THE CARE CRISIS

Caring for those who cannot care for themselves is at a tipping point—and almost certain to reach a catastrophic state.

British sociologist Dowling observes that in the U.K. between 2012 and 2022, the number of 75-year-olds will have increased by 1 million, and their growing needs for care will not cease. However, she writes, “the forces of capital have become less interested in the reproduction of any national labour force.” In other words, the tenor of the current British government is one of retrenchment, austerity, and, more than anything else, privatization. Dowling’s examples and language—as when she asks, “is lifting bins or driving a lorry more of a skill than looking after elderly or vulnerable people?”—are British through and through, but of course the Brexit Party took many of their marching orders from the same people who gave us Donald Trump, including the thought that government should unknot its welfare net and outsource as many social service jobs as possible. The result, writes the author, is that home care—“never a high-status job in the first place” but at least one that was recognized as necessary and respectable—is now turned over to low-paid, hourly workers who are not reimbursed for time spent traveling from patient to patient and are penalized for spending too much time with any given one. That is, if they’re paid at all; Dowling notes that much care work is now performed by family members without remuneration. The austerity regime, argues the author, achieves its legitimacy, such as it has any, “through a denial of the structural reasons why people need welfare in the first place,” when in fact those needs are expanding owing to “the systematic underfunding of social care.” Among the possible remedies she explores are social-impact investing, community care, decentralization of state mechanisms to fit the needs of local populations, and, of course, more money.

Health care policymakers and medical consumers alike will find these arguments urgent—and in dire need of solution.