Health Communism

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The politics of health is especially important in a society in which the crisis of the NHS is proclaimed daily, where it can feel like little territory remains for the Left, other than the rearguard action of a dogged defense of ‘our’ health service. Adler-Bolton and Vierkant present not just a utopian alternative, but they offer a concrete politics that moves beyond the mere reduction of waiting lists and creation of more beds. Particularly welcome is the advocacy of patient control of and participation in care, a central demand of the SPK, representing a radical alternative to contemporary tokenistic notions of inclusion and consultation. In this way they went beyond most of the contemporary anti-psychiatry movement that tended to be reformist, with left and right wing political iterations. On the right, US libertarian Thomas Szasz promoted the idea that psychotherapy was mostly fake, but that it’s value was subjective and should be determined by the free market, meaning those who could not afford it were not a major concern to him (134). You introduce a term that I found extremely helpful, called “extractive abandonment.” What is the intellectual genealogy of this idea?

Some people may be surprised to find that, in Health Communism, there’s not a gigantic chapter on COVID-19. But that omission is really intentional: we’re trying to make a hard point. A lot of people like to say that we’ve learned some very tough lessons with COVID, but that’s absolutely not the case. These are not new lessons. These are not new horrors. We’re looking at an acceleration of an existing political economic phenomenon that was already marking people for a slow death. What we’ve seen is the pandemic applying additional pressure to a system that was already unsustainable and in no way conducive to “good health.” While canonical accounts of political economy begin with the “worker,” Adler-Bolton and Vierkant begin with the “surplus class.” In Health Communism , they show how members of the “unproductive” surplus class are cast as burdens even as health capitalism sets up entire cottage industries (e.g. for-profit nursing homes, prisons) to extract value from this very population. Society, Adler-Bolton and Vierkant show, “does immense work to forestall these two groups—the workers and the surplus population—from imagining themselves in solidarity.” In September, we discussed (per the show’s catchphrase) how to be in solidarity forever, and how to stay alive another week. In Health Communism, Beatrice Adler-Bolton and Artie Vierkant first identify and provide an overview of the methods and ideology that have solidified into modern Health Capitalism.

Quick positive comments on Abolish the Family by Sophie Lewis

The position of the AMA, of the organized labor movement, and increasingly in the post-war era, of the American public, carries a lot of the eugenicist and Malthusian assumptions that the authors establish as key to capitalist health care. This is not to say most people are against socialized medicine, only that the assumptions of what that could be have been constricted by now dominant views of what is possible. David Stark Murray, Why a National Health Service?: the part played by the Socialist Medical Association (London: Pemberton Books, 1971), 78. With the term “extractive abandonment,” we’re trying to give people a way of naming how health is constructed through logics that are carceral and extractive, not towards making your quality of life better or relieving your pain or curing you. Rather, there is simply an agreement that this economic relationship is going to pass through you, which is the result of discrete decisions at the structural level—not your personal choices. We’re arguing for a new theory of health and class that pushes beyond this disciplinary relationship in which the subjection of people who are not workers acts as a way of enforcing terrible labor conditions: so-called “health” is actually the primary form of labor discipline. David Widgery, Health in Danger: The crisis in the National Health Service (London: The Macmillan Press, 1979), 32. The ‘communism’ of the book’s title speaks to its manifesto-like character, with the urgency stemming from its clear aim as a political intervention. The short text covers a dizzying amount of ground, switching from case studies to broadly sweeping socio-political analysis with vertigo-inducing speed.

In Health Communism, [Adler-Bolton and Vierkant] show how members of the 'unproductive' surplus class are cast as burdens even as health capitalism sets up entire cottage industries (e.g. for-profit nursing homes, prisons) to extract value from this very population. Charlie Markbreiter, Bookforum Des Fitzgerald et al, ‘Brexit as heredity reduce: Imperialism, biomedicine and the NHS in Britain, Sociological Review, no. 68 (2020): 6, 1170. Adler-Bolton and Vierkant are perhaps best known as two of the hosts of Death Panel , a health justice podcast which takes its name from Sarah Palin’s 2009 claim that federal universal health-care would lead to state-sanctioned austerity and murder (which, as Vierkant has argued, is what capitalism does already). The show stands out not only for its extensive pandemic coverage but also for its analysis of how concepts like “health” and “value” are socially reproduced, that is, how public policy shapes whose lives are supported and whose are forfeited. Building on the concept of the surplus, Adler-Bolton and Vierkant introduce the ‘eugenic and debt burden’. [8] The eugenic burden might be framed as a genetic, demographic or social threat. People who exist outside of supposedly healthy, normative subjectivity. The debt burden is posed in terms of the ‘public purse’ where austerity is naturalised and justified through narratives of ‘personal responsibility’ and ‘affordability’. ‘Citizens’ are ideologically trained by the state to ‘surveil and judge others’ worthiness for aid’. [9] This might be translated into popular discourse as to who is really trans, really disabled or really a refugee. Who is deserving of care and who isn’t? Who is ‘faking’ it? Through the ‘debt/eugenic burden’ those who are deemed deviant are cast as irredeemable and considered a drag on humanity. This sometimes shows as arguments about ‘defrauding the ‘taxpaying citizen’ and the state’; [10] the ‘structural flaws of the political economy’ pushed onto the so-called ‘behavioural flaws of the individual’. In this, the deviant surplus is demonised as a malignant risk to the nation’s health. Ultimately, Adler-Bolton and Vierkant argue, we will not succeed in defeating capitalism until we sever health from capital. To do this will require a radical new politics of solidarity that centers the surplus, built on an understanding that we must not base the value of human life on one’s willingness or ability to be productive within the current political economy. Capital, it turns out, only fears health.Even so, the pharmaceutical industry had a big hand in shaping US colonialism via the creation of capitalist global trade regimes and laws that ensured corporate control over who could produce and profit from vital medicines as well as ensuring scarcity as needed to guarantee higher profits for pharmaceutical companies. Today this regime, known as Trade Related Intellectual Property Rights (TRIPS), means that “in effect, twelve corporations made public law for the world” (90). Those countries not willing to play by the rules of TRIPS may be excluded from trade in and access to life saving drugs and treatments. This “global rationing regime” marks “entire nations as surplus” (78). Review: John Shaffer, Peste Magazine, Better Red Than Dead: Should you read Health Communism before you die, or should you die first? (10/18/2022) Cited: Canadian Dimension: Making the invisible visible - an interview with Megan Linton about the harms of the institutional system, COVID-19, and disabilityjustice (08/26/22) The NHS is often wielded uncritically on the left, reproducing a fetishised, nostalgic notion of its existence. Further, the NHS is intertwined with the left’s nostalgic fetishisation of the Labour tradition and post-war social democracy; Bevan standing over us as a great statue of socialism’s past, as someone we hope to emulate again one day. All of this is understood from an ahistorical, immaterial perspective that erases the way the NHS was birthed through the bloody exploits of the empire. Welfare and warfare coming together. El-Enany highlights how welfare ‘embodied the assertion of white entitlement to the spoils of colonial conquest.’ [20] Alfie Hancox provides a devastatingly lucid account of this in his essay, Lieutenants of imperialism: social democracy’s imperialist soul . Reforming the NHS within the confines of methodological nationalism would leave ongoing imperialist exploitation intact. Just as Bevan ignored this when he proclaimed that Attlees’s Britain had ‘ assumed the moral leadership of the world’, despite how his government spent several years violently repressing communist and anti-colonial uprisings in some of the bloodiest years of British imperialism. We must, as Shafi and Nagdee demand, ‘refuse the British left’s historical dereliction of duty: its compromise with imperialism and its rejection of radical internationalism.’ [21] Anti-Imperialist Health Communism Video: Last Born In The Wilderness, Beatrice Adler-Bolton: SPK; Health Communism; Life & Death Under Capitalism (10/18/2022)

Interview: This Machine Kills, We Are All Surplus (ft. Beatrice Adler-Bolton, Artie Vierkant) (10/19/2022) Health Communism starts and ends with the same contention: “Health is capitalism’s vulnerability.” Because the conditions of health are bought and worked for, illness is its logical effect. On the other hand, many left critiques of capitalism recognize no state of health beyond the eugenic fantasy of wellness, a state of being that ever eludes the worker. The authors Beatrice Adler-Bolton and Artie Vierkant, co-hosts of the biweekly podcast Death Panel, disagree. They seek to reclaim the category of health not only for workers but for the non-working “surplus” adult population precluded from health in the capitalist system. Hence the book’s title. Delegates of pharmaceutical companies visiting the Soviet Union found they had more physicians and medical staff than was expected and that in fact they were exporting their medical workers to less developed countries (39). Some suggested the US engage in a medical arms race against the Soviets as a form of colonial strategy. The authors rightly point to the fact that socialized medicine usually produces better outcomes than capitalist ones. I had slight reservations on some of their descriptions of Bolshevik Russia as “communist” but in the context of the book, this is perhaps a minor quibble, and I have no idea of what critiques of Bolshevism or Leninism they might have. In the aftermath of the SPK, there has been ideological repression of radical critiques of capitalist society and concrete state repression of militant activism. Yet the contemporary moment sees more and more mainstream re-linking of mental health and politics, and the spectre of the unfinished business of the SPK still haunts us. The authors follow the core logic of the SPK, suggesting that illness under capitalism might be reappropriated and turned against the system itself, making illness a weapon against capital. The authors claim that they offer one of the most comprehensive accounts of the SPK in the English language. Indeed, their historical account of the SPK, and their revival of the group’s relevance and political concepts, is one of the book’s greatest strengths. Though the SPK originated as a collective of psychiatric patients and doctor collaborators, the authors emphasise their unitary theory of health, making no differentiation between the physical and mental, rather seeing all illness as the result of social and political determinants.Interview: Spencer Green, The New Republic, Medicare for All Is Not Enough: Beatrice Adler-Bolton and Artie Vierkant make the case for health care revolution (11/7/2022) Interview: Charlie Markbreiter, Bookforum, Care for All: Beatrice Adler-Bolton and Artie Vierkant Discuss Their New Book Health Communism(10/20/2022) Death Panel has an amazing aesthetic, from the show images to the merch to the ending music. These component parts are great in and of themselves, but they really come together to create a very coherent, intentional, and effective aesthetic. Before we go: How was this aesthetic developed, and how would you describe it?