It doesn’t have to be this way
Crisis in the care economy & the role of the state
by Jess Spear
Article originally published in Issue 2 of Rupture, Ireland’s eco-socialist quarterly, buy the print issue:
Covid brought the dependence of capitalism on the care economy into sharp focus. Nurses, doctors, nursing home staff, pharmacy workers, and cleaners all kept things going during lockdown. Yet, for decades, the state not only refused to invest in public services and raise the wage floor, it propagated the myth of individual responsibility and “the market knows best” while handing over billions in public money to private businesses. Jess Spear discusses the role of the state in undermining care work to the benefit of capital, and how an ecosocialist society, putting people and nature at the heart of production and reproduction, would radically reorganise our lives for the better.
As we read those reports coming out of Italy and Spain in March, hundreds dying every day because of the lack of ventilators, doctors and nurses forced to decide who gets treated and who does not, who lives and who dies, we braced for the worst. We knew we didn’t have enough beds. Trolleys line the hallways and patients die waiting for care.[1] Nearly a million people are on waiting lists.[2] In early 2019, nurses went on strike for the first time in 20 years, and only the second strike in 100 years, for pay, retention, and safe staffing levels. Our health system was already on its knees, underfunded, understaffed, and undermined by successive governments.
The government hesitated before finally implementing a nationwide lockdown. They fitted out the RDS, rented out the private hospitals, and launched a recruitment campaign for healthcare workers to “be on call” for Ireland.
Then another crisis hit. With schools and creches closed, healthcare workers were forced to choose between caring for their children and caring for Covid patients. Nearly two-thirds of nurses were forced to take annual leave to care for their children.[3] Other nurses had to send their children away, or live apart from them out of a hotel for up to eight weeks. After nine weeks of deliberation, the government rolled out a childcare scheme for frontline workers that suited almost no one and was scrapped a week later.[4] Again, this crisis was foreshadowed by headline after headline about the skyrocketing costs of privately provided childcare. Thousands of childcare workers protested just weeks before the pandemic hit, calling for more public funding and better conditions.[5]
In response to a global pandemic, the state is scrambling to bridge the chasms in healthcare, childcare, and education created by decades of underinvestment and a turn towards the private market to deliver. The refusal now to build up the capacity in public services for testing and tracing, for schools and colleges to open safely, and for public transport to maintain service with reduced numbers, is exposing a basic truth about capitalism and the role of the state. Caring for people, whether they be young or old, healthy or sick, comes second. Caring for the market and catering to the needs of business comes first. The longer the pandemic is with us, the more clear this becomes.
Social reproduction
“It is the production and reproduction of that means of production so indispensable to the capitalist: the labourer himself.” Karl Marx, Capital (1867)
While the CEOs and bankers holed up in their mansions, the essential workers kept society going. They transported and stocked the food and toiletries in all the shops, they filled our prescriptions, picked up our rubbish, drove the buses and trains, and took care of the sick and the elderly. Added to this is all the domestic work of cooking, cleaning, shopping for food and other necessities, having and raising children, and taking care of elderly family members that is necessary to maintaining the health of workers and producing a new generation fit for work. This ‘care work’, largely done in the home, usually by women, provides a massive subsidy to capitalist production. Indeed, a 2020 report by Oxfam estimated unpaid care work by women globally amounted to nearly $11 trillion a year.6 Altogether these “processes of social reproduction”, of creating and maintaining life, are vital to capitalism. It cannot profit without it.
However, as social reproduction theorist Nancy Fraser explains, “capitalism’s orientation to unlimited accumulation tends to destabilise the very processes of social reproduction on which it relies,” thereby creating a “crisis tendency.”[7] On the one hand, capitalism relies on care work inside and outside the home to maintain workers, keeping them nourished, healthy, and ready for long hours of labour. It also relies on workers to birth, raise, and educate a new generation of workers “fit” for the workplace. But, on the other hand, it underpays and undervalues this specific work. Capital uses its power in the workplace and economy to suppress wages overall so that workers can barely afford to get by, let alone have the means to fully recharge for another day of mind-numbing, soul-crushing work.
The neoliberal state
The state appears to mediate between the needs of production and social reproduction, between ‘profit-making’ and ‘life-making’, and therefore between the interests of the capitalist class and those of the working class. We workers want to work less, but purposefully and without coercion. We also want to eat nice food, stay fit and healthy, raise happy children, socialise freely, and live in thriving communities embedded in a flourishing, biodiverse environment. Capitalists, on the other hand, seek profit above all else, turning all that we need to live and all that we desire for ourselves into commodities for purchase.
How exactly the state functions in this role depends on what kind of state we’re dealing with. The starting point for most Marxists is Lenin’s conception of the state based on the experience of revolutions and counter-revolutions pre-1917 (see box). And while the character of the state described by this text is relevant today, in particular its non-neutrality, a century more of economic crises and working-class struggle have changed some aspects of it and created others. To understand the role of the state today we need an updated conception.
State & Revolution
In the midst of the Russian Revolution in 1917, Lenin penned a classic short theoretical text on the Marxist theory of the state.[8] In it, he outlines three important lessons generalised from the experience of worker and peasant movements from the 1848 revolution and the 1871 Paris Commune.
Firstly, the state is a historical product, not a result of, or a need arising from, ‘human nature’. Humans have not always needed a state, and we can see from archaeological evidence that our ancestors lived for hundreds of thousands of years without one. Changes in how we lived, how we produced, and how we exchanged over time necessitated it. Marx and Engels specifically point to the enclosing and exploitation of land and resources that were previously held communally.[9] This created classes with “conflicting economic interests” such as “[f]reeman and slave, patrician and plebeian, lord and serf”.[10] (Today, it’s capitalist and worker). The subsequent wealth accumulated by the small minority who seized the land and resources, the competition between them, and the recurrent class conflict created the need for a power to rise above them and ensure order. The state, therefore, is composed of “armed bodies of men” which keep ‘order’ at home as well as violently enforcing the rule of capitalists abroad.
Secondly and most importantly, the state is not neutral. While it presents itself as protecting the ‘national interest’ - for example when the government says “we’re all in this together” in the fight against Covid - it actually acts to protect the general interests of the capitalist class. We can see this in the government’s speeding up the end of lockdown, the subsequent second wave of Covid cases, and then watering down the health advice in an attempt to balance the needs of business with preventing more infections and deaths.
Third, the state must be smashed in order for a socialist society to be established. If the modern state is an instrument honed and developed for the capitalist class to rule, then its armies, bureaucracy, and parliaments must be replaced with instruments that measure up to our needs. The Paris Commune of 1871 and soviets (or workers’ councils) in Russia in 1905 and 1917 were a glimpse of what would be different in a workers’ state: democratically organised, armed workers replacing armies, and elected committees or councils that replace parliaments (where elected representatives were responsible for executing decisions, not just passing laws), and no special compensations for civil servants. All elected officials were to be paid a worker’s wage[11] and could be recalled at any time.
Fraser describes three regimes of social reproduction that correspond to the successive regimes of capital accumulation: ‘liberal competitive capitalism’ during the period of industrial revolution, in which the nascent working class was still forming and could rely on subsistence farming and crafts to live; ‘state-managed capitalism’, where the state sought to mitigate capitalist crises and the working class built powerful trade unions and independent workers’ parties that forced the state to provide free universal health care, parental leave, sick pay and pensions; and finally, ‘globalising financialised capitalism’ where the state’s role in providing public services is curtailed, social reproduction is highly commodified, and mostly women, but also men, labour full time both in the formal economy and at home.[12] The state’s role in social reproduction therefore evolved with the changing needs of capital and through pressure from below.
The state in question today then, and in particular the Irish state, is more than the armed bodies of men and parliaments, it is also a bureaucracy (civil service), a health and education system, ideological institutions (both public and private), and an object and focus of class struggle.[13]
““The state’s role in social reproduction, therefore, evolved with the changing needs of capital and through pressure from below.””
It’s a neoliberal state that acts in the interest of capitalism as always, but now also by facilitating the creation of new markets and new consumers. When it does assist people, it assists them in consuming as a private individual, such as with Housing Assistance Payments to private landlords or grants to buy a new house or an electric car. Rather than investing in public services, public housing, public transport, and public healthcare, the neoliberal state acts to privatise social reproduction. They create markets where they don’t yet exist, for example cities and towns are built around car use, which requires a driver’s licence and purchase of a private car. In creating a legal framework for car use, but not providing public facilities to train and licence drivers, the state helps create consumers and another source of profit and capital accumulation. It costs upwards of €600 just to get a licence to drive in Ireland, not to mention the outrageous insurance fees on top.
Alongside privatising social reproduction, the neoliberal state promotes the idea of personal responsibility. Your success or failure in life is dependent on your choices. The state’s job is to help the market provide various options in education, jobs, housing, food, healthcare and transport. It’s entirely up to you if you avail of it or not; and it’s not the fault of the state or society if you didn’t go to college and get the education needed for a well-paying job. If you can’t afford childcare costs, don’t have kids; if you don’t like your job, go get another one. These ideas trickle down to the rest of society as Marx and Engels said over 150 years ago, “[t]he ideas of the ruling class are in every epoch the ruling ideas…”[14] People blame themselves and hold each other responsible for lack of housing, for not having enough money to feed their family, for not budgeting correctly, for spending too much on avocado toast and not saving enough to buy a house, and so on. This ideology bolsters capital’s ability to keep wages low and frees the state from responsibility to provide public services and regulate exploitative practices.
However, the neoliberal state does not operate in isolation. It’s but one link in a global network of commodity supply chains built over the last 40 years of globalisation. As John Bellamy Foster and Intan Swandi recently wrote, “[s]ince the late twentieth century, capitalist globalization has increasingly adopted the form of interlinked commodity chains controlled by multinational corporations, connecting various production zones, primarily in the Global South, with the apex of world consumption, finance, and accumulation primarily in the Global North.”[15] Ireland’s place within that network invariably affects the state’s economy and subsequently, the specific pressures on it to both support the social reproductive needs of capital (for example, a healthy, educated workforce) while also suppressing and subordinating the needs of workers within that.
The Irish state
Like all countries, the Irish state has its own unique features. The history of violent British settler colonialism, revolution and counterrevolution, national oppression, and partition helped to establish close ties between the Catholic Church and the state. From the beginning of the Free State in 1922, the Catholic Church provided education, health care, and social services. Still, today, as decreasing numbers of people attend mass and more and more voices call for separation of church and state, 90% of primary schools[16] and around 50% of secondary schools are owned and controlled by the Catholic Church, but funded by the state. The same goes for hospitals as well. While the Church owns and controls major public hospitals, the state provides the bulk of the funding.[17] The dominance of the Catholic Church in care work, combined with a relatively weaker workers’ movement compared to other western European countries, meant that the construction of the Irish welfare state was only partial by the standard of the rest of Europe. We never had a National Health Service, for example. Attempts in the late ‘40s and early ‘50s to initiate public health care similar to Britain’s NHS were shot down by the Irish Medical Association and the Catholic Church (see ‘A system in a permanent crisis’).
““The dominance of the Catholic Church in care work, combined with a relatively weaker workers’ movement compared to other western European countries, meant that the construction of the Irish welfare state was only partial by the standard of the rest of Europe.” ”
Additionally, Ireland was relatively poor until the Celtic Tiger in the mid-‘90s to 2008 with the influx of foreign direct investment and the establishment of a tax regime that attracted corporations looking to shield their super-profits. While the tax revenue collected from multinationals as a percentage of total corporate tax revenue is the highest in the world[18], bringing in billions, nonetheless some of the most profitable firms pay far below the measly 12.5% headline rate.[19] As a tax haven for capital, the Irish state is culpable in depriving not only its own people of the revenues needed to fund a robust welfare state/adequate standard of social reproduction but also the impoverished billions in the developing world who lose out on $100 billion[20] of tax revenue because of tax havens like Ireland.
Therefore, the starting point for the Irish state’s neoliberal turn and what kind of role it plays in social reproduction is different from states such as Britain, France, and Germany which developed their economies and indigenous industries through imperialist plunder and were forced to provide more robust social welfare programmes by their workers. Wedded to foreign direct investment for economic growth and limited welfare programmes slashed by austerity in the last decade, the neoliberal Irish state is between a rock and a hard place in its response to Covid.
The state and Covid
The decades of underinvestment in public services, and in particular our health service and public housing, meant that when the pandemic hit, we had no reserves at all in our care economy - no capacity to spread out in classrooms, no extra ICU beds, not enough rooms in crowded homes, no space in Direct Provision centres - already housing multiple people in one room - and not enough buses to safely transport workers. The gutting of public services and housing didn’t change the need for them, it just opened up a market for private companies to profit from those who could pay. All those who can’t afford it are relegated to longer and longer waiting lists, and society as a whole is left unprepared to mitigate the impact of a pandemic such as Covid.
Those most at risk to the virus were left particularly vulnerable. The provision of nursing homecare and home care services left almost entirely in private hands has been a disaster. Out of the 1,735 total deaths in the first wave, over half (967) were in nursing homes. Low staff to patient ratios, not enough PPE, lack of sick pay for workers, precarious agency workers shuttling between several different homes and sharing cramped accommodation, and insufficient coordination between public and private providers combined to put our most vulnerable in harm’s way.[21] It’s important to underscore how private nursing homes and homecare companies rely overwhelmingly on migrant men and women, who are vulnerable to poor pay and working conditions, and forced into living conditions which are conducive to spreading the virus.[22]
When the government announced a lockdown in early March, the state was forced to toss out its neoliberal rules and give people money to buy food and other necessities, otherwise, people would be compelled to go out to work and risk their health and lives. It had to ban evictions and rent increases and freeze mortgage payments.
But these measures come at a political cost. Very quickly, the idea that the state couldn’t do these things in the months previously was exposed as bare naked ideology, not anything to do with the Constitution or resources. If the state could borrow billions to pay people to stay home, why could it not borrow that money to build public housing to solve the housing crisis? Why could it not invest long term in a national health service, universal free childcare, hire more teachers, nurses, and doctors on better pay and conditions?
So the government was forced to backtrack from “we’re all in this together” to “individual responsibility”. And very quickly the idea that people were “a hell of a lot better off”[23] (said by Galway Fianna Fáil TD Ann Rabbitte) on the Pandemic Unemployment Payment was spread. Some workers didn’t deserve it because they were on less wages to start with, apparently. To maintain the meritocracy myth, the state has now introduced three different levels of support based on what you earned before the pandemic hit. The hierarchy of self-worth based on what you bring home must go on, even during a pandemic. And largely this reframing has worked to help offload some of the blame from the state to individuals, as indicated by a recent survey showing “70% of respondents said that people who tested positive for the virus had been “reckless or careless”.[24]
After six months of lockdown, phased reopening, and now a plan to “live with Covid”, the state has begun to prioritise the needs of business and capital more and more, while also fumbling to keep control over the situation. This is epitomised by how, under pressure from business, the state reopened the economy faster than planned; and, how it imposed a lockdown in County Kildare after an outbreak at local meat plants - but left the meat plants open. When questioned months earlier in the Dáil about the potential for meat plants to cause an outbreak, the minister for Agriculture claimed RISE TD Paul Murphy was using a “smear tactic”. Meanwhile, we still don’t have the testing and tracing capacity needed to identify the source of infections and stop it spreading. We still don’t have enough hospital beds, nurses, doctors, support staff, as well as the additional teachers, SNAs, and childcare workers needed to safely work and live with Covid.
““The government would rather risk our lives than risk a movement demanding the state play a greater role in social reproduction.””
With the reduction in unemployment supports, refusal to invest in public healthcare and education, nor transport and childcare, it’s clear that under the current regime we’re going to be forced to live with uncertainty and risk for some time to come. Rather than take measures to proactively suppress the virus and move to a Zero Covid response that would see community transmission eradicated entirely on the island, the state’s plan is reactive, attempting to mitigate the virus’s impact as the economy ramps back up. It’s implacably unwilling to set a precedent and raise expectations of its role in providing public services and housing for workers and families. It would rather risk our lives than risk a movement demanding the state play a greater role in social reproduction.
Months and months of inconsistency, with some businesses allowed to open while individuals navigate varying levels of restrictions, have left people exhausted and concerned that we won’t be able to “return to normal.” Fears that this might go on indefinitely are rising and fanning the flames of far-right groups who openly flout covid restrictions and are recruiting amongst working-class people who rightfully distrust the government. It’s vital that the left explain how things could be fundamentally different.
How could it be different?
A glimpse of what could be done if the state worked in the interests of workers, not capitalists, was seen in some of the measures the state enacted, but then quickly rolled back. Socialists call for unwinding the privatisation of public services, fully investing in a national health service, and building zero-carbon public housing on public land alongside public transport, community creches, schools, and shops. That means rather than paying the private hospitals for additional capacity whenever there’s an outbreak, we take them into public ownership and integrate the beds, staff, nurses, and doctors into the public system. The same goes for nursing and homecare facilities, childcare centres, and public transport. Instead of CEOs and corporate boards making the decisions, weighing up their profits over our lives, workers and communities together could democratically plan what’s needed, where, when, and how.
But this points to an entirely different state, one that sees the ‘processes of social reproduction’, instead of being separate from, subordinate to, and in antagonism with the production of commodities, brought to the heart of how society and production are organised. Such a socialist state would bring all its resources to bear in addressing the crises unleashed by capitalist exploitation and oppression, from the pandemic to climate change. No longer would we have production for production’s sake, planned obsolescence, and the anarchy of the capitalist market determining what kind of lives we live and for what purpose we labour. An ecosocialist society would democratically plan for our present and our future, unshackling us from the ideology of individualism and separation from nature, and eroding over time the foundations necessitating a state.
Notes
1. https://www.irishtimes.com/news/crime-and-law/man-found-dead-in-hospital-a-e-waiting-area-inquest-told-1.4083082
2. https://www.rte.ie/news/health/2019/0921/1077331-consultants/
3. https://www.irishexaminer.com/news/arid-31006868.html
4. https://www.irishtimes.com/news/ireland/irish-news/government-must-rethink-frontline-childcare-scheme-inmo-says-1.4253191
5. https://www.thejournal.ie/childcare-protest-today-4992751-Feb2020/
6. https://www.oxfam.org/en/not-all-gaps-are-created-equal-true-value-care-work
7. Nancy Fraser, ““Crisis of Care? On the Social-Reproductive Contradictions of Contemporary Capitalism,” in Social Reproduction Theory: Remapping Class, Recentering Oppression, ed. Tithi Bhattacharya (London: Pluto Press, 2017).
8. https://www.marxists.org/archive/lenin/works/1917/staterev/
9. Or rather private property rights. See https://www.marxists.org/archive/marx/works/1857/precapitalist/ch01.htm
10. https://www.marxists.org/archive/marx/works/1848/communist-manifesto/
11. For example, most socialist representatives, including RISE TD Paul Murphy, take a worker’s wage, donating the rest of the salary and benefits to community campaigns and socialist projects.
12. Nancy Fraser, ““Crisis of Care? On the Social-Reproductive Contradictions of Contemporary Capitalism,” in Social Reproduction Theory: Remapping Class, Recentering Oppression, ed. Tithi Bhattacharya (London: Pluto Press, 2017).
13. Marxists have been debating “what is the state?” for decades and much more could be said on this. We aim to approach other aspects of the state not touched on here in future articles.
14. https://www.marxists.org/archive/marx/works/1845/german-ideology/ch01b.htm
15. https://monthlyreview.org/2020/06/01/covid-19-and-catastrophe-capitalism/
16. https://www.irishtimes.com/news/education/more-than-100-catholic-primary-schools-have-closed-over-past-decade-1.3831812
17. For example, in 2015, nearly €1.5bn in HSE grants (over 10% of total HSE funding) went to religious organisations.
18. https://www.rte.ie/news/business/2020/0708/1152016-new-oecd-tax-data/
19. https://fora.ie/effective-tax-rate-ireland-3622827-Sep2017/
20. https://www.oxfamireland.org/blog/hard-swallow-how-ireland-could-do-more-tackle-corporate-tax-avoidance
21. https://data.oireachtas.ie/ie/oireachtas/committee/dail/33/special_committee_on_covid_19_response/reports/2020/2020-07-31_interim-report-on-covid-19-in-nursing-homes_en.pdf
22. https://www.mrci.ie/app/uploads/2020/01/Migrant-Workers-in-the-Home-Care-Sector-Preparing-for-the-Elder-Boom-in-Ireland.pdf
23. https://www.galwaydaily.com/news/200000-people-a-hell-of-a-lot-better-off-with-covid-payments-says-galway-td/
24. https://www.rte.ie/news/coronavirus/2020/0814/1159162-coronavirus-testing/