The Myth of the Public Good

Andy Hines

Days later, speaking with Adam Harris for The Atlantic, Senator Elizabeth Warren pointed out that the nation’s $1.7 trillion in student loan debt is not the same as other forms of consumer debt. Suggesting that “education is not only a benefit, personally, to the person who gets it but also a benefit for our whole country,” she offered a textbook definition of a public good in her efforts to marshaling support for student loan debt cancellation. Cancellation is a necessary and widely beneficial democratic and redistributive policy that Warren herself has supported in some form since her 2020 campaign.

But in considering future remedies for the debt crisis, Warren defaulted to a circumscribed liberal vision of possibility. To prevent debts from accruing, she offered little more than a technocratic, means-test (income-based) repayment program. Far from precipitating “big structural change,” under this model, the federal government would continue to purchase, rather than produce, higher education via loans pegged to individuals. This would not overhaul the system of higher education in United States, nor would it challenge the logic that created the student loan crisis in the first place.

Many argue that these and other related crises—crises involving debt and the provisioning of goods and services necessary for public and individual health—result directly from the austerity regime imposed under neoliberalism. The solutions that Buttigieg and Warren offer, however, follow a blueprint for provisioning public goods that was established by the federal government long ago, since the era of the New Deal. Rather than directly fund education or healthcare, federal policy delegated the administration of goods and services to private and/or locally supported entities.

Not only has this strategy consistently made these essential services more expensive by the incessant pressures of profit extraction and inconsistent patterns of investment, it has also consolidated power within nominally non-profit institutions built for privately servicing forms of care. From the New Deal onwards, the alignment of universities, hospitals, and the state-capital nexus within the United States responded to issues of inclusivity with capital-friendly fixes, which reinforced the myth that the provision of public goods should be privately created and supported by state expenditure. At its core, the strategy also constituted a schema for the upward distribution of wealth.

Hospitals and universities position themselves as providers and defenders of the public, embracing their central position within the U.S. economy’s ever-expanding care sector. Yet their invocation of the public good in their operations has primarily been a means to foreground capital accumulation, rather than public redistribution. These pillars of the care economy have been integral to the uneven development of American racial capitalism, as well as its ideological mystification.

Despite the fact that they are dominated by some of the same interests, universities and hospitals are often discussed as entirely discrete entities; it is easy to forget that healthcare and education were once under the purview of the same federal agency. Of course, there are certainly differences, real and rhetorical, between universities and their medical centers. Nevertheless, it can be astonishingly clarifying to analyze their intertwined nature.

In many American cities, universities and associated hospitals are the largest private employers. In Columbia’s 2020 report to the U.S. Department of Education, the university tallied $1.2 billion in “patient care expenses” as part of its instructional costs. (This also helped inflate Columbia’s position in the U.S. News college ratings sweepstakes—pure coincidence, of course.) Hospitals and universities also evince similar patterns in shaping labor markets, policing strategies, and real estate development.

Massive endowments, as well as the skyrocketing costs of student tuition and patient care are, in effect, realizing the vision of the state that Buttigieg and Warren espouse. To put it simply: the federal government may provide for the people only by enriching existing modes of capital accumulation.

The accumulative capacity of universities and hospitals is a New Deal-era political and economic solution that has been retooled to address contradictions with capital as industrial profits waned from the mid-century onwards. During this same period, carceral and policing institutions also swelled to enormous size. Viewed together, these shifts register the American notion of “the public good,” as purveyed by the state. This sheen of democratic and collective values burnishes the motives of profit and launders he racialized violence of accumulation. In truth, the state serves capital and its institutions, not the public. A key project of ideology is to invert this perception.

When it comes to land, labor, and finance, social movements and union contestation of the public-good status of hospitals and universities has been fundamental to the historical development of the accumulative power of these institutions.These struggles expose that the public good within universities is a horizon of possibility, rather than a historical reality lost with neoliberalism’s rise.

In Policing the Crisis, Stuart Hall and his co-authors suggest that myth “converts discontinuity into continuity, History into Nature.” Indeed, the notion of such a political-economic dynamic that has produced the public good is nothing but a myth, laden with nostalgia, which must be examined with an eye towards the persistent struggle between mass progressive movements and the state defense of racial capital. Here I chronicle how these dynamics have shaped policy, practice, and arrangement of universities and hospitals over linked sites of contestation. The challenge is to hold together linked fronts that capital hopes our analyses will continue to understand as fundamentally separate.

The development potential of universities and hospitals at the turn of the 21^st century was a realization of a mid-20^th-century effort of the Cold War liberal consensus to “bring back the middle class to the city,” as one university booster put it during a Congressional hearing in 1959. Through the mid-20^th century, numerous urban colleges, including Penn and Temple in Philadelphia, privately considered abandoning their campuses for landholdings elsewhere. The university’s turn to what the geographer Neil Smith would label an instance of revanchism—the will to reverse territorial losses—undergirded the advocacy work undertaken by these institutions and the state to preserve and create value from university and hospital lands.

The 1959 hearing was part of a fact-finding mission to assess the proposed addition of Section 112 to the 1949 Housing Act. Section 112 would provision federal urban renewal funds to match those expended by universities in enlarging their campuses. Universities claimed that such support was necessary because of the pace at which these institutions were expanding, in part thanks to G.I. Bill funds and the National Defense Education Act, which had passed a year earlier. The measure was extended to hospitals when the housing bill was reauthorized in 1961.

Though a public program, Section 112 was shaped directly by private interests, as LaDale Winling has shown. Julian Levi, the University of Chicago’s vice president for business, coordinated lobbying efforts and identified a policy expert to write the text of the measure—while incorporating strict stipulations from a number of mostly private urban universities. Levi had already leveraged policies available to the South East Chicago Commission, the university-funded “urban renewal arm” of the University of Chicago, to acquire eminent domain power. Section 112 essentially nationalized these local victories. In the first decade of the statute’s implementation, universities and hospitals developed over 2,000 acres of land with $774 million in federal credits, about 12% of total federal spending on urban renewal.

Urban renewal legislation was passed by Congress and tested in the courts, but the rules of its implementation were made by bureaucrats in the federal agency now known as the Department of Housing and Urban Development (HUD). The HUD manual specified urban renewal eligibility requirements, including public comment periods, but the criteria themselves were not subject to direct public scrutiny. The regulations allowed blight determinations—crucial for establishing whether an area is eligible for urban renewal funds—to be delegated to private contractors.

Practically, this meant that planners might be working on behalf of a state or city at the same time as they were working with a private university seeking approval for an urban renewal project. In the late 1960s, the Nashville Housing Authority hired the New York firm Clarke and Rapuano to determine whether the neighborhood targeted for development by Vanderbilt and several other local universities was eligible for urban renewal. The same firm, however, had worked closely with Vanderbilt on its late-1950s campus expansion plan, from which the University Center development emerged. These arrangements were not unusual, nor were they frowned upon.

Far from being deemed corrupt, the Vanderbilt project was hailed as exemplary of a productive cooperation between local partners that was aimed at accessing federal funds. The structure of Section 112 incentivized cities to embrace the interests of non-profit private universities and hospitals as their own. Municipalities and states had to contribute a proportion of costs to receive federal urban renewal funds, but the city’s share of the cost could be covered by money that universities spent on land acquisitions in designated urban renewal areas. These funds were transferable, and therefore allowed cities to obtain federal funds for municipal projects, for essentially no additional money down. The delegation of urban renewal administration to state and city governments led to situations wherein universities, cities, states, and contractors worked in concert, often with deleterious consequences for public services.

These nascent forms of public-private partnership were legitimated by rhetorical (as well as literal and material) condemnation of the urban populace around universities as antagonists of the project of higher learning. Speaking in 1967, the Provost of Columbia University, Jacques Barzun, called Morningside Heights “uninviting, abnormal, sinister, and dangerous”—racialized opprobrium that pinpointed low-income people of color as a clear threat to the institution. The extractive and violent dimensions of urban renewal, the roots of which lay under the surface of Section 112, were always clear to those who felt the policy’s ordering force.

Famously, in a 1963 interview with Kenneth Clark, James Baldwin remarked that urban renewal means “Negro removal.” Baldwin’s statement is typically read as an indictment of the deliberate violence of the policies and ambitions of the mid-century racial liberal state. Yet Baldwin’s phrasing echoes a critique of New Deal liberalism and the conditions of Black settlement in U.S. industrial centers during the Second Great Migration. The Black press employed several phrases to emphasize the racial limitation of Franklin Delano Roosevelt’s National Recovery Act of 1933; one was, anticipating Baldwin, the “Negro Removal Act.”

The racialized pattern of university and hospital development in American cities was thoroughly formalized as part of the New Deal. The Federal Housing Administration (FHA) established the positive real estate values of universities and channeled federally-backed mortgages to the neighborhoods surrounding these institutions. Like the HUD urban renewal manual, FHA mortgage underwriting guidelines were established by the agency. These guidelines statedthat “a college campus often protects locations in its vicinity” from “adverse influences.” The reasoning benefited private and public institutions alike by supporting the value of nearby housing stock with mortgage capital.

The Dixiecrat-Democrat compromise that made the New Deal tenable accepted segregationist tendencies and gave state and local agencies federal money to build out programs that transferred wealth to white people via Black exclusion. This included funds that were made directly available to public universities for capital improvements. There were also knock-on benefits to being in areas in which qualifying white families could bring mortgage capital. These practices were most visible in Southern states and on the bright red lines of Federal Home Owners’ Loan Corporation maps.

These direct and indirect transfers of wealth for university expansion coincided with a new framing for the university’s public character: the corporate ideal. The first several decades of the 20^th century saw an increase in the number of bankers, lawyers, and businessmen on the boards of the country’s most prestigious colleges. They sought ways to make the management styles of these institutions mirror those of their profit-seeking businesses.

Scientific management made universities even more appealing for state investment, in part because those outlays would be overseen effectively. The largesse of the Carnegie Foundation for the Advancement of Teaching (CFAT) rapidly spread via free (though not without strings attached) pension plans, consolidating wealth within elite institutions and bringing new expectations about the relationships between managers, faculty, and overseers.

Between 1902 and 1934, CFAT and other foundations sent just 20 institutions nearly $250 million, or approximately three-quarters of their total higher-ed-related expenditures. This funding design consolidated wealthy institutions and was emulated by smaller ones. Foundation funds enforced managerial discipline among faculty as they faced a five-fold increase in the number of students from 1900 to 1930. Faculty eventually compromised, aligning themselves with managerialism and accepting academic freedom and tenure protections in exchange for lower wages and a tacit agreement to limit unionization. The force of capital brought the university within the bounds of the corporate ideal, at the same time as it legitimized further state investment in the institutions’ expansion.

With this configuration came an understanding that higher education warranted the same powers wielded by the massive conglomerates that had vastly expanded the nation’s transportation and communication networks. In 1913, a Connecticut court refused to grant a private college eminent domain powers. After two decades of contestation over the terms of university management, a California appellate court would ultimately grant that power to another private university in a similar case.

The New Deal consensus and the emergent forms of Cold War liberalism that followed had already accepted capital’s alliance with higher education as a precondition for the sector’s public argument. As private institutions were increasingly relied upon for the delivery of services seen as essential to the public good, legislators and city administrators shaped policies to allow them to accumulate more private wealth via public provision. Yet these provisions had a caveat regarding the management of labor. While these institutions certainly facilitated middle-class wages for some, they also required a stream of low-wage workers—cheap labor that their urban renewal activities helped ensure would remain in supply.

Unlike the rosy picture offered by their boosters, universities and hospitals began a race to the bottom for workers’ wages and employment conditions. The result, as Robin D.G. Kelley observed in 1996, is that, “If you’re looking for the American working class, you’ll do just as well to look in hospitals and universities as in the sooty industrial suburbs and smokestack districts. And they are more likely to be brown and female than they are to be the good old blue-collar white boys we’re so accustomed to seeing in popular culture.”

Kelley’s observation has only grown more accurate in the quarter century since it has been made. Only half of higher-ed workers are instructional staff, and, of that instructional staff, three-quarters are in some type of contingent position. Like Kelley observed of the working class generally, contingent faculty are more likely to be people of color and women, and they take on the majority of teaching: the major “care” component of academic labor. Beyond the faculty, roughly a quarter of university workers make less than the U.S. median wage, as estimated from 2020 Bureau of Labor Statistics and U.S. Census data. (This data does not include information on the large number of privately contracted, low-wage workers at these institutions.)

Hospitals also intensify wage stratification. Only half of hospital employees are the high-wage workers viewed as the middle-class saviors of urban areas. Rather than producing good jobs, the care economy accounts for the vast majority of growth in the bottom quintile of the wage structure in the last three decades, according to research by the sociologist Rachel Dwyer. Estimating conservatively, for every high-wage position they create, universities and hospitals produce at least one low-wage job. In turn, these institutions perpetuate uneven development and stage the conditions for their continued role as a capital-intensive savior for American cities.

Hospitals and universities institutionalized forms of gendered care labor in the wake of the collapse of the Fordist family wage, providing a low-wage solution to a material and ideological crisis. Cities in the Rust Belt saw the leading edge of the urban crisis throughout the 1950s. The American exit from Korea and increased global competition from reconstructed Europe and Japan led to stagnation and decline in the growth rate of U.S. industry profits.

Nevertheless, workers in industries like steel exercised their bargaining power to seek higher wages. This pressure eventually led to layoffs and increased capital investment in labor-saving technologies: an erosion of what some view as a post-war compromise between capital and labor. Black workers were last hired and first fired; they also found any earnings evaporating via the extractive state-supported design of the housing market. Observing the conditions wrought by these patterns of deindustrialization in West Philadelphia in 1956, Martin Meyerson, who would later become Penn’s president, insisted that the university develop the neighborhood to avoid the area “becoming a sea of residential slums and commercial and institutional islands.” These dynamics highlight ever and again Stuart Hall’s classic claim that “race is the modality in which class is lived.”

The employment structure of hospitals and universities relies upon the grave circumstances of supposedly unproductive, feminized care work. This work, however, has also been racialized within the United States—therefore, the plentiful low-wage care jobs further reproduce the racial segregation and disinvestment that these anchor institutions are called upon to correct. Directing resources to non-profits intensified the stratification that deindustrialization produced, leaving cities with pools of low-wage workers otherwise rendered surplus by the forces of racial capital. Hospital and universities, particularly private non-profit ones, would benefit immensely, in the form of capital accumulation, from these conditions.

Indeed, the shape of the American economy turned dramatically towards the care sector, which includes both education and healthcare. From 1960 to 2018, national health and education expenditures as a percent of GDP effectively doubled, rising to 24%. Most of that growth was due to a fourfold increase in the percentage of healthcare spending, but the proportion of education spending also increased 1.5 times.

The impetus for this growth was increased access. Legislation like the National Defense Education Act of 1958 and the Higher Education Act of 1965 provided funds to fuel the increase in college enrollments, which leapt from 2.9 million in 1956 to over 8 million in 1969. The 1965 establishment of Medicare and Medicaid offered a form of insurance to the elderly and the poor. This led to wild growth amongst hospitals, which the state further financed in the form of public bonds and via earlier legislation, including the Hospital Survey and Construction Act of 1946.

As historian Gabriel Winant put it in his book The Next Shift, the federal government embraced “collective economic power on the demand side—to buy health care, rather than to provide it.” Winant’s description of the federal approach to healthcare also aptly characterizes its strategy for higher education. In both cases, ample cash was available to generate new modes of accumulation and conglomeration for non-profit institutions, in the guise of the public good.

Healthcare and education are labor-intensive industries—labor costs regularly account for over half of institutional expenditures—and the nature of the work makes these costs relatively impervious to the automation and offshoring that made consistent industrial profits possible. The demand-side infusions of federal cash during the Cold War could only prop up operating costs by crushing labor. Staffing increases occurred in higher ed, but they paled in comparison to the growth of students. In 1969, approximately 450,000 faculty worked in postsecondary institutions, an 18% increase from the decade earlier. In the same period, the number of students increased by 119%. The difference reflect the speed-up of teaching labor, the managerial response, and the rationing of institutional resources.

As has been noted of the CUNY and the University of California systems, the withdrawal of state support coincided with the increased presence of students of color, be it through open admissions or affirmative action policies. CUNY filled in the gaps of its enrollment increases in 1974 by hiring adjunct faculty. Some CUNY campuses, none of which were the predominantly white senior colleges, already had faculty corps that were comprised of 50 to 70% adjuncts. Broadly, university workers found themselves at the intersection of increased workload expectations and disciplinary pressures, which resulted from austerity measures that emerged from a generalized fiscal crisis.

Facing these conditions, university workers of all kinds banded together in unions. The late ‘60s saw the beginning of a steady rise in union organizing among faculty and the spark of increasingly militant activity among already-organized workers to support the formation of additional bargaining units from clerical workers on campuses. Increased healthcare unionism was also facilitated by the 1974 Health Care Amendments of the National Labor Relations Act, which formally recognized the collective bargaining rights of employees at non-profit hospitals. The percentage of non-government, non-profit hospitals with unions increased from 4.6% in 1961 to 20.4% in 1977.

Union militancy was augmented by uprisings of student and community coalitions in a number of settings, as when Harlem and Columbia students occupied the Morningside Heights campus in 1968. These activities sought to publicize and disrupt the contradictions between the democratic aspirations of care work and the institutions’ direct impact on uneven development in U.S. cities, as well as their entanglement with the imperial war regime.  

The backlash to these organizing activities came in the form of extensive disciplinary measures. These developments further consolidated the state’s use of universities and hospitals as conduits for capital accumulation—on the backs of students, patients, and workers. Tax revolt and state receivership necessitated the renegotiation of existing union contracts at public institutions, and the prevalence of austerity logic led to belt-tightening at private ones. Administrators also worked to frame militant labor action as criminal activity that threatened innocent students on campus. At the same time, they argued for the expansion and the professionalization of campus-based police forces by claiming municipal police forces were too violent and the National Guard too distasteful.

This new monopoly on violence targeted the collective protections contractually stipulated or informally developed by workers. University and hospital workers found themselves in workplaces with a higher density of police than most municipal areas, where they were subject to increasingly exploitative conditions. The acceleration of mass incarceration—of which K-12 schools are an integral part—only made conditions worse for workers coming from the immediate proximity of urban campuses.  

These police powers would rapidly position universities as part of what Grace Watkins calls a “global carceral apparatus,” as campus security forces participated in transnational exchanges of policing tactics. There was no avoiding the connection of expanded domestic programs to imperial activity as part of U.S. Cold War militarism. The Higher Education Act and Medicare, both of which passed in 1965, were expansions of programs that had previously applied exclusively to servicemembers, now on offer to the citizenry. Social movements comprised of students, workers, patients, and communities challenged the entanglement of the university with the warfare-welfare state.

At the same time, the diversifying student population was also subject to the policing and stratification that people of color felt most acutely living in neighborhoods surrounding hospitals and universities. With prevailing sociological theories that diagnosed so-called Black criminality and radical political activity as pathological, the state shifted its attention to incarceration and force as a strategy for managing those who sought to challenge the existing forms of the racial state.

The severity of these strategies, in Ruth Wilson Gilmore’s phrasing, “crushed” radical opposition. “Law and order” managed Black and poor people with police; in tandem, the “disciplining power of underemployment and inflation” infiltrated nearly every aspect of their lives. Universities and hospitals, in accordance with the mandates of profit, sought low labor costs and architected purpose-built cities. In doing so, by dint of the imposed priorities of capital, they generated these phenomena: social and interpersonal injustices at inconceivable scales.

In the ‘80s, enrollment growth at for-profit colleges accounted for nearly half of the increase in postsecondary enrollment—all the more striking, given the otherwise-stagnant enrollment figures. With an increase in for-profit institutions came similar growth in the number of loan defaults; for-profit students accounted for 41% of loan borrowers but a full 77% of defaults. As risk increased for investors, however, the government cracked down on such excesses.

But the trends returned with new policy developments in the 21^st century, disproportionately impacting women, Black people and other people of color, and people entering college at an age of 25 or older. University endowment positions in private-equity takeovers of for-profit college systems distributed proceeds of what Tressie McMillan Cottom refers to as the “lower” part of the system upwards, to the most prestigious non-profit institutions.

Debt also made up for those who were underinsured or without insurance—these people existed only in the interstices of a patchwork insurance system that had largely been exclusive to those in certain lines of work. Medical debt is aggressively pursued by hospital systems, many of which are private, non-profit, and university-affiliated. Hospitals seek court judgments to garnish the wages of the indebted. Johns Hopkins Hospital filed 2,400 lawsuits from 2009 to 2019  to collect on unpaid bills, a practice that the hospital continued during the pandemic (earning some degree of infamy for doing so). 86% of those cases targeted Black people. The densest cluster of defendants resided in the immediate proximity of the main hospital, in ZIP codes where unemployment and poverty have proliferated.

From there, it isn’t difficult to deduce the employer from which Hopkins has most commonly garnished wages: itself. Such instances making up 10% of known cases. This is not a unique case; Gabriel Winant has also recounted the experiences of workers at University of Pittsburgh Medical Center who are indebted to their employer for medical services.

Capital and prestige accrue in hospitals like Hopkins because of their approach to unwaged and indebted Black people, not in spite of it. The case of Henrietta Lacks is by now well-known, but it remains particularly illustrative. In 1941 Lacks moved just outside Baltimore with her husband, who had gone in search of work at the Bethlehem Steel plant at Sparrows Point. Entering a segregated unit at Hopkins hospital in 1951, Lacks had unwittingly stepped into a historical space that lay between the decline of one industry and the rise of another.

Her own cells, scraped from a tumor in her cervix, proved to have a unique quality: they ceaselessly reproduced, making them invaluable for medical research involving testing on human tissue. The descendants of cells from the initial culture from her body came to be known as “HeLa” cells—and would come to help fuel an explosion in biomedical research. Decades later, that kind of advanced research would be conducted in new urban “BioParks,” multimillion dollar facilities that displace residents anew in cities like Baltimore.

This path was paved with federal funding for research, in addition to federal policy that was established by the Bayh-Dole Act of 1980, which allows for universities to hold patents on discoveries made with public money. (Lacks’s cells are not patented—genetic material cannot be in the United States—but they have been the basis for some 17,000 patents, about 250 of which are assigned to Hopkins.)        

Lacks’s gynecologist remarked that “Hopkins, with its large indigent Black population, had no dearth of clinical material.” A grim euphemism for human bodies—but this “clinical material” has helped Johns Hopkins rise to prominence as one of the world’s premier research hospitals. The Black Panthers, in writing about Yale-New Haven Hospital in the ‘70s, observed something similar: “Poor people enter the Yale-New Haven hospital not just as sick patients, but as teaching material and ‘interesting cases,’ to be studied and used by medical students, physicians-in-training and ubiquitous researchers.”

Residents in the Middle East neighborhood near Hopkins hospital still recount lore of night vans that pick residents off the street, snatched to be used as research subjects at Hopkins. These stories carry purchase because there is a kernel of truth in them. A Hopkins study of criminal behavior in 1969 examined blood from 7,000 Black children; as recently as the late 1990s, an experiment knowingly exposed Black children to lead. On the outer fringes of Hopkins’s controversial Eager Park development project (which itself capitalizes on patterns of abandonment driven by urban renewal) will be a new building, named for Lacks, which will focus on projects in bioethics and community research.

Universities and hospitals dramatically increase their revenue on the tight margins of low-wage labor and facilities, constructed on land deemed blighted by state disinvestment in places where low-wage workers live. State policies towards hospitals and universities have identified their private interests with those of the state, jeopardizing, rather than granting, democratic access. Universities and hospitals operate as a state-capital nexus, serving only those who have already been enfranchised by race, wealth, and state power. The reactionary tendency of universities towards democratic movements of workers, students, patients, and the communities they directly impact underlines this antagonism.        

Alternatives that envision a true public-good basis for the care economy take their cues from imagined and actual collective-making, of the kind that emerges from progressive social movements. Notions of radical collectivity stand in stark contrast to current structures, constrained as they are by a historical state relation responsive solely to the demands of profit. We must interrogate the range of possible justice-based futures for hospitals and universities—futures in which those structures could serve a real public good, shorn of ideological manipulation and material exploitation at the hands of capital.

We may catch glimpses of these future potentials in the solidarity found in mass movements. Only by collective action can we develop and expand still-inchoate models of redistributive living and collective caretaking. From the classrooms to the cubicles and the cafeterias to the community at large, it is by connection with the true public good that we may fashion democratic models of care and provide the services that are inestimably crucial for life and thriving—while foregrounding the imperatives of rights and justice.♦

 

 

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Andy Hines is the author of Outside Literary Studies: Black Criticism and the University (Chicago, 2022) and the editor of a keywords collection on higher education, to be published by Johns Hopkins University Press. He is the Associate Director of the Aydelotte Foundation at Swarthmore College. 

Cover image: Columbia University students protest during student uprisings in 1968.