Global Capital, Healthcare and the Fourth Industrial Revolution

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by Karim Sariahmed and Marc Shi

The Nonviolent Medicaid Army (NVMA) has long held certain core understandings about the relationship between healthcare and global capital.* Among them: the healthcare sector acts as a relatively recession-proof reservoir for the global ruling class to park their capital. Labor-replacing technology is a means of accumulating wealth for the few at the expense of the many, so long as the ruling class controls the technology. Therefore, the struggle for healthcare as a human right – the de-commodification of healthcare – is a weak point for the ruling class both because it is a site of capital accumulation and they have no solutions for the worsening healthcare crisis, even as they move rapidly to apply artificial intelligence in the healthcare sector. The very idea that healthcare could be removed from the circulation of global finance capital is deeply threatening to the ruling class.

Leaders from the NVMA recently undertook a brief study to understand how the fourth industrial revolution is being expressed in the healthcare system today. We started by listening to lectures from the World Economic Forum (WEF)** on the topic from recent years. If the state apparatus manages the affairs of the bourgeoisie, then the WEF can be viewed as an organizing hub of global capital. It is a meeting of ruling class cadres from different sectors of the economy in coordination with state officials and influential civil society leaders in NGOs and media/entertainment. 

Three themes emerged from our investigation which connect the current commentary of healthcare “thought leaders” to our core understandings above, and to the permanent and increasingly extreme crises faced by our class, the poor and dispossessed working class, every day and around the world.

1. Supply chains link the provision of all of our basic needs to national security and the war economy.
2. The ruling class will continue to prioritize capital accumulation throughout this period of intensifying crisis for working class people. Healthcare is a cornerstone of this effort.
3. The US state has a special role in this process of capital accumulation across the global economy. There are two leading wings of the US ruling class that find political expression in the Democrat and Republican parties.

1 – Supply chains, national security, and our basic needs

We note the connection made early and explicitly between healthcare and American national security concerns at the WEF this year by Michael Sen, the CEO of Fresenius, a German multinational healthcare corporation. One of their subsidiary companies, Fresenius Medical, owns between 35 and 40% of dialysis centers in the US. Fresenius Medical and Davita together own nearly 80%. Their monopoly power increases the price of an objectively scarce*** resource. Here are some of Sen’s opening comments on the connection between technological innovation, healthcare, and geopolitics:

“What we do need is a fundamental change…. With all the scientific progress – you mentioned AI, and I could go into biologics…. How can we grow healthcare without increasing costs – how can we make it more robust and resilient? And here comes the change. In a few countries and regions, I see healthcare becoming a top national security topic, because we come from the security of supply of medication, of critical and essential medicine…. In the US it is moved to more of a national security topic, a topic of sovereignty and resilience and therefore that is then accompanied in a new world order…, which is more transaction-based and based on national interest. There is a clear industrial policy behind it because when it comes to…active pharmaceutical ingredients, we are way too dependent on, for example, countries like India and China.”

“Essential medicines” refer to those medicines which satisfy the most basic and fundamental health needs of a population, like those used for treating high blood pressure, diabetes, cancer, HIV, and tuberculosis. Struggles over intellectual property rights – the rights of wealthy pharmaceutical companies to profit from the sale of life-saving medications – have long been a prominent aspect of economic struggles between world powers. The Trans-Pacific Partnership (TPP), part of the ruling class “pivot to Asia” during the Obama years, was explicitly framed as a successful effort to contain China’s trading power. The US withdrew from the TPP in 2017 under President Trump, with wide-ranging consequences. China and India, the two countries of great concern for Sen, were part of an alternative trade agreement – the Regional Comprehensive Economic Partnership (RCEP). Negotiations for the RCEP began in 2012, but the COVID-19 pandemic raised the stakes on these trade agreements, accelerating the finalization of the world’s largest trade agreement in 2021. In this context, healthcare becomes a question of national security and geopolitical competition with China, not a question of human rights.

In 2026, the devastation being wrought by the United States, Israel, and their allies in Iran and the broader Middle East will reshape the link between global supply chains and healthcare.

2 – Healthcare: A cornerstone for accumulation 

Isabelle Weber is an economist who has focused her research on the relationship between inflation and profit, with a focus on world crises like the COVID-19 pandemic and the current war on Iran. She and her colleagues show that inflation, often viewed as something natural or inevitable during times of crisis, are simply a means for corporations and the wealthy to make extreme profits during times of crisis. 

“One fifth, one third, one third, two fifths, nearly one half – these are the respective shares of global exports of liquefied natural gas, crude oil, fertilisers, helium and sulphur normally passing through the Strait of Hormuz. Our research shows that these are essentials the world economy depends on. Fossil fuels are by far the most systemically significant inputs in (as yet) predominantly fossil fuel-powered capitalism. Food production depends on fertilisers. Helium and sulphur are necessary for microchip production, in turn needed for everything from lawn mowers to data centres sustaining the AI boom. The passage through the strait of these raw materials – key for making everything else – has been effectively suspended since the beginning of the war.”

Her commentary helps us connect our study on supply chains and geopolitics (Theme 1) to a plan for continued accumulation at our expense (Theme 2). 

Our class is facing multiple health-related catastrophes. Climate disasters are setting the stage for the next pandemic, and the economic crisis is poised to deprive our people of food. As this happens, the WEF looks to healthcare broadly as a place to seek “resilience investments.” To the ruling class, the healthcare system is not a place for everyday people to get their needs met, but a place to accumulate capital. As they put forward in their blog this year, there is profit to be made on all aspects of health and disease stemming from the crisis: telemedicine, diagnostics for worsening and perhaps entirely novel respiratory and infectious diseases, demand for cooling systems, and the growth of health systems in poor countries. As we will detail further, AI is of course another area of untapped profit, stemming from its potential ability to replace medical scribes, or, as surgeon and entrepreneur Dr. Nadine Hachach Haram put forward at the WEF in 2026, to remove nurses from operating rooms.

Finally, we must understand the particular role of the United States and the two wings of the ruling class to understand their points of unity and disunity regarding healthcare. The MAGA wing seeks to link the US state’s military apparatus with its technological economy, and does this brazenly through a spectacle of violence, scapegoating different sections of the poor – immigrants, Muslims, Jews, trans people, Black people, white people, unemployed people, etc. The WEF and the Council on Foreign Relations represent the temporarily deposed wing that has been predominant in the US state for generations.

3 – The Role of the US State

While these two sections of the US capitalist class often state their opposition to each other openly, their alignment on healthcare as a site of capital accumulation divorced from actual provision of care to the poor of the US and the world is clear. For example, In 2025, the United States under MAGA leadership divested from the World Health Organization, a major provider of healthcare for poor countries and also a group which sets scientific standards and provides leadership on international health issues like climate change and pandemics. Rather than push back against this or call for healthcare as a human right, the WEF, focuses its attention on the idea of “health equity,” and also the idea of “health sovereignty,” referenced by Sen. The health sovereignty strategy takes examples of healthcare systems which operate successfully with few resources, strips them of their political economic context, and encourages other nations to emulate them. They emphasize national autonomy and independence rather than collaboration, the sharing of resources, or human rights principles. 

“Health sovereignty is not a call to disengage from global health efforts, but the creation of a more equitable global health order – one that honours national autonomy, while fostering cooperation to address shared challenges in an ever-changing and increasingly globalized world.”

The WEF specifically calls out Cuba as an example to emulate, citing their primary care capacity and strong health outcomes which famously rival those of wealthy nations not subject to aggressive economic sanctions. Of course, we know the context for Cuba’s strong healthcare system. Cuba’s revolutionary process brought about a system based around human needs. Cuba has the highest ratio of physicians to population in the world, with many living walking distance from their family doctor. That is the result of a process of transforming society, not the result of “health sovereignty” or any other false narrative. 

Neither wing of the ruling class wants healthcare as a human right, or a transformation of society for the benefit of the poor. This is a point that unites them. They are both committed to using healthcare as an area of unfettered capital accumulation, bolstered by the US state and increasingly linked to US investment in the war economy. Understanding how global capital seeks to control and profit from healthcare is crucial to developing a winning strategy. The ruling class has no conception of the healthcare industry that is not tied to its own profits, and it is this fundamental weakness that we must exploit as the organized poor. 

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*For further reading on these core understandings, look at our articles on the Nonviolent Medicaid Army from 2023 and 2025, as well as an interview covering similar content in 2021.

**For further reading on the World Economic Forum and the Council on Foreign Relations, see this introductory article from 2018 and a more recent update.

***Dialysis is currently one of the most water and energy-intensive medical interventions in existence. Some argue that the resources objectively do not exist to give dialysis to everyone in the world who would benefit, even if resources were shared fairly.