Skip to content

Healthcare crisis causes global spike in excess mortality the system is sick

Marxist Analysis · 2026-05-13

Core Argument

The article argues that the global spike in excess mortality is not a post-pandemic anomaly but the predictable outcome of capitalism's structural incapacity to organise healthcare rationally. The central claim is that austerity, privatisation, and the profit motive have systematically hollowed out health systems worldwide, and that the COVID-19 pandemic merely accelerated a pre-existing crisis. The solution proposed is not reform within capitalism — which the article demonstrates is exhausted — but the revolutionary overthrow of the system itself, with healthcare placed under democratic workers' control.

Theoretical Grounding

The analysis draws on classical Marxist understandings of the contradiction between social need and private appropriation. It does not deploy the tendency of the rate of profit to fall or overaccumulation as explicit categories, but the argument is implicitly grounded in Marx's insight that capitalism subordinates use-value (health, human life) to exchange-value (profit, debt servicing). The article's treatment of imperialist exploitation — debt traps, brain drain, aid dependency — reflects Lenin's theory of imperialism as a system that systematically underdevelops the periphery to enrich the core. The critique of reformism is present throughout: the article treats Labour Party figures like Wes Streeting and Keir Starmer not as well-meaning but misguided, but as conscious defenders of capitalist austerity who will implement cuts when in office. This places the article firmly in the Trotskyist tradition of permanent revolution and the rejection of "stages" theories that postpone socialist transformation.

Conjunctural Relevance

The article is written in February 2023, at a moment when the immediate COVID-19 emergency had receded but its structural aftershocks were becoming visible. Specific data points anchor the argument:

  • European mortality 10 percent above average, with some countries reporting 23 percent increases
  • 40,000 nurses leaving the NHS in the preceding year
  • France having fewer doctors than a decade ago, with 6 million patients lacking a GP
  • 83 out of 189 economies predicted to face contraction in healthcare spending in 2023
  • Lower-middle income countries spending 9 percent of GDP on debt repayments versus 8.3 percent on healthcare
  • The death of a single neurosurgeon in Uganda representing a 25 percent reduction in the country's neurosurgical capacity

The conjuncture is defined by the intersection of post-pandemic exhaustion, inflation-driven real wage cuts for healthcare workers, and the return of austerity as the dominant policy response across both Conservative and Labour formations in Britain, and comparable governments internationally. The article identifies a wave of healthcare strikes — in Britain, Spain, India, Zimbabwe — as evidence of growing class consciousness, but warns that strike action alone cannot resolve the underlying contradiction between social need and capitalist control.

Where the Argument Continues

The article leaves several lines of argument open for development. First, it does not examine in detail the political economy of the pharmaceutical industry — the role of monopoly pricing, patent regimes, and the extraction of surplus from public health systems by private drug companies. This is a natural extension, and IDOM has produced extensive material on vaccine patents and Big Pharma profiteering during the pandemic. Second, the article gestures toward but does not fully theorise the relationship between healthcare crisis and the broader crisis of social reproduction — the way that cuts to health services disproportionately fall on women, who absorb the costs through unpaid care work. Third, the question of transitional demands — what a fighting programme for the health service looks like before revolution — is raised but not elaborated. Readers should consult IDOM's coverage of the NHS strikes (particularly the 2022-23 RCN action), the Against the Stream episode on "Health and Social Care under Capitalism," and Trotsky's own writings on the relationship between trade union struggle and revolutionary politics in The Transitional Program.

Connections

  • Marx, Capital Volume 1 — the chapter on "The Working Day" remains the foundational text on capital's indifference to the health of the worker
  • Engels, The Condition of the Working Class in England — the classic empirical demonstration of how capitalism produces disease and premature death
  • Lenin, Imperialism, the Highest Stage of Capitalism — for the theoretical framework linking debt, exploitation of the periphery, and the export of crisis
  • Trotsky, The Transitional Program — for the strategic question of how to connect immediate demands (defend the NHS, pay nurses) to revolutionary conclusions
  • IDOM, "The NHS Crisis: A Product of Capitalism" (2022) — a companion piece examining the British case in greater depth
  • IDOM, "Big Pharma and the Pandemic: Profits Before People" (2021) — on the pharmaceutical industry specifically

Key Quotes

  1. "While the mouthpieces of the capitalist class are quick to blame the COVID-19 pandemic, which certainly exacerbated the crisis, the reality is that this healthcare catastrophe is ultimately a product of the inefficiencies and indifference of the market."

  2. "In 2019, lower-middle income countries spent more of their GDP on debt repayments (9 percent) compared to healthcare expenditure (8.3 percent). These figures are far more appalling in low-income countries."

  3. "The entire continent of Africa, comprising 16 percent of the global population and 23 percent of the global health burden, accounted for a mere 1 percent of global healthcare spending in 2015. Of this 1 percent, 35 percent was 'out-of-pocket', meaning it came from the meagre wages of workers."

  4. "Ultimately, you cannot plan what you do not control, you cannot control what you do not own."

  5. "Shadow Health Secretary Wes Streeting has spat bile against the doctors' union BMA, while leader Keir Starmer has bluntly stated that Labour would carry out austerity in power, and rely on private provision to 'cut waiting times'."

  6. "Patients' health and lives are being held hostage by a capitalist system wracked with crisis and contradiction. Only a global socialist revolution, placing the levers of the economy into the hands of workers, can resolve this pandemic of inefficiency and austerity."