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Work or Die? ‘Death Panel’ Podcasters and ‘Health Communism’




Health communism

Beatrice Adler-Bolton and Artie Vierkant


October 2022

Health communism begins and ends with the same statement: “Health is the vulnerability of capitalism”. Because health conditions are bought and worked, disease is its logical effect. On the other hand, many leftist critics of capitalism do not recognize any state of health beyond the eugenic fantasy of well-being, a state of being that always eludes the worker. Authors Beatrice Adler-Bolton and Artie Vierkant, co-hosts of the bi-weekly podcast death panel, disagree. They seek to reclaim the category of health not just for workers, but for the unemployed “surplus” adult population, excluded from health in the capitalist system. Hence the title of the book.

The distinction between deserving workers and sunk surplus is sociological. The authors argue that overcoming it – effectively achieving a socialized medicine, in which class, money, race, ability and gender cease to impede the distribution of care – is a condition for overcoming capitalism. The case for socialized American medicine has changed little over the past century. However, the dependence of health on capital has changed, and with it, the determination of debt and need.

To determine the debt and the need of a citizen is to delimit the productive of the surplus population, the latter being made profitable by their storage and their maintenance of order (generally because of their “burden” on society). Interestingly, the authors identify the modern source of this distinction as the English Poor Laws. The first legally defined worker/surplus binomial was the old Workers’ Statute (1349), adopted in response to labor shortages caused by the Black Death, which increased workers’ bargaining power. This law criminalized all able-bodied unemployed people under the age of 60.

It is telling enough that the measure of eligibility for state welfare programs today is not the severity of illness or impairment, but the effect of these on the claimant’s relationship to the work. This confuses health with labor power. The authors argue that the social construction of madness was integral to the certification of ability. The legitimization of psychiatry at the dawn of the 20th century rested on its separation of the curable sick and the incurably handicapped.

Asylums are a paradigm of this intersection of care and carcerality. As institutions grew, they exploited the labor force of patients, from launderers to farmers to research subjects (this is the most heartbreaking part of the book). Deinstitutionalization did not end these profit mechanisms, but distributed them to the current American network of consumer-driven “publicly private” long-term care homes.

This growth has been mirrored and fueled by pharmaceutical monopolies. State subsidization of pharmaceutical rights has instituted capital’s current role “as the defender of a global intellectual property regime,” reinforcing the trade dependence of developing countries. The authors provide a densely documented history of the pathologization of illicit drug use as an alien social contagion and the privatization of licit drug production from the Cold War to the present day. They forcefully argue that resistance to this internationalist privatization requires an internationalist platform. “…[I]Internationalism must be an essential part of health communism if we are to bring about the end of capitalism,” they write.

The accumulation of capital structures precariousness and pathologizes unproductivity. If the surpluses can be disabled, crazy or chronically ill, it is not their condition that makes them precarious but their dependence on the medical-industrial complex. These “burdens” weighing on the State are essential to its benefit. After all, disabled patients bear more GDP in a hospital bed than at home. The authors define this accumulation of capital from surplus bodies as a process of “extractive abandonment”.

As the fight for policies like Medicare for All grows more urgent in America, so does the need to reform the political economy that would deliver those policies. Even quasi-forms of socialized medicine in Canada and the UK are the result of repressive austerity and bureaucratic engines of risk management; the authors recall that the UK promoted its campaign to leave the European Union based on the NHS debt burden. Otto von Bismarck presented the first modern health insurance program as a concession to German workers in the interest of socialist repression.

Health communism ends with a random account of the Sozialistisches Patientenkollektiv (Socialist Patient Collective, SPK) in West Germany and a quick but confusing exposition of the existentialist origins of the mid-century anti-psychiatric movement. The relationship to the authors’ argument becomes hermetic as they explain each failure: the antipsychiatric movement “died as its founders died” because they did not center their patients, the surplus. The SPK (which Sartre considered “the only possible radicalization of the anti-psychiatric movement”) and subsequent European patient groups were censured and vilified by the state and the press, beaten and disbanded by the police because they considered the disease of this surplus not as an individual cause but a social effect of the capitalist political economy.

So far, the authors are clear about what to resist – the social symptoms that sustain disability addiction – but vague about what this resistance entails (particularly in cases where the disease, even if it is socially produced or aggravated, is irreversible). Here, their discussion of SPK’s goals sheds light on theirs: to center self-directed care for the marginalized is to transform an “unconscious malaise” of their addiction into an “unhappy awareness” of the mechanisms of that addiction. To separate one’s status as a patient from its status as a commodity is to separate health from capital.

The current pandemic, during which Health communism was written, is totally and deliberately excluded. None of the “lessons” of the Covid pandemic were unknown, and none of its effects (except the most menial) were unforeseen. They merely affirmed the authors’ socially determined view of health: housing is health, working conditions are health, food is health, and clean air is health. To achieve it is to focus on our demands of the current system and the excess population it creates and extracts.

In short, this seamless book fills an urgent void in leftist theories of disease: a conception of health that is workable within the capitalist system but mutually exclusive with that system’s model of health ( according to a spectrum of ability to work and, failing that, to be an institutional subject of extractive abandonment). Health Communism is a thin book, and its argument is tight. However, it is so tight between the mutually informative threads of class analysis, early modern categorisations of disability, the decline and fall of asylum systems, and international drug policy that achieving such a concise yet compelling framework (helped by the fact that the past years have only confirmed his conclusion) is a marvel.

There is a sense in which we are all sick in the current system. But that doesn’t relegate every conceivable health condition to a eugenic fantasy simply because it’s the logical outcome of current health care management. It is more accurate to argue, with the authors, that none of us are well, inasmuch as we fail to center the margins.