Since the Hu-wen era, the hukou system, along with the related social welfare and public service systems, have undergone substantial reform, to restore some level of redistributive justice (Howell & Duckett, 2019). Yet by no means does this mean that hukou as a mode of differentiation for migrant workers has entirely vanished. This becomes clear when we look closer at how the reform unfolds: in rural areas, universal social welfare and public service provision system is established; in small cities, ruralto-urban hukou transfer becomes easier, meaning rural migrants now can enjoy equal social and civil rights—for example, the right to work and live in urban areas—with urban locals; in megacities like Shenzhen, conditions for hukou transfer remain prohibitively high for migrant workers, but they can now access local social welfare scheme through individual or employer contribution, which in turn give them access to public education and healthcare services, although benefits are marginal and education and healthcare are of low quality compared to urban locals. Additionally, private capital is encouraged to provide these services through the market. Hence, despite the reform, the hukou system remains a relevant mode of differentiation, but the reform has produced a change in the specific mechanism of differentiation, from citizenship-based differentiation to differentiation based on a mix of citizenship status and class status, reflected in growing importance of one’s market capacity in accessing quality education, healthcare and housing services.
For many of my interviewees, the reform indeed provided baseline protection. Yet it failed to relieve them from the heaviest of burdens, namely, health and education. Instead, as the hukou system is increasingly mixed with a class system in cities, pressures to provide for the family are intensified. The situation is further complicated by the various problems within the medical insurance system, especially corruption, the uneven distribution of medical resources and local protectionism. This intensified pressure drove them to excessive overwork, however flexible and free the employment relation is.
Laotang was a case in point. He worked for 14 hours a day, because otherwise he wouldn’t be able to afford his father Tangba’s medical bill. Tangba spent his life as a construction worker, an industry notorious for informal contracting (Swider, 2015). As a result, he had long suffered from hypertension and severe low back pain and was further diagnosed with lung cancer in 2016. Without a formal contract, Tangba was not covered by any protection schemes until joining the New Cooperative Medical Scheme (NCMS) in 2015. After receiving two surgeries in 2017, Laotang’s pressure became all the more intensive. And NCMS was not meaningfully helpful, because of the limited benefits it provides and because doctor earnings are linked to medication fees:
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