If we can't see it, we can't change it.

Rebecca Fischer
Apr 2
7 min read

Updated: Apr 13

Care: The Highest Stage of Capitalism, by Premilla Nadasen, 2023 (book)

Premilla Nadasen is helping us see it.

“It” being the racist, sexist, exploitative profit-making and inequities associated with the care crisis and the care economy in our capitalist society.

But she’s also showing us opportunities to change it through real-world examples spanning several decades, and growing in recent years.

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Nadasen is co-director of the Barnard Center for Research on Women and a professor of history at Barnard College, Columbia University. In her recent book “Care: The Highest Stage of Capitalism,” she invites us into an inclusive discussion on care and its many definitions, from the work it involves to the politics and policies surrounding it.

In defining care and care work, we intrinsically know what it means to care for ourselves and others -- the nurturing, feeding, assisting, nursing, and loving involved. But care work can also be thought of as “the work that makes all other work possible,” a slogan first used by Domestic Workers United in the early 2000s.

However, Nadasen points out that no matter how essential care work is, it is also undervalued -- usually unpaid or underpaid and left out of economic measures like gross domestic product (GDP). The work is done mostly by immigrants, people of color, and white women.

And then who has access to adequate care? Shouldn’t care be a basic right? Who is profiting from care?

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In her book, Nadasen shows us through specific examples how racism, sexism, and exploitation are built into the fabric of care work through a capitalist or free-market neoliberal society that was, and is, built on the backs of vulnerable people.

A primary example is slavery. Slave owners profited from the “free” work extracted plus the sale of human bodies as well as their reproduction, e.g., in the case when slave owners became owners of enslaved people’s babies.

With the end of slavery, freed people were often forced into domestic labor through government training programs or simply because it was the only work available. They often made so little that they weren’t able to care for themselves or their own families. Their forced care work for others allowed those families to profit even more.

These workers were called “part of the family” by their employers, but these "family members" were expected to work long hours with little pay, no benefits, no safety net, often facing abuse. Basically, employers benefited from the type of service a family member might provide -- selfless, doing the work out of love and a sense of duty, etc. -- but that is certainly not how workers felt. In fact, when domestic workers began banding together and fighting for their rights, peaking in the ’60s and ’70s, they often testified that emotional demands were the most taxing part of their job. This coercion to love their employers and their children was felt the strongest among female workers, due in part to gender stereotypes that women are natural caregivers: nurturing, polite, and accommodating.

Grassroots efforts have helped domestic workers gain more rights and better pay, but even today working conditions and pay remain sub-par, with wealthier families continuing to benefit and profit from this care work. The rich get richer off cheap labor. Lower pay can be justified because care workers are "supposed" to love their work, their patients, etc.

This is also an example of how some people’s care needs are met through the exploitation of more vulnerable people. Often it is the people who are providing care for others who are the least able to meet their own and/or their families’ care needs.

On top of that, the private and public sectors are increasingly profiting off the care needs of people, especially vulnerable populations.

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“In this new stage of capitalism, the care economy parasitically feeds off pain; that is, some people’s pain translates into other people’s profit.” -- Premilla Nadasen

Companies, agencies, and organizations that benefit from people’s hardship have a huge incentive to maintain or even exacerbate that hardship, not alleviate it.

Just a few examples Nadasen discusses include the following:

With $3.7 billion in state contracts in New York alone (renewed without competitive bidding), Maximus is a private, for-profit company that is making decisions about who is covered by state programs. One of Maximus' aims is to reduce costs and maximize revenue for state child welfare agencies, which since the 1990s have been more frequently removing children from their families. The company has called foster children a “revenue generating mechanism."
In Mississippi, the welfare program’s amount of misused funds almost equals the total annual welfare budget in the state, nearly all of which comes from the federal government.
The adult guardianship system, which recently came under scrutiny due to the Britney Spears case, has been a fertile ground for fraud, allowing people to profit off of dependent people, usually the elderly or disabled. Rachel Aviv’s 2017 exposé in The New Yorker revealed how “professional” guardians seek out potential victims. The article noted that 1.5 million adults in the U.S. had guardians, who controlled $273 billion in assets.
The U.S. prison system provides opportunities to profit off the unmet care needs of, often and disproportionately, Black and Brown people, while keeping them caught in a cycle of unmet needs.

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Another focus of the book is that many people, including the most vulnerable, are left out of today’s conversations surrounding the “care crisis” in America, highlighted during the COVID-19 pandemic.

This is because the discussion often focuses on “work-family balance,” the extra burden on working women, and the increasing barriers to childcare for working families. This disregards the disabled, people who have to leave their own families to take care of other people, and people outside the labor market.

But aren’t all people deserving of care? What prevents our society from extending care to all?

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Nadasen doesn’t leave us without solutions -- examples of what she calls radical care: “radical” originating from the Latin radix, meaning “root,” and radicalis, or “pertaining to the root.” These include but aren’t limited to mutual aid programs, disability justice, the Movement for Black Lives, Indigenous organizing, and the prison abolition movement.

“Campaigns for transformation ought to occur on multiple levels -- a process that begins in our families and communities,” Nadasen writes.

A few of the specific examples she discusses include:

The Nollie Jenkins Family Center in Holmes County, Miss., which provides a physical space and social safety net for girls and young women in a region where little government social support exists. With a foundational premise that every family needs to be cared for, and everyone has a responsibility to look out and care for one another, the center and its community become the means to address behavioral issues, mental health challenges, and domestic violence at home or school.
Sins Invalid (pronounced like the “not valid” definition), an organization founded in 2005 that celebrates disabled people’s work and bodies and fights for disability justice. Similar care collectives for disabled people and their allies emerged in the early 2000s, often in response to the inadequacy of public health care or the archaic idea that disabled people can’t lead full lives. These groups may focus on the idea of interdependence, fighting against the stigmatized, disempowered definition of dependency and focusing instead on the deep, communal relations it encompasses. They may also celebrate the many types of bodies we as humans inhabit, not just our physical ones.
Street medics ꟷ the doctors, nurses, veterinarians, medical students, EMTs, home-health aides, and other care providers who voluntarily assist people during political protests and other times of strife.
The Black food justice movement, which is led by Black feminists and focuses on empowering Black farmers, advocating for policy reform, and creating alternative models of stewarding the land, including regenerative agriculture, which focuses on restoring soil health, biodiversity, and ecosystem resilience.
Red Nation, a Native-led grassroots organization committed to liberating Native peoples from colonialism and capitalism.
The Debt Collective, “a membership-based union for debtors and our allies,” which helps people facing bail and other carceral debt, legal debt, and student loan debt and believes that no one should have to go into debt to meet their basic needs.

“Only within that interdependency of different strengths, acknowledged and equal, can the power to seek new ways of being in the world generate, as well as the courage and sustenance to act where there are no charters.” -- Audre Lorde, from her essay “The Master’s Tools”

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I have barely grazed the surface of the depths Nadasen dives into in “Care” to show us where people are hurting, and being harmed, in today’s care economy and where others are benefiting from this pain.

Her book has me thinking about things like …

Is capitalism working?

Given all that Nadasen has pointed out in her book, and also considering factors like the following, I can't help but wonder if there's a more inclusive, sustainable path:

This year, the U.S. earned its lowest ranking ever in the Gallup Poll’s World Happiness Report, coming in at 24th.
The U.S. has more people imprisoned than any other country, with 1.8 million people in prison, about 42% of whom are Black. The number represents over 16% of all people incarcerated worldwide (11 million).
Hunger is on the rise in America, with 10.2% of American households experiencing food insecurity in 2021, 12.8% in 2022, and 13.5% in 2023.