The difficulty in conceptualizing health and social care resides in its complex and dialectical character: its constitutive social relations are not reducible to a single logic or type of actor; it is both a descriptive and a normative idea, a tool of classification and evaluation, a means of analysis and a weapon of critique. It is both theoretical and practical, a scientific construct and an ethical stance, rooted both in academic disciplines and the manifold practices of health and social care. This article draws out the radical core of the concept of care as a dialogical form of labor that transcends mere instrumental or strategic action; it then explores the contradictions of this praxis in the context of the social division of care in late capitalism. The concept of careHealth and social care have become a massive set of service, financial, and manufacturing industries shared between the public, private, not-for-profit, and informal sectors. The manufacturing side of health and social care (construction, pharmaceutical products, surgical, diagnostic, and other equipment) is dominated by flourishing capitalist firms selling to the huge, welcoming markets constituted, regulated, or subsidized by states. The financial landscape of health and social care is peopled by a mix of public bodies, private, cooperative, and mutual assurers, as well as individuals paying out of pocket. Health and social care "services" are parceled out in various ways, depending on the country, between public agencies, private firms, cooperatives, charitable and non-profit associations, families, neighbors, and friends.
Why do so many people remain so passive in the face of today’s massive, looming economic, political, and ecological crises, such as climate change? Despite some notable rhetorical and regulatory examples, attempts to stem climate change have, as a rule, not come to frame the activities of most citizens. The inability to confront the imperative of social transformation today is a complex, manifold problem. At root, it has to do with fundamental systemic features of a global social system that we all contribute to reproducing in our everyday lives. While these features do not preclude political engagement, innovation, and action, they do undermine the bases of movements towards truly systemic transformation. This article focuses on one such feature, reification, as a social-structural foundation of passivity that impedes the social innovations required to tackle the climate crisis.
Capitalist development reduces the social labor time necessary for the reproduction of labor power, creating a vast amount of disposable time, but harnesses it as surplus labor. In an alternative political economy of time, capitalist "production of wealth" would be replaced by the postcapitalist "wealth of production." Marx famously saw the "true realm of freedom" as arising beyond that of "necessity," i.e., beyond humans' interaction with nature. He thus distinguished between forms of activity that produce means of production and consumption, and those that are ends in themselves. But what of those forms of activity that are both means and ends? An example is the work of care, a form of activity not explored by Marx. Consideration of disposable time and care suggests that true freedom may not so much blossom beyond the realm of necessity, but instead involve an expansion and complexifi cation of the human relationship with and within nature. T HE POWER OF MARX'S WORK resides in the inextricable bond between his analysis of capital and his vision of its supersession: in fostering the enormous development of productive forces, capitalism gives rise to the potentiality of "disposable time" for all, which is the only possible ground for human freedom. Yet, capitalism thwarts the latter by recycling freed-up time into the everexpanding accumulation of capital. True freedom, for Marx, can only be achieved beyond capitalism. It means not only putting the producers in charge of the production and circulation of goods, but also rethinking and reshaping the productive forces themselves and, thus, the relationships among human beings, nature, and time. This * This article is dedicated to the memory of Bill Livant. Many thanks to Michelle Weinroth for her invaluable comments on various drafts of this paper.
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