Barnard College professor Premilla Nadasen’s latest book, CARE, zeroes in on one of the most salient ways that inequity is perpetuated in the United States, that is, “how care for some people is built on the backs of other, more vulnerable people.”

It’s an obvious point, but by focusing on “social reproduction,” the paid and unpaid work that supports and maintains the continuity of life — from pregnancy care, to childcare, to elder care — she illustrates the way this works and slams the unprecedented profits that have been made by agencies that send workers into our homes to clean, cook and attend to our kin. 

Companies like CARE.com come in for a particular drubbing. Their work, she writes, takes advantage of desperation and is built on a racist and sexist foundation. In fact, the undervaluing of the largely immigrant women who provide care has had dire consequences for them and their communities, often resulting in poverty and family separation. Worse, workplace abuse is endemic.   

But, Nadasen continues, there is recourse, sort of, thanks to welfare programs that are supposed to serve as financial back-up when times get tough. Nadasen defines welfare — direct, albeit meager, monetary allocations through the time-limited Temporary Assistance for Needy Families program; the Supplemental Nutrition Assistance Program, SNAP, better known as food stamps; Medicaid and Supplemental Security Income, SSI, for low-income people who are too incapacitated to work — as a supposed safety net. While these programs are meant to allay destitution, they punish the poor through burdensome certification demands and provide more revenue to administrative entities than to those who are scrambling to make ends meet.

Nadasen’s description of this and her rage over it are heartfelt. What’s more, her reporting on the valiant efforts of welfare recipients, low-wage workers and progressive activists to demand adequate public benefits, or better, a guaranteed annual income, increased wages and policies that address and punish workplace exploitation is inspiring. Nonetheless, it’s clear that these efforts have fallen short of their aims. 

Nadasen posits the blame for this squarely on our economic system. “The care economy and extraction of profit from social reproduction are not products of neoliberalism but of capitalism,” she writes. “Even the liberal welfare state of the mid-twentieth century — which is celebrated for its support for social reproduction — further institutionalized hierarchy and inequality.” It did this, she explains, by strengthening the symbiotic relationship between care provision and the market. As she writes, “Families must turn care work over to the market and enter the formal labor force in order to keep the economy healthy.”

But what choice do we have? 

While numerous care-collective and mutual-aid groups formed during the COVID-19 shutdowns, it seems naive to think that voluntary efforts can meet the growing needs of the country’s aging population. Nadasen understands this. Nonetheless, she is leery of government. “The state and the market have always been intertwined,” she writes. “The state has always been implicated in extracting profit from social reproduction and a care agenda is increasingly being embraced by the private for-profit sector with cooperation of government officials.” 

True, and while I agree that the idea of making a profit over something as essential as personal care is repugnant, the need is far bigger than our ability to meet it as individuals or communities. Instead, it requires a broad-based national strategy.

Nadasen concedes as much, writing that “we cannot reject all forms of governance.”

Nor should we.

Nadasen and I are both cheered by the emergence of resistance movements and grassroots demands for affordable and available support, whether for a new baby or for a family elder who is suffering from a physical or mental infirmity. Where we disagree is over the role of government in providing it.

Perhaps I’m deluded, but I think it’s possible for robust publicly-funded programs to flourish apart from the market. I know that this is a long shot, and will require a shift in priorities from financial gain for the few to care for the many.  Still, letting government off the hook seems like a cop out and I, for one, am ready to go into the halls of Congress and loudly demand full funding for cradle-to-grave care. Want to join me there? 

CARE: The Highest Stage of Capitalism
Premilla Nadasen
Haymarket Books, 272 pages
Release date: October 2, 2023

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