Bullsh%t Jobs – The Ultimate Corporatization of Healthcare

In 1930, John Maynard Keynes predicted that technological advances would enable us to work a 15-hour week. Yet we seem to be busier than ever before. Those workers who actually do stuff are burdened with increasing workloads, while box-tickers and bean-counters multiply.

In an age that supremely prizes capitalist efficiency; the proliferation of pointless jobs is a puzzle. Why are employers in the public and private sector alike behaving like the bureaucracies of the old Soviet Union, shelling out wages to workers they don’t seem to need? Since bullshit jobs make no economic sense, David Graeber argues in his book Bullshit Jobs, their function must be political. A population kept busy with make-work is less likely to revolt.

Is this real? Why do these jobs continue? Graeber provides one “smoking gun” in the form of Barack Obama’s explicit justification for sticking with the US health insurance system: otherwise, millions of form-filling jobs would be lost.

Bullshit jobs as defined by Graeber:

Bullshit jobs are not just jobs that are useless or pernicious; typically, there has to be some degree of pretense and fraud involved as well. The jobholder must feel obliged to pretend that there is, in fact, a good reason why her job exists, even if, privately, she finds such claims ridiculous. There has to be some kind of gap between pretense and reality.

This explains why “professions” such as Mafia hit man and warlord are not bullshit jobs. Sure, they contribute nothing positive to society, but at least nobody has any illusions about what they are. The same cannot be said for myriad (legal) white-collar jobs, which Graeber breaks down into 5 categories:

  1. Flunkies. Flunkies only exist to make their bosses look good. A good example is a receptionist at a small publishing company that only receives two calls a day (after all, a company isn’t a true company without a receptionist). Ditto for doormen and other people who are just there for show. Since managers are often judged by how many people they have working under them, they’re more than happy to spend “other people’s money” on employees that make them appear prominent.
  2. Goons. Goons are aggressive thugs. Goons inspire no respect, and are only needed because somebody else has them. Corporate lawyers are the perfect example of goons. While individual corporate lawyers may perform useful functions for their employers, society would get by just fine if every single corporate lawyer disappeared. The same applies to telemarketers, lobbyists, and people who work in public relations.
  3. Duct tapers. Duct tapers are there to fix problems that shouldn’t exist in the first place. For example, at one of the universities where Graeber taught, there was only a single carpenter. Understandably, this inspired many complaints, which led Graeber to discover that the university hired someone whose sole job was handling complaints. Makes one wonder why they didn’t just hire another carpenter. As Graeber has mentioned many times, hiring duct tapers is like paying someone to empty a water bucket under a leaky pipe – as opposed to simply fixing the damn pipe.
  4. Box Tickers. Box tickers allow institutions to claim that they’re doing something they have no intention of actually doing. In the private sector, this often takes the form of compliance workers. Healthcare institutions, since they have at least a modicum of self-awareness, have to pretend that they’re policing themselves. So do government officials any time there’s an unwarranted police shooting of an unarmed man or a major scandal such as the NSA spying revelations. After their agents get caught transgressing, the authorities always vow that there will be transparency, a thorough investigation, and accountability. In reality, the “investigation” often amounts to obstruction, and there’s seldom much accountability or meaningful reforms in the end.
  5. Taskmasters. Taskmasters don’t require much explanation. Pretty much ever middle manager who does little more than sit in meetings and annoy employees, paints a pretty good picture of taskmasters. Graeber calls them taskmasters because most of their work involves supervising people who don’t need much supervision. Worse, many taskmasters will devise silly and pointless chores for their underlings in order to feel like they’re making a difference.


While we see examples of these roles in the hospital bureaucracy, even more familiar is what Graeber calls the “bullshitization of useful work.”  Doctors, nurses, teachers, and other people with important jobs have to spend an increasing amount of time filling out forms and tending to other soul-crushing administrative tasks – and less time actually doing their jobs.

Given how obsessed businesses are with cutting costs and earning profits, logic dictates that they wouldn’t squander money on deadweight employees. However, such cold logic only applies if we live in rational capitalist societies

In a functioning capitalist economy, business actually has to produce something of value in order to profit. In the new corporatization of healthcare, there is actually more emphasis on extraction than production. Landlords – which are increasingly corporate – fleece their tenants; banks squeeze their customers via high interest rates, late fees, and penalties; and monopolists use their market power to charge exorbitant prices. Like renters of old, today’s Masters of the Universe use property claims and special legal privileges to collect money just for existing. Moreover, another thing they have in common with their feudal forebears is distributing loot to various lackeys.

Graeber aptly describes the modern version of this arrangement as “managerial feudalism,” and it’s depressingly similar to the old school kind. Think of CEOs and owners as today’s lords. Likewise, instead of vassals, there are lower level executives. In the place of knights, there are HR and middle manager enforcers; and instead of well-dressed retainers tweezing their lord’s mustache, cubicle robots turn in meaningless reports.

Under this system, hierarchy and loyalty (or at least obedience) is more important than economic growth. As Graeber likes to emphasize, the proliferation of bullshit jobs is the result of political considerations, not economics. As proof, I return to Barack Obama’s smoking gun acknowledgment that America’s heavily privatized healthcare system is inefficient and burdensome, but nevertheless necessary because it keeps duct tapers working in the healthcare industry employed. On the other hand, everyday workers who actually create value – today’s serfs – are relentlessly squeezed, and no special efforts are made to prevent them from getting laid off. Funny how that works.

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