Chomsky's main argument in Hegemony or Survival is that the socio-economic elite who control the United States have pursued an "Imperial Grand Strategy" since the end of World War II in order to maintain global hegemony through military, political and economic means. He argues that in doing so they have repeatedly shown a total disregard for democracy and human rights, in stark contrast to the U.S. government's professed support for those values. Furthermore, he argues that this continual pursuit of global hegemony now threatens the existence of the human species itself because of the increasing proliferation of weapons of mass destruction.

Drawing historical examples from 1945 through to 2003 to support his argument, Chomsky looks at the U.S. government's support for regimes responsible for mass human rights abuses, including ethnic cleansing and genocide, namely El Salvador, Colombia, Turkey, Israel, Egypt, South Africa and Indonesia. He also discusses U.S. support for militant dissident groups widely considered "terrorists", particularly in Nicaragua and Cuba, as well as direct military interventions, such as the Vietnam War, NATO bombing of Yugoslavia, Afghan War and Iraq War, in order to further its power and grasp of resources. In doing so, he highlights that U.S. foreign policy – whether controlled by Republican or Democratic administrations – still follows the same agenda of gaining access to lucrative resources and maintaining U.S. world dominance.