health care
Dear friends,
I've been reflecting on some often theorised yet under-discussed elements of capitalism, which I believe warrant further discussion. Parasitism, or privatisation, is a vampiric process which has driven a great deal of expansionism and exploitation[1]. It also draws wealth from the proletariat, and concentrates it in the bourgeoisie. Working class people, through taxes, payments for goods and services, and other forms of revenue generation, subsidise private corporations who extract 'surplus' from the revenue stream, this repeats all the way down. In some spaces, this exploitation is particularly obvious, and multiplies layers of extraction and wealth skimming. Surplus value that was once retained in the public sector (and theoretically benefiting society collectively) is now extracted as private profit. Joy.
Over time we see this process expanding, subsuming public moneys into bourgeoisie wealth. This creates a contradiction where taxpayers pay more for the same service because we are now funding both the actual work and the profit margins of the private company[2]. Meanwhile, these workers experience more immiseration as conditions worsen despite their labour remaining equally productive and costing more. The broader pattern, where this underpaid worker experiences a chain of privatised services throughout their own life, illustrates how working class folks become trapped in a web of capitalist relations (and we'll look at an example of this in the context of disability services below). We are exploited as workers, then exploited again as consumers of privatised utilities, healthcare, transport, and so on. Each privatised service extracts profit while delivering what were once public goods – yet the same service is delivered – often for less pay for the worker.
We have seen that capitalism holds a strong tendency to expand into all spheres of social life, transforming public goods into commodities and creating new avenues for surplus value extraction. Concentrating vast wealth amongst the wealthy. The state facilitates this process by transferring publicly-owned assets and services to private capital, subsidising capital accumulation with public resources while workers bear the costs through reduced wages and higher prices for essential services. And have you met Woolworths and Coles?
Continuing in this same examination, this morning some news about vital public services flashed briefly across a fast moving news live blog. I'm intrigued by this format for the news, too, where counter-hegemonic observers actually stand a chance at critical analysis because the live blog is not subject to as much editorial and political review as regular articles (thereby exposing casual observers to a more realistic feed of politics).
This post about public service design also had me questioning the propagandist rubbish that the Labor party progress as "good government". The NDIS is a terribly managed service which exemplifies the behaviours above we just discussed the extreme[3]. Parasitic companies skim wealth out of the NDIS and provide subpar or underdeliver promised services to already exploited people with a disability. We see the capitalist state prioritising profit, again, over supporting social reproduction. Yet the Labor government wonders why no one is having babies... But let's spend a moment analysing the supposed overspend of the NDIS in the way the propagandists have advanced it. Taking a step back, we should have a look at the word from the horses mouth[4].
Grattan has spent more time evaluating how to reform Australia's National Disability Insurance Scheme (NDIS). Reportedly, the scheme has become financially unsustainable and has failed to deliver "optimal" outcomes for people with a disability. The NDIS, introduced in 2013, provides individualised funding packages to people with permanent disabilities. Because of systematic mismanagement and large scale privatisation (oops am I editorialising myself?) costs have skyrocketed from around $2.4 billion to over $41 billion annually, growing at roughly 24% per year. Their report proposes a "rebalancing" of the system by creating stronger "foundational supports" (general disability services available to all people) while making individualised funding "more targeted" (harder to attain) for those with the "most severe needs". They argue this can be achieved by redirecting existing NDIS funds rather than requiring new government spending - essentially moving about 10% of current individualised payments into commissioned services(!!!).
The report reveals the contradictions in the "support" of social reproduction under capitalism through market mechanisms. The NDIS was designed as a market where people act as consumers purchasing services with government-allocated budgets. However, this commodification of care has created exactly the problems we expect in unchecked market capitalism: inefficiency, inequality, and unsustainable cost growth as private providers extract extreme "surplus" value while people with a disability navigate a complex marketplace[5]. Grattan's "rebalancing" could be a partial recognition that market-based individual consumption cannot efficiently organise social care. Jackpot? Not by a long shot. Their answer, moving toward commissioned services and reducing reliance on individualised purchasing, could move toward socialised provision, except we're dealing with a Labor government. The fundamental issue remains: disability support is still conceived as a cost to be managed rather than a collective social responsibility, with the reforms primarily motivated by fiscal sustainability rather than human need.
The institute places emphasis on "foundational supports" essentially acknowledging that "the market" cannot, will not, and could never provide the basic infrastructure of care that people require[6]. Yet the solution remains trapped within neoliberal logic. They seek to reorganise service delivery to be more cost-effective rather than questioning why our obligation to support people with a disability should be subject to budget constraints at all – or even conceived as a cost in the first place. The report's proposed success is that reforms could be achieved "without spending more money" this shows the fundamental ideological limitation: improved care is only acceptable if it doesn't threaten capital accumulation elsewhere in the economy. And certainly, under these same broken logics, reform is not appropriate if it affects private provider wealth skimming.
Labor's panic over the NDIS growing "too big" is a manufactured crisis to distract from the fundamental wealth redirection from public to private. Under capitalism, care for people with a disability is treated as a cost to be minimised rather than a social necessity[7]. The framing of disability support as an unsustainable financial burden shows both capital's logic, and the inhumanity of the Labor party: only labour that produces surplus value is valued, while the costs of maintaining those who cannot be fully exploited for profit are seen as drains on accumulation. Neoliberal capitalism has systematically defunded universal public services where they existed. Research here shows that market mechanisms and commodification only entrench disadvantages faced by people with a disability[8]. The push of the 1970s and 80s towards socialising care, support, and other vital social reproduction services is long gone, and Labor has long been twisted by greed and exploitation and forgotten their working class roots. What we see now is artificial scarcity, and not just in the NDIS, people are forced to compete for individualised underfunded packages, purchase private health care, or languish in underfunded emergency care services because collective, comprehensive support systems have been dismantled. This has happened under Labor and Liberal leadership. And this only serves capital's interests by keeping support costs highly visible and therefore "contestable" – the source of panic in propaganda, rather than embedded in universal, collective, social infrastructure.
This is a key part of capitalism's contradictory relationship with social reproduction[9]. Capital needs a healthy, educated workforce, but doesn't want to pay for maintaining those who may not be able to contribute as much (even temporarily) to surplus value extraction. The NDIS individualises what should be collective social responsibility, making each person's needs appear as separate cost items rather than part of society's obligation to care for all members. Importantly, though, it is maintained in this way because it funds another parasitic industry – providers and service coordinators who exploit all in their care and employment. Deserving and important people coordinate care, provide care, and seek care. All these people offer great value to society, and yet are depicted in media and discourse as a drain. This is exemplary of capital's consistent dehumanisation and the stripping of human values from civil society (in Gramscian terms). The proposed "foundational supports" will move toward ever more more "means-tested", residual welfare - providing minimal support while maintaining the pressure on individuals to prove their worthiness for assistance. This keeps the focus on managing costs rather than addressing the systemic exclusion that capitalism breeds.
Ultimately, this reflects capitalism's fundamental inability to adequately provide for human needs that don't generate profit. Let's not even get started on housing, real estate companies, and tenancy authorities – parasitic rent seekers. Deep breaths, folks.
Rather than "managing" disability through state bureaucracy and boundless layers of private rent seekers, an indigenist approach could centre our concepts of collective responsibility and kinship [10]. Care might then be organised through community collectives based on Country and recognising that colonial capitalist structures created many disabling conditions through dispossession, cultural destruction, and environmental degradation. Disability support would be understood as a healing of collective trauma while recognising the validity of may diverse ways of being, contributing, and behaving. No more would we need to medicalise and pathologise difference. Alongside this, a Marxist transformation could eliminate the entire market apparatus. No more purchasing services, provider profits, or competitive tendering. Instead, we might see care organised as freely associated labour where communities directly organise to meet each other's needs[11]. People with a disability wouldn't be consumers or clients but participants in democratic planning of support systems. Care workers would be community members rather than employees, with work organised around social need not profit extraction. Resources could then flow based on principles of reciprocity, relationship and (feminist) ethics of care, recognising how racism, sexism, transphobia, and ableism intersect[12]. Rather than individual assessments and budgets, communities might collectively determine support based on relationships and protocols. Queer and trans disabled people, disabled women of colour, and Indigenous disabled peoples would have their experiences centred in how care is organised, moving beyond normative assumptions embedded in current systems. These normative assumptions would be dismantled – not centring (manual) labour in conceptions of wellness.
Our goal should not be "independence" or fuller economic participation. We should strive toward social conditions where all bodies and minds can flourish. Work itself should be transformed: shorter hours, meaningful activity, accommodation as default rather than exception. Technology would be developed cooperatively to enhance autonomy rather than increase surveillance. The artificial separation between "disabled" and "non-disabled" would dissolve as society reorganises around collective interdependence rather than individual productivity[13]. We should also draw on indigenist approaches which recognise disability as part of natural human diversity while also addressing how environmental destruction creates disabling conditions. Care should be integrated with restoration of Country, sustainable food systems, and healing damaged relationships. Away from anthropocentric capitalism towards connecting personal healing and healing Country.
Just a casual restructuring of society. And you know what? The only barriers are human: greed and hate.
Brain and body work,
Aidan
- https://doi.org/10.1177/0308518X16689085 ↩︎
- https://doi.org/10.4324/9780203119600 ↩︎
- https://theconversation.com/understanding-the-ndis-the-challenges-disability-service-providers-face-in-a-market-based-system-57737 and https://doi.org/10.1080/09687599.2023.2263629 ↩︎
- https://grattan.edu.au/wp-content/uploads/2025/06/Saving-the-NDIS-Grattan-Institute-Report.pdf ↩︎
- https://doi.org/10.1080/09687599.2020.1782173 and https://doi.org/10.1111/spol.12607 amongst many others ↩︎
- Joseph makes sound arguments on this here https://openjournals.library.sydney.edu.au/index.php/SWPS/article/view/14059 ↩︎
- Campbell looks at how ableness is produced and maintained, which sits well with our discussion of disability as social/political construct under capitalism https://doi.org/10.1057/9780230245181 ↩︎
- https://doi.org/10.15353/cjds.v4i2.211 ↩︎
- cf., https://doi.org/10.3389/fsoc.2023.1305301 ↩︎
- See https://doi.org/10.1016/j.socscimed.2022.115047 https://doi.org/10.1017/elr.2025.14 https://doi.org/10.1111/hsc.14040 for indigenist perspectives – just three amidst many. ↩︎
- Again https://doi.org/10.1111/hsc.14040 ↩︎
- https://doi.org/10.1177/0891243218801523 ↩︎
- https://doi.org/10.1177/0018726715612901 ↩︎
Dear friends,
Overnight in the US a person killed a private health care company’s CEO [1]. The suspicion, of course, is that this company denied the person’s (or their family/friends) health care claim. I commented on mind reader that this could well be the start of rolling out the guillotines to end billionaires. Let’s see how good our odds are looking of an anti-capitalist revolution through our theoretical lenses, before we start partying on dead CEO’s graves. Hang about though because there is some cause for a party right out the gate: healthcare companies in the US have been allowing claims at a much higher rate today, they’ve removed information about their boards and directors, and are obscuring details about their CEOs. Okay, so one of those is a good thing. But it is interesting how scared the capitalist class is today. This is a deeply theoretically interesting time – if morally challenging.
While, of course, one cannot advocate for violence, there are some interesting nuances to consider in both the reaction to these events, and the fallout of showing “it’s possible” to bring an end to violence, suffering, and death – if only for a moment. To be extremely clear, I mean that quite literally the removal of a CEO brings a net positive in the world. Today, hundreds if not thousands of US citizens fortunate enough to have health cover are more likely to have their claims accepted. The direct causal effect of a CEO being murdered over the perception that their company denied too many claims and therefore became a target has led to mass positives. This tells us a lot about the nature of capitalism.
Normally, our “economy” – discussed ad nauseam, this is a fallacy to mask human suffering – channels all production towards capitalists (investors, shareholders, directors, CEOs, billionaires, and so on). But what if companies were operated for humanity instead? We see a brief glimpse of this as direct action forces the hand of corporate scumbags. Of course, sadly, this wont last. If the US people rally enough that they kill a CEO a week, perhaps for a short time corporations will turn to serving the people – a move that they can easily afford, and is the morally correct thing to do, but inconveniences the Musk types. More likely, though, is that Trump’s oligopoly succeeds [2].
There are a few implications, here, for Gramscian theorisation, and amongst these are: the role of the police as class-treacherous enforcers of capital (reacting only when CEOs are killed, not when thousands are denied owed healthcare claims), the media’s complicity in ethically sanitising billionaires and other oligarchs, and the role of politics and hegemonic enforcement in ensuring a status quo that oppresses 99% of people. As always, the reaction of various institutions reveal much about how hegemony operates. The media’s immediate rush to condemn individual action while normalising the systemic violence of denied healthcare claims demonstrates the manufacturing of consent that Chomsky identified. Corporate media portrays the daily deaths from denied claims as unfortunate but natural “market outcomes”, while framing any resistance as illegitimate violence. This selective morality serves capital’s interests by making the violence of the system appear invisible while spotlighting any challenge to it.
But particularly interesting, to me, is the role of “enforcement”.
The role of class traitors becomes particularly visible in these moments. Police mobilise (verging on massive) resources to protect corporate leadership while showing little interest in investigating deaths from denied claims. Middle managers in healthcare companies enforce policies they know harm people, having internalised capital’s logic that profits matter more than lives. The system’s gatekeepers – from HR departments to media commentators – work to maintain a status quo that ultimately harms them too, demonstrating how thoroughly hegemonic control shapes consciousness. Isn’t it weird? Don’t you find how amoral and unethical society is just extremely weird?
We teach kids to care for each other, to show respect, compassion, and to work collaboratively. We talk about centring values we describe as human: “kindness,” “care,” “love,” “affection” and so on, as natural, desirable, and important characteristics… At least of young people. As we age, this completely reverses. Cutthroat middle managers are celebrated – gaslighting and lying to employees, CEOs are lauded for their profiteering, and in Trump’s America, billionaires – the ones most responsible for the catastrophic environmental destruction which is sure to kill us all within a handful of years, are installed as dictators of government departments. The values held by Vice Chancellors, CEOs, directors, managers, and many many more belligerent, meaningless, and ultimately inhuman creatures are the direct opposite of “kindness”, “respect”, or “decency”. And yet, our system is geared for their protection – and is enabled in such a way that to even notice the cruelty and inhumanity of the system to which all 8 billion of us have consented requires a violent act? Ughhhh.
I think particularly revealing here is how quickly companies changed their behaviour when faced with direct consequences. This exposes the lie that denied claims are unfortunate necessities rather than choices made to maximise profit. The instant shift toward approving more claims proves these companies could always afford to provide care – they simply chose not to while the costs of their violence remained externalised onto the working class. At every possible moment, these corporate giants seek only to extract the maximum profit from us, all of us, yes you – dear reader, even your “wannabe millionaire friends” – we are all screwed over by billionaires and corporate giants. We created these machines of toxic destruction, and we empower their lackeys – the sycophantic narcissists that populate management in our institutions, corporations, and governments. Like a cancer they have grown and subsumed everything good, wholesome, healthy, and positive about the world – to the extent that our planet is dying.
The ruling class’s reaction also illuminates how democracy under capitalism is conditional. When electoral politics and permitted forms of protest fail to protect human life, and people feel driven to direct action, we see how quickly the system drops its democratic pretence [3]. The same voices who justify the violence of poverty, houselessness, and denied healthcare suddenly become deeply concerned with “law and order” when the 1% face consequences.
This moment forces us to grapple with uncomfortable questions about how change happens in a system designed to prevent it. While we cannot advocate violence, we must acknowledge how the system’s inherent violence – from denied healthcare to ecological collapse – creates conditions where people feel they have no other recourse. The fact that a single action produced more concrete positive change than decades of permitted resistance reveals the bankruptcy of working only within the system’s approved channels. And that is perhaps the most terrible part of all – in order to defeat this violent, disgusting system, the response that works seems to be more violence?
And yet, perhaps most importantly, this reveals the fiction of market inevitability. When faced with sufficient pressure, companies can choose to prioritise human wellbeing over maximum profit extraction. So, what, how do we build movements powerful enough to force this choice consistently, rather than temporarily? The answer as always lies in rebuilding class consciousness and solidarity while developing tactics that impose real costs on capital’s violence, without resorting to our own. Or at least that is my hope, because violence (physical and otherwise) does not bring good things – ever, not in the long run, it is incompatible with compassion, respect and decency.
The path forward requires understanding these dynamics while working to create alternatives to both individual actions of desperation and the system that produces them. This means building dual power – developing democratic institutions to meet human needs while delegitimising the structures that prioritise profit over life.
I feel like today I needed the “or something” more than the last post. This is a complex space to navigate, and it’s hard sometimes not to jump for joy when cracks in capital’s facade appear – even if they are brought by murder. I’m hopeful this is the start of some revolutionary activity that centres humanity, but I’m also fearful that we’re just seeing a further exponent on the curve towards extreme anti-human violence and that this isn’t really anti-capitalist at all, but rather a convenient scapegoat for further global authoritarianism…
In solidarity,
Aidan