By Adia Harvey Wingfield, author of Flatlining: Race, Work, and Health Care in the New Economy

This guest post is part of our ASA blog series published in conjunction with the meeting of the American Sociological Association in New York City, NY, August 10-13. #ASA19

With the 2020 election season under way, discussions about health care are already returning to candidates’ platforms and conversations about their goals and plans for the presidency. While most of the Democratic candidates agree that our current health care system is broken, there are divergent views on what solutions are most effective—Medicare for All, a “public option” that coexists with our current system of private insurance, modifying the Affordable Care Act, or a combination of these and other ideas. 

What comes up much less frequently in these discussions are the ways that potential policy changes could impact not just patients, but health care workers. And politicians certainly aren’t talking publicly about how black health care workers play an important, if overlooked, role in shaping how health care is provided. 

My book Flatlining: Race, Work, and Health Care in the New Economy, is a look at how broader structural and economic changes have had an impact on black professionals. I wanted to consider how larger economic and cultural shifts, such as the move to a more neoliberal economic ideology and the mainstreaming of diversity rhetoric, are restructuring work for underrepresented groups. The health care industry is a perfect microcosm for many of these changes that are occurring, and black health care workers provide a unique focal point for assessing the consequences of these cultural and economic transformations. 

I found that as organizations attempt to respond to neoliberal ideologies that privilege individualism, maximizing profits, and deregulation, they scale down their support for labor. We know this is leaving workers stressed, anxious, and economically insecure. However, as organizations now also say that they want to support diversity, the dwindling resources devoted to labor mean that black professionals end up picking up much of the slack. In other words, as companies devote fewer resources to labor while also asserting their support for diversity, they rely on black professionals to do the actual work of making organizations more accessible and available to communities of color. This work is often unpaid, unrecognized, and unrewarded, but it is invaluable to companies that must operate in a more racially diverse society. 

What does this mean for health care policy? As candidates consider how to restructure our health care systems to be more effective, it is important to think through how Medicare for All, public options, and other solutions that involve the public sector implicitly rely on black professionals. In order for these policy solutions to be as effective as possible, they will require more support for and investment in black workers who provide much of the care in these settings. Black professionals cannot continue to do this additional labor with no compensation, and the candidates who are serious about improving care in the United States must to take their contributions into consideration. Otherwise, they risk creating new problems in the health care industry in addition to the ones they are trying to solve.