this post was submitted on 30 Dec 2024
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The manager/administrator class is certainly taking over hospitals as much as other institutions, but I don't think doctors can be fully proletarianized for as long as they remain scarce, and carrying a certain prestige, and able to have their own firms individually.
I'm not saying the classic terms of proletariat and bourgeoisie aren't useful anymore, but it's more and more difficult to see pure manifestations of them like you could a century or two ago. This is part of why if you talk about these classes to anyone who's not already a socialist, you get a blank stare at best and an eye roll at worst, because without an extensive explanation it seems foreign or scholarly and then people won't apply it to their worldviews.
With so much production being obscured across national borders, it's harder for people to identify themselves exclusively in relation to production. Consumption, especially powered by debt, is a huge part of how people today identify. Having a quantifier for the relative monetary relationship is something that applies to consumption of products and especially strongly to interactions with financial institutions, while still being applicable to employment. And crucially, it can take into account the opposition* between core countries and peripheral countries.
*using this word instead of "contradiction", for accuracy and versatility
I will say I agree that proletariat and bourgeoisie, as terms, are mostly useful for discussing theory. If I'm talking to a normal person I'll just say working class and ruling class, and I'll even use terms like "middle class" like I've done here in this discussion.
But I don't think we need to throw out the concepts to capture the "consumer" as a social class, because the revolution will not be fought by consumers. Consumers are inherently reactionary; a direct result of the redistribution of superprofits to workers within the imperial core. That's a settler class. They have disposable income from high salaries and investments, the ability to retire, their own homes, the ability to start their own business, and that is all bourgeoisification. They're workers who exist in a stratum above the workers of the rest of the world in their own special "middle class." They are bourgeoisified - or like you said, creditors more than debtors.
The debourgeoisified proletariat, without the superprofits from imperialism, can buy what they need to live and that's it. They aren't "consumers" and they certainly wouldn't identify that way. They buy whatever is cheapest and will get them to their next paycheck, they make do with whatever knockoff garbage they can afford, and they pirate whatever they can't buy. I don't think the "consumer" identity is an important one for building class consciousness, and it will decline as conditions worsen and the contradictions sharpen.
Now if we bring this back to doctors, I agree that they will probably never be in these dire straits. Same with any other highly compensated profession. But! Their ability to consume whatever they want will decline, and as a result, being able to identify as a consumer will decline as well. There's also a difference between doctors in their own private practices and doctors in hospitals. One is petite bourgeois with ownership of their own business, the other performs socialized labor in an industrialized setting alongside much less well compensated fellow workers. That's like saying mechanics can't be proletarianized because there are private mechanics. It's the industrial labor that makes the prole.
I think these recent strikes, with doctors striking right alongside other healthcare workers, are a sign that doctors are being proletarianized and losing their bourgeoisified status.