Covid-19 Has Exposed Our Broken Care System

The commodification and marketisation of care – and its unloading onto the underpaid and unpaid – has been brutally exposed by the Covid-19 pandemic. In its wake, we need an entirely new system.

The care crisis is everywhere. In the wake of austerity and against the backdrop of the failures of privatisation, over-stretched and underfunded public services have left people in the lurch. Expensive childcare exposes the limits of a dual earner model for households, and it is still women who are doing much of this care work. Care workers are overburdened and underpaid.

Demographic changes affect care, too. An ageing population means more people live longer and with complex care needs. Many elderly people are already not receiving the care they need. Mobility and migration mean we want care infrastructures to be adaptable to change.

Vulnerable populations such as single mothers, people with disabilities, refugees or the long-term unemployed are affected most when benefits and services are cut. But vulnerability is not an inherent or inevitable characteristic of any of these populations: it is a function of the disadvantages of structural inequality and neglect that need not be that way.

Stress, burnout and a rise in mental health issues, including among children, are definite causes for concern. The flipside is a burgeoning wellbeing industry, ready to diagnose an infinite range of conditions while offering the concomitant solutions at a hefty price.

The care crisis does not affect everyone in the same way, whether locally or globally. But societies that systematically erode their care infrastructures cannot thrive in the long term. The coronavirus crisis has been a painful lesson in this regard.

Charting a Way Out

As the world becomes seemingly more uncaring, the calls for people to be more compassionate and empathetic towards one another – in short, to care more – grow louder. But the work of caring never stopped, even as it is done under increasingly difficult conditions. What is more, compassion is all too quickly mobilised to plaster over an enduring crisis of care. The deep and multi-faceted crises of our time will not be addressed by simply (re)instilling the virtues of empathy.

We are stuck in a perpetuum mobile of care fixes that cannot solve the underlying care crisis in any sustainable way, instead merely displacing it. From the frantic caring of the new clean living to the abandonment of those who are of no interest to financial services or conspicuous consumption, except where the abandoned can be financialised; from the overburdening of some people with care duties while others go carefree, to the exploitation of care workers whose already tenuous situations are made worse as care is further marketised and more jobs are casualised; from the instrumentalisation of compassion in the interests of keeping everything going; to the many general appeals for more empathy and compassion as a solution to society’s woes.

Our present is a system that emphasises personal responsibility while expanding the opportunities for marketisation and financialisation that are premised on precariousness and the perpetuation of unequal burdens of care work and unequal access to care. How do we escape the toxic mix of problems that characterise the current care crisis and the short-term fixes that entrench division and need?

Yes, we need to care better for each other. The central question is how to do so in more sustained and sustainable ways. However, this is not a goal that can be achieved by trying to harmonise compassion with markets, nor will simple earnest calls for everyone to care more and be considerate of others be enough to effect real change. Instead there must be a transformation of the structural conditions for care. This will only happen if care has a different status and is organised differently, not just as a feeling or a way of behaving, but rather as a social and material practice – at the level of institutions and the everyday.

One response to the growing care crisis is to expand the care economy. There is an expectation that the rise in the demand for care, whether arising from demographic changes, such as an ageing population, or social changes, such as a larger female labour force, will result in the market for care getting bigger. The dynamic of growth and expansion that characterises capitalist economies drives a process of ever-increasing commodification. In the search for new investment opportunities, new areas of social life are brought into markets, including financial markets. The realm of care is no exception.

However, turning care into a commodity soon comes up against limits, because care is not infinitely rationalisable and productivity gains are few. Thus, care can only be mass-marketed in limited ways. If these dynamics are left to their own devices, there is a deterioration of standards of care, of wages and of working conditions for carers.

If anything, care becomes a luxury commodity for those willing and able to pay lots of money; alternatively, profits for care providers have to be subsidised by the state. In other words, valorising care in this way actually involves a systematic devaluation of care in order to extract surplus value. Moreover, the idea of cost saving – whether to facilitate wealth extraction or whether to operate under conditions of austerity – means that reserve capacities are depleted. This makes the care infrastructure fragile and vulnerable to unexpected events like the coronavirus pandemic.

Public investment in the care economy can further economic growth by enabling greater female participation in the labour market. In this more progressive model, tax receipts generated by economic growth pay for expanded social infrastructure. In countries such as Britain and the US the conventional wisdom of the post-war era has been that economic growth benefits all: we contribute our labour to the overall ‘pie’ of gross domestic product and in return receive the dividend of wages or access to publicly funded infrastructures.

But the doctrine of economic growth rests on several untenable premises. It has never been true that economies can keep growing endlessly and that everyone will thereby be cared for. When we consider how women’s unpaid and invisible caring and reproductive labour in homes and communities underwrote the productive capacities of workers, this is unambiguous.

If care cannot solve the problems of capitalism, capitalism is indeed preventing us from solving the problems of care. Ending the care crisis means transforming the conditions for caring. To do so requires fundamentally rethinking how to value care.

Valuing Care

Following the Global Financial Crisis of 2008, governments bailed out many banks and businesses that were deemed systemically indispensable. The COVID-19 pandemic has challenged the criteria of just who or what the system needs, and the workers who keep life going have received much more attention. Many people went out on their doorsteps to ‘clap for our carers’ every week. This ignited a debate over whether or how such symbolic appreciation could evolve into the greater valuing of healthcare workers, and of all carers.

Feminist scholars, activists and practitioners have long demanded the transformation of societal responsibilities for caring. Truly valuing care will mean allocating more time, money and societal capacities to it. It will also mean elevating care’s undervalued political and ethical status in our everyday attitudes and practices and in their underlying objectives.

Care is not regulated by one domain but is influenced by state and market policies and public and private motives, and because it entails paid and unpaid labour, creating change will require rethinking care in the household, the workplace and beyond – in relation to one another and as mediated by the state. Truly valuing care means having time for unpaid caring in our everyday lives and publicly funding a care infra- structure with well-paid care work. Taken together, the two strategies could form the basis for ending the care crisis.

Care is not a luxury good. Everyone needs to be cared for and everyone needs access to care, although not everyone has the same needs. An effective care infrastructure cannot be built on personal responsibility – not everyone is able to care for themselves.

No one should be left without care because they have no one to care for them; nor should access to care be based solely on whether someone happens to like someone else, acts out of charity, or acquires a sense of responsibility through kinship. So, there need to be universal guarantees in place that all people will be entitled to care. This calls for a capacious understanding of care that recognises diversity and is sensitive to different needs in enabling and empowering ways.

Effective and inclusive care requires a collective social infrastructure based on risk-pooling. We must expand publicly funded childcare, mental healthcare, adult social care and eldercare through a progressive reform of the tax system – which should include regulating against offshoring and tax evasion.

For example, a number of proposals (including costings) exist already that call for the establishment of a National Care Service. They include suggestions for local authorities to design and deliver free services directly, instead of issuing personal budgets for the individual purchase of marketised services, or the commissioning of services from private providers. This can involve bringing services back in-house, as well as publicly funding new and innovative models for care.

Valuing care means allocating resources, not taking them away. There is an urgent need to dismantle the apparatus that allows private wealth extraction from society’s care structures, so that any new funds made available for the public care infrastructures do not simply prop up profits. Care needs to be shielded from the volatilities of financial markets, not be drawn deeper into them.

Therefore, the realms of care should not be available to high-risk forms of financial investment, including private equity and debt-based forms of financial engineering, where expectations of high returns on capital are upheld at the expense of quality of employment and quality of care. Nor should public services and the care sector be exposed to free trade agreements that undermine labour, consumer and environmental protections. This is a pressing issue in the wake of Britain’s departure from the European Union.

With the rise of entrepreneurial approaches to social change coupled with the social turn of finance, local community attempts to organise care in new kinds of collectives, networks and cooperatives also risk serving as fields of experimenta- tion for the development of new kinds of financial business models. Such developments merely deepen our dependency on finance as a mode of accumulation and as a form of social organisation, and our exposure to the volatility of global financial markets that comes with it.

We should proceed with caution when encouraging micro-lending, crowdfunding or community shares, time banks or alternative currencies that become training grounds for the investor self and follow in the steps of asset-based community development, which is premised on the deeper penetration of free-market principles into the social fabric of communities. We must conceive and practice different modes of valuing care than those that serve financial wealth extraction.

Democratising Care

Quality and safety of employment is a condition of the quality of care. Care work must be better paid, with better working conditions, better training, more resources and improved technological support that enables better caring.

All care workers need secure employment conditions and adequate salaries that include sick pay, holiday pay and pay for overtime; provision for the materials and resources required; training and opportunities for further qualification and the time and means for exchange with co-workers. This means an immediate end to zero-hour contracts and to the time pressures that many care workers face, so that the needs of care workers and those cared for are centre-stage.

Care workers are experts. Their experience, knowledge and skill are crucial to designing and developing better care infrastructures that give care workers more control over their work. This requires a real democratisation of workplaces and a voice for care workers.

There should be more equal consideration of the needs of those who care and those who are cared for through the establishment of a common ground between everyone involved in the process of caring, from professional and informal carers, the cared-for and their friends and relatives. Collaboration between professional care workers, care recipients and informal carers should be encouraged, recognising that care is not merely a service that is provided and consumed, but something that is necessarily collaborative and co-produced.

A collective infrastructure for care requires institutions that can organise and allocate the necessary resources. One such institution is the welfare state. Anyone seeking progressive change will be ambivalent about the welfare state.

Is it the culmination of hard-won social rights fought for by successive social movements? Or is it the material manifestation of co-option, a tool to both discipline and deter struggles for a better world? Can a welfare system so intricately bound up with the developments of industrialised capitalism be any- thing but the latter? What might an emancipatory version look like?

Service user and disability rights movements give us a cautionary perspective on the welfare state, immunising against nostalgia and rose-tinted views forgetful of the realities of exclusion, punishment and abandonment that have been all too pervasive.

Scholar-activist Peter Beresford notes that a lack of political participation has been a feature of the welfare state since its inception. This placed the general population in a passive role as recipients of assistance, precluding a real sense of ownership and active involvement in a direct democratic process. Also excluded were the voices of the caring and the cared for.

In her book, Caring Democracy, the political theorist Joan Tronto argues that ‘democratic politics should centre upon assigning responsibilities for care and for ensuring that democratic citizens are as capable as possible of participating in the assignment of responsibilities.’

A caring democracy would thus not simply be about changing forms of political representation or who represents us, but rather about changing the very way that we conduct politics and what themes we fore- ground. The question of democracy is not merely one of the negotiation of interests, nor is it simply about participation; rather it pertains equally to the scope and processes of, as well as access to, democratic decision-making, hand in hand with the ethical values that underpin it.

A complementary consideration is that of the necessary transformation of public institutions towards alternative models of ownership based on alternative modes of valuing care. Remunicipalisation movements in Europe and elsewhere have sought to reverse privatisation and bring services back into the public hands of municipalities and local authorities.

Key to these initiatives has been the elimination of the profit motive and the rollback of corporate control over key utilities, especially where this has had detrimental effects on universal access, quality of service provision and costs.

A form of ‘care municipalism’ based on public funds and non-profit ownership models could offer a democratic locale for the negotiation of participation, ownership and the allocation of resources, without the dangers of exclusivity that are hazards of small, self-selecting collectives.

Putting Care in its Place

Ending the care crisis will require a profound shift in mentalities. It will require an agreement to allocate far more societal resources – means, time and capacities – to care. Considerable political will is needed to put the issue of care at the forefront of what we do, whether in our relationships, communities, neighbourhoods, workplaces or politics.

This does not mean making caring the guiding principle of all conduct, or positing caring as the solution to all woes. But it does mean giving care a prominent place as a structural condition of our lives. I know that invoking an all-inclusive ‘we’ is perilous: it is easy to fall into the trap of seeking to produce the most general agreement possible among disparate forces whose interests may well be counterposed.

Moreover, to speak from the position of ‘we’ is often to suggest a bird’s-eye view where the perspective may well be much narrower. The question of who this ‘we’ may include is inseparable from the social and political conflicts of our present that ensue from deepening inequalities, racism and rising nationalisms.

However, some kind of ‘we’ built on inclusive solidarity is necessary to achieve change. There is no stand-alone answer, no neat policy proposal, no technocratic solution to the crisis of care, and what I have sketched out here is intended as a contribution to the developing conversation.

A growing movement to end the care crisis is currently demanding that care work and the labour of social reproduction be ‘recognised, reduced and redistributed’, while ensuring decent pay and working conditions in the care sector. To escape incessant care fixes and end the care crisis, we must reclaim the means to care from the prerogatives of profitability and put better ways of valuing care into practice.

This article is excerpted from Emma Dowling’s ‘The Care Crisis: What Caused It and How Can We End It?’ which is now out from Verso Books.

About the Author

Emma Dowling is a lecturer at the University of Vienna. Her writing has appeared in the Financial Times, New Humanist and OpenDemocracy.