25 How does capitalism dominate Western healthcare?

Part of Antonio Gramsci’s work, along with Theodor Adorno, Herbert Marcuse, and Max Horkheimer, looked at dominant, taken-for-granted, or ‘hegemonic’ ways of thinking, and asked what made them seem natural, compelling, sensible, and obvious to us? He asked why it requires a deliberate and sustained effort to convince people of the existence of hegemonic ideas like capitalism? And why was it so hard to overturn them? Marx believed that one of the victims of hegemony was praxis, or our capacity to act against oppressive material or social circumstances. People simply accepted the truth of hegemonic ideas, and so, like alienation, hegemonies reduced the ‘unique capacity of humans to collectively create and transform their material and social relationships’ ^[1]. Gramsci argued that part of the reason societies were often slow to break with their current ways of thinking, was because this required people to challenge the things that they had long taken-for-granted. There had to be a strong reason for people to break with what felt comfortable and familiar to them; a process that, for Gramsci, demanded a deliberate act of ‘counter-socialisation’.

Biomedicine, for instance, is so deeply grounded as a hegemonic discourse in western healthcare, that people often naturally accept its very specific and particular way of thinking and practicing without question. Marx also believed that the classical liberal idea of the autonomous, sovereign individual at the heart of contemporary Western healthcare was a powerful and dangerous hegemonic idea because; ‘This abstract individual comes into the world needing no one and relies exclusively on her own wits and abilities to pursue her self-interest’ ^[2]. Over the last half-century, a number of sociologists have considered how capitalism affects Western healthcare and the professions that work within it. Two of the most prominent here has been Harry Braverman and Magali Larson.