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Health care jobs are critical to sustaining a middle class, not only in the current recession but in the face of long-term economic restructuring, but more training will not make these jobs good enough to do so. President Obama has heralded projected gains in health care jobs and promised to "give our workers the skills they need to compete for these jobs of the future." In a July 23 editorial, the New York Times responded to the inadequacy of the recent increase in the federal minimum wage by calling for higher wages, but also defaulting to the position that "career ladders" and on-the-job training--especially in health care--will mitigate the growth of low-paying jobs.

The importance of health care to the security of American workers, and entire communities, cannot be overstated.  Data from the Bureau of Labor Statistics (BLS) shows that health care has been the sole private industry to add jobs in recent months and 12% of all American workers are in the health sector.

Yet, most of the new jobs in health care are for low-paid positions such as home health aides and nursing assistants, which are also among the fastest-growing occupations in the country. The Washington Post has reported former middle-class autoworkers are now making $12 an hour as nurses’ aides. In order to sustain the idea that such jobs will some how lead us out of the "Great Recession" or compensate for the larger restructuring of the labor market, liberals must and do join hands with conservatives in emphasizing the promise of career ladders. The Times’ editors in particular singled out programs that help nurses’ aides become licensed practical nurses (LPNs) and urged more funding for job training partnerships between unions, employers, and colleges.

They were likely thinking of one such partnership in their own backyard: the joint labor-management training programs run by one of the country’s most powerful labor unions, 1199 SEIU United Health Care Workers East. New York State has poured hundreds of millions of dollars into 1199’s programs in recent years, and although the use of those funds has been far from transparent, my research has shown even such generously supported partnerships not only fail to change the prospects of low-wage workers as a whole, but in some situations become an obstacle to efforts to do so.

In 1199 SEIU’s programs, some workers have been able to obtain better paying jobs. Nursing assistants have been trained, after years of concurrent full-time work and school, to become LPNs, earning about $23 an hour--$8 more on average than nursing assistants in the New York City area. But BLS data shows they earn $14 an hour less than area registered nurses (RNs), to whom their work is identical in many respects. There have also been renewed efforts to train more RNs, but there is no ladder from nurses’ aide to nurse positions. The LPN credential provides no advanced standing for a nursing degree and like many other highly-touted "skills" and "certificate" programs, it does not even provide college credits.

When job training helps individual workers obtain better paying jobs, it still does nothing to change a labor market that creates low-paid jobs faster than highly-paid jobs, all the while requiring more credentials for the former. President Obama points out that "jobs requiring at least an associate’s degree are projected to grow twice as fast as jobs requiring no college experience," but does not explain that this may be the result of employers simply being able to hire more well-trained workers for the same low-paid jobs. In New York City, nursing assistants’ level of formal training has increased in the last few decades while their wages have declined relative to all health care occupations.

Encouraging workers in low-paid jobs to move on to "better" ones is an especially odd strategy in health care. The demand for home health aides and nursing assistants will only grow in coming years—and not only because employers are using them to replace more highly-paid workers like nurses. Hands-on caregiving is vital work unlikely to be replaced by "jobs of the future," and one that mostly women (and in New York, women of color) do under stressful working conditions in addition to shamefully low pay. While such workers deserve opportunities to improve their education and training, the constant reply to such workers’ dissatisfaction—upgrade yourself—communicates that they are inadequate and dismisses the value of the work they already do. Moreover, the promise of career ladders, whether it is made by unions, employers, or politicians, stifles frontline workers’ attempts to address problems in health care that negatively affect everyone—not least patients—by presenting them as escapable: understaffing, work intensification, underutilization of health care providers’ skills, and capricious management.

Perhaps most troubling in the case of 1199’s joint labor-management programs is that much of the training has not been for jobs with better pay or working conditions, but in things like "soft skills," which often suggest workers can improve their working conditions and future prospects by changing their attitudes. Such programs, regardless of the intentions behind them, often cajole workers into accommodating so-called facts of life such as a profit-driven health care system or organizational reengineering programs that create deteriorating conditions in health care facilities.

More training is never a guaranteed route to better wages and jobs, as a recent study of federal job training reports (PDF) and many social science researchers have long known. Not all training, however, should be dismissed, as Brandon Roberts and David Fischer, of the Working Poor Families Project, argued on recently on Huffington Post.  Nonetheless, just as Roberts and Fischer claim "when training outcomes do not meet expectations, the findings should not be considered as definitive," neither should we take the promises of training programs at face value, especially in the absence of long-term follow-up studies. This is especially so when training becomes a crutch that replaces political commitment to maintaining livable wages and supporting full employment.

The change most likely to sustain the struggling middle-class in the current economic climate is an increase in the number of unionized workers and unions. Only 12% of American workers are in a union at all, so even the most effective labor-management training programs can have little impact on growing wage inequality and decimation of decent jobs. Legislation like the Employee Free Choice Act would enable more workers to join unions. But as labor scholar Jonathan Cutler argued in the Hartford Courant, (now on Portside archives) existing labor rules also need to be changed to allow for more competition between unions themselves. In a competitive environment, union leaders might be less inclined to see new training programs as an adequate response to their members’ dissatisfaction. Instead, they might be forced to fight for the wages and working conditions that would make being a home health aide, for instance, good enough.

Originally posted to Ariel Ducey on Thu Aug 20, 2009 at 10:11 AM PDT.

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