This article argues that privatization of health care since the 1970s has created a paradox whereby a neoliberal discourse of ‘freedom of choice’ masks the fact that it is increasingly difficult to make good choices when it comes to caring for oneself and for one’s loved ones. Part one historicizes this paradox by examining the pioneering international feminist movement Wages for Housework. I argue that Wages for Housework offered a glimpse of a counter-model of state-renumerated care through its revolutionary demand that all houseworkers receive a government wage. At the same time, I call attention to limitations of the movement. Building on the insights of this case study, part two contends that the privatization and commodification of care – especially in the US and the UK in recent years—is fundamentally linked to the ‘responsibilization’ of female-identified subjects. To demonstrate this, I turn to the issue of self-care, arguing that the emergence of self-care as a lucrative twenty-first century market is an important consequence and indicator of this responsibilization. Specifically, I show how individual choice is recast as a societal obligation to assume a consumerist standpoint of ‘self-investment’ that, in itself, becomes a necessary precondition of the ‘right’ choice. I conclude by asserting that it is unjust to frame care—whether for oneself or for others—as a problem of individual responsibility and explore proposals for a ‘universal basic services’ model as the most equitable solution to the current care crisis.

本文认为，自 20 世纪 70 年代以来的医疗保健私有化造成了一个悖论，新自由主义的“选择自由”话语掩盖了这样一个事实：在照顾自己和亲人时，做出正确的选择越来越困难。第一部分通过研究开创性的国际女权主义运动“家务劳动工资”来历史化这一悖论。我认为，家务劳动工资通过其革命性的要求，即所有家务劳动者都获得政府工资，让我们一睹国家计酬护理的反模式。同时，我呼吁人们注意运动的局限性。基于本案例研究的见解，第二部分认为，护理的私有化和商品化——尤其是近年来在美国和英国——与女性身份主体的“责任化”有着根本的联系。为了证明这一点，我转向自我保健问题，认为自我保健作为二十一世纪利润丰厚的市场的出现是这种责任化的重要结果和指标。具体来说，我展示了个人选择如何被重新塑造为一种社会义务，以采取“自我投资”的消费主义立场，这本身就成为“正确”选择的必要先决条件。最后，我断言，将护理（无论是为自己还是为他人）视为个人责任问题，并探讨“普遍基本服务”模式的建议，作为当前护理危机最公平的解决方案，这是不公正的。