The Contradiction of Exchange and Use Value in American Healthcare
Eddie L. Smith
Abstract
This article applies Marx’s analysis of the commodity developed in Capital as the fundamental “cell-form” of bourgeois society — to the American healthcare system, arguing that its pervasive dysfunctions arise from the structural contradiction between use-value and exchange-value under capitalism. After clarifying the three forms of value (use-value, exchange-value, and value proper), the article demonstrates how the profit-driven imperatives of U.S. healthcare subordinate human well-being to the extraction of surplus value. Through examinations of the insurance industry, preventative care, surgical practices, pharmaceutical production, and the marginalization of holistic medicine, the author illustrates how capitalist competition compels healthcare institutions to prioritize revenue over outcomes, even when doing so produces irrational, harmful, and deadly results. Drawing on both empirical evidence and personal experience with chronic Lyme disease, the article shows how commodification distorts medical practice, incentivizes overtreatment and dependency, and suppresses effective but less profitable forms of care. Ultimately, it argues that only a socialist transformation of healthcare, rooted in public ownership, preventative care, and the primacy of use-value, can resolve the systemic contradiction identified by Marx and deliver a rational, humane healthcare system for the American working class.
Keywords
marxism, commodity theory, use-value, exchange-value, value, healthcare commodification, american healthcare system, surplus value, insurance industry, pharmaceuticals, preventative care, holistic medicine, capitalist competition, healthcare reform, socialist healthcare, Edward Liger Smith
