How the Public-Private Welfare State Makes Social Class

• In Event: Contemporary Problems in Work and Labor in the U.S. in Historical Perspective

Abstract

In recent decades, a dense and vibrant literature has charted the costs, causes, and consequences of the American state’s reliance on private actors to carry out core functions. Special attention has been given to the distributive consequences of what is widely described as the “public-private” welfare state, with scholars showing that such arrangements tend to boost the political and economic power of wealthy and private interests. Despite its vast coverage of the various policy domains, including social welfare benefits (e.g., Howard 1997), access to credit (e.g., Thurston 2018), and civil law, this scholarship has neglected a key mechanism through which the public-private welfare state produces inequality: employment opportunities.

In this paper, as part of a broader book-length dissertation project that examines the American health care workforce, I demonstrate how the public-private welfare state has shaped the political and economic development of a core set of workers in the post-industrial U.S. economy: nurses. In particular, I identify and theorize how several sets of policies that implicate both public and private actors–bundles of policies that I conceptualize as fiscal, regulatory, infrastructural, and labor force–have shaped the development of “professional” and “non-professional” nursing. I show how such policies have not only influenced the social class of nurses, but also how nurses have responded, in turn, to influence the contours of the public-private welfare state itself. This paper has empirical and theoretical implications for our understanding of key-yet-understudied institutions that shape the workplace; the development of social class in the post-industrial U.S.; and American state-building.

Author

• Trevor Brown, Cornell University