From a leading public health expert and physician, and in the style of Studs Terkel's Working , comes an eye-opening look at what it’s like to have to work physically hard for your money in America . . . A Living is a vivid portrait of the working lives of the patients who visit Dr. Michael Stein, a primary care doctor in urban America. What makes his patients unique is that they, by and large, do demanding manual labor. Very few have the luxury of working remotely, or seated. Inspired by Studs Terkel’s classic Working , Stein produces an eye-opening look at what it’s like to have to work long hours at physical jobs for a paycheck in America. A Living is composed of vignettes, snap shots of people’s working lives, the dramas, disappointments and frustrations workers have with their colleagues, family co-workers, and supervisors. And yet it also captures the sense of accomplishment and satisfaction, the opportunities for initiative and self-expression that come from doing intricate work with one’s hands. Work gives Stein’s patients a sense of identity and a social environment to thrive in. Ultimately, A Living is an extraordinarily powerful and poetic tableaux of working-class America at this moment when manual labor may be the final refuge in the new era of AI. Praise for A Living : "A little bit Orwell, Terkel, Ehrenreich, and very much America right now. Read it and you'll understand your country better." --Bill McKibben, author of The End of Nature “For me, reading this book was like sitting in an old union hall filled with voices speaking in a wide range of tones - stoical and aggrieved, resigned and determined, angry and poignant. This is an important book for our times. I wish every member of Congress would read it.” -- Tracy Kidder, Pulitzer Prize winning author of The Soul of a New Machine "Stein wisely comments on the weariness that so many workers experience. An eye-opening and empathetic look at the lives and plights of workers in contemporary America." -- Booklist " Michael D. Stein’s A Living: Working-Class Americans Talk to Their Doctor affirms the dignity of work while refusing to reduce workers to transactions." -- PopMatters ". . .revealing." -- Publishers Weekly "William Carlos Williams said that as a primary care physician, ‘every sort of individual that it is possible to imagine in some phase of his development, from the highest to the lowest, at some time exhibited himself to me. I am sure I have seen them all’. Freud said that to sustain our humanity we need love, but also work. Michael Stein has proven the truth of both sayings . Though Stein is candid about the inequality and injustice of the world of labor, A Living is a generous, gracious and ultimately hopeful book about the reality of life and work in America today." -- Gavin Francis, author of Recovery: The Lost Art of Convalescence Praise for Previous Work: "No other writer has captured the essential truths about illness with as much clarity.” -- Annie Dillard "Michael Stein has written a brilliant and important book. His view of health takes a wider lens that includes poverty, social support, and environment to look at factors that drive the need for health care. Me vs. Us should be required reading for anyone trying to understand how a nation that spends so much on health care fails to deliver on health." -- Tom Insel , MD, author of Healing: Our Path from Mental Illness to Mental Health and former Director, National Institute of Mental Health "Stein offers a critically important approach for creating a new partnership between the health care and public health systems. This is a daring and original work for our divided times." -- Bapu Jena , MD, PhD, economist and physician at Harvard University and host of Freakonomics , MD MICHAEL STEIN, MD, is a physician and health policy researcher. He currently serves as the Chair and Professor of Health Law, Policy & Management at the Boston University School of Public Health. Prior to his appointment at Boston University, he served as Professor of Medicine and Director of the Behavioral Medicine and Addiction Research at Brown University. He has published 13 books and over 400 scientific journal articles, as well as essays and columns in The Washington Post, The Boston Globe, The New York Times, and elsewhere. INTRODUCTION Because I am a primary care doctor in a mid-sized industrial city in the northeastern United States where small manufacturing still exists (although the unions and the mills and factories where my patients’ parents worked have mostly disappeared), I often see people who work with their hands. My patients are the frontline workers who remain hidden from top-income Americans; they live in neighborhoods I don’t know. Few of my patients are in the nation’s highest income strata. In 2019, the year before COVID-19 arrived, 62 percent of people in the top quarter of American income were able to work remotely, as