The pandemic strained American lives. It forced families to educate their own children, cook meals at home and care for their elderly family members. Businesses shuttered. People lost their jobs. Hospitals ran staff shortages. The pandemic brought forth how dependent we are on each other and how helpless we are without the support.
Who gets cared for? Who provides care? Premilla Nadasen, activist, historian and associate professor at Barnard College, wants us to keep these questions in mind while reading her book “Care: The Highest Stage of Capitalism.”
In a traditional strict economic sense, work done to sustain the lives of others has been seen solely as a means to maintain the labor force. Today, private industry, with the help of government, has transformed the concept of care into one of the most profitable industries in itself, writes Nadasen.
Instead of thinking about these jobs as “caregiving” or referring to “the care economy,” Nadasen prefers the term “social reproduction,” because it offers a broader definition, including work like preparing food, cleaning buildings and transporting goods — any work that sustains human life.
In her book, Nadasen traces a history of social reproduction from the end of slavery through more than a century of government welfare policies to current tax codes, dependence on the two-income family and the colossal rise of the care industry.
The book’s title is a play on Vladimir Lenin’s “Imperialism: The Highest Stage of Capitalism,” in which Lenin argues, in part, that competitive markets become monopolistic and exploit labor in underdeveloped countries while workers at home live in fear of unemployment.
Nadasen posits that market and government forces have used race, gender, immigration status and economic class to exploit labor in the care industry, camouflaging work in the name of love. The financialization of social reproduction has led to exploitation of laborers and those requiring labor. She asserts this economic paradigm is not a failure of neoliberalism but of capitalism. Nadasen both praises and criticizes government programs and initiatives. According to her, these dehumanizing results are a result of profit-seeking.
“The sick, elderly, disabled and poor people, parents and guardians, children without guardians, housing- and food-insecure people — all have become potential sources of profit,” Nadasen writes.
An industrial powerhouse World War II, an aging workforce, dwindling birth rate, higher living and housing costs, and increased prison populations shifted U.S. economic production inward. While only 8% of Americans work in manufacturing, 28% work in social reproduction. Four out of the 10 largest companies in the U.S. in terms of revenue are in the health care and pharmaceutical industries.
In 2019, the federal government spent $1.2 trillion on health care — more than the $732 billion it spent on defense that year. Total U.S. spending on care, including by state governments, businesses and households, reached $3.8 trillion in that year. Total health care spending in 2022 increased to $4.1 trillion.
A family earning $50,000 a year with employer-backed insurance will spend 10% of that, or $5,000, on healthcare. About 100 million Americans, or 40% of the population, have medical debt, which is the primary cause of personal bankruptcy in the country. At the same time, health care alone contributes 18% of the country’s gross domestic product. The U.S. Bureau of Labor Statistics forecasts the health care industry to grow faster than any other over the next 10 years.
In America, Black people have always worked in and cared for white households at the expense of their own. African American women comprised the largest number of domestic workers in the country until the 1970s, despite being a sliver of the population. This domestic work was so valuable that in the early 1900s, Georgia passed a law forcing Black women parolees to work as domestic workers to serve out their time.
Domestic workers have been expected to tend to their employer’s every need while earning meager wages, often in degrading conditions. Employers have even conflated paid and unpaid labor and presumed domestic workers are laboring out of love for the family, while often treating them second-class or worse, Nadasen writes.
Carolyn Reed, an African American labor organizer in New York in the 1970s and former domestic worker, wrote:
“One night, the woman of the house — who had been having an affair and was very, very nervous — began to scream at me for not having done something she thought I should have done. … As she screamed, I realized I wasn’t real to her. I mean, I wasn’t a person to her, maybe even a slave.”
Since President Franklin Roosevelt’s New Deal, which excluded domestic workers from receiving minimum wage, federal and state legislation has been slow to acknowledge the rights of social reproduction workers, primarily Black and Brown women. Some states even took action to protect their pool of de facto forced labor. In 1943, Louisiana legislators denied Black women government assistance during cotton-picking season.
While decades of activism brought gradual protections, government benefits such as cash allowances and food stamps were stripped and tied to work requirements that many could not and cannot fulfill. For example, Mississippi has the highest level of poverty in the country and the least amount of people on welfare.
“Since the 1970s, there has been a systematic dismantling of programs serving poor people and a shift away from direct government economic assistance. The welfare state has been replaced by the carceral state, which has both exacerbated the care crisis and created new opportunities for growth in the care economy,” Nadasen writes.
According to Nadasen’s research, “most care policies are premised on assumptions of whiteness, full employment and ample economic resources.” That leaves out a large part of the population, as solutions instead “rely on the market economy or are geared toward people who can outsource care and take advantage of tax credits.”
In a heteronormative, nuclear white U.S. family, the wife tended to the children while the husband worked a formal job and brought home a paycheck. The value of domestic work was tied up in the husband’s paycheck, Nadasen writes. Then, families with dual incomes rose to 60% of the population in 2012, compared to 25% in 1960. With women in the workforce, the care that was previously subsidized by the husband’s work now needed filling.
Federal and state governments have shifted away from providing direct financial aid, to instead channel funds and outsource the work to nonprofits and private companies. The government’s retreat from providing services has been “vital to the growth of the care economy, creating jobs and sustaining a faltering economy, although little of this money has benefited the poor directly,” Nadasen writes.
She praises select nonprofits but questions the value of those whose employees earn white-collar salaries, which some companies use to offload goods for tax purposes. Sometimes, nonprofits engaged in providing food often hand out donated products that people do not need, like candy or nearly expired goods. Shifting government benefits from direct financial support to nonprofits is another way of saying “poor people don’t know how to manage their money,” Nadasen writes.
Nadasen uses the term “radical care” to call for an abolition of the state’s and private companies’ grip on social reproduction, but she recognizes practical limitations of operating without them. “We need to be strategic about which programs are worth keeping and which ones are not. The answer may change over time, location and people’s changing needs,” Nadasen writes.
While radical care aims to abolish or circumvent profit-seeking, some state programs or private industries may have to exist for practical reasons, she writes. For example, would taking profit out of the pharmaceutical industry require a government agency to produce medications? Some community-run programs, like a daycare center in a neighbor’s house, could bypass government interference and control, but in other circumstances, government assistance is the only lifeline people have.
Temporary Assistance for Needy Families, better known by its acronym TANF, stigmatizes, disciplines and surveils its beneficiaries but also provides assistance.
Fulfilling our collective needs will necessitate work and pit radical collectivism against a vision of individual freedom, Nadasen writes.
Caring for others is human. The reason why we help our disabled friend, care for our elderly parents and offer assistance to those in need “is a building block for a different kind of society, gesturing to an abolitionist future in which care is not defined by capitalist profit-making or racial and gendered norms but by an equally distributed commitment to the well-being of others.”
Nadasen’s book wants us to imagine what if our loved ones were not for sale.
Read more of the March 6–12, 2024 issue.