Abstract This paper is an edited version of the Deutscher Memorial Lecture delivered in November 2023 which expands upon The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America. It develops an account of the productivity limits of interpersonal service work more firmly rooted in Marxism and argues that the separation of social reproduction from production is primarily economic rather than political. This theoretical device is then deployed to argue that there is indeed a global ‘crisis of care’. This crisis is triggered not only by destabilisation of earlier care regimes, but also the encounter between the productivity limit and new forms and expanding volume in demand for care. Finally, this crisis is linked to the new global sociology and politics of gender and sexuality. Methodologically, the paper argues for renewed attention to the empirical specificity of proletarianisation processes, rather than ‘class abstractionism’.