USSCDWIRDR. On sleep, see Alan Derickson, Dangerously Sleepy: Overworked Americans and the Cult of Manly Wakefulness (Philadelphia: University of Pennsylvania Press, 2013), 53–83. Grievance form, HD-65166, September 19, 1965, box 10, folder 5, USSCDWIRDR. 56. Interview, Wickerham. Injury reports, box 14, item 2, USSCDWIRDR; Minutes of Meeting with Grievance Committee, November 12, 1963, box 31, folder 2, USSCDWIRDR; “Minor Injuries 1955,” box 55, USSCNDWR. 57. Beth Novak, diary, November 24, 1958; Wymard, Talking Steel Towns, 57–61. 58. Interview, Bob McFeely, Box 2, Folder 11, SOHP. 59. Wickerham, interview.
288
N o t e s t o Pag e s 5 2 – 5 7
60. Industrial Engineering Methods Division, Variance Improvement Standards Tightening, April 1961, box 32, folder 1, USSCDWIRDR. 61. Minutes of Meeting with Grievance Committee, June 17, 1955, box 2, folder 6, USSCDWIRDR. 62. Events Leading to Walk-Out—Thursday, May 21, 1959, box 17, folder 3, USSCDWIRDR; Pipefitter Strike Log, June 5, 1959, box 17, folder 3, USSCDWIRDR. 63. Pipefitters’ Strike, 7–3 Turn, May 22, 1959, box 17, folder 3, USSCDWIRDR; Vernon Sidberry to John W. Price, June 4, 1959, box 17, folder 3, USSCDWIRDR; Pipefitter Strike Log, June 5, 1959, box 17, folder 3, USSCDWIRDR; Strike photo graphs, box 17, folder 3, USSCDWIRDR; Proposed Procedure with Respect to the Discipline in Connection with the Pipefitter Work Stoppage, May 27, 1959, box 17, folder 3, USSCDWIRDR. 64. Summary by Industrial Relations, Industrial Engineering, and L egal Departments of Holdings of Section 2-B Arbitration Cases, July 3, 1956, box 8, folder 1, USSCDWIRDR; emphasis in original. On Section 2-B, see Stebenne, Arthur J. Goldberg, 120–232, Metzgar, Striking Steel, 13–117; James D. Rose, “The Struggle Over Management Rights at US Steel, 1946–1960: A Reassessment of Section 2-B of the Collective Bargaining Contract,” Business History Review 72 (Autumn, 1998), 446–477. 65. Section 2- B Local Working Conditions, box 8, folder 1, 1958, USSCDWIRDR. 66. E. J. Woll to Superintendents of Industrial Relations, November 11, 1958, box 8, folder 1, USSCDWIRDR. 67. Review of Local Working Conditions, December 2, 1958, box 8, folder 1, USSCDWIRDR; Local Working Conditions, December 19, 1958, box 8, folder 1, USSCDWIRDR; Proposed Changes to 8-3-56 P&M Labor Agreement, November 11, 1958, box 8, folder 1, USSCDWIRDR. 68. L abor Relations Meeting, December 12, 1958, box 32, folder 21, USSCDWIRDR; Stebenne, Arthur J. Goldberg, 202. 69. Statement by David J. McDonald, August 18, 1959, box 7, folder 4, USWA 1397. 70. Dues Protest Committee Slate, 1957, vol. 1, USWADPCS. 71. See John Herling, The Right to Challenge: People and Power in the Steelworkers Union (New York: Harper & Rowe, 1972); John P. Hoerr, And the Wolf Finally Came: The Decline of the American Steel Industry (Pittsburgh: University of Pittsburgh Press, 1988), 252–253; Metzgar, Striking Steel, 161–175; “ ‘Trotskyite’ Tag Hit by USW Dues Foe,” PP, December 4, 1956; “USW Official Hanged in Effigy,” PP, December 19, 1956; “Bribe Charge a Lie, McDonald Tells USW,” PP, January 13, 1957; “McDonald Sees High Pay, More Leisure in Future,” PPG, January 16, 1957; “McDonald Pushes 3-Months Vacation Plan,” PP, January 20, 1957. 72. Confidential report, Labor Relations meeting, May 6, 1960, box 8, folder 16, USSCDWIRDR; Metzgar, Striking Steel, 65.
N o t e s t o Pag e s 5 7 – 6 5
289
73. Strike or Work Stoppage Reports, no. 72, December 16, 1959, box 17, USSCDWIRDR. 74. Metzgar, Striking Steel, 68; Novak, diary, 1959; Joyce Henderson, interview with Gabriel Winant, July 20, 2016; Carol Henry, interview with Gabriel Winant, July 21, 2016. 75. Metzgar, Striking Steel, 73; Mrs. Mike Micklo to L. B. Worthington, December 11, 1959, box 15, folder 4, USSCDWIRDR. 76. “Ask the Steelworker’s Wife,” October 19, 1959, box 54, USSCNDWR; F. J. Schaeffer to W. T. Lowe, Jr., September 1, 1959, box 54, USSCNDWR (ellipses in original). 77. F. J. Schaeffer to W. T. Lowe Jr., September 1, 1959, box 54, USSCNDWR; “Wives Surrender Strike to Mates,” Pittsburgh Sun-Telegraph, September 4, 1959. 78. Smemo, Sonti, and Winant, “Conflict and Consensus,” 46–48. 79. Smemo, Sonti, and Winant, “Conflict and Consensus,” 68–70. 80. Stankowski, Memory of Steel, 65. 81. Steelworkers v. United States, 361 U.S. 39 (1959).
2. Dirty Laundry 1. Beth Novak diary, July 31, 1961, diary facsimiles in author’s possession. 2. Linda Novak, interview with Gabriel Winant, June 22, 2015. 3. Interview S-15-C, p. 3, WEMHOHPR. Like all subjects of this oral history project, this woman is anonymous. See, for one of many examples, Award in Case No. USC-645, Grievance No. A-57-2, Duquesne Works, February 19, 1958, box 29, folder 6, USSCDWIRDR. 4. Eve Kosofsky Sedgwick, Tendencies (Durham, NC: Duke University Press, 1993), 5–6. 5. Alice Kessler-Harris, Out to Work: A History of Wage-Earning Women (New York: Oxford University Press, 1982). See also Ruth Schwartz Cowan, More Work for Mother: The Ironies of Household Technology from the Open Hearth to the Microwave (New York: Basic Books, 1985); Eileen Boris, Home to Work: Industrial Motherhood and the Politics of Industrial Homework in the United States (New York: Cambridge University Press, 1994); Susan Strasser, Never Done: A History of American Housework (New York: Holt, 2000). This chapter takes inspiration from Susan Porter Benson, Household Accounts: Working-Class Family Economies in the Interwar United States (Ithaca, NY: Cornell University Press, 2007). 6. Maurine Weiner Greenwald, “Women and Class in Pittsburgh, 1850–1920,” in City at the Point: Essays on the Social History of Pittsburgh, ed. Samuel P. Hays (Pittsburgh: University of Pittsburgh Press, 1989), 33–68; Pittsburgh Regional Planning Association, Region in Transition (Pittsburgh: University of Pittsburgh Press, 1963), 34. See also Sabina Deitrick, Susan B. Hansen, and Christopher Briem, “Gender Wage Disparity in the Pittsburgh Region: Analyzing C auses and
290
N o t e s t o Pag e s 6 6 – 67
Differences in the Gender Wage Gap,” University Center for Social and Urban Research, University of Pittsburgh, 2007; Kessler-Harris, Out to Work; Dorothy Sue Cobble, The Other Women’s Movement: Workplace Justice and Social Rights in Modern America (Princeton, NJ: Princeton University Press, 2004). See also Karen Olson, “The Gendered Social World of Steelmaking: A Case Study of Bethlehem Steel’s Sparrows Point Plant,” in U.S. L abor in the Twentieth C entury: Studies in Working-Class Struggle and Insurgency, ed. John Hinshaw and Paul Le Blanc (Amherst, NY: Humanity Books, 2000), 101–126. 7. Cowan, More Work for Mother, 192–209; Stephanie Coontz, The Way We Never W ere: American Families and the Nostalgia Trap (New York: Basic Books, 1992), 23–41. For Parsons quotation, see Talcott Parsons, “Age and Sex in the Social Structure of the United States,” American Sociological Review 7, no. 5 (1942), 3, qtd. in Andrew J. Cherlin, Labor’s Love Lost: The Rise and Fall of the Working- Class Family in Americ a (New York: Russell Sage Foundation, 2014), 3; Lizabeth Cohen, A Consumer’s Republic: The Politics of Mass Consumption in Postwar America (New York: Knopf, 2003), 154; Cobble, The Other W omen’s Movement. 8. See Ralf Dahrendorf, Class and Class Conflict in Industrial Society (Stanford, CA: Stanford University Press, 1959); Ferdynand Zweig, The Worker in an Affluent Society: Family Life and Industry (New York: F ree Press of Glencoe, 1961). For a counterpoint see Ely Chinoy, Automobile Workers and the American Dream (New York: Doubleday, 1955). On the persistent classed consumption habits of workers. see Shelly K. Nickles, “More Is Better: Mass Consumption, Gender, and Class Identity in Postwar America,” American Quarterly 52, no. 4 (2002), 581–662. 9. Helen H. Lamale and Margaret S. Stotz, “The Interim City Worker’s Family Budget,” Monthly L abor Review 83, no. 8 (August 1960), 785–808, cited in Marc McColloch, “Modest but Adequate: Standard of Living for Mon Valley Steelworkers in the Union Era,” in U.S. L abor History in the Twentieth Century, ed. Hinshaw and Le Blanc. 10. McColloch, “Modest but Adequate,” especially 254. 11. John Bodnar, Roger Simon, and Michael P. Weber, Lives of Their Own: Blacks, Italians, and Poles in Pittsburgh, 1900–1960 (Urbana: University of Illinois Press, 1983); Joyce Henderson, interview with Gabriel Winant, July 20, 2016. 12. Lee Rainwater, Richard B. Coleman, and Gerald Handel, Workingman’s Wife: Her Personality, World and Life Style, 2nd ed. (New York: Arno Press, 1979), 19, 58–59; National Manpower Council, Womanpower: A Statement by the National Manpower Council (New York: Columbia University Press, 1957), 3, qtd. in Kessler-Harris, Out to Work, 300. 13. Joann Vanek, “Time Spent in Housework,” Scientific American 231, no. 5 (November 1974), 116–121; Susan Thistle, From Marriage to the Market: The Transformation of W omen’s Lives and L abor (Berkeley: University of California Press, 2006), 39–41. See Nancy Fraser, in “Behind Marx’s Hidden Abode: For an
N o t e s t o Pag e s 6 8 – 7 5
291
Expanded Conception of Capitalism,” New Left Review 86 (March–April 2014), 55–86. 14. Talcott Parsons and Robert F. Bales, Family: Socialization and Interaction Process (London: Routledge, 1956), 16. 15. See Mirra Komarovsky, Blue-Collar Marriage (New York: Random House, 1964); Elaine Tyler May, Homeward Bound: American Families in the Cold War Era (New York: Basic Books, 1988); Coontz, The Way We Never W ere; Joanne Meyerowitz, “Women and Gender in Postwar America, 1945–1960,” in Not June Cleaver: Women and Gender in Postwar America, 1945–1960, ed. Joanne Meyero witz (Philadelphia: Temple University Press, 1994), 1–18; Alice Kessler-Harris, In Pursuit of Equity: W omen, Men, and the Quest for Economic Citizenship in 20th- Century America (New York: Oxford University Press, 2003); Nancy F. Cott, Public Vows: A History of Marriage and the Nation (Cambridge, MA: Harvard University Press, 2000); Margot Canaday, The Straight State: Sexuality and Citizenship in Twentieth-Century America (Princeton, NJ: Princeton University Press, 2009). 16. Census of Population, 1960, T ables 26, 45. For a discussion of the ideology of the home in the Catholic working-class household, see Robert A. Orsi, The Madonna of 115th Street: Faith and Community in Italian Harlem (New Haven, CT: Yale University Press, 1985). 17. S-13-B, pp. 8, 11–13, WEMHOHPR. 18. S-13-C, p. 1, WEMHOHPR. 19. S-23-B, pp. 3–33, WEMHOHPR. 20. S-9-C, p. 36, WEMHOHPR. 21. See Wally Seccombe, Weathering the Storm: Working-Class Families from the Industrial Revolution to the Fertility Decline (London: Verso, 1995). 22. S-25-C, p. 11, WEMHOHPR. 23. S-5- B, pp. 20–21, WEMHOHPR; S-18- B, p. 25, WEMHOHPR; Ellie Wymard, Talking Steel Towns: The Men and Women of America’s Steel Valley (Pittsburgh: Carnegie Mellon, 2007), 62. 24. S-15-B, p. 18, WEMHOHPR. 25. S-14-B, pp. 32–33, WEMHOHPR; S-5-B, pp. 53–54, WEMHOHPR. 26. Komarovsky, Blue-Collar Marriage, 58–59; E. P. Thompson, “Time and Work-Discipline in Industrial Capitalism,” Past and Present 38 (1967), 79. 27. I-5-B, WEMHOHPR. 28. Interview, Queen E. Wright, box 4, folder 207, POHP. 29. Census of Population, 1960, Table 129; Census of Population, 1960, Table 176; Census of Population, 1960, T able 176; Application Form, November 3, 1961, box 33, folder 2, NAACPPBR. 30. Interview, Lucille Smith, box 4, folder 223, POHP. See Evelyn Nakano Glenn, “From Servitude to Serv ice Work: Historical Continuities in the Racial
292
N o t e s t o Pag e s 7 5 – 82
Division of Paid Reproductive L abor,” Signs 18, no. 1 (1992), 1–43; Carol Henry, interview with Gabriel Winant, July 23, 2016; S-14-A, pp. 27–28, WEMHOHPR. 31. Wymard, Talking Steel Towns, 60; I-8-B, WEMHOHPR. 32. S-1-A, p. 73, WEMHOHPR; S-14-B, p. 52, WEMHOHPR; S-13-B, pp. 18– 25, WEMHOHPR. 33. I-1-A, WEMHOHPR; I-4-C, WEMHOHPR; Wymard, Talking Steel Towns, 62–67. 34. Beth Novak diary, May 6, 1958. 35. Beth Novak diary, May 19, 1958; Wymard, Talking Steel Towns, 60–61. 36. S-18-C, pp. 32, 36, WEMHOHPR. 37. S-10-B, pp. 20–22, WEMHOHPR. 38. S-14-B, p. 2, WEMHOHPR; S-23-B, p. 4, WEMHOHPR. 39. Frank Takach, interview May 19, 1976, box 1, folder 20, HAOHPR; James Longhurst, Citizen Environmentalists (Lebanon, NH: Tufts University Press, 2010), 42. On similar issues in an aluminum town, see Pavithra Vasudevan, “An Intimate Inventory of Race and Waste,” Antipode 51, no. 2 (March 2019), 1–21. 40. Wymard, Talking Steel Towns, 62–67; Henderson, interview; Raymond Henderson, My Three Books: A Life Journey (Wilmington, DE: CreateSpace In dependent Publishing Platform, 2017), 42–43. 41. Judith Modell and Charlee Brodsky, “Envisioning Homestead: Using Photographs in Interviewing,” in Interactive Oral History Interviewing, ed. Eva M. McMahan and Kim Lacy Rogers (New York: Routledge, 2013), 148. 42. Census of Population, 1960, table 72. 43. See Thomas J. Sugrue, “Crabgrass-Roots Politics: Race, Rights, and the Reaction against Liberalism in the Urban North, 1940–1964,” Journal of American History 82, no. 2 (September 1995), 551–578; Becky M. Nicolaides, My Blue Heaven: Life and Politics in the Working-Class Suburbs of Los Angeles, 1920–1965 (Chicago: University of Chicago Press, 2002). 44. S-11-B, p. 30, WEMHOHPR; S-1-A, pp. 71–72, WEMHOHPR. 45. “Rankin F amily of 9 Unprotected from Rain and a Leaking Floor in Cellar,” Pittsburgh Courier, November 9, 1957. 46. Rainwater, Coleman, and Handel, Workingman’s Wife, 159. 47. I-5- A, WEMHOHPR; S-25- A, p. 8, WEMHOHPR; S-1- B, pp. 59–71, WEMHOHPR; S-24-A, p. 20, WEMHOHPR. 48. Henderson, interview; I-1-A, WEMHOHPR; I-22-B, p. 47, WEMHOHPR; I-8-A, WEMHOHPR; Earline Coburn, interview with Gabriel Winant, July 20, 2016. 49. I-5-B, WEMHOHPR. 50. Beth Novak diary, July 24 1961-July 25, 1961. 51. See also Karen Olson, Wives of Steel: Voices of W omen from the Sparrows Point Steelmaking Communities (University Park: Pennsylvania State University Press, 2005).
N o t e s t o Pag e s 82 – 9 0
293
52. The Kitchen Debate—Transcript, July 24, 1959, available at http://w ww .foia.cia.g ov/sites/d efault/fi les/document_conversions/1 6/1959-07-24.pdf; S-25-C, pp. 8–9, WEMHOHPR. 53. McColloch, “Modest but Adequate”; “Out-of-Work Steelworker’s F amily in Dire Plight,” Pittsburgh Courier, April 1, 1960; Henry, interview. 54. Karl N. Llewellyn, “Behind the Law of Divorce,” Columbia Law Review 33 (1933), 256–257, n.12, n.16, qtd. in Cott, Public Vows, 3–4. 55. I-1-A, WEMHOHPR. 56. S-1-A, p. 88, WEMHOHPR; S-25-A, p. 8, WEMHOHPR. 57. S-15-B, pp. 16–17, WEMHOHPR; S-14-A, p. 23, WEMHOHPR; Mrs. Mike Micklo to Mr. Worthington, December 11, 1959, Box 15, Folder 2, USSCDWIRDR. 58. I-8-B, WEMHOHPR; S-11-B, p. 17, WEMHOHPR. 59. Jack Metzgar, Striking Steel: Solidarity Remembered (Philadelphia: T emple University Press, 2000), 186–199. 60. Sherri Peterson, “Sociology 10 Class Project,” 1987, Sociology 10 Course Project on Student Family Histories Collection, box 1, folder 24, Archives & Special Collections, University Library System, University of Pittsburgh. 61. R.W.M. Memo re: Mrs. Czap’s letter to J. W. Price, September 5, 1961, box 15, folder 2, USSCDWIRDR. 62. S-7-C , pp. 17–20, WEMHOHPR; S-23-B, pp. 34–36, WEMHOHPR. 63. S-9-C, pp. 34, 38–40, WEMHOHPR. 64. Novak diary, January 7–12, February 14, 1961; Novak, interview. 65. Lillian B. Rubin, Worlds of Pain: Life in the Working-Class Family (New York: Basic Books, 1976), 138; S-10-A, p. 13, WEMHOHPR; S-13-C, p. 13, WEMHOHPR; S-3-A, p. 38, WEMHOHPR; S-2-A, p. 53, WEMHOHPR; S-18-B, p. 26, WEMHOHPR. 66. S-15-A, p. 17, WEMHOHPR; Wymard, Talking Steel Towns., 58–60. 67. S-16-A, p. 24, WEMHOHPR; S-11-B, p. 11, WEMHOHPR. Olson echoes this view in “The Gendered Social World of Steelmaking,” 122–123. 68. Wymard, Talking Steel Towns, 58–59. See also Komarovsky, Blue-Collar Marriage, 100; Wymard, Talking Steel Towns, 95. 69. Paula S. Fass, “The Child-C entered Family? New Rules in Postwar Amer ica,” in Reinventing Childhood A fter World War II, ed. Paula S. Fass and Michael Grossberg (Philadelphia: University of Pennsylvania Press, 2012), 7–8; William Graebner, “Coming of Age in Buffalo: The Ideology of Maturity in Postwar Amer ica,” Radical History Review 34 (January 1986), 53–74; Martin Kohli, “The Institutionalization of the Life Course: Looking Back to Look Ahead,” Research in Human Development 4, nos. 3-4 (2007), 253–271. 70. US Census, Statistics of Population, Occupations, Agriculture, Manufactures, and Mines and Quarries for the State, Counties and Cities, 1920, State Compendium Pennsylvania, t able 8. The “steel town” calculation is based on Braddock, Duquesne, Homestead, and McKeesport.
294
N o t e s t o Pag e s 9 1 – 1 0 0
71. 1-3-C, WEMHOHPR; S-13-B, p. 18, WEMHOHPR. 72. Wymard, Talking Steel Towns, 63. 73. I-22-B, p. 33, WEMHOHPR; S-10-A, p. 24, WEMHOHPR; S-13-B, p. 19, WEMHOHPR. 74. S-9-B, p. 14, WEMHOHPR; Wymard, Talking Steel Towns, 64. 75. S-9-C , pp. 45–46, WEMHOHPR; S-18-B, pp. 30–31, 52, 56, WEMHOHPR; S-18-C, 4, WEMHOHPR. 76. S-22-B, 4, 12, 18–19, 49. 77. Earline Coburn, interview. 78. Henderson, My Three Books, 10–11, 21–22, 31; Henry, interview. 79. See Kessler-Harris, In Pursuit of Equity; Wymard, Talking Steel Towns, 86; Edward F. Stankowki Jr., Memory of Steel (Lima, OH: Wyndham Hall Press, 2004), 20. 80. See Coontz, The Way We Never Were, 42. See also Nancy Chodorow, The Reproduction of Mothering: Psychoanalysis and the Sociology of Gender (Berkeley: University of California Press, 1978); “ ‘Mrs. Steelworker’ Is Now In Charge of Home,” PC, July 25, 1959. 81. Lauren Berlant, The Female Complaint: The Unfinished Business of Sentimentality in American Culture (Durham, NC: Duke University Press, 2008), 1–2.
3. “You Are Only Poor if You Have No One to Turn to” 1. “Unemployed Father of 8 in Condemned House Faces Eviction for Unpaid Rent,” PC, September 20, 1958. 2. William Julius Wilson, When Work Disappears: The World of the New Urban Poor (New York: Vintage, 1996). But see also Carol B. Stack, All Our Kin: Strategies for Survival in a Black Community (New York: Basic Books, 1974); Ida Susser, Norman Street: Poverty and Politics in an Urban Neighborhood (New York: Oxford University Press, 1982). See Susan Gore, “The Effect of Social Support in Moderating the Health Consequences of Unemployment,” Journal of Health and Social Behavior 19, no. 2 (June 1978), 158. 3. See Andrew Herod, Labor Geographies: Workers and the Landscapes of Capitalism (New York: Guilford Press, 2001). 4. Sharon Patricia Holland, The Erotic Life of Racism (Durham, NC: Duke University Press, 2012), 6. 5. Sean F. Reardon, Stephen A. Matthews, David O’Sullivan, Glenn Firebaugh, Chad R. Farrell, and Kendra Bischoff observe in Pittsburgh one of the most fine-grained patterns of segregation in the country in “The Geographic Scale of Metropolitan Racial Segregation,” Demography 45, no. 3 (August 2008), 489–514; Gwendolyn Mitchell, The HistoryMakers A2003.304, interview by Larry Crowe, December 18, 2003, The HistoryMakers Digital Archive.
N o t e s t o Pag e s 1 0 0 – 1 02
295
6. Allen Dieterich-Ward, Beyond Rust: Metropolitan Pittsburgh and the Fate of Rust Belt Americ a (Philadelphia: University of Pennsylvania Press, 2015); Earline Coburn, interview with Gabriel Winant, July 20, 2016. On white flight, see Thomas J. Sugrue, The Origins of the Urban Crisis: Race and Inequality in Postwar Detroit (Princeton, NJ: Princeton University Press, 1998); Eric Avila, Popular Culture in the Age of White Flight: Fear and Fantasy in Suburban Los Angeles (Berkeley: University of California Press, 2006). 7. John Bodnar, Roger Simon, and Michael P. Weber, Lives of Their Own: Blacks, Italians, and Poles in Pittsburgh, 1900–1960 (Urbana: University of Illinois Press, 1983); Marc McColloch, “Modest but Adequate: Standard of Living for Mon Valley Steelworkers in the Union Era,” U.S. L abor in the Twentieth Century: Studies in Working-Class Struggle and Insurgency, ed. John Hinshaw and Paul Le Blanc (Amherst, NY: Humanity Books, 2000). 8. Joe W. Trotter and Jared Day, Race and Renaissance: African Americans in Pittsburgh Since World War II (Pittsburgh: University of PP, 2010); Ruth M. McIntyre, “The Organizational Nature of an Urban Residential Neighborhood in Transition: Homewood-Brushton of Pittsburgh” (PhD diss., University of Pittsburgh, 1963); Ralph Lemuel Hill, “A View of the Hill: A Study of Experiences and Attitudes in the Hill District of Pittsburgh, Pennsylvania from 1900 to 1973” (PhD diss., University of Pittsburgh, 1973); Melvin D. Williams, On the Street Where I Lived (New York: Holt, Rinehart, and Winston, 1981); Fidel Makoto Campet, “Housing in Black Pittsburgh: Community Struggles and the State” (PhD diss., Carnegie Mellon University, 2011); Jessica D. Klanderud, “Street Wisdom: African American Cultural and Community Transformations in Pittsburgh, 1918– 1970” (PhD diss., Carnegie Mellon University, 2013). On the making of postwar ghettos in general, see Arnold R. Hirsch, Making the Second Ghetto: Race and Housing in Chicago, 1940–1960 (New York: Cambridge University Press, 1983); Sugrue, The Origins of the Urban Crisis; Robert O. Self, American Babylon: Race and the Struggle for Postwar Oakland (Princeton, NJ: Princeton University Press, 2003); Heather Ann Thompson, Whose Detroit?: Politics, Labor, and Race in a Modern American City (Ithaca, NY: Cornell University Press, 2004); Donna Jean Murch, Living for the City: Migration, Education, and the Rise of the Black Panther Party in Oakland, California (Chapel Hill: University of North Carolina Press, 2010). 9. Population Growth Trends, box 2, folder 2, MSP; Trotter and Day, Race and Renaissance, xix. 10. Edward F. Stankowski Jr., Memory of Steel (Lima, OH: Wyndham Hall Press, 2004); Census of Population, 1950, table 35; Census of Population, 1960, tables 72–75. See also Kristoffer Smemo, Samir Sonti, and Gabriel Winant, “Conflict and Consensus: The Steel Strike of 1959 and the Anatomy of the New Deal Order,” Critical Historical Studies 4, no. 1 (Spring 2017), 39–73.
296
N o t e s t o Pag e s 1 02 – 1 0 5
11. Census of Population and Housing, 1960, Pittsburgh Standard Metropolitan Statistical Area, Final Report PHC(1)-9 (Washington, 1962), table P-3, 171; Census of Population, 1970, table 87; “Mon-Valley NAACP Seeks to Aid Jobless,” PC, August 11, 1962. 12. “Focal Point Pittsburgh: A Community Examination,” box 46, folder 10, NAACPPBR; “Pittsburgh in Danger of Losing Status as ‘Boom’ Town,” PP, August 4, 1967; Community Action Pittsburgh, “Target Neighborhood Report,” box 126, folder 5, RHWPA; “Negro Jobless Rates Highest,” PPG, February 27, 1968; Community Action Pittsburgh, “Target Neighborhood Report,” box 126, folder 5, RHWPA. 13. Donald T. Barnum, “A Statistical Analysis of Negro Employment Data in the Pittsburgh Area Basic Steel Industry, 1965,” cited in Herbert Hill, “Race and the Steelworkers Union: White Privilege and Black Struggles,” New Politics 8, no. 4 (2002), 7; John H. Hinshaw, Steel and Steelworkers: Race and Class Struggle in Twentieth-Century Pittsburgh (Albany: SUNY Press, 2002), 207. 14. August Wilson, Two Trains Running (New York: Penguin, 1992), 20. 15. “Poverty in Southwestern Pennsylvania,” box 126, folder 2, RHWPA. 16. See Employment Applications, box 12, folder 4, NAACPPBR; box 17, folder 7, NAACPPBR; box 24, folder 13, NAACPPBR; box 33, folder 2, NAACPPBR. 17. Mary Lou Holt, Letter to League Members, January 23, 1958, box 20, folder 9, NAACPPBR. 18. “Bias Narrows Choice of Housing,” PPG September 13, 1963. On Pittsburgh, see Roger S. Ahlbrandt Jr., “Exploratory Research on the Redlining Phenomenon,” Real Estate Economics 5, no. 4 (1977), pp. 473–481; William S. J. Smith, “Redlining: A Neighborhood Analysis of Mortgage Lending in Pittsburgh, Pa.” (MA thesis, University of Pittsburgh, 1982); Council of Industrial and Interracial Relations, Presbytery of Pittsburgh and Department of Racial and Cultural Relations, Council of Churches of the Pittsburgh Area, Testimony Given to the Subcommittee on Housing of the Senate Committee on Banking and Currency, December 13, 1957, p. 3; “Population Shifts Underscore Restrictions,” Human Relations Review 2, no. 8 (November–December 1957). Both quotations are cited in Mary Lou Holt, Letter to League Members, January 23, 1958, box 20, folder 9, NAACPPBR; Trotter and Day, Race and Renaissance, 66; “Hill Still City’s Most Crowded Area,” April 16, 1952, box 1, folder 8, WCWP. 19. Census of Population and Housing, 1960, vol. IX, table P-3—Occupancy and Structural Characteristics of Housing Units, by Census Tract, p. 173; Community Action Pittsburgh, “Target Neighborhood Report,” box 126, folder 5, RHWPA. 20. Census of Population and Housing, 1960, vol. IX, table H-1—Occupancy and Structural Characteristics of Housing Units, by Census Tract, p. 233. Defi-
N o t e s t o Pag e s 1 0 6 – 1 0 8
297
nitions of “deteriorating” and “dilapidated” in Census of Population and Housing, vol. IX, introduction, p. 9. 21. “ ‘Negro Not Guilty of Creating Slums,’ Witnesses Tell Senate Housing Group,” PC, January 4, 1958; “Two Landlords Fined, 7 Others Charged With Failing to Repair Slum Properties,” PC, December 20, 1958; Trotter and Day, Race and Renaissance, 65; Pittsburgh Commission on Human Relations, Testimony to the Subcommittee on Housing of the Senate Committee on Banking and Currency, December 13, 1957, p. 9, cited in Holt, Letter to League Members; “Tenants Picket Own Apartment,” PC, August 17, 1963; “Tenant, Landlord Get Hospital Care,” PC, October 3, 1959. 22. Barbara Ferman, Challenging the Growth Machine: Neighborhood Politics in Chicago and Pittsburgh (Lawrence: University of Kansas Press, 1996), 59–66; Roy Lubove, Twentieth-Century Pittsburgh (Pittsburgh: University of Pittsburgh Press, 1996); Dieterich-Ward, Beyond Rust; “Pittsburgh’s Redevelopment: The First Ten Years,” box 1, folder 11, WCWP. 23. Ferman, Challenging the Growth Machine, 59–66; Gregory J. Crowley, The Politics of Place: Contentious Urban Redevelopment in Pittsburgh (Pittsburgh: University of Pittsburgh Press, 2005), 58–89. 24. Crowley The Politics of Place, 83–88. 25. “Lower Hill Relocation Facts—1,” box 3, folder 20, EESP; Michael Weber, “Rebuilding a City: The Pittsburgh Model,” in Snowbelt Cities: Metropolitan Politics in the Northeast and Midwest Since World War II, ed. Richard Bernard (Bloomington: Indiana University Press, 1990), 227–246; Lubove, Twentieth-Century Pittsburgh, vol. 1, 130–132; Ferman, Challenging the Growth Machine; Michael Sean Snow, “Dreams Realized and Dreams Deferred: Social Movements and Public Policy in Pittsburgh, 1960–1980” (PhD diss., University of Pittsburgh, 2004); Trotter, Race and Renaissance, 67–72; Dieterich-Ward, Beyond Rust, 172–197; Interview, James Dean, box 3, folder 81, POHP. On Homewood, see also Williams, On the Street Where I Lived. On the “second ghetto,” see Hirsch, Making the Second Ghetto. On urban uprisings in the 1960s, see Gerald Horne, The Fire This Time: The Watts Uprising and the 1960s (Charlottesville: University of Virginia Press, 1995); Thompson, Whose Detroit?; Joshua Clover, Riot.Strike.Riot: The New Era of Uprisings (New York: Verso, 2016), 103–126. On Pittsburgh’s uprising, see Alyssa Ribeiro, “ ‘A Period of Turmoil’: Pittsburgh’s April 1968 Riots and Their Aftermath,” Journal of Urban History 39, no. 2 (March 2013), 147–171. 26. Coburn, interview. 27. Bodnar, Simon, and Weber, Lives of Their Own. 28. Jim Cunningham and Joel Tarr, “The Communities of the Mon Valley: A Strategy for Recovery,” table 1(B), paper presented for conference, “Mill Towns: Despair, Hopes, and Opportunities, May 5–6, 1988, Pittsburgh, box 124, folder 10, RHWPA.
298
N o t e s t o Pag e s 1 0 8 – 1 1 4
29. Norman Krumholz, “Some City-Suburban Social and Economic Comparisons for the United States, Northeast Region, Pittsburgh Region, and Allegheny County,” January 1968, box 3, folder 16, EESP. 30. “Woman Claims Blacks Barred From Renting in Bethel Park,” NPC, December 1, 1973. 31. Sarah Andersz, interview with Gabriel Winant, July 14, 2016; Carol Henry, interview with Gabriel Winant, July 23, 2016. 32. Henderson, My Three Books, 39. 33. Field Report, Case CRC #511, November 9, 1956, box 17, folder 6, NAACPPBR; Public accommodations complaints, box 17, folders 6 and 9, NAACPPBR; Klanderud, “Street Wisdom,” pp. 193–199. On Kennywood, see Thomas J. Sugrue, Sweet Land of Liberty: The Forgotten Struggle for Civil Rights in the North (New York: Random House, 2008), 157; Victoria W. Wolcott, Race, Riots, and Roller Coasters: The Struggle over Segregated Recreation in America (Philadelphia: University of Pennsylvania Press, 2012), 59, 105. 34. Joel A. Tarr and Denise Di Pasquale, “The Mill Town in the Industrial City: Pittsburgh’s Hazelwood,” Urbanism Past & Present 7, no. 1 (Winter / Spring 1982), 1–14. 35. Census of Population and Housing, 1970, Census Tracts, table P-1, p. 10. 36. Census of Population and Housing, 1960, vol. IX, table H-1—Occupancy and Structural Characteristics of Housing Units, by Census Tract, p. 238. 37. Census of Population, 1950, table 1—Characteristics of the Population, by Census Tracts, p. 25; Census of Population and Housing, 1960, vol. IX, t able P-1— Occupancy and Structural Characteristics of Housing Units, by Census Tract, p. 43; Census of Population and Housing, 1970, Census Tracts, table P-1, p. 28. 38. See William Kornblum, Blue-Collar Community (Chicago: University of Chicago Press, 1975); Jonathan Rieder, Canarsie: The Jews and Italians of Brooklyn against Liberalism (Cambridge, MA: Harvard University Press, 1985). 39. “Black F amily u nder Constant Harassment in Hazelwood Home,” NPC, December 30, 1972. On Chicago and Detroit, see Hirsch, Making the Second Ghetto, 40–67; Sugrue, The Origins of the Urban Crisis, 235–241; Henderson, My Three Books, 36; “Hazelwood Rioting Jails 11 Negro, 5 White Teens,” PC, June 6, 1964; Richard Michael Hessler, “Perceived Stress and Physical and Emotional Health Status of a Large Municipal Housing Project” (PhD diss., University of Pittsburgh, 1969), p. 77. 40. Hessler, “Perceived Stress,” pp. 140, 181. 41. “District City Hit with Race Disturbances,” NPC, July 1, 1967. 42. “Aliquippa Riot Ebbs, Parleys on Race Start,” NPC, May 30, 1970. 43. “Braddock Girl Says Policeman Beat Her,” PC, November 14, 1964; “Racial Feud in Braddock Hills Erupts,” PC, May 22, 1965; “Students Hold Walkout Over Racial Incident,” WOR, January 7, 1969; “Four Braddock Schools Close in Racial
N o t e s t o Pag e s 1 15 – 1 2 2
299
Tension,” PPG, May 12, 1970; “Area High Schools Hit By Racial Strife,” NPC, May 16, 1970; “Duquesne High Race Walkout Woes Mend,” PPG, April 22, 1971; “Trouble Erupts in Donora, 6 Students Arrested,” NPC, May 1, 1971; “Charleroi Area Schools Charged With Bias,” NPC, May 11, 1974; “Cops Force Calm at Gladstone: Cmdr. Bill Moore Cools Militant Black Students,” New Pittsburgh Courier, February 22, 1969; “Tired of Dousing Racial Fires, Moore Quits School Board Post,” NPC, February 20, 1971. 44. “Smoldering Hate, Fear Still Threaten Perry, South Hills,” NPC, October 3, 1970; “4 Students Dismissed From White Oak School,” NPC, May 4, 1974; “Slaying of Black Youth Sets Off Monessen Conflict,” NPC, April 22, 1972; “White Parents Group Wants Clairton High Closed Down,” WOR, April 23, 1973. 45. S-14-B, p. 51, WEMHOHPR. 46. Larry Victor Stockman, “Poverty and Hunger: A Pittsburgh Profile of Selected Neighborhoods” (PhD diss., University of Pittsburgh, 1982), pp. 36–39. 47. S-14-A, pp. 27–28, 31, WEMHOHPR; S-1-B, p. 78, WEMHOHPR; S-19-B, p. 9, WEMHOHPR. 48. S-19-B, pp. 46–47, WEMHOHPR. 49. S-10-B, p. 4, WEMHOHPR. 50. S-19-B, pp. 4–5, WEMHOHPR. 51. I-23-B, pp. 10–25, WEMHOHPR. 52. I-23-B, pp. 26, 33; Stockman, “Poverty and Hunger,” p. 55. 53. Henderson, My Three Books, 47. 54. Interview, Sadie Adams, box 4, folder 203, POHP. 55. Williams, On the Street Where I Lived, 17. 56. “Donora Family Seeks Help as Rainstorm Destroys New Home, Furniture, Clothing,” PC, September 6, 1958. 57. “Housing Authority Evicts M other and Five Sons from Oakland Home,” NPC, September 8, 1973. 58. Williams, On the Street Where I Lived, 111. 59. Lou Berry, interview with Gabriel Winant, July 13, 2016; “Elderly Homewood C ouple Lives in Poverty 2 Years,” NPC, July 17, 1976; Williams, On the Street Where I Lived, 52; Barbara Ciara, The HistoryMakers A2003.304, interview by Larry Crowe, February 7, 2012, The HistoryMakers Digital Archive; Edward Parker, The HistoryMakers A2004.073, interview by Regina Williams, June 14, 2004, The HistoryMakers Digital Archive; “A Team Player for Arlington Hts,” NPC, May 31, 1980. See also Stack, All Our Kin. 60. “UNPC Hits ‘Filthy’ Stores: Health Dept. to Get Area Survey Report,” PC, June 5, 1965; “UNPC Says Public Defender Staff Should Have Negro,” PC, October 16, 1965; “Negro-Hiring Pact Ends Picket,” PP, August 7, 1963; “Negroes Plan March on Light Firm,” PPG, August 8, 1963; “Negro Job Protest Facing 2 Firms Here,” PPG, September 21, 1963; “Reach Agreement on Negro Hiring,” Gettysburg
300
N o t e s t o Pag e s 1 2 2 – 1 2 5
Times, October 4, 1964. “State Admits Past Bias in Job Agency; Reveals New Plan,” PC, March 7, 1964; “Penn-Sheraton Assures UNPC On Job Issue,” PC, May 30, 1964; “UNPC Skirmishes in Warning of All-Out Warfare for Jobs,” PC, May 23, 1964; “Demonstration Success, Meat Firm to Talk,” PC, November 14, 1964; “Expect Department Store Jobs for Negroes,” PC, May 14, 1966; “UNPC Hails Important Breakthrough: A&P On-t he-Job-Training Set Up, Salaries Boosted, 56 Negroes Hired Since January,” PC, March 19, 1966; “Major Job Breakthrough Seen in Auto Dealership,” PC, February 12, 1966. 61. “Mellon Faces Picketing; PPG Under Attack,” NPC, October 4, 1969; “How Building Factions Differ Over Black Jobs,” NPC, September 27, 1969. 62. Marc Linder, Wars of Attrition: Vietnam, the Business Roundtable, and the Decline of Construction Unions (Iowa City, IA: Fănpìhuà Press, 2000), 246. On affirmative action and workplace integration in the 1970s, see Nancy MacLean, Freedom Is Not Enough: The Opening of the American Workplace (Cambridge, MA: Harvard University Press, 2008). On construction in particu lar, see Jefferson R. Cowie, “Nixon’s Class Struggle: Romancing the New Right Worker, 1969–1973,” Labor History 43, no. 3 (2002), 257–283. 63. “Golden Triangle Is Hit with Cop Brutality, Mass Arrests,” NPC, August 30, 1969; “Plan More Demonstrations as U.S. Moves into Jobs Fight,” NPC, September 20, 1969. 64. “Job Tensions at a New High,” NPC, September 27, 1969; “Plan More Demonstrations as U.S. Moves into Jobs Fight,” NPC, September 20, 1969; “BCC Calls for Job Moratorium as Talks Stall,” NPC, October 4, 1969. 65. “Community Is Puzzled over Coalition-Union Agreement,” NPC, February 7, 1970; “Black Construction Coa lit ion ‘Bested’ by White Trade Unions,” NPC, February 8, 1970; “Nate Smith Should Resign from Pgh. Plan,” NPC, May 8, 1971; “Black Construction Coa lit ion Backs Pgh. Plan Trainees,” NPC, May 22, 1971; “New Pittsburgh Plan Proposal Is Labeled Inadequate by NAACP,” NPC, November 13, 1971; “Costly Pgh. Plan Due for Refunding,” NPC, February 5, 1972; “Pgh. Plan Is Working, Called Good Investment,” NPC, September 28, 1974. 66. On race in steel, see Dickerson, Out of the Crucible: Black Steelworkers in Western Pennsylvania (Albany, NY: SUNY Press, 1980), 215–246; Judith Stein, Running Steel, R unning America: Race, Economic Policy, and the Decline of Liberalism (Chapel Hill: University of North Carolina Press, 1996); Hinshaw, Steel and Steelworkers; Ruth Needleman, Black Freedom Fighters in Steel: The Struggle for Democratic Unionism (Ithaca: Cornell University Press, 2003). On job practices in steel, see “J&L Agrees to Fair Job Practices,” NPC, March 14, 1970. 67. Dickerson, Out of the Crucible, 215–246; U.S. Steel Disclaims Bias,” NPC, September 12, 1970. See also “USW Protests Mapped in 3 Cities Meets,” NPC, August 1, 1970; “Steelworkers To Appeal Case Against Homestead Works,” NPC, October 12, 1974; “Charge J&L—Union With Bias,” NPC, January 24, 1970; “J&L Steel Is U nder Attack,” NPC, December 6, 1969; “U.S. W ill Probe Bias At J&L,”
N o t e s t o Pag e s 1 2 5 – 1 2 9
301
NPC, January 3, 1970; “UBPC Gears For E. Pgh., Westinghouse,” NPC, February 14, 1970; “J&L Agrees to Fair Job Practices,” NPC, March 14, 1970; “HUD To Investigate ALCOA’s Job Records,” NPC, April 4, 1970. 68. David E. Epperson, “Administering a Federal Policy: The Case of the Pittsburgh Poverty Program” (PhD diss., University of Pittsburgh, 1975), 57; Ferman, Challenging the Growth Machine. 69. “The War on Poverty in Pittsburgh,” p. 14, box 126, folder 2, RHWPA. 70. Lubove, Twentieth-Century Pittsburgh, vol. 1, 106; Tracy Neumann, Remaking the Rust B elt: The Postindustrial Transformation of North America (Philadelphia: University of Pennsylvania Press, 2016); Epperson, “Administering a Federal Policy,” 155–157; “The War on Poverty in Pittsburgh,” p. 37, box 126, folder 2, RHWPA. 71. Snow, “Dreams Realized and Dreams Deferred.” 72. Premilla Nadasen, “Expanding the Boundaries of the W omen’s Movement: Black Feminism and the Struggle for Welfare Rights,” Feminist Studies 28, no. 2 (Summer 2002), 270–301. 73. William Allan Sr., “Welfare Rights: Woman In Eye of a Storm,” PP, July 6, 1980, p. 25. 74. “Welfare Recipient Benefits Are Raised,” NPC, January 10, 1970; Health and Welfare Association of Allegheny County, “Goals for Income Maintenance,” July 1968, box 111, folder 6, RHWPA. 75. “Homewood DPA Office Policy Studied by WRO,” NPC, September 6, 1975; “Welfare Group Seeks Funds for Clothing,” PPG, November 28, 1968; “Welfare Group Blasts Shafer’s ’70-’71 Budget,” NPC, May 9, 1970; “Hundreds of Pittsburgh Children, Parents Going to ‘Survival’ March,” NPC, March 25, 1972; Jenkins v. Georges, 312 F. Supp. 289 (W.D. Pa. 1969); “Black’s Jubilant over Tronzo’s Suspension,” NPC, January 31, 1970; “Jeter Protests Roaches,” NPC, October 1, 1977; “Special Investigating Team Is Checking Mother’s Bias Claim,” NPC, October 25, 1969; “Late Rent May Be Taken out of Welfare Checks,” NPC, May 5, 1979; “Welfare Rights Head Hits Proposed Day Care Rules,” NPC, November 27, 1976; “Welfare Rights: Woman in the Eye of a Storm,” PP, July 6, 1980. 76. Simone M. Caron, “Birth Control and the Black Community in the 1960s: Genocide or Power Politics?” Journal of Social History 31, no. 3 (1998), 556–558. On Haden, see “Bouie Haden, Black Leader of ’60s, Dies,” PP, July 30, 1974; Trotter and Day, Race and Renaissance, 94–96, 134–135. 77. See Shyrissa Dobbins-Harris, “The Myth of Abortion as Black Genocide: Reclaiming Our Reproductive Choice,” National Black Law Journal 26, (2017), 85–128. 78. Caron, “Birth Control and the Black Community in the 1960s,” 559–561. 79. See Matthew Frye Jacobson, Roots Too: White Ethnic Revival in Post-Civil Rights America (Cambridge, MA: Harvard University Press, 2006); David R. Roediger and James R. Barrett, “How White People Became White,” in Critical
302
N o t e s t o Pag e s 1 3 0 – 1 3 7
White Studies: Looking B ehind the Mirror, ed. Richard Delgado and Jean Stefancic (Philadelphia: T emple University Press, 1997), 404; Stankowski, Memory of Steel, 6. 80. S-23-B, pp. 37–49, WEMHOHPR. 81. “9th Ward Retreating in War on Poverty,” PP, May 5, 1966; Census of Population and Housing, 1970, Census Tracts, table H-1, p. 8; “City Prepped for First Ethnic Stand,” PPG, September 16, 1969; “White Poor Vow They’ll Join Poverty Effort,” NPC, September 27, 1969. 82. I-23-B, pp. 43–47, WEMHOHPR. 83. “Ethnic Poor of City Organize to End Neglect,” PPG, September 15, 1969; “Polish Hill Residents Rap Plan,” PPG, July 30, 1968; “Model Cities Plan Protested on Polish Hill,” PPG, May 12, 1969. 84. “Pittsburgh’s Polish Poor—or, the White Ethnic Alienated,” Baltimore Sun, August 10, 1969. See also John T. McGreevy, Parish Boundaries: The Catholic Encounter with Race in the Twentieth-Century Urban North (Chicago: University of Chicago Press, 1996). 85. Lubove, Twentieth-Century Pittsburgh, vol. 2, 104, 322n56; “How City Voted,” box 2, folder 8, MSP; Marian Irwin, interview with James Barrett, May 19, 1976, p. 7, box 1, folder 7, HAOHPR.
4. Doctor New Deal 1. S-15-A, p. 29, WEMHOHPR. 2. “Union Push at Hospital Is Slowed,” PPG, March 25, 1970, box 33, folder 5, MFR; Wyndle Watson, “Judge Lewis to End Six-Day Presby Strike,” PP, March 25, 1970, box 33, folder 5, MFR. 3. “Mercy Hit by Hospital Unionists,” PPG, February 11, 1970, p. 14; James P. Gannon, “Mercy ‘Must Permit’ Workers to Organize,” Pittsburgh Catholic, undated, box 33, folder 5, MFR; Hospital Council of Western Pennsylvania, “An Open Letter to—Employees, Patients, the Public,” box 33, folder 3, MFR; “Posvar Backs Presby Vote,” PP, March 25, 1970, box 33, folder 5, MFR. 4. On the hospital as “quiet zone,” see Leon Fink and Brian Greenberg, Upheaval in the Quiet Zone: 1199 SEIU and the Politics of Health Care Unionism, 2nd ed. (Urbana: University of Illinois Press, 2009); Department of Health, Education, and Welfare, A Report to the President on Medical Care Prices (Washington, DC: Government Printing Office, 1967), 2. 5. See Rosemary Stevens, In Sickness and In Wealth: American Hospitals in the Twentieth Century (Baltimore, MD: Johns Hopkins University Press, 1999); Christy Ford Chapin, Ensuring America’s Health: The Public Creation of the Corporate Health Care System (New York: Cambridge University Press, 2015). 6. Beatrix Hoffman, Health Care for Some: Rights and Rationing in the United States Since 1930 (Chicago: University of Chicago Press, 2012), 90–142.
N o t e s t o Pag e s 1 3 7 – 1 3 9
303
7. Robert Stevens and Rosemary Stevens, Welfare Medicine in America: A Case Study of Medicaid (New York: F ree Press, 1971), 19–71; Laura Katz Olson, The Politics of Medicaid (New York: Columbia University Press, 2010), 20–50; Hoffman, Health Care for Some, 117–167; Julian E. Zelizer, “The Contentious Origins of Medicare and Medicaid,” in Medicare and Medicaid at 50: America’s Entitlement Programs in the Age of Affordable Care, ed. Alan B. Cohen, David C. Colby, Keith Wailoo, and Julian E. Zelizer (New York: Oxford University Press, 2015), 3–20; Chapin, Ensuring America’s Health, 194–232. On veterans, see Robert O. Self, All in the Family: The Realignment of American Democracy Since the 1960s (New York: Hill and Wang, 2012), 47–74; Jennifer Mittelstadt, The Rise of the Military Welfare State (Cambridge, MA: Harvard University Press, 2015). On psychiatric care, see Richard G. Frank and Sherry A. Glied, Better but Not Well: Mental Health Policy in the United States since 1950 (Baltimore, MD: Johns Hopkins University Press, 2006). 8. See Kenneth J. Arrow’s classic essay, “Uncertainty and the Welfare Dynamics of Medical Care,” American Economic Review 53, no. 5 (December 1963), 941– 973. See also Jonathan Simon, “The Ideological Effects of Actuarial Practices,” Law & Society Review 22, no. 4 (1988), 771–800; Marie Gottschalk, The Shadow Welfare State: L abor, Business, and the Politics of Health Care in the United States (Ithaca, NY: Cornell University Press, 2000); Jacob S. Hacker, The Divided Welfare State: The B attle over Public and Private Social Benefits in the United States (New York: Cambridge University Press, 2002); Colin Gordon, Dead on Arrival: The Politics of Health Care in Twentieth- Century Amer i ca (Prince ton, NJ: Princeton University Press, 2003); Jennifer Klein, For All Th ese Rights: Business, Labor, and the Shaping of America’s Public-Private Welfare State (Princeton, NJ: Princeton University Press, 2003). 9. This process was anticipated by Daniel Bell, but he envisioned such conflicts as the result of affluence rather than deprivation. See The Coming of Post-Industrial Society: A Venture in Social Forecasting (New York: Basic Books, 1973), 127–128. 10. Klein, For All Th ese Rights, 129–130; Margaret C. Albert, A Practical Vision: The Story of Blue Cross of Western Pennsylvania, 1937–1987 (Pittsburgh: Blue Cross of Western Pennsylvania, 1987), 25. See also Gerald Markowitz and David Rosner, “Seeking Common Ground: A History of L abor and Blue Cross,” Journal of Health Politics, Policy and Law 16, no. 4 (1991), 695–718. On working-class Catholicism, see Ronald W. Schatz, “American L abor and the Catholic Church,” International Labor and Working-Class History 20 (Fall 1981), 46–53. 11. Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982), 335–363; Lawrence S. Root, Fringe Benefits: Social Insurance in the Steel Industry (Beverly Hills, CA: Sage, 1982); Klein, For All These Rights; Inland Steel Co. v. National L abor Relations Board, 170 F.2d 247 (7th Cir. 1948); W.W. Cross & Co. v. National Labor Relations Board, 174 F.2d 875 (1st Cir. 1949).
304
N o t e s t o Pag e s 1 3 9 – 1 4 2
12. Alan Derickson, “Health Security for All?: Social Unionism and Universal Health Insurance, 1935–1958,” Journal of American History 80, no. 4 (March 1994), 1333–1356; Gottschalk, The Shadow Welfare State, 1–38; Klein, For All These Rights, 204–247; Adam D. Reich, Selling Our Souls: The Commodification of Hospital Care in the United States (Princeton, NJ: Princeton University Press, 2014), 71. 13. See Alan Derickson, “The United Steelworkers of America and Health Insurance, 1937–1962,” in American Labor in the Era of World War II, ed. Sally M. Miller and Daniel A. Cornford (Westport, CT: Greenwood Press, 1995), 69–87. See also Robyn Muncy, “Coal- Fired Reforms: Social Citizenship, Dissident Miners, and the Great Society,” Journal of American History 96, no. 1 (June 2009), 72–98. 14. Albert, A Practical Vision, 73. See Carol A. Heimer, Reactive Risk and Rational Action: Managing Moral Hazard in Insurance Contracts (Berkeley: University of California Press, 1985). On community rating, see Klein, For All Th ese Rights, 214, 227; Gottschalk, The Shadow Welfare State, 40–41, 57–58. 15. Albert, A Practical Vision, 75; “Blue Cross Enrollment Affected by Steel: Collective Bargaining and Blue Cross,” Blue Cross Bulletin 1, no. 8 (November 1959), p. 1, box 104, folder 1200, ISFP. 16. Program of Insurance Benefits, September 1, 1956, box 8, folder 3, United States Steel Corporation Duquesne Works Industrial Relations Records, Archives & Special Collections, University Library System, University of Pittsburgh; Statement by David J. McDonald before the Medical Society of Pennsylvania, October 15, 1958, box 110, folder 1309, ISFP; I. S. Falk and Joseph J. Senturia, “The Steelworkers Survey Their Health Serv ices: A Preliminary Report,” October 21, 1959, box 115, folder 1388, ISFP. See also Derickson, “The United Steelworkers of America and Health Insurance, 1937–1962.” 17. Community Planning and Hospital Design, February 11, 1960, box 105, folder 1238, ISFP; Pittsburgh’s Fortresses of Health: 200 Years of Hospital Progress, 1758–1958, pp. 28–47, box 136, folder 5, RHWPA. 18. Community Planning and Hospital Design, February 11, 1960, box 105, folder 1238, ISFP. On the Hospital Planning Association and the “hospital-civic relationship” more broadly, see Andrew T. Simpson, The Medical Metropolis: Health Care and Economic Transformation in Pittsburgh and Houston (Philadelphia: University of Pennsylvania Press); Pittsburgh’s Fortresses of Health, pp. 28–47, box 136, folder 5, RHWPA; Hospital Planning Association of Allegheny County, “Executive Director’s Report,” May 23, 1960, box 105, folder 1238, ISFP. Joshua B. Freeman argues similarly that the political and industrial composition of New York City created a local social democracy. See Working-Class New York: Life and Labor Since World War II (New York: New Press, 2000), 125–142. 19. Ronald Branca to John Tomayko, July 7, 1960, box 105, folder 1238, ISFP; David P. Willis to I. S. Falk, June 29, 1960, box 105, folder 1238, ISFP.
N o t e s t o Pag e s 1 4 3 – 1 4 6
305
20. Chart 3, The Unit Costs for Hospitalization Benefits, 1954–1962; Chart 9, Summary of Utilization Rates and Costs, 1953–1962, box 115, folder 1386, ISFP; Statement by David J. McDonald before the Medical Society of Pennsylvania, October 15, 1958, box 110, folder 1309; ISFP Evaluation and Improvement of Steelworkers’ Health Insurance Program, October 30, 1959, box 105, folder 1235, ISFP; Special Report on Insurance, Pensions and Supplemental Unemployment Benefits, September 15–19, 1958, box 110, folder 1309, ISFP. 21. Special Study on the Medical Care Program for Steelworkers and Their Families, August 20, 1960, box 115, folder 1394, ISFP. 22. Falk and Senturia, “The Steelworkers Survey Their Health Serv ices.” 23. Comments by John P. Tomayko, October 21, 1959, box 115, folder 1388, ISFP. On group practice plans, see Starr, The Social Transformation of American Medicine, 321–342; Klein, For All These Rights, 190–200. 24. Comments by John P. Tomayko. 25. Memorandum of Agreement, January 7, 1960, box 111, folder 1326, ISFP. 26. R. A. Albright, “Tomorrow’s Costs of T oday’s Group Insurance Plan,” October 21, 1960, box 103, folder 1180, ISF. 27. Joint Committee to Study the Future of the Health Insurance Program, October 7, 1959, box 110, folder 1311, ISFP; “Some Relations Between Physicians’ Charges and Blue Shield Insurance Benefits,” August 14, 1964, box 109, folder 1301, ISFP; “Utilization and Claim Costs Under the Blue Cross and Blue Shield Contracts Covering Employes of United States Steel Corporation,” 1957–1962, box 109, folder 1301, ISFP; “Steel, Doctors, USW Explore Medical Care,” PP, June 24, 1959. 28. “Steel Industry, Union, Study Pre-Paid Health Program Possibilities,” NYT, June 25, 1959; Summary Notes, Meeting of Joint Sub-Committee on Medical Care and the American Medical Association, January 29, 1961, box 110, folder 1312, ISFP; Summary Notes, Meeting of Joint Sub-Committee on Medical Care and the American Medical Association, January 24, 1961, box 110, folder 1312, ISFP; “Group Practice Prepayment Plans,” July 24, 1964, box 111, folder 1323, ISFP; “Steel Union Acts to Build Clinics,” NYT, September 21, 1960, box 110, folder 1310. On divisions within the medical profession, see Chapin, Ensuring America’s Health, 66–94. 29. E. R. McCluskey to I. S. Falk, February 16, 1959, box 109, folder 1301, ISFP; Correspondence with Allegheny General Hospital, 1959–1960, box 103, folder 1189, ISFP; Minutes, Medical Care Sub-Committee Meeting, November 10, 1964, box 111, folder 1325, ISFP; Group Practice Prepayment Plans for Steelworkers and Their Families, November 10, 1964, box 111, folder 1325, ISFP. 30. John Hoerr, And the Wolf Finally Came: The Decline and Fall of the American Steel Industry (Pittsburgh: University of Pittsburgh Press, 1988), 17; “Uphill Fight to Get Decision Before Strike Deadline,” Associated Press, July 11, 1959; Union Members’ Rejection of Company Members’ Proposal for a “Major Medical” Pilot Project, January 21, 1962, box 110, folder 1316, ISFP; Insurance and
306
N o t e s t o Pag e s 1 4 6 – 1 4 9
Medical Care Problems, January 22, 1962, box 110, folder 1317, ISFP; P. E. Johnson to I. S. Falk, September 9, 1965, box 104, folder 1204, ISFP; Exhibit B: Insurance, June 19, 1963, box 54, USSCNDWR. 31. See Starr, The Social Transformation of American Medicine, 335–378; Health Security for the American People, June 13, 1961, box 6, folder 107, ISFP. 32. USS-USW Minutes, February 17, 1962, box 54, USSCNDWR; Starr, The Social Transformation of American Medicine, 368. 33. Theodore Marmor, The Politics of Medicare (Chicago: Aldine, 1973); Jill Quadagno, The Transformation of Old Age Security: Class and Politics in the American Welfare State (Chicago: University of Chicago Press, 1988), 173; Gottschalk, The Shadow Welfare State, 3; Hacker, The Divided Welfare State, 409410n135; Klein, For All These Rights, 254–257; Gordon, Dead on Arrival, 22–31, 116–119; Olson, The Politics of Medicaid, 20–50; Hoffman, Health Care for Some, 90–142; Zelizer, “The Contentious Origins of Medicare and Medicaid”; Chapin, Ensuring America’s Health, 194–232. 34. Michael Harrington, The Other America: Poverty in America (New York: Simon & Schuster, 1962); William P. Jones, “The Unknown Origins of the March on Washington: Civil Rights Politics and the Black Working Class,” Labor 7, no. 3 (September 2010), 33–52; David Stein, “Containing Keynesianism in an Age of Civil Rights: Jim Crow Monetary Policy and the Struggle for Guaranteed Jobs, 1956–1979,” in Beyond the New Deal Order: U.S. Politics from the Great Depression to the Great Recession, ed. Gary Gerstle, Nelson Lichtenstein, and Alice O’Connor (Philadelphia: University of Pennsylvania Press, 2019), 124–140. See “Remarks of Vice-President Humphrey United States Steel Corporation National Works Mc Keesport, Pennsylvania,” p. 3, October 29, 1968, box 39, Speech Text Files, Hubert H. Humphrey Papers, Minnesota Historical Society. 35. Population Trends in Eastern Allegheny County, Steven Sieverts to I. S. Falk, selected data, January 30, 1969, box 105, folder 1234, ISFP; Homestead Hospital, June 26, 1968, box 105, folder 1234, ISFP. 36. Homestead Hospital Administrator’s Annual Summary of Activities, July 1, 1966—June 30, 1967, box 105, folder 1234, ISFP. 37. Homestead Hospital Administrator’s Annual Summary of Activities, July 1, 1966—June 30, 1967, box 105, folder 1234, ISFP; Specific Considerations, April 15, 1967, box 105, folder 1234, ISFP. 38. Homestead Hospital, June 26, 1968, box 105, folder 1234, ISFP. 39. For Immediate Release: Congressman Joseph M. Gaydos—20th Congressional District, box 105, folder 1234, ISFP; “Homestead Hospital Firm Despite Wave of Protest,” PP, February 21, 1969; “Homestead Must Reopen Baby Unit,” PP, December 12, 1969. 40. Adjudication, Homestead Hospital Cot Club et al. v. Homestead Hospital of Homestead, PA., et al., No. 1874 (April Term 1969), box 105, folder 1234, ISFP.
N o t e s t o Pag e s 150 – 15 3
307
41. Flagiello v. Pennsylvania Hospital, 417 Pa. 486 (1965). 42. “Our Visiting Nurse Association Anticipates a ‘Care’ Explosion,” PPG, ca. 1961, box 2, folder 6, VNAACR. 43. Philip Jenkins, The Cold War at Home: The Red Scare in Pennsylvania, 1945–1960 (Chapel Hill: University of North Carolina Press, 1999). 44. Program of Insurance Benefits effective August 1, 1970, box 112, folder 1335, ISFP; Hospital and Medical Benefits Supplementing Medicare, January 1, 1969, box 6, folder 4, USWA 1397; Comments concerning union insurance proposal, July 24, 1968, box 1, Coordinating Committee Meetings and Union Meetings, book 2, RCCP; Costs of proposed settlement, July 30, 1968, box 1, Coordinating Committee Meetings and Union Meetings, book 2, RCCP. 45. Productivity growth lagged significantly b ehind employment growth. See Jerry Cromwell, “Hospital Productivity Trends in Short-Term General Non-teaching Hospitals,” Inquiry 11, no. 3 (September 1974), 181–187; Victor R. Fuchs, The Service Economy (New York: National Bureau of Economic Research, 1968), 116; Census of Population, 1950, table 79; Census of Population, 1960, table 127; Census of Population, 1970, table 186. 46. Proposed Memo of Understanding; Richard J. Person to Sister Mary John, January 15, 1968, box 7, folder 34 CORP; “5 W omen Walk Lonely Picket Line,” Oil City Derrick, February 16, 1968. 47. Census of Population, 1970, table 94. Economist Helen Ginsburg found that, around the country, urban hospitals w ere more able to suppress wages by drawing on the nonwhite labor market. See “Wage Differentials in Hospitals, 1956–1963: A Study Emphasizing the Wages of Nurses and Unskilled Workers in Nongovernment Hospitals” (PhD diss., New School for Social Research, 1967), 120–122. 48. Census of Population, 1970, t able 94; Carol A. Brown, “Women Workers in The Health Serv ice Industry,” in Organization of Health Workers and Labor Conflict, ed. Samuel Wolfe (Farmingdale, NY: Baywood Publishing, 1976), 116; “Blacks’ Pay at Hospitals Hit as Low,” PPG, January 27, 1970. Susan Kocin, “Basic Provisions of the 1966 FLSA Amendments,” Monthly Labor Review 90, no. 3 (March 1967), 2–3; Earline Coburn, interview with Gabriel Winant, July 20, 2016. 49. Gregg L. Michel, “ ‘Union Power, Soul Power’: Unionizing Johns Hopkins University Hospital, 1959–1974,” Labor History 38, no. 1 (1996), 28–66; “Hospital Union Effort Launched,” Associated Press, November 4, 1969; Steve Lowman, “1199 Starts Organi zing Drive in Pittsburgh,” Modern Hospital 114, no. 2 (1970), 99–103. 50. “Arbitrator to Rule on Pitt Union,” PPG, January 1, 1970; “Three City Hospitals Face Strike,” PP, March 18, 1970; “Will Strike, Says Union at Mercy,” PPG, December 31, 1969.
308
N o t e s t o Pag e s 15 3 – 15 7
51. “Hospital Union Hits Snag H ere,” PPG, April 13, 1970; “Jewish Home Demands Pushed,” PP, December 24, 1969; “Irvis, Kaufman Back Hospital Union Fight,” PP, January 27, 1970. 52. Lowman, “1199 Starts Organizing Drive in Pittsburgh”; Elliott Godoff to Max Greenberg, February 16, 1970, box 73, folder 6, 1199 AF. 53. Murray Kempton, “Sticking to the Union,” New York Review of Books, April 9, 1970, qtd. in Leon J. Davis and Moe Foner, “Organization and Unionization of Health Workers in the United States: The Trade Union Perspective,” in Organization of Health Workers and Labor Conflict, ed. Wolfe, 18. 54. “Notes on the Union Situation,” March 9, 1970, Record Group III, box 3, folder 5, CUPWWPAF; “Stop the Back Door Deal,” undated, box 33, folder 7, MFR; “Elections Won’t Bring Hospital Peace,” PPG, January 13, 1970Charles Volk to David Montgomery, December 31, 1969, box 33, folder 3, MFR. See also Correspondence, Committee to Secure Justice for Hospital Workers, box 1, David Montgomery Papers, Tamiment Library and Robert F. Wagner Archives, New York University, New York. 55. “Organizer for Union Is Arrested at Hospital,” January 9, 1970, PPG; Draft, “High Noon in Pittsburgh,” ca. January 1970, box 33, folder 9, MFR; Edward H. Noroian memo to employees, February 2, 1970, box 73, folder 6, 1199 AF. 56. “Will Strike, Says Union at Mercy,” PPG, December 31, 1969; “End Dictatorship at Presby!” undated, box 33, folder 7, MFR; “2nd Arrest in Hospital Drive Made,” PPG, January 10, 1970; “30 Employes Suspended by Two Hospitals,” PPG, January 8, 1970; “2nd Arrest in Hospital Drive Made,” PPG, January 10, 1970; “Three City Hospitals Face Strike,” PP, March 18, 1970; “Mercy Hospital, Western Psychiatric Strike Threat Fails to Materialize,” Associated Press, March 21, 1970; Donald Janson, “Service Employees Strike at Pittsburgh Hospital,” NYT, March 21, 1970; “Hospital Union Hits Snag Here,” PPG, April 13, 1970. 57. “Hospital Union Hits Snag Here,” PPG, April 13, 1970; Draft, “High Noon in Pittsburgh,” undated, box 33, folder 9, MFR; Gabriel Winant, interview with Kay Tillow, August 8, 2016; Fink and Greenberg, Upheaval in the Quiet Zone, 161–167. 58. C. Patrick Hardwick and Harvey Wolfe, “Evaluation of an Incentive Reimbursement Experiment,” Medical Care 10, no. 2 (March-April 1972), 112; Godoff to Max Greenberg, February 16, 1970, box 73, folder 6, 1199 AF. 59. Jon Shelton, Teacher Strike!: Public Education and the Making of a New American Political Order (Urbana: University of Illinois Press, 2017), 26–55. 60. “Irvis, Kaufman Back Hospital Union Fight,” PP, January 27, 1970; Pennsylvania General Assembly, Legislative Journal 1, no. 144, July 13, 1970, 1309; “New Law to Trigger Hospital Union Drive,” PP, March 29, 1970; interview, Kay Tillow. 61. Dennis D. Pointer, “The 1974 Health Care Amendments to the National Labor Relations Act,” Labor Law Journal 26, no. 6 (June 1975), 353; US Depart-
N o t e s t o Pag e s 15 7 – 1 6 1
309
ment of Labor, Labor-Management Serv ices Administration, Federal Mediation and Conciliation Service, Office of Research, Effect of the 1974 Health Care Amendments to the NLRA on Collective Bargaining in the Health Care Industry (Washington, DC: Government Printing Office, 1979), 19. 62. “Opening Statement of Robert Taft, Jr. Regarding Extension of the National Labor Relations Act to Non-profit Hospitals,” 1974, p. 4, container 295, folder 11, RTJP. 63. Lawrence F. Feheley, “Amendments to the National Labor Relations Act: Health Care Institutions,” Ohio State Law Journal 36, no. 2 (1975), 235–298; “Hospital NLRA,” ca. 1974, container 295, folder 11, RTJP. 64. American Hospital Association, Taft-Hartley Amendments: Implications for the Health Care Field (Chicago: American Hospital Association, 1976), 10; American Hospital Association, Taft-Hartley Amendments, 46; American Hospital Association, Taft-Hartley Amendments, 47. 65. Wanda W. Young, Robert Blane Swinkola, Kathleen M. Barker, and Martha A. Hutton, “Factors Affecting Hospital Inpatient Utilization,” Blue Cross of Western Pennsylvania, Research Series 17 (June 1977), 16–22. 66. Young et al., “Factors Affecting Hospital Inpatient Utilization,” 3–7; US Department of Health, Education, and Welfare, Medical Care Expenditures, Prices, and Costs: Background Book (Washington, DC: US Government Printing Office, 1975), 34. 67. Young et al., “Factors Affecting Hospital Inpatient Utilization,” 22. See also Root, Fringe Benefits, 197. 68. Travelers Insurance Company v. Blue Cross of Western Pennsylvania, 361 F. Supp. 774 (W.D. Pa. 1972); Stevens, In Sickness and in Wealth, 290. 69. Patricia B. Pelkofer to Commonwealth of Pennsylvania Air Quality Board, December 3, 1971, box 6, folder 3, GASPR; Peter Safar, “Physician’s Concern About Pollution,” October 22, 1970, box 6, folder 1, GASPR. 70. Young et al., “Factors Affecting Hospital Inpatient Utilization,” 19. See Nancy Tomes, Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers (Chapel Hill: University of North Carolina Press, 2016). 71. Handicapped and Elderly Transportation Advisory Committee, Minutes, April 18, 1978, box 4, folder 4, EESP; Laura C. Leviton, “Implications of an Aging Population for the Health Care System in Southwestern Pennsylvania: Report of a Study,” p. 79, Health Policy Institute, Policy Series No. 2, August 1981, box 6, item 24, BGC. 72. Beaufort B. Longest, “The Pattern of Utilization of Inpatient Hospital Ser vices in Southwestern Pennsylvania: Report of a Study,” p. 10, Health Policy Institute, Policy Series no. 1, November 1980, box 136, folder 8, RHWPA; Young et al., “Factors Affecting Hospital Inpatient Utilization,” 4–7. Root observes of a group
310
N o t e s t o Pag e s 1 6 1 – 1 6 5
of steelworkers that 68 percent of their health expenditure went to hospital charges. See Fringe Benefits, 63. 73. S-14-B, p. 13, WEMHOHPR; S-23-B, p. 42, WEMHOHPR. 74. S-5-B, p. 50, WEMHOHPR; S-15-B, p. 25, WEMHOHPR; S-15-C, p. 10, WEMHOHPR; John Jameson, Larry J. Shuman and Wanda W. Young, “The Effects of Outpatient Psychiatric Utilization on the Costs of Providing Third-Party Coverage,” Medical Care 16, no. 5 (May 1978), 383–399. 75. “Nurse Aide Adept Housekeeper,” PP, January 9, 1962, box 2, folder 20, VNAACR; Poem, May 21, 1976, box 1, folder 13, HAOHPR; “ ‘Home Health Aides’ Giving Shut-I ns New Will to Live,” PP, May 15, 1966, box 2, folder 20, VNAACR. 76. Carol Henry, interview with Gabriel Winant, July 23, 2016. 77. See Carolyn Leonard Carson, Healing Body, Mind, and Spirit: The History of the St. Francis Medical Center, Pittsburgh, Pennsylvania (Pittsburgh: Carnegie Mellon University Press, 1995); Georgine Scarpino, The Rise and Fall of the Faith- Based Hospitals: The Allegheny County Story (Bloomington, IN: AuthorHouse, 2013); Georgeanne Koehler, interview with Gabriel Winant, June 22, 2015; “Critical Issues Surrounding the Hospital Industry’s Participation in the Medical Assistance Program,” April 1976, box 19, folder 15, EESP. 78. See Gordon, Dead on Arrival, 172–209; Rosemary Stevens, The Public- Private Health Care State: Essays on the History of American Health Care Policy (New Brunswick, NJ: Transaction Publishers, 2007), 219–222; Lisa Levenstein, A Movement Without Marches: African American W omen and the Politics of Poverty in Postwar Philadelphia (Chapel Hill: University of North Carolina Press, 2009), 157–180; Alondra Nelson, Body and Soul: The Black Panther Party and the Fight against Medical Discrimination (Minneapolis: University of Minnesota Press, 2011); Charles Owen Rice to Jack Lynch, November 1, 1967, box 6, folder 34, CORP. 79. Trotter and Day, Race and Renaissance, 85; Sr. M. Ferdinand Clark, RSM, “A Hospital for the Black Ghetto,” February 1969, box 33, folder 3, MFR. 80. Scarpino, The Rise and Fall of the Faith-Based Hospitals, 22; Exhibit 1, box 13, folder 1, CORP. 81. Items to be resolved as presented to Pittsburgh Hospital by the Homewood- Brushton Health Committee on September 15, 1966, box 13, folder 1, CORP; Dr. L. LeMon and Dr. Oscar Gonzalez to Samuel B. Casey, September 1, 1966, box 13, folder 1, CORP; Minutes, Health Committee, Meeting with Pittsburgh Hospital, July 12, 1966, box 13, folder 1, CORP. 82. “Doctor Outlines Health Controversy,” PPG, October 7, 1967; “Urban League Okays Pittsburgh Hospital,” PPG, September 29, 1967; “Health Unit Imperiled by Dispute,” PPG, February 6, 1968; “Health Center Peace Effort Parley Slated,” PP, February 6, 1968; “Negroes Win Hospital Post for Their Man,” News & Letters, April, 1968; “Bouie Haden, Black Leader of ’60s, Dies,” PP, July 30, 1974;
N o t e s t o Pag e s 1 6 5 – 1 6 8
311
“Health Center Election Slated,” PP, March 29, 1971; “Homewood-Brushton Health Center Defends Building Ownership,” PP, February 2, 1977; “Monday Report: Rivals Debate Health Needs of Homewood,” PPG, February 14, 1977; “Homewood Health Unit Shifted to New Board,” PPG, February 24, 1977. 83. Trotter and Day, Race and Renaissance, 127–128; Chuck Staresinic, “Send Freedom House!” Pittmed, February 2004, 32–34. See also Andrew Simpson, “Transporting Lazarus: Physicians, the State, and the Creation of the Modern Paramedic and Ambulance,” Journal of the History of Medicine and Allied Sciences 68, no. 2 (April 2013), 180–183; Simpson, The Medical Metropolis, 55–60. 84. “Central Medical Health Serv ices: A Responsive New Health Delivery System for the Residents of Greater Pittsburgh,” 1972, box 91, folder 32, HSASPR. 85. Irving H. Breslow and Dr. Stanley J. Brody, Initial Design for a Health Ser vice System for Central Medical Pavilion, box 3, folder 30, CORP; Zoning Report— Pittsburgh City Planning Commission, March 9, 1971, box 3, folder 30, CORP; Herbert S. Denenberg, “New Hospital Rated Costly to Public,” PP, September 26, 1972; “Lower Hill Hospital Plan Draws Protests,” PP, January 19, 1971. 86. “Group Suggests Revised Hill Hospital Plan,” PPG, July 29, 1972; “Medical Pavilion Prob lems Taken to Con sul tants,” November 26, 1974; “Receivership Urged For Uptown Hospital,” PP, January 5, 1977. 87. “Amputees, Other Vets, Battle Red Tape, Despair,” PP, July 21, 1974; “Long Waits, Crowded Units Work Against Care For Veterans,” PP, July 22, 1974. 88. “Vets Won Big Victory with Inking of PL 93–82,” Pottsville Republican and Herald, December 3, 1973; “Ailments from 3 Wars Swamp Vets Facilities,” PP, July 27, 1974; Jennifer Mittelstadt, The Rise of the Military Welfare State (Cambridge, MA: Harvard University Press, 2015); Paul Starr, James F. Henry, and Raymond P. Bonner, The Discarded Army: Veterans A fter Vietnam; The Nader Report on Vietnam Veterans and the Veterans Administration (New York: Charterhouse, 1973); “Long Waits, Crowded Units Work against Care for Veterans,” PP, July 22, 1974. 89. Stevens, In Sickness and in Wealth, 287–297; Allegheny County Code, chapter 210, article IV; “County to Give Help In Hospital Borrowing,” PPG, January 23, 1971. 90. Gail Radford, The Rise of the Public Authority: Statebuilding and Economic Development in Twentieth-Century Americ a (Chicago: University of Chicago Press, 2013), 163. 91. Pennsylvania Economy League, “Issues Surrounding the Planning and Financing of Capital Improvements to Allegheny County Hospitals,” April 1978, box 12, folder 2, EESP; Irwin Wolkstein, “The Impact of Legislation on Capital Development for Health Facilities,” in Health Care Capital: Competition and Control, ed. Gordon K. MacLeod and Mark Perlman (Cambridge, MA: Harper Collins, 1978), 11.
312
N o t e s t o Pag e s 1 6 8 – 1 7 1
92. Pennsylvania Economy League, “Issues Surrounding the Planning and Financing of Capital Improvements to Allegheny County Hospitals”; Arnold H. Raphaelson and Charles P. Hall Jr., “Politics and Economics of Hospital Cost Containment,” Journal of Health Politics, Policy, and Law 3, no. 1 (Spring 1978), 87–111. 93. Jerry C romwell, Helene T. Hewes, Nancy L. Kelly, and Saul Franklin, “Comparative Trends in Hospital Expenses, Finances, Utilization, and Inputs, 1970–81,” Health Care Financing Review 9, no. 1 (1987), pp. 51–69. 94. Greta R. Krippner, Capitalizing on Crisis: The Political Origins of the Rise of Finance (Cambridge, MA: Harvard University Press, 2011); Kim Phillips-Fein, Fear City: New York’s Fiscal Crisis and the Rise of Austerity Politics (New York: Metropolitan, 2017). 95. H. Robert Cathcart, “Discussion of the Projected Response of the Capital Markets to Health Facilities Expenditures,” in Health Care Capital, ed. M acLeod and Perlman, 349–350. 96. Nathan J. Stark, “Foreword,” in Health Care Capital, ed. M acLeod and Perlman, xv; Wesley W. Posvar, “Chancellor’s Welcome,” in Health Care Capital, ed. MacLeod and Perlman, xix. 97. See Gottschalk, The Shadow Welfare State, 53–57. 98. “City World Famous as Health Center,” PP, January 18, 1966; “Pitt’s Health Center Gets Grant for Regional Medical Program,” February 2, 1967, box 14, folder 119A, CUPDHKAF. On this phenomenon generally, see Stevens, In Sickness and in Wealth, 317–320; Lawrence D. Brown, “The More Th ings Stay the Same the More They Change: The Odd Interplay between Government and Ideology in the Recent Political History of the U.S. Health-Care System,” in History and Health Policy in the United States: Putting the Past Back In, ed. Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns (New Brunswick, NJ: Rutgers University Press, 2006), 40–45; Minutes of the First Meeting of the Incorporators of the University Health Center of Pittsburgh, September 7, 1965, box 14, folder 119B, CUPDHKAF; Minutes of Board of Directors Quarterly Meeting, Health Center Hospital Serv ice Corporation, December 20, 1966, box 14, folder 119B, CUPDHKAF; Arthur G. Hennings to Edward J. Magee, May 1, 1969, box 1, folder 30, EESP. 99. Hospital Investments, 1973–1977, University Health Center, box 19, folder 18, EESP; “Health Center Maps Rotating Development Plan,” PP, March 2, 1976; “Medical Center Breakthrough,” PPG, September 30, 1977; “Obituary: Nathan J. Stark,” PPG, November 13, 2002. 100. See Vicente Navarro, Medicine u nder Capitalism (New York: Prodist, 1976); Douglas R. Brown, “A Study of the Pool of Possible Candidates for Admission to University Programs in Hospital Administration in September 1963,” March 1965, box 2, folder 30, ISFP; Gary L. Filerman, “The Teaching of Medical
N o t e s t o Pag e s 1 7 1 – 1 74
313
Care in Graduate Programs in Hospital Administration,” paper presented the Annual Meeting of the Committee on Medical Teaching of the Association of Teachers of Preventive Medicine, October 31, 1966, box 2, folder 31, ISFP; Robert M. Sigmond, Hospital Administration 11, no. 3 (1966), 28–34. 101. “Fight for OK on Consolidation Still on at Homestead Hospital,” PPG, August 10, 1973. For a case study of this phenomenon in a similar setting, see Stephanie Woolhandler, David U. Himmelstein, Ralph Silber, Martha Harnly, Michael Bader, and Alice A. Jones, “Public Money, Private Control: A Case Study of Hospital Financing in Oakland and Berkeley, California,” American Journal of Public Health 73, no. 5 (1983), 574–587. 102. Richard A. Rettig, “Origins of the Medicare Kidney Disease Entitlement: The Social Security Amendments of 1972,” in Kathi E. Hanna, ed., Biomedical Politics (Washington, DC: National Academy Press, 1991), 176–208; Edward D. Berkowitz, “The Historical Development of Social Security in the United States,” in Social Security in the 21st Century, eds. Eric R. Kingson and James H. Schulz (New York: Oxford University Press, 1997), 36–37. 103. Richard D. Lyons, “Nixon Signs $5-Billion Bill Expanding Social Security,” New York Times, October 31, 1972; Evan M. Melhado, “Health Planning in the United States and the Decline of Public-Interest Policymaking,” Milbank Quarterly 84, no. 2 (June 2006), 359–440; Jonathan P. West and Michael D. Stevens, “Comparative Analysis of Community Health Planning: Transition from CHPs to HSAs,” Journal of Health Politics, Policy, and Law 1, no. 2 (1976), 173– 195; Bonnie Lefkowitz, Health Planning: Lessons for the Future (Rockville, MD: Aspen, 1983); Melhado, “Health Planning in the United States and the Decline of Public-Interest Policymaking.” 104. Leah R. Judd and Robert J. McEwen, “A Handbook for Consumer Participation on Health Care Planning,” 1977, pp. 4–5, box 19, folder 4, EESP; “Cut District Hospital Beds 13% In 8 Years, Health Agency Urges,” PPG, October 18, 1977; Michael A. Vojtecky, “Status and Control in Voluntary Community Health Planning Groups,” Medical Care 20, no. 12 (December 1982), 1168–1177. 105. The South Side Hospital Program for Development, vol. I, Summary, January 1978, box 129, folder 620, HSASPR. 106. “Bettering South Side Hospital,” PPG, March 20, 1979; “South Side Hospital Good, Must Be Used,” PP, September 15, 1978. Obituary, “Anne L. (Kicinski) Jenneve,” PPG, August 18, 2007. 107. Letters to the Editor, PPG, March 20, 1979; Letters to the Editor, PPG, April 14, 1979; “Legislator Supports South Side Hospital,” PP, March 21, 1979. 108. “S. Side Hospital Plan Draws Political Support,” PP, March 14, 1979; “New South Side Hospital Wins State Approval,” PP, May 1, 1979. 109. “New South Side Hospital Wins State Approval,” PP, May 1, 1979; “MacLeod Proposes Elections to Boards of Health Systems,” PPG, May 12, 1979.
314
N o t e s t o Pag e s 1 74 – 1 8 0
110. “State Promises Full Hearing for St. John’s,” PP, January 27, 1977; “The eople Speak: We Need Both,” PPG, February 14, 1977; “Drop Plans, State Tells P St. John’s,” PP, February 23, 1977; “St. John’s Denied OK to Rebuild,” PPG, January 13, 1977; “Health Agency Denies Anti-City Claim,” PP, January 19, 1977; “St. John’s Work Is Now Assured,” North Hills News Record, February 24, 1978; “Health Planners Secretive—Peirce,” PPG, May 17, 1977. 111. Health Systems Agency of Southwestern Pennsylvania, “Review: HAS Completes First Year of Project Review Activity,” October 1977, box 19, folder 4, EESP. 112. Longest, “The Pattern of Utilization of Inpatient Hospital Serv ices in Southwestern Pennsylvania,” pp. 25–26. See Theodore R. Marmor, Donald A. Wittman, and Thomas C. Heagy, “The Politics of Medical Inflation,” Journal of Health Politics, Policy, and Law 1, no. 1 (1976), 69–84. 113. Except where otherw ise noted, the Kane Hospital narrative is a summary of Gabriel Winant, “A Place to Die: Elder Abuse and the Political Economy of the 1970s,” Journal of American History 105, no. 1 (June 2018), 96–120. 114. Joseph Nagy, interview with Gabriel Winant, January 16, 2019. 115. Nagy, interview. On this intellectual history, see Gabriel Winant, “The Making of Nickel and Dimed: Barbara Ehrenreich and the Exposé of Class in America,” Labor 15, no. 1 (March 2018), 67–79. 116. Nagy, interview. 117. Institute of Medicine, Controlling the Supply of Hospital Beds: A Policy Statement (Washington, DC: National Academy of Sciences, October 1976), viii. For a parallel narrative, see Muncy, “Miners, Social Citizenship, and the G reat Society.” 118. William J. Baumol, The Cost Disease: Why Computers Get Cheaper and Health Care Doesn’t (New Haven, CT: Yale University Press, 2012). See also Uwe E. Reinhardt, “Table Manners at the Health Care Feast,” in Financing Health Care: Competition Versus Regulation, ed. Duncan Yaggy and William G. Anlyan (Cambridge, MA: Ballinger, 1982), 13–36.
5. Enduring Disaster 1. Lou Berry, interview with Gabriel Winant, July 13, 2016; Earline Coburn, interview with Gabriel Winant, July 18, 2016. 2. David E. Biegel, James Cunningham, Hide Yamatani, and Pamela Martz, “Self-Reliance and Blue-Collar Unemployment in a Steel Town,” Social Work, 34, no. 5 (September 1989), 399. On the 1970s and l abor history, see Jefferson R. Cowie, Stayin’ Alive: The 1970s and the Last Days of the Working Class (New York: New Press, 2010); Lane Windham, Knocking on Labor’s Door: Union Organizing in the 1970s and the Roots of the New Economic Divide (Chapel Hill: University of North Carolina Press, 2017). For the classic study of industrial job loss, see William Ju-
N o t e s t o Pag e s 1 8 0 – 1 85
315
lius Wilson, When Work Disappears: The World of the New Urban Poor (New York: Knopf, 1996). 3. Thomas K. Glennan Jr. et al., Education, Employment, and the Economy: An Examination of Work-Related Education in Greater Pittsburgh (Santa Monica: RAND Corporation, 1989). 4. Dennis C. Dickerson, Out of the Crucible: Black Steelworkers in Western Pennsylvania (Albany, NY: SUNY Press, 1980); John H. Hinshaw, Steel and Steelworkers: Race and Class Struggle in Twentieth-Century Pittsburgh (Albany, NY: SUNY Press, 2002); “Strike Threat Effects,” August 30, 1967, box 1, Coordinating Committee Meetings, vol. 2, RCCP. See also John P. Hoerr, And the Wolf Finally Came: The Decline of the American Steel Industry (Pittsburgh: University of Pittsburgh Press, 1988). 5. Christian Associates of Southwestern Pennsylvania, “Report of the Task Force on Full and Equitable Employment,” February 1978, box 6, folder 75, WUCR; “People Laid Off as of 2/9/66, Held in Open Hearth,” February 11, 1966, box 19, folder 1, USSCDWIRDR; “Departments Effected by Open Hearth Shutdown,” August 27, 1965, box 19, folder 1, USSCDDWIRDR. 6. “Negro Jobless Rates Still Highest,” PPG, February 28, 1968. 7. “To Every Employee of the Pittsburgh Works,” December 29, 1969, box 52, USWA 1843. 8. “Massive Layoffs Hit Steel Industry,” Associated Press, August 6, 1971; “Steel Feast . . . and Famine,” PPG, March 21, 1973; “Jobless Rate of 8.8% Tied to Steel Layoffs,” PPG, January 5, 1977. 9. Employment Data, May 16, 1972, box 55, b inder 1, USSCNDWR. On the struggle for racial justice in steel, see Dennis C. Dickerson, Out of the Crucible: Black Steelworkers in Western Pennsylvania (Albany, NY: SUNY Press, 1980); Judith Stein, Running Steel, R unning America: Race, Economic Policy, and the Decline of Liberalism (Chapel Hill: University of North Carolina Press, 1996); Hinshaw, Steel and Steelworkers; Ruth Needleman, Black Freedom Fighters in Steel: The Struggle for Democratic Unionism (Ithaca, NY: Cornell University Press, 2003). 10. Women of Steel, no. 4 (November 1979), box 1, folder 10, SDP; “Meeting of Duquesne Works W omen,” box 1, folder 10, SDP. 11. “20 Questions and Answers about I. W. Abel’s No-Strike Agreement,” box 1, folder 35, SDP. 12. “Sadlowski Will Run for Presidency of USW,” PPG, September 14, 1976; “Abel’s E.N.A.: Check the Record,” box 1, folder 35, SDP. 13. “A Message to Steelworkers and Their Families,” box 1, folder 23, SDP; emphasis in original. 14. Ken Kelley, “Penthouse Interview: Ed Sadlowski,” Penthouse, January 1977. 15. See Cowie, Stayin’ Alive, 30–38; Ken Kelley, “Penthouse Interview: Ed Sadlowski,” Penthouse, January 1977; James B. Lane and Mike Olszanski, eds., “Steelworkers Fight Back: Inland’s Local Union 1010 and the Sadlowski / Balanoff
316
N o t e s t o Pag e s 1 8 5 – 1 8 9
Campaigns,” Steel Shavings 30 (2000), 1–144; S.M.A.R.T. (Steelworker Members Against Radical Takeover), box 1, folder 28, SDP; “A Gutter View of a Candidate in Penthouse,” box 1, folder 24, SDP; “What Sadlowski R eally Said,” box 1, folder 25, SDP; Hoerr, And the Wolf Finally Came, 78–79. 16. Steelworkers Stand Up, November 1976, box 1, folder 4, SDP; Thomas Geoghegan, Which Side Are You On?: Trying to Be for Labor When It’s Flat on Its Back (New York: Farrar, Strauss & Giroux, 1991), 81–82; Steelworkers Stand Up, “Special Bulletin on 1557 Local Contract Negotiations” and Steelworkers Stand Up, “Local Issues Collapse,” box 1, folder 4, SDP. 17. Mike Stout, Homestead Steel Mill—The Final Ten Years: USWA Local 1397 and the Fight for Union Democracy (Oakland, CA: PM Press, 2020). 18. Judith Stein, Pivotal Decade: How the United States Traded Factories for Finance in the Seventies (New Haven, CT: Yale University Press, 2010), 245–247; “A Sad Day for Steel Workers: 25 Years Later, Ex-Foreman Recalls Demise of Blast Furnace,” PPG, June 22, 2004. 19. On this transition, see David Harvey, A Brief History of Neoliberalism (Oxford: Oxford University Press, 2005); Robert Brenner, The Economics of Global Turbulence (London: Verso, 2006). On stagflation, see Wolfgang Streeck, Buying Time: The Delayed Crisis of Democratic Capitalism, trans. Patrick Camiller (London: Verso, 2014); “Volcker Asserts U.S. Must Trim Living Standard,” New York Times, October 18, 1979. 20. Stein, Pivotal Decade, 276; Federal Open Markets Committee, transcript of conference call, June 5, 1980, p. 10; On steel mill closures, see Hoerr, And the Wolf Finally Came. 21. “Milltowns in the Pittsburgh Region: Conditions and Prospects,” box 124, folder 9, RHWPA; Christopher Briem, “Recessions and Pittsburgh,” Pittsburgh Economic Quarterly (December 2008), 2. 22. “U.S. Steel’s Debt-Shrouded Future,” Business Week, October 18, 1982; Jack Metzgar, “Would Wage Concessions Help the Steel Industry?” Labor Research Review 1, no. 2 (1983), 26; “USS scraps $100 million plan for Edgar Thomson,” PPG, December 16, 1982; Edward F. Stankowski Jr., Memory of Steel (Lima, OH: Wyndham Hall Press, 2004), 104; Briem, “Recessions and Pittsburgh,” 2. 23. “U.S. Steel to Close 30 Mills, Cut 15,000 Jobs,” UPI, December 28, 1983; “U.S. Steel Says Steel Profit Best in 2½ Years,” PPG, August 1, 1984; “U.S. Steel’s Homestead Works Rolls Final Order before Shutdown,” WOR, May 25, 1986; “Shutting Down: Tube Works’ Last 22 Workers Bid Farewell to Jobs, Each Other,” PPG, August 29, 1987. 24. Allegheny Conference on Community Development, “A Strategy for Growth: An Economic Development Program for the Pittsburgh Region,” vol. 1, November 1984, p. 16, box 7, folder 89, ACCDC; James C. Musselwhite Jr., Rosalyn B. Katz, and Lester B. Salamon, Government Spending and the Nonprofit Sector in Pittsburgh / Allegheny County (Washington, DC: Urban Institute Press,
N o t e s t o Pag e s 1 8 9 – 1 9 1
317
1985), p. 14, box 60, folder 2, RHWPA; “Pittsburgh Unemployment Rate Highest in 1983,” WOR, August 10, 1984; “Hunger in Allegheny County: A Study of the Food Assistance System and the Hunger Problem,” May 1986, box 17, folder 6, RKR; William Serrin, “Steel Union Leaders Ratify Concessions,” New York Times, March 2, 1983, p. A16; J. Bruce Johnston to Steelworker-Represented Employees, December 13, 1982, box 2, folder 6, RKR; Elizabeth Blocher, “Introduction,” in Aliquippa: Struggle for Survival in a Pittsburgh Milltown, 1984 and Before, ed. Elizabeth Blocher, Cathy A. Cairns, James V. Cunningham, and C. Matthew Hawkins (Pittsburgh: University of Pittsburgh School of Social Work, 1984), 3. 25. Hoerr, And the Wolf Finally Came, 78–80; Nonprofit Sector Project, “Impact of Government Cutbacks on Allegheny County,” pp. 8, 28–30, box 60, folder 1, RHWPA; “States Borrowing Heavily from U.S. to Pay Jobless Aid,” Associated Press, January 13, 1983; “Smaller Budgets Strain Towns, Jobless,” PP, April 4, 1984. 26. “Fiscal Trends: Allegheny County and Institution District, 1968–1974,” PELR; “Potential Impact of Federal Cutbacks, Moratoriums, and New Regulations on Allegheny County Programs and Consumers of Services,” 1973, box 43, folder 6, RHWPA; Nonprofit Sector Study Research Guide, Part II, December 21, 1982, box 59, folder 8, RHWPA; Nonprofit Sector Project, “Impact of Government Cutbacks on Allegheny County,” box 60, folder 1, RHWPA. 27. Nonprofit Sector Project, “Impact of Government Cutbacks on Allegheny County,” box 60, folder 1, RHWPA; Barney Oursler, interview by Steffi Domike, August 5, 1983, box 2, folder 50, SDP. 28. On resistance to plant closures in Pittsburgh in the 1980s, see Dale A. Hathaway, Can Workers Have a Voice?: The Politics of Deindustrialization in Pittsburgh (State College: Pennsylvania State University Press, 1993). On the protest, see “4,000 Unemployed Protest President’s Arrival H ere,” PP, April 6, 1983; on the Jackson campaign, see “Rev. Jackson rallies support in Homestead,” News Messenger, April 11, 1984, box 23, RKR. On unemployed activism, see Cynthia Deitch, “Collective Action and Unemployment: Responses to Job Loss by Workers and Community Groups,” International Journal of Mental Health 13, no. 1–2 (1984), 139–153. 29. “Hunger in Allegheny County: A Study of the Food Assistance System and the Hunger Problem,” pp. 12–27, May 1986, box 17, folder 6, RKR. On Act 75, see also Anne E. Parsons, From Asylum to Prison: Deinstitutionalization and the Rise of Mass Incarceration after 1945 (Chapel Hill: University of North Carolina Press, 2018), 129–132; “Welfare Cutback May Force Carrick M other To Quit Job,” PP, December 27, 1981. 30. “Hunger in Allegheny County,” p. 12; “A Study of Act 75—Executive Summary,” p. 2, box 2, folder 29, MVUCC. 31. “Hunger in Allegheny County”; Nonprofit Sector Project, “Impact of Government Cutbacks on Allegheny County,” p. 22, box 60, folder 1, RHWPA;
318
N o t e s t o Pag e s 1 9 2 – 1 9 4
“Survey of Shelter Care Problems in Allegheny County,” February 1980, box 90, folder 7, RHWPA; Draft Proposal, Homeless / Health, December 20, 1984, box 90, folder 9, RHWPA. On deinstitutionalization, see Parsons, From Asylum to Prison; Karen Tani, “Deinstitutionalization as Expropriation,” unpublished paper, 2020. 32. “The Reagan visit,” box 11, folder 3, Lawrence F. Evans Collection, 1978– 1988, AIS.1988.17, Archives & Special Collections, University of Pittsburgh Library System; Allegheny Conference on Community Development, “A Strategy for Growth: An Economic Development Program for the Pittsburgh Region,” vol. 1, November 1984, p. 27, box 7, folder 89, ACCDC. See also Guian McKee, The Problem of Jobs: Liberalism, Race, and Deindustrialization in Philadelphia (Chicago: University of Chicago Press, 2008); Tracy Neumann, Remaking the Rust B elt: The Postindustrial Transformation of North America (Philadelphia: University of Pennsylvania Press, 2016). 33. Job bank applications, box 23, RKR. Names from this collection have been changed. 34. Oursler interview, box 2, folder 50, SDP; “Towns: Life on the Line,” box 1, folder 10, RKR. Nonprofit Sector Project, “Impact of Government Cutbacks on Allegheny County,” pp. 27–34, box 60, folder 1, RHWPA. 35. “Towns: Life on the Line,” box 1, folder 10, RKR; Linda Ganczak, interview by Steffi Domike, box 2, folder 39, SDP; Jim Cunningham and Pamela Martz, eds., “Steel People: Survival and Resilience in Pittsburgh’s Mon Valley,” p. 52, box 17, Item 8, RKR. 36. “Retraining Fund Delay Puts Jobless in Squeeze,” PP, August 11, 1983; Unemployed Survey, box 1, folder 54, MVUCC. 37. “On Black Pittsburgh (II),” PPG, August 31, 1981; “Thornburgh Signs Mandatory-Sentencing Bill,” WOR, March 9, 1982; Pennsylvania Commission on Crime and Delinquency, “A Strategy to Alleviate Overcrowding in Pennsylvania’s Prisons and Jails,” January 1985, box 1, folder 6, MMDP; “New Prison W on’t Ease Crowding Much,” PPG, September 20, 1988; Pennsylvania Commission on Crime and Delinquency, “A Strategy to Alleviate Overcrowding in Pennsylvania’s Prisons and Jails,” January 1985, box 1, folder 6, MMDP; “Allegheny County Jail Reviewed,” WOR, April 18, 1980; “Prison System u nder Siege,” Allegheny Times, December 17, 1989; Borough of Homestead arrest records, January 15, 1986, box 1, folder 46, MMDP; Parsons, From Asylum to Prison. On the rise of mass incarceration, see Ruth Wilson Gilmore, Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California (Berkeley: University of California Press, 2007); Marie Gottschalk, Caught: The Prison State and the Lockdown of American Politics (Princeton, NJ: Princeton University Press, 2016); Elizabeth Hinton, From the War on Poverty to the War on Crime: The Making of Mass Incarceration in America (Cambridge, MA: Harvard University Press, 2016); Julilly Kohler-Hausmann, Getting Tough: Welfare and Imprisonment in 1970s America (Princeton, NJ: Princeton University Press, 2017).
N o t e s t o Pag e s 1 9 5 – 1 9 7
319
38. Sharon Browning, interview with Gabriel Winant, July 11, 2016; Gambhir Dev Bhatta, “Migration Patterns and Trends of the Ten-County Region of Southwestern Pennsylvania, 1980–1985,” p. 36, Pittsburgh Department of City Planning, September 1987. 39. Christopher P. Briem, “Beyond Hell with the Lid Off” (unpublished manuscript, January 2020), 168–172. 40. See Jim Cunningham and Pamela Martz, eds., “Steel P eople: Survival and Resilience in Pittsburgh’s Mon Valley,” p. 84, box 17, Item 8, RKR; “Pittsburgh Ranks Low as U.S. Trend Setter,” PPG, November 9, 1982; “The Feminization of Poverty,” PPG, October 13, 1986; Martha Baum, Barbara K. Shore, and Kathy Fleissner, “When Unemployment Strikes: The Impact on W omen and Families,” November 1988, pp. 15–21, box 125, folder 2, RHWPA. 41. “Milltowns in the Pittsburgh Region: Conditions and Prospects,” box 124, folder 9, RHWPA; “Allegheny Still Second Oldest Big County in United States,” PPG, May 24, 2001; Glennan Jr. et al., Education, Employment, and the Economy, 13, shows the concentration of outmigrants in the 15–34 age bracket; Health and Welfare Planning Association, “Background Papers: United Way of Allegheny County Priority Setting Forum,” March 1987, p. 8, box 17, RKR. 42. “A Time for Concern: The Status of Elderly and Handicapped in Western Pennsylvania,” box 1, Reports on Allegheny County, Archives & Special Collections, University Library System, University of Pittsburgh, Pittsburgh, PA; Beaufort B. Longest, “The Pattern of Utilization of Inpatient Hospital Serv ices in Southwestern Pennsylvania: Report of a Study,” Health Policy Institute, Policy Series No. 1, November 1980, box 136, folder 8, RHWPA; “Background Information, Long Term Care,” box 88, folder 2, RHWPA. 43. Laura C. Leviton, “The Implications of an Aging Population for the Health Care System in Southwestern Pennsylvania,” Health Policy Institute, Graduate School of Public Health, 1981, 78, box 6, Item 24, BGC; The Nonprofit Sector Project, “Impact of Government Cutbacks on Allegheny County,” box 60, folder 1, RHWPA; Bob Macey, interview with Robert L. Anderson, SLC, p. 12; “Background Information, Long Term Care,” p. 23, box 88, folder 2, RHWPA. 44. Hospital Council of Western Pennsylvania, “Long-Term Care: A Perspective,” box 136, folder 6, RHWPA; Planning Committee on Long Term Care for the Elderly, Final Report, June 1979, box 26, Item 2, PELR. On the relationship between population aging and fiscal crisis, see Meredith Minkler and Carroll L. Estes, eds., Critical Perspectives on Aging: The Political and Moral Economy of Growing Old (Amityville, NY: Baywood Publishing Com pany, 1991); Paul Pierson, “Irresistible Forces, Immovable Objects: Postindustrial Welfare States Confront Permanent Austerity,” Journal of European Public Policy 5, no. 4 (December 1998), 539–560; Laura Katz Olson, The Not-So-Golden Years: Caregiving, the Frail Elderly, and the Long-Term Care Establishment (Lanham, MD: Rowman & Littlefield, 2003).
320
N o t e s t o Pag e s 1 9 7 – 2 0 1
45. I-22-B, p. 31, WEMHOHPR; Nonprofit Sector Project, “Impact of Government Cutbacks on Allegheny County,” box 60, folder 1, RHWPA. 46. Louise Child Care Center, Annual Report, 1975, box 32, folder 11, RHWPA; Nonprofit Sector Proj ect, “Impact of Government Cutbacks on Allegheny County,” box 60, folder 1, RHWPA. On the Nixon administration and the politics of day care, see Marisa Chappell, The War on Welfare: Family, Poverty, and Politics in Modern America (Philadelphia: University of Pennsylvania Press, 2012), 104; Kirsten Swinth, Feminism’s Forgotten Fight: The Unfinished Struggle for Work and Family (Cambridge, MA: Harvard University Press, 2018), 156–179. 47. Nonprofit Sector Project, “Impact of Government Cutbacks on Allegheny County,” box 60, folder 1, RHWPA; Thomas J. LaBelle and Christopher Ward, “Education and Training in the Mon Valley,” Paper Prepared for the President’s Conference: Mill Towns: Despair, Hopes and Opportunities, May 5–6, 1988, pp. 12–13, box 125, folder 1, RHWPA. 48. See Kirsten Swinth, “Post–Family Wage, Postindustrial Society: Reframing the Gender and Family Order through Working Mothers in Reagan’s America,” Journal of American History 105, no. 2 (September 2018), 311–335. 49. Glennan Jr. et al., Education, Employment, and the Economy, 16–17. On youth and African American unemployment, see Allegheny Conference on Community Development, “A Strategy for Growth: An Economic Development Plan for the Pittsburgh Region,” vol. II, November 1984, p. VII-5, box 7, folder 79, ACCDC. 50. Daniel Sullivan and Till von Wachter, “Job Displacement and Mortality: An Analysis Using Administrative Data,” Quarterly Journal of Economics 124, no. 3 (August 2009), 1266. See also Martin Browning and Eskil Heinesen, “Effect of Job Loss Due to Plant Closure on Mortality and Hospitalization,” Journal of Health Economics 31 (2012), 599–616; Jessamyn Schaller and Ann Huff Stevens, “Short-Run Effects of Job Loss on Health Conditions, Health Insurance, and Health Care Utilization,” Journal of Health Economics 43 (September 2015), 190–203. 51. Pee Wee Veri, interview with Robert L. Anderson, p. 12, SLC; Michele McMills, interview with Robert L. Anderson, May 8, 1991, p. 32, SLC; Irwin M. Marcus, “The Deindustrialization of America: Homestead, a Case Study, 1959– 1984,” Pennsylvania History 52, no. 3 (July 1985), 174; Hoerr, And the Wolf Finally Came, 19; Sara Bachman Ducey et al., Poor Infants, Poor Chances: A Longitudinal Study of Progress toward Reducing Low Birth Weight and Infant Mortality in the United States and Its Largest Cities, 1979–1984 (Washington, DC: Food Research and Action Center, 1987), 45, 178–179; “Unemployment Tied to Infant Death Rise,” PPG, November 19, 1983. 52. Henry W. Pierce, “Woes of All Kinds Grow in Hard Times,” PPG, May 18, 1982, pp. 1–4. For Brenner’s report to Congress, see Joint Economic Committee of the Congress of the United States, Estimating the Effects of Economic Change on National Health and Social Well-Being, 98th Cong., 2nd sess., 1984. See also
N o t e s t o Pag e s 2 0 1 – 2 0 5
321
Ramsay Liem and Paula Rayman, “Health and Social Costs of Unemployment,” American Psychologist 37, no. 10 (October 1982), 1116–1123; Allison Zippay, From Middle Income to Poor: Downward Mobility among Displaced Steelworkers (New York: Praeger, 1991), 91–112; “Study Finds Suicide, Depression Levels High in Mon Valley,” PPG, July 25, 1985; “Survey Claims 50% Jobless Rate in Valley, Suicides High,” PP, July 25, 1985; Centers for Disease Control and Prevention, National Center for Health Statistics, Compressed Mortality File 1979–1998, CDC WONDER On-line Database, compiled from Compressed Mortality File CMF 1968–1988, series 20, no. 2A, 2000, and CMF 1989–1998, series 20, no. 2E, 2003. 53. “Living—a nd D ying—w ith Steel,” Philadelphia Inquirer, August 11, 1986; Georgeanne Koehler, interview with Gabriel Winant, June 24, 2015. 54. “Crying Out,” PP, March 6, 1983; Health and Welfare Planning Association, “Background Papers: United Way of Allegheny County Priority Setting Forum,” March 1987, p. 6, box 17, RKR; Elizabeth Blocher, “Social Serv ices,” in Blocher et al., Aliquippa, 23. 55. “Joblessness, Inflation Take Health Toll,” PPG, June 18, 1982; “Psychiatric Care Issue Vexes Health Committee,” PPG, July 1, 1982. 56. Richard (Buz) Cooper, Poverty and the Myths of Health Care Reform (Baltimore: Johns Hopkins University Press, 2016), 39. Cooper is discussing Milwaukee. 57. “Jobless Need Aid on Paying Health Bill,” PPG, March 11, 1983. 58. “Lost Health Care Sickens Jobless,” PP, April 10, 1983; “Free Health Programs for Jobless Not in Great Demand in South Hills,” PP, July 28, 1983. 59. Biegel, Cunningham, Yamatani, and Martz, “Self-Reliance and Blue-C ollar Unemployment in a Steel Town,” 404; “Jobless to Get Free Health Care,” PP, January 26, 1983; Judith Feder, Jack Hadley, and Ross Mullner, “Falling through the Cracks: Poverty, Insurance Coverage, and Hospital Care for the Poor, 1980 and 1982,” Milbank Memorial Fund Quarterly 62, no. 4 (Autumn 1984), 545. 60. See, for example, “Notice of Availability of Hill-Burton Uncompensated Ser vices,” PP, August 30, 1985; “Blue Cross Offers Plan to Jobless,” PPG, April 21, 1983, p. 6; “Health Care Access for Poor Dwindling,” PP, July 21, 1985; “Lost Health Care Sickens Jobless”; “80,000 May Use New Health Plan for Jobless,” PP, April 21, 1983. 61. Jack Hadley and Judith Feder, “Hospital Cost Shifting and Care for the Uninsured,” Health Affairs 4, no. 1 (Fall 1985), 67–80; “Thousands Assail Medicaid Cut, but Thornburgh Says It’ll Stay,” Philadelphia Inquirer, February 9, 1983. 62. “Health Care Access for Poor Dwindling,” PP; Koehler, interview. 63. A Study of Act 75—Executive Summary,” p. 3, box 2, folder 29, MVUCC; Hoerr, And the Wolf Finally Came, 79; “Welfare Case Work: Cutbacks, Red Tape, Delays,” PPG, September 27, 1983; Nonprofit Sector Study Research Guide, Part II, December 21, 1982, pp. 46–49, box 59, folder 8, RHWPA. 64. Rand J. Wortman to Representative Thomas Michlovic, April 7, 1992, box 12, folder 5, TAMP.
322
N o t e s t o Pag e s 2 0 5 – 2 0 8
65. “L abor, Its Clout Waning, Fights for Jobs,” PP, April 6, 1984; “Steel Union Leaders Ratify Concessions,” NYT, March 2, 1983; J. Bruce Johnston to Steelworker- Represented Employees, December 13, 1982, box 2, folder 6, RKR; Hoerr, And the Wolf Finally Came, 554. 66. “LTV Benefit Cuts Stir Strike Threats,” PP, July 24, 1986; US Congress, Senate, Special Committee on Aging, Retiree Health Benefits: The Fair-Weather Promise, 99th Cong., 2nd sess., 1987, August 7, pp. 1, 108; “Director of PBGC Turns Optimist,” PPG, January 23, 1988; “Ritter Promises Help On Pensions,” Allentown Morning Call, May 16, 1988. See Staughton Lynd and Alice Lynd, “Labor in the Era of Multinationalism: The Crisis in Bargained- For Benefits,” West Virginia Law Review 93, no. 4 (Summer 1991), 912–921; “Broken Promises: For Tens of Thousands of LTV Retirees and Their Families, Health-Care Coverage Now an Issue,” PPG, March 24, 2002; Kaiser Family Foundation, “Retired Steelworkers and Their Health Benefits: Report from a 2004 Survey,” May 2006, available at https://w ww.k ff.org/w p-content/uploads/2 013/0 1/7518.pdf. 67. “Researchers Examine Steelworkers’ Benefits,” Latrobe Bulletin, May 9, 1986; see also Edward A. Montgomery and Otto A. Davis, “Private Income Security Schemes in Times of Crisis: A Case Study of US Steel,” Labour and Society 15, no. 1 (1990), 75–88. 68. American Hospital Association, Hospital Statistics (Chicago: American Hospital Association, 1982), 169–172. 69. “Hospitals Face Crisis as Patients Can’t Pay,” PPG, August 5, 1985; Nonprofit Sector Study Research Guide, Part II, December 21, 1982, pp. 46–49, box 59, folder 8, RHWPA; Jim Cunningham and Pamela Martz, eds., “Steel People: Survival and Resilience in Pittsburgh’s Mon Valley,” pp. 57–58, box 17, Item 8, RKR; Koehler, interview; Margaret A. Potter and Allison G. Leak, Health Care System Change and Its Employment Impacts in Southwestern Pennsylvania (Pittsburgh: Health Policy Institute, University of Pittsburgh, 1995), 9. 70. Musselwhite, Katz, and Salamon, Government Spending and the Nonprofit Sector in Pittsburgh / Allegheny County, p. 17, box 60, folder 2, RHWPA; Health Policy Institute, “The Implications of a Changing Economy for the Hospital System in Southwestern Pennsylvania,” pp. 97–103. 71. “Health Department Approves $127 Million Project at Children’s Hospital in Pittsburgh,” September 18, 1981, box 164, folder 3, series XI, DTP. 72. Draft Application for a Stage One Planning Grant to the Robert Wood Johnson Foundation, June 17, 1982, p. 5, box 41, folder 4, ACCDR; George Ross Fisher, The Hospital That Ate Chicago: Distortions Imposed on the Medical System by Its Financing (Philadelphia: Saunders Press, 1980), 102; Brian M. Kinkead, “Medicare Payment and Hospital Capital: The Evolution of Policy,” Health Affairs 3, no. 3 (Fall 1984), 49–74; Health Policy Institute, “The Implications of a Changing Economy for the Hospital System in Southwestern Pennsylvania,” xii-xiv, box 136, folder 8, RHWPA; “Background Information, Long Term Care,” p. 31, box 88, folder 2, RHWPA.
N o t e s t o Pag e s 2 0 8 – 2 1 1
323
73. “Health care and related data,” box 41, folder 3, ACCDR; Department of Health and H uman Services, National Center for Health Statistics, Utilization of Short-Stay Hospitals: Annual Summary for the United States, 1979 (December 1981), 2; Draft Application for a Stage One Planning Grant to the Robert Wood Johnson Foundation, June 17, 1982, box 41, folder 4, ACCDR. 74. Draft Application for a Stage One Planning Grant to the Robert Wood Johnson Foundation, June 17, 1982, box 41, folder 4, ACCDR; Max Shain and Milton I. Roemer, “Hospital Costs Relate to the Supply of Beds,” Modern Hospital 92, no. 4 (April 1959), 71–74; Paul B. Ginsburg and Daniel M. Koretz, “Bed Availability and Hospital Utilization: Estimates of the ‘Roemer Effect,’ ” Health Fare Financing Review 5, no. 1 (Fall 1983), 87–92; Longest, “The Pattern of Utilization of Inpatient Hospital Services in Southwestern Pennsylvania,” p. 26; Potter and Leak, Health Care System Change and Its Employment Impacts in Southwestern Pennsylvania, 9; “Profiting from Health Care,” PPG, January 10, 1990. 75. Allegheny Conference on Community Development, “A Strategy for Growth: An Economic Development Program for the Pittsburgh Region,” vol. 1, p. 36, box 7, folder 89, ACCDC; Allegheny Conference on Community Development, “Five Year Economic Development Report,” November 1984, p. 10, box 7, folder 90, ACCDC. On the role of Pittsburgh elites in economic restructuring, see Tracy Neumann, Remaking the Rust Belt: The Postindustrial Transformation of North America (Philadelphia: University of Pennsylvania Press, 2016). 76. Allegheny Conference on Community Development, “A Strategy for Growth,” vol. 2, III-2-III-3, box 7, folder 89, ACCDC. 77. Daniel Bell, The Coming of Post-Industrial Society: A Venture in Social Forecasting (New York: Basic Books, 1973), 128, 137; Allegheny Conference on Community Development, “A Strategy for Growth: An Economic Development Program For the Pittsburgh Region,” vol. 1, p. 18, box 7, folder 89, ACCDC; US Congress, House of Representatives, Committee on Banking, Finance and Urban Affairs, Subcommittee on Economic Stabilization, Service Industries: The F uture Shape of the American Economy, 98th Cong., 2nd sess., 1984, June 8, p. 103. 78. Potter and Leak, Health Care System Change and Its Employment Impacts in Southwestern Pennsylvania, 31. 79. Rachel E. Dwyer, “The Care Economy? Gender, Economic Restructuring, and Job Polarization in the U.S. L abor Market,” American Sociological Review 78, no. 3 (June 2013), 404. See also Irene Butter, Eugenia Carpenter, Bonnie Kay, and Ruth Simmons, Sex and Status: Hierarchies in the Health Workforce (Ann Arbor: Department of Health Planning and Administration, School of Public Health, University of Michigan, 1985). 80. Ralph L. Bangs and Thomas Soltis, “The Job Growth Centers of Allegheny County: Interim Report for the Project: Linking the Unemployed to Growth Centers in Allegheny County,” June 1989, p. 19, box 124, folder 3, RHWPA; Potter and Leak, Health Care System Change and Its Employment Impacts in Southwestern Pennsylvania, 24–25.
324
N o t e s t o Pag e s 2 1 2 – 2 1 8
81. Census of Population, 1990, Social and Economic Characteristics, T able 146. 82. “Strike Breakers Assailed By Labor,” PP, December 15, 1985. For a memoir of this strike and some of its consequences, see Billy Joe Jordan, Union Man (Bloomington, IN: AuthorHouse, 2003). 83. “Health Insurance Cut Upsets Custodians,” PP, July 24, 1986; Richard W. Hurd and William Rouse, “Progressive Union Organizing: The SEIU Justice for Janitors Campaign,” Review of Radical Political Economics, 21, no. 3 (September 1989), 70–75. 84. Job bank applications, box 23, RKR. 85. Browning, interview. 86. Browning, interview. 87. See Susan Thistle, From Marriage to the Market: The Transformation of Women’s Lives and L abor (Berkeley: University of California Press, 2006), 43; Coburn, interview; Henderson, interview; Job bank applications, box 23, RKR; Henry, interview. 88. S-25-A, p. 11, WEMHOHPR. 89. Interview with Terry Chalich, SLC, p. 10; Linda Ganczak, interview by Steffi Domike, box 2, folder 39, SDP; S-7-C, p. 3, WEMHOHPR; S-10-B, pp. 5–7, WEMHOHPR; Arbitration Proceeding, in the Matter of Monsour Hospital Serv ice Employees International Union, Local 585 AFL-CIO, Brief on Behalf of the Union, January 26, 1983, box 69, folder 3, SEIU 585. 90. VNA Inc., “Homemaker / Home Health Aide Training Programs For the Ten County Southwestern Pennsylvania Region,” July 1986, box 25, HSASPR. See also Thistle, From Marriage to the Market, 59–65. 91. Torben Iversen and Anne Wren, “Equality, Employment, and Budgetary Restraint: The Trilemma of the Serv ice Economy,” World Politics 50, no. 4 (July 1998), 513; Gøsta Esping-A ndersen, Social Foundations of Postindustrial Economies (Oxford: Oxford University Press, 1999); Kathleen Thelen, Variet ies of Liberalization and the New Politics of Social Solidarity (New York: Cambridge University Press, 2014). 92. Baum, Shore, and Fleissner, “When Unemployment Strikes.”
6. “The Task of Survival” 1. Documents related to Elfreida Murray grievance, May 3, 1984, box 121, folder 5, SEIU 585. For a discussion of the norms surrounding agreement among caregiving staff, see John and Barbara Ehrenreich, “Hospital Workers: A Case Study in the ‘New Working Class,’ ” Monthly Review (January 1973), 17. 2. Jonathan Oberlander, The Political Life of Medicare (Chicago: University of Chicago Press, 2003), 120–135; Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century (Baltimore: Johns Hopkins University, 1999), 324–330.
N o t e s t o Pag e s 2 2 1 – 2 2 3
325
3. Columbia Hospital Employee’s Handbook, 1974, box 87, folder 3, SEIU 585. Interview transcript, Pauline Oravetz, WHWSR; Interview transcript, Sally Pearman, WHWSR; Interview transcript, Cecilia Kravice, WHWSR; Regina Horvat, interview with Gabriel Winant, July 12, 2016. On this transformation, see Michael Bittman and Nancy Folbre, Family Time: The Social Organization of Care (London: Routledge, 2004); Karen V. Hansen, Not-So-Nuclear Families: Class, Gender, and Networks of Care (New Brunswick, NJ: Rutgers University Press, 2004); Dan Clawson and Naomi Gerstel, Unequal Time: Gender, Class, and F amily in Employment Schedules (New York: Russell Sage Foundation, 2014). On emotional and affective l abor, see Arlie Russell Hochschild, The Managed Heart: Commercialization of H uman Feeling (Berkeley: University of California Press, 1983); Kathi Weeks, Constituting Feminist Subjects (Ithaca, NY: Cornell University Press, 1998); Michael Hardt, “Affective Labor,” Boundary 2 26, no. 2 (Summer 1999), 89–100. 4. Interview transcript, Pauline Oravetz, WHWSR. On the role of ward clerks in the hospital in this period, see Karen Brodkin Sacks, Caring by the Hour: Women, Work, and Organizing at Duke Medical Center (Urbana: University of Illinois Press, 1988), 71–78. See also Ariel Ducey, “More Than a Job: Meaning, Affect, and Training Health Care Workers,” The Affective Turn: Theorizing the Social, ed. Patricia Ticineto and Jean Halley (Durham: Duke University Press, 2007), 187–208; Interview transcript, Anne Brumfield, WHWSR; Arbitration Proceeding, in the Matter of Monsour Hospital Serv ice Employees International Union, Local 585 AFL-CIO, Brief on Behalf of the Union, January 26, 1983, box 69, folder 3, SEIU 585; Congressional Record, S.2375, 96 Cong., 2nd sess., 1980, September 19, p. S13015. 5. Gale Ridenour files, May to December 1976, box 69, folder 2, SEIU 585. See Mignon Duffy, Amy Armenia, and Clare L. Stacey, eds., Caring on the Clock: The Complexities and Contradictions of Paid Care Work (New Brunswick: Rutgers University Press, 2015). 6. Interview transcript, Cheryl Hershberger, WHWSR; Phyllis D. Coontz, Judith A. Martin, and Edward W. Sites, “Steeltown Fathers: Raising Children in an Era of Industrial Decline,” in Social Work Intervention in an Economic Crisis, ed. Martha Baum and Pamela Twiss (New York: Haworth Press, 1996), 112; Interview transcript, Robin Floyd, WHWSR; Interview transcript, Charlene Bierer, WHWSR. See Lisa C. Ruchti, Catheters, Slurs, and Pickup Lines: Professional Intimacy in Hospital Nursing (Philadelphia: T emple University Press, 2012). 7. Interview transcript, Carolyn Piper, WHWSR; interview transcript, Sondra Bisher, WHWSR. See Arlie Russell Hochschild, The Second Shift: Working Families and the Revolution at Home (New York: Penguin, 1989). 8. Interview transcript, Kathy Keffer, WHWSR; “How Frick Is Faring in Strike,” June 10, 1978, box 51, folder 15, SEIU 585; Interview transcript, Charlene Bierer, WHWSR. 9. US Department of Health and H uman Serv ices, “HHS News,” October 6, 1982, box 24, folder 9, RSSP.
326
N o t e s t o Pag e s 2 2 4 – 2 2 8
10. Martin Gaynor, Lynn Barth, Kathleen Calore, Carol Carter, and David Juba, Health Care Financing Administration, “National Hospital Prospective Payment Evaluation: Case Study Site Report: Pittsburgh, Pennsylvania,” November 17–21, 1986, pp. 1–2, 7. 11. Beaufort B. Longest, “A Plan for Reducing Inpatient Hospital Utilization in Southwestern Pennsylvania,” January 1982, p. 5, box 41, folder 3, ACCDR; Oberlander, The Political Life of Medicare, 121. 12. US Congress, Senate, Special Committee on Aging, The Future of Medicare, 98th Cong., 1st sess., 1983, October 6, April 13, pp. 88–89; US Congress, Senate, Special Committee on Aging, Controlling Health Care Costs: State, Local, and Private Sector Initiatives. 98th Cong., 1st sess., 1983, October 6, p. 43. See Michael B. Katz, ed., The “Underclass” Debate: Views from History (Princeton, NJ: Princeton University Press, 1993). 13. “Opening Statement of Senator Richard S. Schweiker (R-Pa.) at Subcommittee on Health and Scientific Research Hearings Concerning Administration’s Hospital Cost Containment Proposal,” March 9, 1979, box 21, folder 54, RSSP. 14. Rick Mayes and Robert A. Berenson, Medicare Prospective Payment and the Shaping of U.S. Health Care (Baltimore: Johns Hopkins Press, 2006), 29; David G. Smith, Paying for Medicare: The Politics of Reform (Hawthorne, NY: Aldine de Gruyter, 1992), 28–30. 15. Robert G. Fetter, David A. Brand, and Dianne Gamache, eds., DRGs: Their Design and Development (Ann Arbor, MI: Health Administration Press, 1991). 16. Mayes and Berenson, Medicare Prospective Payment and the Shaping of U.S. Health. 17. “Statement of Richard S. Schweiker, Secretary of Health and H uman Ser vices, before the Senate Committee on Finance, Subcommittee on Health,” p. 3, February 2, 1983, box 24, folder 21, RSSP. 18. Smith, Paying for Medicare, 47–56; Mayes and Berenson, Medicare Prospective Payment and the Shaping of U.S. Health Care, 42–46. 19. “DRGs and Quality of Care,” Washington Report on Medicine & Health, November 25, 1985; US Congress, Senate, Special Committee on Aging, Quality of Care U nder Medicare’s Prospective Payment System: Hearings before the Special Committee on Aging, 99th Cong., 1st sess., 1985, November 12, pp. 1–2, 261. 20. Wanda W. Young, Robert Blane Swinkola, and Martha A. Hutton, “Assessment of the AUTOGRP Patient Classification System,” Medical Care 18, no. 2 (February 1980), 228–244; Wanda W. Young, Robert B. Swinkola, and Dorothy M. Zorn, “The Measurement of Hospital Case Mix,” Medical Care 20, no. 5 (May 1982), 512. 21. Margaret A. Potter and Allison G. Leak, Health Care System Change and Its Employment Impacts in Southwestern Pennsylvania (Pittsburgh: Health Policy Institute, 1995), 27–28. 22. Maryann Johnson, interview with Gabriel Winant, March 24, 2017.
N o t e s t o Pag e s 2 2 8 – 2 32
327
23. Gaynor et al., “National Hospital Prospective Payment Evaluation,” pp. 7–8, 24; Hospital Council of Western Pennsylvania, “Changing for Good: The Transformation of Hospitals in Western Pennsylvania over the Next Five Years,” December 1985, Section 2, “Repositioning,” p. 2, box 186, folder 9, ACCDR; Health Policy Institute, “The Future of Health Planning in Southwestern Pennsylvania,” March 1987, p. 16, box 293, folder 4, ACCDR. 24. Hospital Council of Western Pennsylvania, “Hospitals at Risk: The Need for an Operating Margin,” February 13, 1987, p. 6, box 186, folder 9, ACCDR; Beaufort B. Longest, “The Prognosis for Hospitals in Western Pennsylvania,” June 15, 1988, pp. 1–5, box 295, folder 19, ACCDR. 25. Hospital Council of Western Pennsylvania, “Hospitals at Risk,” pp. 6, 11; Beaufort B. Longest, “The Prognosis for Hospitals in Western Pennsylvania,” June 15, 1988, pp. 9, 11, box 295, folder 19, ACCDR. 26. Gaynor et al., “National Hospital Prospective Payment Evaluation,” pp. 12– 13; Potter and Leak, Health Care System Change and Its Employment Impacts in Southwestern Pennsylvania, 27–28. 27. Daron Acemoglu and Amy Finkelstein, “Input and Technology Choices in Regulated Industries: Evidence from the Health Care Sector,” Journal of Political Economy 116, no. 5 (October 2008), 837–880; “Presby’s Plan to Expand, Renovate Approved by HSA,” Presby News 18, no. 4 (April 1987), p. 1, box 2, Presbyterian- University Hospital Aid Society Records and Photog raphs, 1945–1996, MSS 934, Library and Archives Division, Senator John Heinz History Center; Certificate of Need Application CON-86-H-6280-B, especially pp. 160, 201, box 4, BGC. 28. Carol Henry, interview with Gabriel Winant, July 23, 2016. 29. “Hospital Trying to Ease Financial Woes Caused by Federal Rules,” PPG, May 20, 1989. 30. Braddock Medical Center Partnership Update, February 8, 1991, box 12, folder 2, TAMP; “Saving Braddock General,” PPG, March 30, 1990; Braddock Medical Center Presentation to Representative Dwight Evans, Chairman, House Appropriations Committee, Representative Thomas A. Michlovic, and Representatives of the Braddock Borough Council, April 21, 1992, box 12, folder 5, TAMP. 31. Potter and Leak, Health Care System Change and Its Employment Impacts in Southwestern Pennsylvania, 27–28; Gaynor et al., “National Hospital Prospective Payment Evaluation,” p. 9; Braddock Medical Center Partnership Update, February 8, 1991, box 12, folder 2, TAMP; Braddock Medical Center Presentation, box 12, folder 5, TAMP. 32. “Hospital, Union Plan Meeting,” Greensburg Tribune-Review, November 19, 1983; “Frick Reduces Staff By 100,” Greensburg Tribune-Review, November 18, 1983; Before and a fter 12/19/83, box 56, folder 9, SEIU 585. 33. Louis B. Kushner to Joseph R. McFerron, December 15, 1983, box 56, folder 9, SEIU 585; Frick Committee Sign-In Sheet, December 18, 1983, box 56, folder 9, SEIU 585; “Union To Protest Cutbacks At Frick,” Greensburg Tribune-Review,
328
N o t e s t o Pag e s 2 32 – 2 3 6
December 19, 1983; “Frick Staff Stages Vigil,” Greensburg Tribune-Review, December 20, 1983; Leaflet, box 56, folder 9, SEIU 585. 34. Anne Brumfield to Robert Butler, January 18, 1984, box 121, folder 4, SEIU 585. 35. Disciplinary action report, Joanne Warrick, June 22, 1984, box 121, folder 6, SEIU 585. 36. Thomas H. Prickett to Rosemary Trump, March 24, 1987, box 119, folder 3, SEIU 585. 37. The 9to5 National Survey on Women and Stress (Cleveland: 9to5, National Association of Working Women, 1984), 4, 51. 38. Record of Verbal Counseling, Phylis Frock, October 10, 1984, box 121, folder 5, SEIU 585. 39. Health and Welfare Planning Association, Background Information, Long Term Care, p. 1, box 88, folder 2, RHWPA. See also Barry R. Chiswick, “The Demand for Nursing Home Care: An Analysis of the Substitution Between Institutional and Non-Institutional Care,” National Bureau of Economic Research, Working Paper Series, no. 98, July 1975, p. 9; VNA Inc., “Homemaker / Home Health Aide Training Programs For the Ten County Southwestern Pennsylvania Region,” July 1986, p. 35, box 25, HSASPR. 40. Service Employees International Union, “Beverly Enterprises in Pennsylvania: Profits and Problems in the Nursing Home Industry,” May 1986, p. 3, box 102, folder 12, SEIU 585. 41. Gaynor et al., “National Hospital Prospective Payment Evaluation,” pp. 28– 29; Health and Welfare Planning Association, Background Information, Long Term Care, pp. 15–16, box 88, folder 2, RHWPA. On the relationship between health policy change and home care, see Nona Y. Glazer, Women’s Paid and Unpaid Labor: The Work Transfer in Health Care and Retailing (Philadelphia: T emple University Press, 1993), 109–219; Eileen Boris and Jennifer Klein, Caring for America: Home Health Workers in the Shadow of the Welfare State (New York: Oxford University Press, 2012), 158–162. 42. An Overview of the Medicaid System in Pennsylvania,” box 102, folder 4, SEIU 585; “Nursing Care Signing Eyed,” McKeesport Daily News, ca. 1984, box 20, folder 6, MVUCC; “Union Hall Converted in Duquesne,” PPG, “PG South,” February 5, 1987, 9; “4 USX Plants Idled,” PPG, February 5, 1987. See also Timothy Diamond, Making Gray Gold: Narratives of Nursing Home Care (Chicago: University of Chicago Press, 1992); Nancy Foner, The Caregiving Dilemma: Work in an American Nursing Home (Berkeley: University of California Press, 1995); 43. Service Employees International Union, “Beverly Enterprises in Pennsylvania,” pp. 1–8. 44. Service Employees International Union, “Beverly Enterprises in Pennsylvania,” p. 11; “Testimony of the Serv ice Employees International Union, AFLCIO before the Committee on Energy and Commerce, Subcommittee on Health
N o t e s t o Pag e s 2 3 6 – 2 4 2
329
and the Environment, Medicaid Nursing Home Quality Care Amendments of 1986,” September 19, 1986, Submitted by Rosemary Trump, International Vice President, President Local 585, Pittsburgh, PA, p. 1, box 123, folder 4, SEIU 585. On the SEIU campaign see Timothy J. Minchin, “A Successful Union in an Era of Decline: Interrogating the Growth of the Serv ice Employees International Union, 1980–1995,” Labor History 61, nos. 3–4 (2020), 306–307. 45. Service Employees International Union, “Beverly Enterprises in Pennsylvania,” p. 31; “Testimony of the Service Employees International Union,” pp. 30–33. 46. For the full, unsigned account of the h ousekeeper’s troubles, see box 120, folder 7, SEIU 585; Survey, Chris Meier, September 20, 1987, box 120, folder 8, SEIU 585; Survey, Barb Latharow, October 11, 1987, box 120, folder 8, SEIU 585. 47. “Lawsuit Expected In Nursing Home Death,” Pittsburgh Tribune-Review, March 9, 1985; “When Medical Staff Errors Cost Patients’ Lives,” Associated Press, May 7, 1985. 48. Complaint Investigation, Negley House, September 16, 1985, p. 2, box 1, folder 38, MMDP; Complaint Investigation, Shadyside Manor, September 9, 1985, p. 5, box 1, folder 38, MMDP. 49. Complaint Investigation, Shadyside Manor; “Aged Abuse Curbed,” PP, October 6, 1985. On the “web of time” in health care, see Clawson and Gerstel, Unequal Time. 50. Grievance, JoAnne Ariondo, February 24, 1987, box 120, folder 8, SEIU 585. 51. For a parallel argument, see Bethany Moreton, To Serve God and Wal-Mart: The Making of Christian F ree Enterprise (Cambridge, MA: Harvard University Press, 2009), 65. 52. Grievance, Jennifer Lis, February 23, 1987, box 120, folder 8, SEIU 585. 53. Benjamin Hensler to Georgine Scarpino, October 26, 1992, box 12, folder 11, CORP; Esther Jefferson, “Interrogation 9 / 30,” box 12, folder 11, CORP. 54. Carol Henry, interview with Gabriel Winant, July 23, 2016. On the “chain of care,” see Rhacel Salazar Parreñas, Servants of Globalization: W omen, Migration, and Domestic Work (Stanford, CA: Stanford University Press, 2001). 55. Neferti X. M. Tadiar, Things Fall Away: Philippine Historical Experience and the Makings of Globalization (Durham, NC: Duke University Press, 2009), 91. 56. Michael Walzer, Spheres of Justice: A Defense of Pluralism and Equality (New York: Basic, 1983), 181; Hochschild, The Managed Heart; Joan Tronto, “Beyond Gender Difference to a Theory of Care,” Signs 12, no. 4 (Summer 1987), 661. 57. Donna Haraway, “A Manifesto for Cyborgs: Science, Technology, and Socialist Feminism in the 1980s,” Socialist Review 80 (1985), 133; Jesse Jackson, “1988 Democratic National Convention Address,” July 19, 1988, https://w ww .americanrhetoric.com/speeches/jessejackson1988dnc.htm. 58. Mary Brignano, Beyond the Bounds: A History of UPMC (Pittsburgh: Dorrance Publishing, 2009), 63.
330
N o t e s t o Pag e s 2 4 2 – 2 4 6
59. “Center for Transplants Aids Pittsburgh Ascent,” New York Times, September 16, 1985; Brignano, Beyond the Bounds, 82–83; Andrew T. Simpson, The Medical Metropolis: Health Care and Economic Transformation in Pittsburgh and Houston (Philadelphia: University of Pennsylvania Press), 79–92. 60. Certificate of Need Application CON-86-H-6280-B, p. 300, box 4, BGC; Brignano, Beyond the Bounds, 90–92. 61. “Pittsburgh area hospitals,” December 1989, box 10, folder 3, JFP; “A Tale of Two Pittsburgh Hospitals . . .” Health Care, December 1989, pp. 12, 35; Brignano, Beyond the Bounds, 119–126. 62. “Profiting from Health Care,” PPG, January 10, 1990. It is notable, however, that hospitals did not account for “profit” the same way as for-profit businesses did. See Jonathan Levy, “Accounting for Profit and the History of Capital,” Critical Historical Studies 1, no. 2 (Fall 2014), 171–214. Pennsylvania antitrust regulators tended to f avor acquisitions to keep community hospitals open. On acquisitions, see Gregory Vistnes, “Hospital Mergers and Antitrust Enforcement,” Journal of Health Politics, Policy, and Law 20, no. 1 (Spring 1995), 188–189. In Pennsylvania, see “Harrisburg Monopoly,” Modern Healthcare, January 26, 1998; “PA Hospitals Hold Out,” Modern Healthcare, March 23, 1998. 63. “Profiting from Health Care,” PPG, January 10, 1990; Executive Summary, Braddock General Hospital Proposed Joint Venture, November 3, 1989, box 12, folder 2, TAMP; “Saving Braddock General,” PPG, March 30, 1990. 64. Rand J. Wortman to Representative Thomas Michlovic, April 7, 1992, box 12, folder 5, TAMP; Thomas Michlovic notes on board meeting, June 1993, box 12, folder 3, TAMP; Braddock Medical Center Assumptions and Projected Results for Operating Budget, box 12, folder 7, TAMP. 65. Minutes of Combined Board Meeting, June 14, 1993, pp. 3–4, box 12, folder 3, TAMP; “Medical Cuts Threaten New Pain in Mill Town,” Philadelphia Inquirer, March 31, 1996. 66. “Imperiling of Benefits Puts Scare into Couple,” PPG, March 18, 1996. 67. “A fter Years of Profits, Hospitals Are Starting to Feel the Squeeze,” PPG, ca. 1996, box 25, folder 6, TMP; “Safety Net Goes under the Knife,” PPG, March 18, 1996; St. Francis Medical Center v. Donna E. Shalala, 32 F.3d 805 (3d. Cir. 1994). St. Francis was l ater acquired by UPMC. 68. Brignano, Beyond the Bounds, 74–75; Wesley W. Posvar to Thomas Detre, “Governance of the University of Pittsburgh Medical Center within the University,” April 19, 1991, pp. 3, 10, box 55, folder 908.00, Chancellor of the University of Pittsburgh, CUPWWPAF. 69. Brignano, Beyond the Bounds, 105; Transcript of Presentation by Thomas Detre, M.D., at Board Retreat of Presbyterian University Hospital and Montefiore University Hospital, November 19, 1990, pp. 5–7, box 55, folder 908.0b, WWPAF. 70. Brignano, Beyond the Bounds, 107–112.
N o t e s t o Pag e s 2 4 7 – 2 50
331
71. Beaver Falls focus group notes, July 15, 1991, box 77, HWP; Jacob S. Hacker, The Road to Nowhere: The Genesis of President Clinton’s Plan for Health Security (Princeton, NJ: Princeton University Press, 1997), 10–41. 72. “Clinton’s Campaign Signs On Strategists Who Aided Wofford,” New York Times, December 3, 1991; “Wofford Chairs Hearing on Retiree Health: Says Current System Leaves Early Retirees Vulnerable,” March 2, 1994, box 1, folder 8, HWP. US Congress, Senate, Subcommittee on Labor of the Senate Committee on Labor and H uman Resources, Retiree Health Benefits: The Impact on Workers and Businesses, 103rd Cong., 1st sess., 1993; “Democrats Scramble to Fill Health Gaps,” Detroit F ree Press, July 31, 1994. On labor’s role, see Marie Gottschalk, “ ‘It’s the Health-Care Costs, Stupid!’: Ideas, Institutions, and the Politics of Orga nized L abor and Health Policy in the United States,” Studies in American Political Development 14, no. 2 (October 2000), 235–252. On the role of fiscal restraint, see Theda Skocpol, Boomerang: Health Care Reform and the Turn against Government (New York: Norton, 1996). 73. Paul O’Palka, Jr. to Harris Wofford, January 24, 1994, box 6, folder 1, HWP; “Clinton to Establish Global Budget for Nation’s Health Care,” October 1993, box 6, folder 1, HWP; Skocpol, Boomerang, 166–167; “Keep Wofford in United States Senate,” Pittston Sunday Dispatch, November 6, 1994; “Union Distorts Santorum Record,” Allentown Morning Call, September 24, 1994. See also Colin Gordon, Dead on Arrival: The Politics of Health Care in Twentieth- Century Amer i ca (Princeton, NJ: Princeton University Press, 2003). 74. Brignano, Beyond the Bounds, 115. 75. “Blue Cross Plans Major Migration to Managed Care,” PBT, July 12, 1993; “Blue Cross Invites 64 Hospitals to Join New Managed-Care Networks,” PBT, March 7, 1994; “Local Hospitals Still Find Themselves u nder the Knife,” PBT, October 23, 1995; “Ohio Valley General Chief Braces for New Market,” PBT, October 11, 1993; “Health Care Faces Consolidation as Reform Plans Bubble,” PBT, December 27, 1993. 76. Brignano, Beyond the Bounds, 117–118 77. Agreement with UPMCS, September 12, 1996, pp. 11–12, box 12, folder 8, TAMP; “Pennsylvania Hospital in Poor Community Contemplates Life a fter Pittsburgh Takeover,” Philadelphia Tribune, December 13, 1996; UPMC-Braddock Hosp. v. Sebelius, 592 F.3d 427 (3d Cir. 2010). 78. “Credit Firm Says Cuts Would Imperil 7 Area Hospitals,” PPG, November 3, 1995; Merger announcement, October 23, 1996, box 144, folder 2, SEIU 585; “Nurses Use City Rally to Push Contract Points,” McKeesport Daily News, October 12, 1995; John E. Lyncheski to Rosemary Trump, October 6, 1995, box 144, folder 2, SEIU 585; Contract vote notice, November 25, 1996, box 144, folder 2, SEIU 585. 79. “Aliquippa Community Hospital Makes Strides to Stay Alive a fter Cutting the Cord from UPMC,” PPG, February 3, 2002; Brignano, Beyond the Bounds, 119–126.
332
N o t e s t o Pag e s 2 50 – 2 5 6
80. “Blue Cross, Blue Shield Merger a ‘High Probability’ Insurers Say,” PBT, March 20, 1995; “Docs Sue to Torpedo Blue Shield-Blue Cross Merger,” Central Penn Business Journal, January 10, 1997; Brignano, Beyond the Bounds, 144. 81. Lawton R. Burns and Alexandra P. Burns, “Policy Implications of Hospital System Failures: The Allegheny Bankruptcy,” in History and Health Policy in the United States: Putting the Past Back In, ed. Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns (New Brunswick, NJ: Rutgers University Press, 2006), 275–278; “Anatomy of a Bankruptcy,” PPG, January 17–24, 1999; Burns and Burns, “Policy Implications of Hospital System Failures,” 251; Lawton R. Burns, John Cacciamani, James Clement, and Welman Aquino, “The Fall of the House of AHERF: The Allegheny Bankruptcy,” Health Affairs 19, no. 1 (January 2000), 7–41. 82. “Pennsylvania Approves Highmark-West Penn Allegheny Health System Merger,” PPG, April 30, 2013; Brignano, Beyond the Bounds, 112, 153. 83. “Aliquippa Hospital Shuts Down Abruptly,” PPG, December 13, 2008; “New Era Begins For UPMC South Side Hospital,” PPG, June 26, 2009; “UPMC to Close Braddock Hospital,” PPG, October 17, 2009. 84. Census of Population, 1980, table 122; Census of Population, 1990, table 35. 85. Bureau of Labor Statistics, State and Area Employment, Hours, and Earnings, Pittsburgh, Pennsylvania. 86. On some of the coercive and exploitative dimensions of care labor, see Paula England and Nancy Folbre, “The Cost of Caring,” Annals of the American Academy of Political and Social Science 561, no. 1 (1999), 39–51; Paula E ngland, “Emerging Theories of Care Work,” Annual Review of Sociology 31 (2005), 381–399. 87. Dana Beth Weinberg, Code Green: Money-Driven Hospitals and the Dismantling of Nursing (Ithaca, NY: Cornell University Press, 2003); Laurie J. Bates and Rexford E. Santerre, “Does the U.S. Health Care Sector Suffer from Baumol’s Cost Disease? Evidence from 50 States,” Journal of Health Economics 32, no. 2 (March 2013), 386–391; Pat Armstrong, Hugh Armstrong, and Krista Scott- Dixon, Critical to Care: The Invisible Women in Health Services (Toronto: University of Toronto Press, 2008). 88. Frances M. Kolle, “L abor Productivity Monitoring System,” July 22, 1994, box 144, folder 1, SEIU 585. 89. Earline Coburn, interview with Gabriel Winant, July 18, 2016. 90. Coburn, interview. 91. Coburn, interview. 92. Joyce Henderson, interview with Gabriel Winant, July 22, 2016. 93. Henderson, interview. 94. Census of Population, 1990, Social and Economic Characteristics, Metropolitan Areas, t ables 34–35, pp. 1691, 1823; US Census Bureau, 2005 American Community Survey, Occupation by Class of Worker for Civilian Employed Popu-
N o t e s t o Pag e s 2 5 6 – 2 6 0
333
lation 16 Years and Over, Pittsburgh Standard Metropolitan Statistical Area; Potter and Leak, Health Care System Change and Its Employment Impacts in Southwestern Pennsylvania. See also Acemoglu and Finkelstein, “Input and Technology Choices in Regulated Industries.” 95. See Ariel Ducey, Never Good Enough: Health Care Workers and the False Promise of Job Training (Ithaca, NY: ILR Press, 2009). 96. Henderson, interview; Lou Berry, interview with Gabriel Winant, July 13, 2016; City of Pittsburgh Wage Review Committee, “Report on the Impact of Raising Wages for Serv ice Workers at Pittsburgh’s Anchor Institutions,” December 8, 2015, p. 10, https://apps.pittsburghpa.gov/d istrict9/FINAL .R eport _ o f _t he _Wage _ R eview _C ommittee _12082015 _%281%29 _%281%29 _%281%29.pdf. 97. Johnson, interview; Robert L. Brannon, “Restructuring Hospital Nursing: Reversing the Trend toward a Professional Workforce,” International Journal of Health Ser v ices 26, no. 4 (1996), 643–654; Weinberg, Code Green; Suzanne Gordon, Nursing against the Odds: How Health Care Cost Cutting, Media Stereo types, and Medical Hubris Undermine Nurses and Patient Care (Ithaca, NY: Cornell University Press, 2005); Sanchia Aranda and Rosie Brown, “You Must Be Clever to Care,” The Complexity of Care: Nursing Reconsidered, ed. Suzanne Gordon and Siobhan Brown (Ithaca, NY: ILR Press, 2006) 124. 98. Berry, interview; “UPMC Sued Again by Family of Patient Who Died a fter Mold Infection,” PPG, April 20, 2017; City of Pittsburgh Wage Review Committee, “Report on the Impact of Raising Wages for Serv ice Workers at Pittsburgh’s Anchor Institutions,” December 8, 2015, pp. 39, 109. 99. Amy S. Wharton, “The Affective Consequences of Serv ice Work,” Work and Occupations 20, no. 2 (May 1993), 205–232; Gabrielle Meagher, “What Can We Expect from Paid Carers?” Politics and Society 34, no. 1 (March 2006), 33–53.
Epilogue 1. Kimberly J. Morgan and Andrea Louise Campbell, The Delegated Welfare State: Medicare, Markets, and the Governance of Social Policy (New York: Oxford University Press, 2011); Brian H. Balogh, “ ‘Keep Your Government Hands Off My Medicare’: A Prescription that Progressives Should Fill,” Forum 7, no. 4 (December 2009), 1–21; Daniel P. Gitterman and John P. Scott, “ ‘Obama Lies, Grandma Dies’: The Uncertain Politics of Medicare and the Patient Protection and Affordable Care Act,” Journal of Health Politics, Policy, and Law 36, no. 3 (June 2011), 555–563. 2. Suzanne Mettler, The Submerged State: How Invisible Government Policies Undermine American Democracy (Chicago: University of Chicago Press, 2011); Morgan and Campbell, The Delegated Welfare State.
334
N o t e s t o Pag e s 2 6 0 – 2 62
3. David H. Autor and Mark G. Duggan, “The Growth in the Social Security Disability Rolls: A Fiscal Crisis Unfolding,” Journal of Economic Perspectives 20, no. 3 (Summer 2006), 71–96; Göran Therborn, The Killing Fields of Inequality (Cambridge: Polity, 2013); Anne Case and Angus Deaton, “Rising Morbidity and Mortality in Midlife among White Non-Hispanic Americans in the 21st Century,” Proceedings of the National Academy of Science 112, no. 49 (December 2015), 15078– 15083; David A. Ansell, The Death Gap: How Inequality Kills (Chicago: University of Chicago Press, 2017); James S. House, Beyond Obamacare: Life, Death, and Social Policy (New York: Russell Sage Foundation, 2015); Richard (Buz) Cooper, Poverty and the Myths of Health Care Reform (Baltimore: Johns Hopkins University Press, 2016); Nathan Seltzer, “The Economic Underpinnings of the Drug Epidemic,” SocArXiv (2019), accessible at https://osf.io/preprints/socarxiv/cdwap/; James Tyner, Dead L abor: Toward a Political Economy of Premature Death (Minneapolis: University of Minnesota Press, 2019); Katherine McLean, “ ‘ There’s Nothing Here’: Deindustrialization as Risk Environment for Overdose,” International Journal of Drug Policy 29 (March 2016), 25. 4. Jacqueline Azzarto, “Medicalization of the Problems of the Elderly,” Health & Social Work 11, no. 3 (Summer 1986), 189–195; Carroll L. Estes and Elizabeth A. Binney, “The Biomedicalization of Aging: Dangers and Dilemmas,” Gerontologist 29, no. 5 (October 1989), 587–596; Peter Conrad, The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (Baltimore: Johns Hopkins University Press, 2007); Elizabeth H. Bradley and Lauren A. Taylor, The American Health Care Paradox: Why Spending More Is Getting Us Less (New York: PublicAffairs, 2013); Richard (Buz) Cooper, Poverty and the Myths of Health Care Reform (Baltimore: Johns Hopkins University Press, 2016); Nicolas P. Terry, “Structural Determinism Amplifying the Opioid Crisis: It’s the Healthcare, Stupid!” Northeastern University Law Review 11, no. 1 (2018), 315–371. 5. Ruth Wilson Gilmore, Ruth Wilson Gilmore, Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California (Berkeley: University of California Press, 2007). 6. Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey, and Varduhi Petrosyan, “It’s the Prices, Stupid: Why The United States Is So Different From Other Countries,” Health Affairs 22, no. 3 (May / June 2003), 89–105. 7. Gabriel Winant and Shantonia Jackson, “What’s Actually G oing on in Our Nursing Homes,” Dissent, Fall 2020, 33. 8. “UPMC to Close Braddock Hospital,” PPG, October 17, 2009. 9. Lou Berry, interview with Gabriel Winant, July 13, 2016. 10. City of Pittsburgh Wage Review Committee, “Report on the Impact of Raising Wages for Serv ice Workers at Pittsburgh’s Anchor Institutions,” December 8, 2015, p. 110.
N o t e s t o Pag e s 2 63 – 2 6 5
335
11. Nila Payton, interview with Gabriel Winant, September 9, 2018; City of Pittsburgh Wage Review Committee, “Report on the Impact of Raising Wages for Service Workers at Pittsburgh’s Anchor Institutions,” pp. 43, 55. 12. City of Pittsburgh Wage Review Committee, “Report on the Impact of Raising Wages,” pp. 53, 104, 133; Payton, interview. 13. Ryan Deto, “UPMC Workers to Participate In One-Day Strike on Oct. 4,” Pittsburgh City Paper, September 24, 2018; US Department of L abor, Bureau of Labor Statistics, “Major Work Stoppages in 2018,” February 8, 2019. 14. “ ‘Fire through Dry Grass’: Andrew Cuomo Saw COVID-19’s Threat to Nursing Homes. Then He Risked Adding to It,” ProPublica, June 16, 2020; “Coronavirus Cases Rise Sharply in Prisons Even as They Plateau Nationwide,” NYT, June 16, 2020; “Black Americans Face Alarming Rates of Coronavirus Infection in Some States,” NYT, April 14, 2020; Centers for Disease Control COVID-19 Response Team, “Characteristics of Health Care Personnel with COVID-19—United States, February 12–April 9, 2020,” Morbidity and Mortality Weekly Report 69, no. 15 (April 17, 2020), 477–481. 15. City of Pittsburgh Wage Review Committee, “Report on the Impact of Raising Wages for Service Workers at Pittsburgh’s Anchor Institutions,” pp. 68, 132. 16. City of Pittsburgh Wage Review Committee, “Report on the Impact of Raising Wages,” p. 68.
Acknowledgments
abor is social, and this book is no exception. It bears my name, and its mistakes L are of course my own, but its contributions are owed to collective work in several different configurations. Without this combined effort, support, and solidarity, the book would not have been possible. First, I thank the faculty who taught and advised me as a graduate student at Yale, each of whom provided something distinct. This project developed from a paper I wrote for Glenda Gilmore, who gave critical advice in a formative moment. I also had the chance to talk through ideas in James C. Scott’s breakfast discussion group. The ambitions in this project toward ethnographic depth of analysis are thanks in large part to the encouragement of Jean-Christophe Agnew, who is a model for historians of how to range across intellectual traditions and remain open to unexpected a ngles of approach t oward archival evidence. Despite his comradely disavowal of the concept of mentorship, Michael Denning showed me how to be an egalitarian subject of the university as much as possible. His singular lack of interest in academic hierarchy and commitment to the highest standard of materialist analysis encouraged me to try to make bolder claims. Beverly Gage helped me ground my work in concrete questions and debates about American life and politics in the twentieth c entury. She helped me make this project a work of US history. And Jennifer Klein has supported and pushed me e very step along the way, from large-scale framing of the questions asked to the nitty-g ritty methods for finding answers. We have been arrested together twice, and she was always ready to do it again when called upon—a rare quality in a doctoral adviser. Second, I owe thanks to the wider academic and intellectual community from which I have benefited. Colleagues and friends who have read parts or all of this book and offered helpful comments include Tim Barker, Alyssa Battistoni, Rudi Batzell, Ally Brantley, John Canham-Clyne, Alex Colston, Lena Eckert-Erdheim, Ted Fertik, Katrina Forrester, Max Fraser, Lisa Furchtgott, Puya Gerami, Stephanie Greenlea, Tina Groeger, Amanda Hall, David Huyssen, Jeremy Kessler, Jamie Martin, Kurt Newman, Arianna Planey, Justin Randolph, Anita Seth, Tim Shenk, Kit Smemo, Samir Sonti, David Stein, Jonah Stuart-Brundage, Hillary Taylor, Lindsay Zafir, and Ben Zdencanovic.
338
Ac k n ow l e d g m e n t s
The ideas in the later chapters w ere formed in the context of Yale’s Working Group on Globalization and Culture. Every member of that group put a stamp on my work as well: Alyssa Battistoni, Jonny Bunning, Sigma Colon, Jorge Cuéllar, Michael Denning, Ed King, Geneva Morris, Peter Raccuglia, Yami Rodriguez, Courtney Sato, Randa Tawil, and Damian Vergara. Yale’s Marxism and Culture reading group, also coordinated by Michael Denning, was similarly key to my theoretical development. I have also benefited from discussion with and commentary from Eileen Boris, Meg Jacobs, Nelson Lichtenstein, Guian McKee, Lev Menand, Alina Méndez, Jack Metzgar, Joe McCartin, Ellie Shermer, Drew Simpson, the late Judith Stein, and Katherine Turner. Nancy Folbre, Kim Phillips-Fein, Karen Tani, and Adam Tooze read large parts or all of the manuscript and gave me invaluable feedback. Sam Lebovic and the peer reviewers at the Journal of Social History helped me work out key ideas. My time at the American Academy of Arts and Sciences helped this book mature. I am grateful to Paul Erickson, Jeannette Estruth, Ben Holtzman, and Palmer Rampell for the intellectual companionship and friendship. While in Cambridge, I appreciated participating in the 20th-Century U.S. History Workshop at Harvard, whose members I thank. I was proud also to be a member in t hese years of the so- called “Somerville Soviet”: Tim Barker, Alyssa Battistoni, Maggie Doherty, Katrina Forrester, Aaron Kerner, Jamie Martin, Quinn Slobodian, Ben Tarnoff, Simon Torracinta, Moira Weigel, and Kirsten Weld. My colleagues at the University of Chicago have welcomed me and my work with both rigor and warmth. Emilio Kourí made possible the research leave in which I finished this book. I especially owe thanks to Aaron Benanav, Kathleen Belew, Brodwyn Fischer, Adam Green, Destin Jenkins, Jonathan Levy, Emily Osborn, Steve Pincus, Michael Rossi, Bill Sewell, James Sparrow, Amy Stanley, and Tara Zahra for attending to my work closely and seriously and offering advice at key moments. Marie Gottschalk, Will Jones, and Ann Shola Orloff went above and beyond the call, coming to the University of Chicago to provide sharp and constructive criticism, the mark of which I hope they recognize in the final product. Thanks also to Cyndee Breshock for her incredible helpfulness and competence. I have received financial support for my research from the Yale Department of History; the Harvard History of Capitalism program; the American Academy of Arts and Sciences; and the Social Sciences Division at the University of Chicago. This project would not have been accomplished without this funding, and I thank t hose at all t hese bodies that chose to support my work. While I am grateful to all the archival workers at all the libraries where I worked, I asked a lot from the staff at the Archives Serv ice Center at the University of Pittsburgh in particu lar. Zach Brodt, David Grinnell, Miriam Meislik, and Ashley Taylor were all fixtures in my research life over a period of years. The project would not have been possible without their help. At Yale, it is difficult to imagine how t here even was a history depart-
Ac k n ow l e d g m e n t s
339
ment before Marcy Kaufman became graduate registrar. Sofonias Getachew assisted with research at a crucial moment. Chris Briem is a font of Pittsburgh knowledge and proved very helpful in pointing me toward the answers on key statistical questions. I am exceedingly grateful to LaToya Ruby Frazier for allowing me to use one of her images, and generally appreciative of the museums and archives that have let me use their images. Every effort has been made to identify copyright holders and obtain their permission for the use of copyright material. Notification of any additions or corrections that should be incorporated in f uture reprints or editions of this book would be greatly appreciated. I am tremendously appreciative to everyone who sat down to talk to me about their own histories or connected me to others who did. I regret feeling obliged to mask a number of names, but I would like to express my deep gratitude to all interviewees and t hose who connected me to them and got me oriented in Pittsburgh. Those whom I can name here include Lou Berry, Anne Brumfield, Tony Buba, Earline Coburn, Emily Eckel, Joyce Henderson, Christoria Hughes, Georgeanne Koehler, Jerry Klehm, Joseph Nagy, John Haer, Gabe Kramer, Nila Payton, Joni Rabinowitz, Kay Tillow, Rosemary Trump, and Howard Wickerham. I trust the others recognize themselves in the narrative and hope they know how grateful I am. A number of editors gave me the chance to try out my ideas in less detailed and scholarly form than they appear h ere. I am especially grateful to Charles Petersen for this. I also owe thanks to Steve Fraser, Mark Krotov, Natasha Lewis, David Marcus, Laura Marsh, Marco Roth, the honorable Nikil Saval, Nick Serpe, and Tim Shenk. Alex Press tolerated my irregular schedule while finishing the book. At Harvard University Press, Andrew Kinney gave this project his support and enthusiasm from the beginning and was critical to seeing it through. I also appreciate the work of Olivia Woods and Mihaela Pacurar in making the book real, and the peer reviewers for their perceptive comments. Thanks to Isabelle Lewis for her excellent mapmaking. Thanks to Eli Cook for the connection. And I am grateful to James Brandt, who appears in this section because he works for Harvard University Press and certainly gave helpful advice about the book, but who especially is to be thanked for sharing m usic, hikes, beer, and friendship. I would not be the same person as I am now and would not see history as I do now, if not for the years I have spent in the struggle for recognition for Local 33— UNITE HERE, formerly GESO. This struggle has connected me to generations of unionists, organizers, workers, and intellectuals who have passed through Yale. I would like to name in particu lar Abbey Agresta, Alyssa Battistoni, Ally Brantley, Kate Brackney, Jeffrey Boyd, Camille Cole, Robin Dawson, Charles Decker, Sarah Ifft Decker, Lena Eckert-Erdheim, Andrew Epstein, Ted Fertik, Max Fraser, Adom Getachew, Kelly Goodman, Aaron Greenberg, Stephanie Greenlea, David Huyssen, Kate Irving, Matt Keaney, Jamicia Lackey, Chris McGowan, Lukas Moe, Michelle Beaulieu-Morgan, Brais Outes-León, Evan Pease, Julia Powers, Hari Ramesh, Justin
340
Ac k n ow l e d g m e n t s
Randolph, Mary Reynolds, Mark Rivera, Paul Seltzer, Emily Sessions, Anita Seth, Tif Shen, Sam Snow, Josh Stanley, Simon Torracinta, James Super, Susan Valentine, Lindsay Zafir; and the wider u nion family—including Eddie Camp, John Canham-Clyne, Ellen Cupo, Frank Douglass, Antony Dugdale, Ian Dunn, Sarah Eidelson, Connie Ellison, JJ Fueser, Marcy Kaufman, Melissa Mason, Yuval Miller, Adam Patten, Jesse Seitel, Margaret Sharp, and Ella Wood. It is thanks to my time with this group of p eople that I know what Eugene Debs meant when he spoke about the “ecstasy in the handclasp of a comrade.” A few more people have played very important roles beyond anything mentioned above. Nicole Wires is a comrade and friend of unimaginable—even unenviable— commitment; I am grateful for the care she shows the whole world. Maggie Doherty read most of this manuscript—and most everything e lse I have written. I have learned so much from her and would not be who I am today if we had not known each other. I have enjoyed a friendship with Alyssa Battistoni unlike any other in my life, a near-constant dialogue now reaching back sixteen years. I think we have been doing the same work all along. My partner Adom Getachew helped me sharpen and improve this book by reading and commenting, but more importantly by her presence in my life. I have tried to accomplish something worthy of her high standard of commitment and integrity that makes good on my scandalous good luck to be with her. My s isters Carmen Winant and Johanna Winant have been companions in the struggle to build meaningful lives of the mind in our moment and generation. I lost two grandparents in the final year of this project: Melvin and Yvonne Rogow. Alongside Dé Winant and the late Karl Winant, they connect me to the Lower East Side and Brooklyn, Amsterdam and Vienna; and, beyond t hese, to the Women’s International League for Peace and Freedom, Yiddish socialism, and the intellectual tradition of Jewish Vienna. In other words, they are my predecessors not only genealogically but historically, and I have done my best to carry on the line. Above all, I owe thanks to my parents Deborah Rogow and Howard Winant, to whom this book is dedicated. They have heard and read countless iterations of what is written h ere and have offered endless support and love. In ways hidden and obvious, this project is about them, the world they made, and the place they gave me in it.
Index
Abel, I. W., 185 Acemoglu, Daron, 229 Action Coa lit ion of Elders, 176 Ad Hoc Committee of Concerned Black Steel Workers, 124 administrators, and collective bargaining, 153–156, 239; and hospitals, 14, 136, 149, 169, 248, 252; and long-term care, 238, 254; and new health care technologies, 229, 242; and “rise of administrators” in 1970s and 1980s, 171, 174–175, 199; and VA, 167; and War on Poverty, 124, 125 affirmative action, 124, 183, 213 aging, 16, 21, 102; and steel workforce, 147, 173, 196, 217; and transformation of Pittsburgh’s political economy, 220, 224, 228, 234, 243 Aid to Families with Dependent C hildren (AFDC), 191, 193, 204 air pollution, 78, 159 Albright, R. A., 145 Alcoa, 34 alcohol, 51–52, 88–89, 200, 248, 261 alienation, 50, 61, 71 Aliquippa, 114, 183; and Aliquippa Hospital, 174, 203, 230, 249–250, 252; and deindustrialization, 187, 189, 201, 217, 252 Allegheny Conference on Community Development (ACCD), 106, 209 Allegheny County, 6; and aging of its population, 160; 168, 173–175, 196; and civil rights, 101, 127; and crisis of late 1970s, 194, 197, 198, 200, 201, 204; and decline of steel industry, 20, 29, 209; and hospitals, 141, 150, 167, 168, 251, 262; and increasing centrality of health care, 207,
210–214, 231, 235, 243, 249; and unemployment, 187–190, 192 Allegheny County Hospital Development Authority, 167 Allegheny County Mental Health / Mental Retardation Program, 200 Allegheny General Hospital, 243–244, 250–251 Allegheny Health Education and Research Foundation (AHERF), 251 Allegheny River, 29, 249 American Federation of Technical Employees, 151 American Hospital Association, 14, 145, 157, 158 American Medical Association, 145, 226 American Standard, 40, 65 Andersz, Sarah, 108 anticommunism, 10, 59, 150 Appalachia, 8, 28 Association of Pittsburgh Priests, 176 automation, 4, 16, 73, 102, 239 Bales, Robert F., 68, Barr, Joseph, 123 Bartus, John, 50–51 basic oxygen furnace technology, 34, 38, 181–182 Begala, Paul, 247 Bell, Daniel, 137n9 Bell, James, 153, 154 Berlant, Lauren, 96 Berry, Lou, 120, 179, 180, 256–258, 262. See also Coburn, Earline Beverly Enterprises, 235, 236, 238 Black Power movement, 16, 123, 131
342
Black Construction Coa lition (BCC), 122, 123 Blue-Collar Marriage, 72 Blue Cross: and crisis of early 1980s, 203, 207; and debt-fi nancing of hospital expansion, 168, 209; early history of Blue Cross of Western Pennsylvania, 139–141; and failure of Clinton’s health care reform efforts, 247; and high health care utilization rates by steelworkers, 158–160, 224; and hospital workers’ collective bargaining, 156; merger with Blue Shield, 250; and 1990s, 248; merger with Highmark, 251; and pushback against DRGs, 227; and USWA, 144–148, 163 Bodak, Leonard, 130 “boilermaker” (drink), 52 Boland, Rose, 76 bond market, 167, 168, 170, 171, 175, 208 Boy Scouts, 40 Braddock (town): and African American community, 179, 205; and aging of population, 160; and Braddock Hospital, 152, 205, 230–231, 244, 245, 248–250, 252, 254, 261–262; and racism, 109, 112, 114, 120; and working-class everyday life, 78, 95, 115, 119 Branca, Ronald, 141, 142 Brenner, M. Harvey, 200 Briem, Christopher, 195 Broward County (FL), 21, 196 Brown, Bertram, 202 Brown, Homer, 107 Browning, Sharon, 194–195, 213–214 Brumfield, Anne, 232 Bureau of Labor Statistics (BLS), 66 bureaucracy, 42, 44, 184 “bureaucratic despotism,” 60 business cycle, 12, 29, 35, 86 Business Week, 60, 66 capital flight, 16 care economy, 2–7, 23, 141, 166, 210, 219 Carneg ie, Dale, 42 Carneg ie Mellon University, 123 Carrie Furnace, 29, 78, 200, 202 cartel, 38 Carter, Carol, 74 Carter, Jimmy, 225 Carville, James, 247 Casey, Bob, 246
Index
Cathcart, H. Robert, 169 Catholicism: and anti-Communism, 10; and Committee to Improve Kane Hospital, 176; and Duquesne University, 129; and fight against “socialized medicine,” 139; and labor politics, 136; and public-private welfare state, 150; and racism, 163; and reproductive politics, 88, 128; and working- class community, 65, 93, 215 Catholic Hospital Association, 139 Caute, David, 10 Central Medical Health Serv ices, 165 Central Medical Pavilion (CMP), 165–166 Chicago, 8, 34, 100, 112, 120, 176, 184, 185, 206, 225, 261 Chinitz, Benjamin, 40 chrononormativity, 50. See also Freeman, Elizabeth churches: and African American politics, 127, 164; and volunteerism, 72, 116, 117, 149; and white working-class culture, 99, 109, 119, 129, 133, 215 Citizens Against Inadequate Resources, 126 Citizens Against Slum Housing (CASH), 126 citizenship, 23, 66, 156, 157, 176 citizenship, social: and collective bargaining,12, 61, 62; deindustrialization and, 134, 148; differential access to and racial disparities, 116, 155, 179; and family, 96, 99; and guaranteed access to health care, 136, 137, 139, 158 Clairton (town), 51, 114, 115, 141, 183, 212 Clairton Works, 29, 98, 119, 185 Clinton, Bill, 247 coal, 9, 79, 130, 150, 231, 239: and coal dust, 78; and geography of coal-mining towns, 20; and introduction of surface mining, 16; and steel-making process, 28–29, 184. See also coke Coburn, Earline (neé Berry): and description of understaffing of hospitals, 254; and discussion of childhood, 107, 179, 180; and discussion of residential segregation, 100; and discussion of survival skills imparted by older f amily members, 80, 81, 94; and entry into nursing profession, 152, 214 Cohen, Lizabeth, 66 Cohen, Wilbur, 146 coke, 9, 185: coke oven workers, 48, 50, 51, 103; as ingredient in steel-making process,
Index
28–29, 32; and predominance of Black workers in coke ovens, 103, 183. See also coal Cold War, 8, 13, 33, 36 collective bargaining: and deindustrialization, 181; and health insurance, 137, 224; and hospital workers, 153, 156, 158; and New Deal, 8; and 1949 bargaining agreement in steel, 140; and shaping of postwar welfare state, 10–15, 136, 139, 150; and USWA, 33, 36, 60–61 Colville, Bob, 174 Committee on Economic Security, 12 Committee to Secure Justice for Hospital Workers, 153 Communist Party (CPUSA), 10. See also anticommunism communitarianism, 178, 203: and Catholicism, 139, and corporatization of health care, 166, 174, 219, 220, 227; and reproductive l abor, 217, 239; and volunteerism, 116, 249 “community rating,” 140. See also health insurance Comprehensive Employment and Training Act (CETA), 192 Congress of Industrial Organizations (CIO), 9, 10, 14, 59 Conners, Martin, 44, 51 consent decrees, 124, 125, 183, 200, 213 consumerism, 59, 64, 80, 220 contracts (u nion): and Experimental Negotiating Agreement (ENA), 181; and health insurance, 147, 150,158, 159, 205, 206; and layoffs, 182; and 1959 steel strike, 59, 60; and nurses’ u nion, 223, 232, 249, 250; and retiree benefits, 147, 151; and strikes, 12; and wage reductions, 189, 213; and Section 2-B, 55, 61 Cooper, Richard (Buz), 202 “cost crunch,” 46 “cost disease,” 3 cost-of-living increases, 11, 33, 38, 172 “cost-plus” payment, 148, 218. See also Medicare cost-productivity gap, 46 Cott, Nancy, 83 COVID-19, 263 Cowie, Jefferson, 27 Czap, Mary, 86
343
Day, Jared, 163 debt: and construction of new hospitals, 167–169, 171, 173, 175, 209, 235; and mergers and acquisitions wave of 1980s, 187, 249, 250; and precarity, 4, 263; and steel industry capital expansion, 38; and steel strike of 1959, 86 debt financing, 167 deindustrialization: and health care, 18, 19, 260; as historical process, 17, 21, 134, 245; and technological unemployment, 185; and welfare state, 181; and working-class community, 99 Denenberg, Herbert, 166 Denominational Ministry Strategy, 190 Department of Health and H uman Serv ices (HHS), 223–226 Department of Public Assistance, 127 Detre, Thomas, 245–246, 248 Detroit: and African American kinship networks, 120; in comparison with Pittsburgh, 34, 100, 102, 112, 159, 182; and deindustrialization, 195, 206; and growth of health care and social assistance sector, 5, 6; and New Deal order, 8 diagnostic related groups (DRGs), 226, 227 Dillard, Annie, 38, 40 discipline: and social policy, 11, 15; and collective child-rearing, 121; discipline slips, 43, 54, 62–63; and domesticity, 70–75, 84, 89–96; of the market, 227; in steel workplace, 26, 41, 238, 239 disinvestment, 16, 107, 125, 202, 245 divorce, 195, 214 Dohanic, Pete, 46, 47 domesticity, 64, 73, 77, 78, 80, 96, 116, 222 domestic emigration, 195 domestic violence, 200, 201 domestic work, 90, 116, 152, 179, 223, 232 Donora, 114, 120 Dravo, 34 Dravosburg, 58, 86 dualization of economy, 2. See also polarization of economy Dues Protest Committee (DPC), 56, 59 Duquesne (town), 29, 52, 78, 108, 114, 193, 207, 217, 235 Duquesne University, 122, 129, 130 Duquesne Works, 86: and installation of basic oxygen furnace, 181; and management,
344
Duquesne Works (continued) 40–44, 47, 53–57; and Pete Dohanic case, 46; and plant closure of 1984, 188, 193, 235; and protest of sexual harassment by women workers, 183; and racism, 48; and unsanitary facilities, 45 Dvorsky, Joe, 53 Eckel, Emily, 176 Edgar Thomson Works, 29, 78, 179, 187 Edwards, Herb, 48 efficiency, 2, 11, 39, 52, 80, 145, 235, Eisenhower, Dwight D., 36, 60, 62 Equal Employment Opportunity Commission, 103 Esping-A ndersen, Gøsta, 3 Experimental Negotiating Agreement (ENA), 181, 183 Fair L abor Standards Act, 15 Falk, Isidore, 143–144 family: and African American families, 78–81, 98, 108, 109, 111, 119, 120, 179; and aging of Pittsburgh population, 160, 194, 197; and deindustrialization, 175, 181, 188, 191, 199, 201, 213; and gender, 70–75, 84, 85–90, 92–97; and health care, 150, 162, 184, 220; and “like a family” ethos in health care sector, 135–136, 158, 161, 163, 230, 258; and patriarchal family-wage liberalism, 11, 13–15, 18, 19; and racism, 164; and reproductive l abor, 195, 214, 222, 223, 234, 240, 241; and steel strike of 1959, 58–59; and steelworkers’ wages, 82; and survival strategies during economic downturns, 115, 189; and War on Poverty, 125, 132; and white ethnic steelworkers, 118, 130, 150, 215; and working-c lass everyday life, 41, 50, 63–69, 83 Fass, Paula, 90, 95 Federal Reserve, 186 feminism, 11, 66, 127–128, 133, 176, 240, 241 Fields, Harriet, 128 Finkelstein, Amy, 229 fiscal crisis of state, 16 “fissuring” of workplace, 1, 2, 15 Flagiello v. Pennsylvania Hospital, 150 Flaherty, Pete, 132, 174 Florida, 6, 88, 195 Foerster, Thomas, 173, 174
Index
food stamps, 18, 119 foremen, 25, 32, 42–45, 53, 55, 62, 102, 183 foremen, “general” vs “turn,” 44 Fraternal Order of Eag les, 44 Freeman, Elizabeth, 50 Freedom House Ambulance Serv ice, 165 Frick Hospital (Henry Clay Frick Community Hospital), 219, 221, 227 fringe benefits, 36 Gaydos, Joseph, 149, 173 gender: and African American w omen’s organizing, 128, 155; and community labor, 116–117; and deindustrialization, 17, 180, 184, 216; and division of l abor, 35; and h ousehold, 68, 74–75, 95; and housework, 71, 91; and 1959 steel strike, 58–59; and postwar welfare state, 11, 15; and reproductive l abor, 3, 240, 252, 257; and work in health care sector, 136, 213–214, 220, 239, 252 general strike of 1946, 9, 35 generational warfare, 23 Gephardt, Richard, 225 ghettos, 101, 115, 118 ghettoization, 112 Glen-Hazel housing project, 112–113 Gilded Age, the, 18 Godoff, Elliott, 153 Goree, Henrietta, 135 Gray Panthers,176 Great Depression, 9 g reat exception, the, 27. See also Cowie, Jefferson Great Society, the, 16, 147, 163 Greenlee, Dr. Charles, 126, 128, 153, 164–165 Haden, Bouie, 126, 164 Haraway, Donna, 241 Harff, Henry, 53 Harris, Edward, 52 Havrilla, Helen, 71, 76, 77 Hazelwood (neighborhood), 108–114, 125, 130, 135 Head Start, 199 Health Care Financing Administration, 226 health insurance: and collective bargaining, 136–137, 205; and failure of national health insurance proposals, 11, 139, 247; and
Index
postwar welfare state, 12, 18, 140, 150, 224. See also Blue Cross; Medicaid; Medicare health maintenance organization (HMO), 120, 165–166, 224 Health Policy Institute, 196, 211–212, 224, 228–229 Health Systems Agency (HSA) of Southwestern Pennsylvania, 172, 174, 177, 196–197 Heinz (corporation), 34, 40 Heinz, John, 206, 224, 226, 227, 246 Henderson, Joyce, 58, 67, 77, 78, 80, 255–256 Henderson, Ray, 78, 95, 109, 112, 119 Hennings, Arthur G., 170 Henry, Carol, 58, 74, 82, 108, 162, 214, 230, 240 Herrigel, Gary, 33 Highmark (insurance company), 250, 251. See also Blue Cross Hill, David G., 126 Hill District, 101, 104–105, 111, 119, 131, 156 Hill-Burton Act, 139, 141 Hinshaw, John, 103 Hochschild, Arlie, 241 Hoerr, John, 200, 205 Holland, Sharon Patricia, 99 Holzman, Dr. Ian, 200 home care programs: and Medicare, 148–149, 162; in 1980s, 234–235, 237; rapid growth in 1990s, 252, 254, 256 homeownership, 66–67, 79, 100 Homestead Hospital, 148, 149, 171–172, 249 Homestead (town): changing demographic profile of, 112, 148, 160; deindustrialization, 201; everyday life, 28; 69; 77; gender gap, 68; housing, 78; poverty, 115, 194; racism, 100, 108, 113; schools, 114 Homestead Works: and conflict between workers and management, 52; closure of, 188; and Local 1397, 185, 190, 192; and manufacture of plate, 32; and racism, 103, 124; and sexual harassment, 183; and US Steel, 25, 69 Homewood-Brushton, 101, 107, 164, 165 Homewood-Brushton Alliance, 126, 128 hospitals: access to as marker of social citizenship, 161; and Catholicism, 163; conflicts over scheduling and staffing, 254; consolidation movement of 1980s and 1990s, 5, 219, 220, 230, 250–252; debt-fi nancing of expansion, 167–170, 173, 208; discrimination against African
345
American patients, 138, 178; drives to u nionize workers, 14, 153–158, 240–241; and economic crisis of early 1980s, 2, 17, 203; and economic polarization of health care industry, 242–46, 248–250, 256, 261; and expansion of u nion health care plans, 140, 141, 144–145; gendered / racialized divisions of l abor, 35, 152, 257; growth of in post-industrial Rust Belt, 137, 159, 160, 167, 174; and ideologies of “care work,” 15, 16, 223, 253, 264; and inflation, 224; investment in new technologies in 1980s, 229; and labor law, 135–136; and Medicaid, 204; and Medicare, 148, 150, 207; and prospective payment system (PPS), 218, 225–228, 231; private non-profit hospitals, 12, 137, 139; rise of administrators, 171, 172; shift toward acute care in 1980s, 233–236; as source of employment, 210–212; and Veterans Administration, 166; and War on Poverty, 126; and working-c lass community, 133 Hospital Council of Western Pennsylvania, 171–172, 204 household-workplace divide, 20 Housing and Urban Development Department (HUD), 131–132 Humphrey, Hubert, 147 “Hunky Hollow,” 129 inflation: and collective bargaining, 36, 38, 60–61, 139, 146; and fiscal austerity, 207, 226, 228; and health care, 171–172, 211, 220, 223, 260; and public-private welfare state, 13, 169, 190, 196; and “stagflation,” 186, 224 inflationary cycles, 13, 36, 169 interstate commerce, 8, 14 interstate highway system, 33 Irvin Works, 29, 48, 56, 63, 76, 81, 147, 190 Irvis, Leroy, 156 Irwin, Marian, 132 Jackson, Jesse, 190, 241 Jenneve, Anne, 173 Jeter, Frankie Mae, 127 Jewish Home and Hospital for the Aged, 152 Job Corps, 126 job security, 12, 185 Job Training and Partnership Act, 192
Index
346
Jones & Laughlin Steel: acquisition by LTV Steel, 186–187; and Hazelwood neighborhood, 109; and housing, 106; and Pittsburgh Works, 182; and shop-floor racism, 48, 82, 125; steel production process, 29, 31; and working-class everyday life, 71, 84, 89. See also LTV Steel and National L abor Relations Board v. Jones & Laughlin Steel Corporation and Stankowski Jr., Edward Justice for Janitors, 213 Kane Hospital (John J. Kane Hospital), 167, 175 Kane Hospital: A Place to Die, 176 Kauffman’s department store, 212 Kefauver, Estes, 38 Kempton, Murray, 153 Kennedy, John F., 102 Kennedy, Ted, 225 Khrushchev, Nikita, 36, 82 King, Coretta Scott, 153–154 King, Martin Luther, Jr., 107 “kitchen debate,” 36 Kober, Jane, 151 Komarovsky, Mirra, 72 Korean War, 35 labor-management accord, 27 labor movement, 8, 9, 11, 65–66, 184 labor productivity monitoring system (LPMS), 254 Laborers’ International Union of North America, 157 Lally, James, 173 Lawrence, David, 106 Lawrenceville, 105, 131 Lawrenceville Economic Action Program (LEAP), 130 Leech Farm, 166 Leonard, Bishop Vincent, 135 Lewin, Mary, 176 Libsohn, Sol, 93, 142 Lindberg, Anna Mae, 42 Linder, Marc, 122 Llewellyn, Karl, 83 Local 1199, 135, 152, 155, 157, 239 Longest, Beaufort, 196, 228–229 Lower Hill, 98, 104–105, 107, 165 LTV Steel, 186–187, 205–206. See also Jones & Laughlin Steel
Lyles, Helen, 135 Lynd, Staughton, 190 acLeod, Gordon, 173–174, 176 M male-headed household, 13, 68 management: conflict with hospital workers, 14, 153, 221, 237–239, 250; conflicts over scheduling, 48, 56; conflicts regarding work rules, 55; and discipline slips, 54; discrimination against Black workers, 124–125; drive to increase productivity in hospitals, 253–254; drive to increase productivity in steel, 34, 39, 40, 42, 45, 47; fights over medical coverage, 146; and growth of health care sector, 168, 180–181, 226, 229, 234; and hospital mergers and acquisitions, 242, 243; and inflation, 36, 38; managerial solidarity, 41, 43–44; and 1980s, 190, 206, 212; and 1959 steel strike, 59, 60, 144–145; and 1970s, 182; and postwar labor-management accord, 27; and workers’ resistance, 53 managerial offensive (1950s), 45–47 Marathon Oil, 187 March on Washington, 147 marriage, 13, 15, 64, 67–71, 83, 87–88, 93, 118, 179 Marshall Plan, 36 mass incarceration, 18 McCarthyism, 10 McDonald, David, 56–57, 143 McKeesport: and aging of population, 160, 194, 203; and health care, 166; and McKeesport Hospital, 249, 250, 254; and National Tube Works, 32, 42, 51, 103, 147; and 1980s, 188, 233, 235; and racism, 113–115, 183; and steel strike of 1959, 58; working-class community, 78, 161, 260. See also National Tube Works Medicaid: and the ACA, 259; as counter- cyclical economic force, 204, 206, 224; decline of as source of hospital revenue, 243–245; and elder care, 175; establishment of, 137, 147; and ethos of care, 163; and “health systems agencies,” 172; in 1980s, 18, 205, 234–235, 241; and privatization, 177 Medicare: and the “chronically needy,” 204; establishment of, 12, 137, 146–148; and growth of hospitals, 150, 168–169; and health care reform, 247; and inflation, 172,
Index
223–224, 227–228; Medicare Part D, 259; and 1980s, 205, 207, 231, 235, 243–244, 246; and prospective payment system (PPS), 218, 226; and “right to care,” 220; share of medical costs with u nions, 151, 159 Mercy Hospital, 249: and Local 1199, 135, 152–54, 239; and nurses, 76–77, 215; and racism, 163–164 Mering, Otto von, 132 Mesta Machine, 29, 34 Met Life Insurance, 165 Metzenbaum, Howard, 206 Metzgar, Jack, 27, 57–58, 84–85 Midwest Academy, 176 Mitchell, John, 60 Mittelstadt, Jennifer, 167 Model Cities program, 131–132, 166 Monessen, 114–115 Mon (Monongahela) River: and Duquesne Works, 188; and favorability of Pittsburgh area for steel manufacturing, 28, 29, and racial segregation, 107, 110, 113; and South Side Hospital, 173 Mon (Monongahela) Valley: and African American community, 101, 107, 114; and fertility rates, 90; and health care as engine of local economy, 206, 244; and Irvin Works, 56; and steel production process, 29; and unemployment, 102, 190, 193, 200 Monongahela (town), 120, 206 Monsour Medical Center, 221 Montefiore Hospital, 240, 244, 246, 249 Montgomery, David, 153–154 Mooney, Ann, 201 Moore, Bill, 114 Moss, Frank, 175 Murray Manor, 236–239 Musmanno, Michael, 150 Nagy, Joseph, 176 National Association for the Advancement of Colored People (NAACP), 122, 124, 130, 153 National Institutes of Health, 139 National L abor Relations Act (NLRA), 8, 9, 15, 135, 154–155, 157 National L abor Relations Board (NLRB), 8, 11, 14 National L abor Relations Board v. Jones & Laughlin Steel Corporation, 8–9, 15
347
National Tube Works (McKeesport), 29, 42, 103, 188 National War L abor Board, 139 nationalization of steel industry, 60 Negley House, 238 Neighborhood Youth Corps, 126 neoliberalism, 134, 186, 262 New American Movement (NAM), 176 New Deal: and health care, 12, 14, 135, 139; and l abor movement, 9, 15, 27, 61, 140; and postwar welfare state, 8, 11, 19, 127 Nicholas, Henry, 152–153 Nickeson, Jean, 77 The 9to5 National Survey on W omen and Stress, 233 Nixon, Richard, 36, 60, 82, 123, 132, 157, 172, 198 normative life course, 12, 50 Noroian, Edward, 154 North American Free Trade Agreement (NAFTA), 247 North Side, 101, 105, 115, 118, 243, 250 Novak, Dan, 48–49, 58 Novak, Beth, 63, 76, 81, 88 Novak, Linda, 63, 88 nurses: and African American women, 152, 179, 214; and ideologies of care, 142, 221; and ideologies of gender, 214–216; and Medicare, 150, 227; and resist ance to cost-cutting, 231, 232, 237; and transformation of health care work in recent dec ades, 257–258, 262; and working women, 69, 77 Oakland, 9, 120, 130, 166, 250 Obama, Barack, 259 Office Buildings Association of Pittsburgh, 213 Office of Equal Opportunity, 127 Ohio River, 28–29, 249 Oursler, Barney, 190, 192 Palm, Lefty, 206 Parsons, Anne E., 194 Parsons, Talcott, 65, 68 Patient Protection and Affordable Care Act (ACA), 259 Patrick, Rev. LeRoy, 164 Peirce, Robert, 173–174 pension plans, 11–12, 146, 205
348
Peterson, Mark, 86, 176 Pettijohn f amily, 119 picketing, 54, 105, 135, 154 pipefitters, 53–54 Pittsburgh Hospital, 164–165, 249 Pittsburgh Plan, the, 124 Pittsburgh Plate Glass, 34 Pittsburgh Visiting Nurse Association, 150 Planned Parenthood, 128 polarization of economy, 2–3, 210, 242. See also dualization Polish Hill, 69, 105, 131–132 Polish Hill Civic Association, 131 Posvar, Wesley, 136, 170, 245 precarity, 4, 14, 232, 236, 240 Presbyterian-University Hospital, 135, 229, 243, 249 price controls, 225 productivity: and “cost disease” in health care sector, 2–4; and management efforts to streamline hospital work, 136, 227, 253; and managerial offensive against steel workers, 55–56; and serv ice work, 216, 254, 261; and steel industry, 36, 38–40, 44–46 prospective payment system (PPS), 218–219, 225, 227–228, 240. See also Medicare public assistance, 81, 105, 119–120, 126–127, 190, 198 public housing, 106, 119, 127, 179 Radford, Gail, 168 RAND Corporation, 180, 199 Rankin (town), 79, 107, 115 Rarick, Donald, 56, 59, 147. See also Dues Protest Committee (DPC) Reagan, Ronald, 190–191, 223, 225–226 recession, 82, 87, 182, 199 recession of 1954, 41 recession of 1957, 38, 48, 57, 98 recession of 1979–1980, 186–88, 201, 204, 207–209, 223 Reibman, Jeanette, 156 repair work, 32, 47, 51 retired workers: and home care, 162; and Medicare, 151, 159, 205; and u nion health insurance, 12, 137, 143–148, 206, 246–247 Retiree Benefits Protection Act, 206 retirement benefits, 12, 145, 147–148, 151, 166, 205, 206, 247
Index
residential segregation, 18, 78, 99, 100, 108–109, 131, 187 Rice, Father Charles Owen, 59–60 right-to-work laws, 9. See also Taft-Hartley Act Roderick, David, 187–188 Romanelli, James, 173 Romney, George, 132 Romoff, Jeffrey, 246, 248 Rorem, Rufus, 141 Ross, Wilbur, 206 Rostenkowski, Dan, 225 Rubin, Lillian, 88 Rumsfeld, Donald, 127 Sadlowski, Edward, Jr., 183–185 St. Adelbert’s Church, 116 St. Francis Hospital, 151, 163, 201–202, 245, 249 St. Margaret’s Hospital, 249–250 St. John’s Hospital, 174, 243, 249 St. Joseph Nursing and Health Care Center, 117, 239–240 St. Michael’s Church, 149 Salaj, Edward, 26, 27, 33, 40, 43, 45, 50 Salvation Army, 149 Santorum, Rick, 247 Saulnier, Raymond, 60 schools: and anticommunism, 10; and austerity, 199; elementary school, 59, 72, 87; and gendered l abor, 72, 75, 85, 115; high school, 25, 69, 71, 82; and racism, 13, 109, 114, 115, 118, 130; medical school, 246, 251; school strikes, 212; and Trade Readjustment Act, 193; and white working-class culture, 90, 94, 119, 133, 216; and volunteerism, 116, 117 Schweiker, Richard, 221, 223, 225–226 Section 2-B (of steelworkers’ contract), 55, 56, 57, 60–61 security, 22, 23: and collective bargaining, 10, 136–139, 142–143, 147, 160, 178; and downturn of 1970s, 169, 180–181, 189, 194, 213; economic security, 65, 90, 94, 98–99, 114, 127; and f amily, 13, 96; and health care, 147, 153, 168, 177; job security, 62, 169, 185; national security, 60; and private-public welfare state, 3, 11, 191, 206, 220, 247; and race, 128–129, 163, 179; and social citizenship, 12, 14, 15, 18, 27; and
Index
working-class community, 109, 113, 115–119, 133. See also Social Security Sedgwick, Eve Kosofsky, 64 Senate Special Committee on Old Age, 226 Senate Subcommittee on Antitrust and Monopoly, 38 sen iority rights: and aging of steel workforce, 21; and deindustrialization, 188; and health insurance, 144, 189, 204; and racism, 101–102, 122, 124, 181, 183; secular crisis of manufacturing, 16, 17; serv ice work, 73, 152, 216; and social citizenship, 12, 137, 150; and working class life cycle, 25, 48, 87, 194 Serv ice Employees International Union (SEIU), 236 Seybert, Pat, 75 Shadyside Hospital, 238, 243, 249–250 Shadyside Manor, 238 Shafer, Raymond, 156 Sidberry, Vernon, 53 Sigmond, Robert M., 171 Sisters of Charity, 164 Skocpol, Theda, 247 Sloan, Martha, 88–89 Smith, Lucille, 74 Smith, Nate, 124 social reproduction: and deindustrialization, 19, 220, 225; and health care, 22, 17, 251–252, 260; and Pittsburgh working class, 21, 119, 188; and postwar welfare state, 15, 217; and WROAC, 128 Social Security, 81, 105, 137, 143, 172, 189 Sopko, Andrew, 190 South Side (neighborhood): and aging population, 160; and 1980s, 191; and public housing, 106; and racial conflict, 114, 130; and working-class culture, 26 South Side Hospital, 172–173, 249, 250, 252 stagflation, 16, 38, 186, 224 Staisey, Leonard, 167 standard of living, 27, 65–66, 71, 82 Stankowski, Edward, Jr., 26, 42, 50, 61, 96, 102, 129, 187 Stark, Nathan, 171 Stawicki, John, 46 steel strike of 1959, 35, 54: and bifurcation of social citizenship, 61, 144–145; economic
349
hardship resulting for workers, 58, 81; effects of in 1960s, 181; Eisenhower administration’s efforts to s ettle, 60; and gender, 96; and “kitchen debate,” 82; lead-up to strike, 57 steel-toed boots, 45 Stone, Robert Rade, 173 suburbs, 20, 66, 78, 101, 108, 112, 187, 212, 247 suicide, 201 Sullivan, Daniel, 200 Supreme Court of Pennsylvania, 14, 150 Supreme Court of the United States, 8, 62 Tadiar, Neferti, 240 Taft-Hartley Act, 9, 10, 14–15, 60 Taft, Robert, Jr., 157–158 Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982, 225–226, 231 teachers’ strike (1968), 156 Thomas Merton Center, 176 Thompson, E. P., 72 Thornburgh, Richard, 191, 208, 246, Three Rivers Stadium, 122, 123 time: and care work, 22, 117, 161, 216–217, 235, 238; and domestic routine, 72, 73; and everyday life, 66, 69; and the life cycle, 13, 64; and managerial discipline, 44, 46, 56, 238, 239; and reproductive l abor, 74–79, 86–96, 118, 195, 197; and resistance, 45, 53, 55, 234; and timesheets, 237; and women workers as producers of, 136, 199, 240, 241; and the working day, 51–52 time cards, 52–53 Tomayko, John, 145 Trade Readjustment Act (TRA), 193 transplant surgery, 230, 242, 255 trilemma, 2, 3, 216 Tri-State Conference on Manufacturing, 190 Tronto, Joan, 241 Trotskyism, 56 Trotter, Joe, 101, 163 Truman, Harry S., 36, 60 Tydings, Millard, 14–15 unemployment: and deindustrialization, 199–202; and gender, 222; and health care, 16, 204; and management offensive against u nions in 1980s, 212–213; and new technologies, 102, 184; and policy trilemma, 2, 3, 216–217; and racial disparity, 110, 152, 182; and replacement of high-wage
Index
350
Veterans Administration (VA), 166–167 volunteerism, 116 Volcker, Paul, 186, 228
War on Poverty, 16, 125–126, 128, 147, 164–165 Warrick, Joanne, 232 Washington, Mary, 213–214 Welfare Rights Organization of Allegheny County (WROAC), 127–128 welfare state: and carceral state, 194; collapse of, 241; and failure of health care reform, 247; and fiscal austerity, 230; and generational tensions, 23; and health care, 153, 158, 177, 205, 220–224; and industrial decline, 4, 21, 180–181, 189; as “military welfare state,” 167; and organized labor, 10–19, 146–148, 150; and presumption of male breadwinner-headed household, 99, 138; public-private character of, 3, 127, 150, 208, 217, 260; and race, 73, 178 Western Psychiatric Institute, 122, 152, 242, 249 West Penn Hospital, 152, 249 Westinghouse, 10, 34, 40 white ethnics, 108 white flight, 100, 107, 108, 112, 148 whiteness, 94, 118, 129, 131 White House Conference on Effective Uses of Woman-power, 67 Wickerham, Howard, 25–27, 33, 42, 43, 51, 52, 58 Wideman, John Edgar, 101 wildcat strikes, 47, 53–54, 56 Williams, Melvin, 119–121 Wilson, August, 101, 103 Wofford, Harris, 246–247 Woll, E. J., 55 workfare, 191 workplace injuries, 51, 77, 98, 239 Worlds of Pain (Rubin), 88 women’s work, 67, 72, 102 Woodring, E. R., 50 Workingman’s Wife, 67, 80
Wachter, Till von, 200 Wagner-Murray-Dingell Bill, 139 Wallace, George, 123, 132 Wallace, Henry, 10
Yale University, 225–227 Yatzko, Joe, 26 Young Lords, 16 Yurcon, Anne, 28
unemployment (continued) industrial jobs with low-wage serv ice industry jobs, 180; and social citizenship, 12; and stagflation, 38, 186; and transformation of labor in neoliberal era, 4; and unemployment insurance, 190, 193; and “Volcker shock,” 186–189; and working- class community, 77, 99 unemployment insurance, 190 u nion density, 9 United Food and Commercial Workers, 212 United Negro Protest Committee (UNPC), 121, 122 United Electrical Workers (UE), 10 United Movement for Prog ress, 128, 164 United Steelworkers of America (USWA): bureaucratic character of, 56; and decline of steel industry, 190, 200; and geography of steel industry, 34; and health care, 141–148, 205; and postwar order, 26, 65; and price-setting, 33; strikes, 35, 60; and racism, 124 University Health Center (UHC), 170–171 University of Pittsburgh, 132, 136, 153, 170, 224, 229, 242–246 University of Pittsburgh Medical Center (UPMC), 1, 249, 261 Urban Institute, 188 Urban Redevelopment Agency (URA), 106–107 urban renewal, 33, 106, 107, 119, 125, 132 US Senate Committee on Aging, 224 US Steel, 29, 179, 181, 183, 187, 188, 190, 206, 213