‘How does capitalism keep the unemployed on hand?’ you ask.

Simply by compelling you to work long hours and as hard as possible, so as to produce the greatest amount. All the modern schemes of ‘efficiency’, the Taylor and other systems of ‘economy’ and ‘rationalization’ serve only to squeeze greater profits out of the worker. It is economy in the interest of the employer only. But as concerns you, the worker, this ‘economy’ spells the greatest expenditure of your effort and energy, a fatal waste of your vitality.

It pays the employer to use up and exploit your strength and ability at the highest tension. True, it ruins your health and breaks down your nervous system, makes you a prey to illness and disease (there are even special proletarian diseases), cripples you and brings you to an early grave — but what does your boss care? Are there not thousands of unemployed waiting for your job and ready to take it the moment you are disabled or dead?

That is why it is to the profit of the capitalist to keep an army of unemployed ready at hand. It is part and parcel of the wage system, a necessary and inevitable characteristic of it.

It is in the interest of the people that there should be no unemployed, that all should have an opportunity to work and earn their living; that all should help, each according to his ability and strength, to increase the wealth of the country, so that each should be able to have a greater share of it.

But capitalism is not interested in the welfare of the people. Capitalism, as I have shown before, is interested only in profits. By employing less people and working them long hours larger profits can be made than by giving work to more people at shorter hours. That is why it is to the interest of your employer, for instance, to have 100 people work 10 hours daily rather than to employ 200 at 5 hours. He would need more room for 200 than for 100 persons — a larger factory, more tools and machinery, and so on. That is, he would require a greater investment of capital. The employment of a larger force at less hours would bring less profits, and that is why your boss will not run his factory or shop on such a plan. Which means that a system of profit-making is not compatible with considerations of humanity and the well-being of the workers. On the contrary, the harder and more ‘efficiently’ you work and the longer hours you stay at it, the better for your employer and the greater his profits.

You can therefore see that capitalism is not interested in employing all those who want and are able to work. On the contrary: a minimum of ‘hands’ and a maximum of effort is the principle and the profit of the capitalist system. This is the whole secret of all ‘rationalization’ schemes. And that is why you will find thousands of people in every capitalist country willing and anxious to work, yet unable to get employment. This army of unemployed is a constant threat to your standard of living. They are ready to take your place at lower pay, because necessity compels them to it. That is, of course, very advantageous to the boss: it is a whip in his hands constantly held over you, so you will slave hard for him and ‘behave’ yourself.

from Now and After by Alexander Berkman, Chapter 5: Unemployment. Available to read for free here.

Even in countries where healthcare is socialised, they are run “efficiently” like a capitalist business by administrators who care not for healthcare but for finances, “balancing the books”, and bean counting.

The greatest fear of capitalist administrators is that there might be a slow night in the hospital and a few employees have some down time to take a breath where no “production” is taking place. The shareholders would not be amused. That’s why they staff hospitals with the bare minimum, paying them as little as possible and using them as much as possible.

You know what’s funny? I actually think the situation is a lot better than you’re making it out to be.

You’re not entirely wrong. There absolutely are positions in hospitals where people do insane schedules like 24 or 48 hour shifts. But that’s mostly concentrated around emergency medicine, trauma, surgical residency, ICU coverage, and certain on-call specialties. There’s definitely a culture surrounding ER staff and surgeons where sleep deprivation almost gets treated like some badge of honor.

But the majority of the medical world in America does not operate like that.

Most hospitals primarily run on normal shift structures. Nurses on regular floors and patient wings are usually working standard 8 or 12 hour rotations with multiple shift changes throughout the day just like any other industry. And once you get into private practice, some doctors are only in office a few days a week seeing a relatively small number of patients across different locations.

People also forget hospitals are not run exclusively by doctors and nurses. They’re massive operations with huge amounts of support staff, technicians, imaging departments, transport, administration, custodial staff, billing, labs, and so on, most of whom work completely normal schedules.

So yes, what you’re describing does exist. But I don’t think it’s remotely as universal or apocalyptic as people make it sound. A lot of public perception comes from dramatized media where every hospital is portrayed like a nonstop trauma center operating at DEFCON 1 twenty-four hours a day.

No one does this outside of the USA. It is not at all normal, just like being stuck with the imperial system of measurements.

Having been chronically overworked for a while in my profession, the last thing I want is my life in the hands of somebody chronically overworked.

At least in my profession the mistakes I made because of being so tired did not kill anybody or handicapped somebody for life.

You know, healthcare jobs are the only ones I see “advertised” here in the Southwest. There are billboards for all sorts of medical careers. I’ve had friends and acquaintances talk about being a nurse as a backup career plan.

Nursing is a career path where you cannot rise to the top ranks. Nurses cannot ever rise above doctors, because the next step up is a doctor. The repeat clients in a hospital setting in the southwest are drug addicts or psych patients. The “average” person going to the hospital is going there with something severe. Not to say that everyone doesn’t deserve care, but know your patient base. Nurses are strapped in the entire shift, and being late from lunch is like being late to work. It’s incredibly stressful, and there are studies that essentially show that nurses are worked to the mental and physical limit in their lifetime.

Nurses are treated like shit, and there’s a steady stream of them leaving the profession or moving into admin positions where they’ll settle in; you’re way better off in every way to just aspire to the admin jobs with a master’s of public health. Tell your friends. You’re welcome.

my gf is a nurse and it is absolutely bonkers how the healthcare system works at all, shit is very run down and society as a whole needs a lot of shifting for how taxation affects the health care system. tax the fucking rich and make them pay their fair share and siphon that into healthcare.

I’m not really OK with it, but I never got a vote on the subject.

Most of them actually. Am a nurse and was once psychiatrically hospitalized alongside a train conductor and we really bonded over our ridiculous and yet supposedly “high reliability industry” jobs. She actually got hooked on speedballs because there’s some weird loophole in our state where the train conductors need to give something like 48–72h notice or something to take sick leave so most of them just show up for their 16h shifts fucked up on amphetamines to stay awake then benzos so the amphetamines don’t give them tachycardia and one of her managers actually basically gave her a pep talk on which doctors to go to and what to say to get them prescribed legally but given that they’re both extremely addictive substances her dosages spiraled wildly out of control extremely quickly such that she was only able to get effective doses extralegally. On the plus side though losing that job and getting shipped to the other end of the state just to find a bed got her away from both her dealer and her cartoonishly abusive ex (even a week into her stay the bruising was pretty wild). And then actually when I left the hospital my third time I met my now husband in partial although we lost touch for like a year until we ran into each other again and he helped me escape my much more subtly shitty relationship and actually graduate / get licensed (if you think nurse pay is shit I was getting paid $12.50 as a nursing assistant working with criminally insane men and that was after the promotion).

I’m not sure I’d say we’re ok with it. But what’s the alternative? Die? Not really attractive either.

We should just start supporting policies that improve the conditions of the healthcare system, but, that would require a majority of people agreeing to improve things globally. Good luck with that.

The decision making center of your brain is the prefrontal cortex. It’s the really thinky bit. It is what does the explicit thought about novel situations. When something is done “instinctively” or out of habit, that’s usually handed off to the amygdala. It’s used more for stuff that you’ve done many many times before.

When you are tired, haven’t eaten well, and any number of other conditions that overworked and overstressed doctors face, your prefrontal cortex will do a lousy job. The amygdala will actually secrete chemicals that inhibit the performance of the PFC. As such, routine things are probably ok. something novel comes up? Bad times.

I’d prefer my doctor is well rested and in a good frame of mind to make quality decisions, thank you.

Because one lunatic doctor had a cocaine addiction and could go days at a time without sleep, so he demanded the same from all his students who werent riding the white lightning, which inevitably left a deep cultural impact and expectation for everyone that followed to do the same, because “I suffered, so you suffer too”

No we’re not. But generally governments everywhere want to starve the medical industry to make it generate profit for the wealthy. The US is their role model.

Glares at Doug Ford

A combination of a few things.

First, the founder of modern medical teaching was a man who loved cocaine and created a fairly aggressive education program which fed into a profession without work-life balance. The profession hasn’t self-reformed while cases where skilled labor has massive overtime is generally more regulated.

Second, the cost of education is enormous. Medical training for a doctor costs north of half a million dollars, so there is a high cost to training an additional doctor. Because of that, it is more cost effective to add additional shifts to existing doctors and nurses.

Third, a lot of doctors have a god complex and don’t want to admit they are fallible people. Because of this, they resist a lot of best practices other industries; checklists for operations are a 21st century “medical technology”. There isn’t a push within the industry to study how people fail like there is in other industries.

If I recall, most medical mistakes take place over shift changes. Things like a patient getting a double dose of meds because they didn’t realize the prior shift already gave them. The idea is that minimizing the number of shift changes reduces the number of mistakes.