Never Good Enough: Health Care Workers and the False Promise of Job Training

Introduction: Health Care and Getting By in America

Introduction Health Care and Getting By in America Hospitals are the economic and social centers of many urban neighborhoods in the United States, but in New York their number and size is unusual. The campuses of major academic medical centers occupy entire city blocks and their buildings loom over the apartment buildings, brownstones , tenements, and public housing projects that surround them. Seen from above, hospital campuses are as easy to pick out as famous city landmarks ; approaching them on the street, they are like magnets, drawing in thousands of workers and patients each day. Inside these metropolises, medical students shuffle between lecture halls, the medical library, and patient units, and physicians conduct procedures, check patient charts, and write orders. Doctors, however, are only a minority of people working in such hospitals. Many spend only a few hours of the day there before returning by car service to their private offices in more serene settings. They are even less numerous in the smaller community hospitals that dot the city. Nurses and nursing assistants, overwhelmingly women, make up the bulk of the hospital workforce, and they arrive to 2 Never Good Enough work by subway and bus in their scrubs and thick-soled shoes, an ID card hanging around their necks—many on a colored cord that identifies their union. There are other workers too, overwhelmingly people of color and immigrants: maintenance workers, food service workers, housekeepers, laundry workers, technicians of many types, social workers, paramedics, therapists, and therapy assistants—workers whose experiences claim less scholarly and journalistic attention, perhaps because their work seems less crucial to patient care. Patients and their loved ones are tourists in these places (though some unfortunately become like members of the community ), who disrupt the movement of hospital staff when they stop short in busy corridors to look at the signs hanging from the ceilings or the colored lines on the floors intended to guide them through the labyrinth of buildings. New Yorkers work hard in a variety of service industries, old and new: as retail salespeople, waitresses, cab drivers, street vendors, garment workers, teachers. But health care is unusual because it offers the possibility of economic security for entire communities. The proliferation of health care jobs available to women, immigrants, and people of color constitutes the possibility of reversing, or at least slowing, the growing inequality that characterizes contemporary America. Already, over one in ten employed Americans work in health care settings or occupations, while in New York City, where health care is the largest employer, that number is closer to one in eight.1 At the peak of the dot-com bubble, in 2000, business services briefly surpassed health care as the city’s number one private employer, but the bubble’s collapse shortly thereafter returned health care to its traditional leading position.2 In hospitals and the neighborhoods they dominate you can still feel the buzz of working-class New York, the city that was for a long time de- fined as much by the tradespeople, craftsman, and semiskilled laborers in its sprawling and diverse manufacturing sector as it was by Wall Street traders and real estate brokers.3 Health care has produced the workingclass jobs that make up for the evisceration of the manufacturing sector in the traditional industrial strongholds of the northeast—at least partially. In New York City, health care added 21,400 jobs between 2000 and 2003, while manufacturing lost 50,000 jobs in approximately the same period.4 The northeast corridor stretching from Baltimore to Boston, the “nation’s health epicenter,” added 50,000 jobs between 2000 and 2002 while all other Introduction: Health Care and Getting By in America 3 industries combined shed 220,0000.5 Even in Manhattan, hub of the nation ’s financial and commercial networks, health care is the social and economic anchor. Not only is health care today the largest employer in New York City, but it is of central importance for workers in the “sub-baccalaureate labor market,” those who have at least a high school diploma but not a baccalaureate degree, who may or may not have some college education.6 Despite the hype about the “knowledge economy” and postindustrial, flexible, creative workplaces of advanced capitalist nations, three-quarters of workers in the United States do not have a baccalaureate degree.7 Most of these workers are employed in the growing service sector, and the...