Capitalism Is Making Us Sick and Sucking Us Dry

“Framing health as a personal responsibility doesn’t work. And it’s one of the greatest tricks that capitalism has ever pulled,” says author and podcaster Beatrice Adler-Bolton. In this episode of “Movement Memos” Adler-Bolton and host Kelly Hayes discuss the extractive nature of the U.S. health care system, the dominance of COVID nihilism, and why we cannot give up on universal health care.

Music by ​Son Monarcas and Silver Maple

TRANSCRIPT

Note: This a rush transcript and has been lightly edited for clarity. Copy may not be in its final form.

Kelly Hayes: Welcome to “Movement Memos,” a Truthout podcast about organizing, solidarity and the work of making change. I’m your host, writer and organizer Kelly Hayes. Today, we are going to talk about health care in the United States, and how capitalism makes us sick and then sucks us dry. So how bad is health care in the United States? A 2020 study comparing the U.S. to 10 other high-income countries found that private medical spending is five times higher in the United States than Canada, which was the second-highest spender. Medical bills are the number one cause of bankruptcy in the U.S. Such expenses might be forgivable if they meant we were getting the best care in the world, but the U.S. also had the lowest life expectancy and highest chronic disease burden of any wealthy nation featured in the study. And sadly, our caregivers are not faring much better. Even prior to the pandemic, women who were employed as nurses died by suicide at twice the rate of women who were not employed as nurses. More than 100,000 U.S. nurses left the profession in 2021.

The pandemic from the beginning should have sparked a revolution over universal health care. Instead, many people have poured their angst and energy into blaming each other for pandemic outcomes, even as government officials continue to systematically deprioritize our survival. The idea of transforming health care may seem pretty far-fetched to some people, in the current political moment, but I want us to take a moment to stretch our imaginations. Because, when we take a beating, the way we have in recent months, with the fall of Roe and other setbacks, our imaginations can contract. But when our sense of what’s possible shrinks and dissipates, and our thinking becomes purely defensive, we are ceding a lot of ground, and forgoing a lot of potential. So let’s take some time today to really think about the nature of this health care system and consider: What kind of political action and education do we need around health care, amid a global pandemic and the further criminalization of abortion and gender-affirming care? Because the government has a lot of people thinking like individuals about problems that we cannot confront on our own, and there’s a reason for that.

Today’s guest is Beatrice Adler-Bolton, who is the co-host of the “Death Panel,” which is a podcast about the political economy of health. She is also the co-author of Health Communism: A Surplus Manifesto — which is available for pre-order from Verso books. The “Death Panel” podcast is a personal favorite of mine. On the show, Beatrice and her co-hosts — Artie Vierkant and Philip Rocco — offer weekly reality checks about the catastrophic state of health care in the U.S., and discuss why these things are happening, and where we might go from here. In their upcoming book, Health Communism, Beatrice and Artie Vierkant offer an overview of life and death under capitalism and argue for a new global left politics aimed at divorcing capitalism from health — which they argue would result in capitalism’s undoing.

Beatrice and I began our conversation by discussing how early in the pandemic, there was a lot of messaging and discussion around protecting the vulnerable. But in the two years since, we have seen an evacuation of solidarity and mutual concern from public health messaging, and a weary public has become all too accepting of deaths that are largely preventable.

Beatrice Adler-Bolton: So there’s this tension, obviously, that we’ve seen long-term throughout the duration of the pandemic that frames COVID as both this huge population-level threat, and also simultaneously something that only affects the most vulnerable people in society. And this kind of paradox, unfortunately, I think has driven not only a lot of confusion from people who maybe thought that they were invulnerable to COVID and were misled or confused by these framings, whether that’s about their own health, about maybe children or about other people in their lives.

And one of the things that I think we’ve seen long-term is that some of these sort of structural problems that are working their way out through the pandemic, what we’re seeing in terms of state neglect of considerations for people who are medically vulnerable in the workforce, the state refusing to approach the pandemic in a way that’s seeking to assert sort of a collective approach to a population level threat instead of going for more of a classic personal responsibility, consumer model of health framing.

All of these problems, including the abandonment of some of the most vulnerable people in our society, that’s all really just kind of part and parcel of our normal political economy of health. And obviously, COVID has accelerated it, and it has made so many clear examples evident, I think, in a kind of temporal space that’s unusual. And so what I think a lot of people are realizing for the first time is that in our society, we like to think that we take care of the most vulnerable, and we absolutely don’t.

KH: Health Communism stresses the importance of prison abolition and efforts to abolish surveillance. Drawing upon Ruth Wilson Gilmore’s concept of “organized abandonment,” the authors explore the ways in which people who are in ill health are deemed part of the surplus population, because they no longer serve capital as workers, and are then targeted for extraction by capitalist forces. That is to say, the system injures us, and makes us sick, and then turns our illness or debilitation into a source of profit, as we attempt to restore our ability to work, or to simply survive. Much like how prisons are sites of extraction, in which time is extracted from people who have been removed from society, the medical system is a site of extraction targeting people who have been injured or overworked, or who have otherwise become no longer exploitable as workers by capital.

BAB: It’s actually very difficult, I think, to separate the history of the development of medical authority and the carceral structures of the United States. We have a long history of providing warehoused care in the U.S., and also of prioritizing funding models for warehoused-based care. For a long time, we went with these systems of state hospitals, asylums, and hospital schools, where people who were disabled by work, who maybe couldn’t work anymore, people who were born disabled, people who were considered unproductive in any way, whether that was because they were a little bit different, whether that was because they were mad, whether that was because they were disabled, what we did for a long time is we sort of concentrated that care and we sent people to live in these institutional settings.

And there’s been, I think, a long history of looking into how medical authority develops partially through being able to study and have authority over these captive populations. And even as we’ve deinstitutionalized, which is a process that started in the United States in the 1950s and to this day is ongoing, that kind of carceral approach to population management never really left the structures of how physicians were taught to engage with certain populations. And so what we’ve seen also is that even as institutions have closed, these carceral logics are still reproduced outside of the original institutions.

And as we’ve seen in many instances within the realm of actual prisons and jails, there are many things that are prisons by other names. And often, a lot of our care structures, whether that’s dictated by the financial mechanisms or whether that’s dictated by something stigmatizing being associated with that type of health care, for example, in the case of harm reduction services or in the case of the current monkeypox epidemic, you have this moment where the kind of curtain falls back, and you actually see fully that so much of the structure of what we think of as a kind of system of delivering support and care and health is actually about surveillance, punishment, and blaming individuals for things that are happening to them as a result of structural forces, and taking that structural force and abstracting it into an individual biological problem.

KH: So we can see similarities, between how people are sentenced to prison, and a loss of life in that sense, over problems that society forcibly generates, and how people are sentenced to death, debilitation and illness by the injurious conditions of capitalism, and then subjected to financial ruin through the extractive mechanisms of our health care system. When it comes to prisons, the stigma of criminalization and the idea that some people deserve to suffer prevents many people from identifying with imprisoned people and fighting to upend carceral mechanisms. Ableism and denial may drive some people to separate themselves from the people they see being ground under by the medical system, but the past two years have brought our collective vulnerability into sharp relief. So why are we not seeing a stronger movement for universal health care in the U.S.?

BAB: I think the question of why people are not talking about Medicare for All right now has a lot to do actually with the pandemic. What we saw is that health care was this major talking point issue, not just in the 2020 election cycle in the United States, but also in the 2016 cycle. When Biden took control of the presidential primary, it became very clear that Medicare for All was not going to happen in the early fall of 2020. And the fact that that was happening in the context of the pandemic and the message of the Sanders campaign couldn’t even come through in the context of this once in a lifetime plague level, population mass disabling event, essentially, the moment that Medicare for All should be the most salient, what we had is a immediate blanket of messaging that now Medicare for All was completely removed from the political horizon.

And the fact of the matter is that these sentiments…. We don’t all exist in vacuums. We are receptive to the kinds of messages that are all around us. And when we have these sort of apparatus that we do have in the United States that are very good at carrying water for people like Joe Biden, who are very good at trying to take these kind of liberal centrist tendencies, the third-wave vibes, towards essentially maintaining the status quo at all costs, that when those institutions all begin to reflect that messaging, it has a real effect on people.

And I think we tend to deny the fact that it really sucks, actually, to be told over and over that the thing that you really believe is not just going to help you, but help people you care about in your life and help people you don’t even care about, people you hate, right? Something like a universal policy, that’s the point. It’s for everyone. And I think that the horizon was really choked quite small at that point. And I totally understand that what results in that sort of retraction is a resurgence of cynicism and regret and neglect and feeling like the fact of hoping in the first place was an immature judgment or futile and a waste of time and energy.

And that’s a shame, because ultimately, these kinds of things, they’re self-fulfilling, right? And if we are dealing in a climate, right, where all we’re told is that everything that we want and that we demand is absolutely impossible and not feasible, eventually we’re going to start believing the bullshit if there aren’t these kinds of alternative conversations pushing back. And I think what happened and what we saw is that so often in the United States, the conversation around health care and health reform stays in this very narrow discussion.

KH: When we do manage to have conversations about Medicare for All, they are often hampered by questions about how we’re going to pay for it. Of course, we never run into those questions when we are talking about the military or policing or the consequences of fossil fuel extraction because in the U.S., there is always money for death-making. Our government expects us to understand its violence as existing for our benefit, to such an extent that we are all expected to fund state-sanctioned murder, torture, confinement and the havoc of war. But when it comes to sustaining human life, including our own, we are told that funds are scarce, and that taxpayers will reject any taxation for the sake of life.

BAB: We’re always in this position where we’re being asked to sort of justify policies on these economic terms, right, where the fact of the matter is that Medicare for All, whether it would save money or not, whether it’s a good economic decision or not, it’s the right decision to figure out how to provision health care and to provide services to people who need them. And right now, what we have is a fundamentally inefficient system for providing those services. And so I think a lot of people tend to say, “Well, okay, what we can do here is we can take Medicare for All and we’re going to pitch it to people, and we’re going to say Medicare for All is going to save money.”

But fundamentally, that’s a trap, because what that does is that buys into the kind of austerity logic that a policy like Medicare for All is supposed to push back against. And in doing that, we have put ourselves in a position where we’re playing on their terms and we’re not playing on our terms. It fundamentally doesn’t really matter what Medicare for All costs. It doesn’t even matter if Medicare costs some amount that looks really proportionally good when compared to military spending. I mean, we should be spending as much money on health care as is necessary, and we need to expand beyond the very narrow approach to health care that Medicare for All takes.

And it’s going to take money to do that. It’s going to take money and investment. And this is ultimately how capital works, right? It gets into the economy somehow, and it can get in there via public-private partnerships and bullshit like Pete Buttigieg’s Medicare for all who want it, or these kinds of ideas of like, “Well, what if we found a way to continue the private healthcare system just a little bit and then offer a public option?”

All these public-private hybrid versions of Medicare for All that we saw materialized during the 2020 election cycle, I think these are all reflective of the fact that essentially, the only way to move forward with health care is to be starting to rip these industries that have latched on like leeches, like parasites around the way that we provision health services in the United States. And one by one, we’re going to have to go through. We’re going to have to abolish them and stand up new things in their place. And those things do not have to be copies of the institutions that we tear down before.

KH: We are in a particularly challenging moment right now, when many people are being denied the care they need. In addition to people who were already being denied health care, on the basis of their inability to pay, many abortion seekers and trans people can no longer access care in their home states within the bounds of the law. The larger medical system, which was under-staffed and battered by austerity even before the pandemic, is in shambles. In the face of so much injustice and collapse, I think a lot of people who care about these issues simply don’t know where to begin.

BAB: Well, I think one of the things that’s really important is that there should never be a need that we feel to commit to one strategy. And I think one of the things we try to do in “Death Panel” is to really push towards an engagement with the theory of social determinants of health that the left has really gestured towards and talks about a lot and is needed, but I think is underdeveloped. And some of the reasons why I think we are in these situations where some of the ideas that we talk about on “Death Panel” would seem to be so far out on left flank that they don’t even fit relative to a policy proposal or whatever.

But that doesn’t mean that that idea is not valid and shouldn’t be studied and discussed and analyzed and broken down and disseminated and reproduced in the same way. I think we have to always have a long-term goal in mind that we can hold in place in order to keep orienting ourselves towards that goal. And I think we have to try and figure out ways to balance the need to have these dual strategies, where we’re both addressing needs for immediate survival, addressing and dealing with the kinds of compromises that come with the difficult work of struggling to survive and trying to organize with each other and trying to live in the world that we live in.

But we have to also make room for the other stuff. It can’t always be about being “practical.” If we’re only ever restricting ourselves to imagining what’s possible in the current political economy, we’re going to never get to the point of the actual goal, which in my mind should be overthrowing this current status quo system, trying to look at ways that we can take our political economy and refashion, refigure, revolutionize it to have different values and goals embedded in it.

Because ultimately, the problem that we have now is that the values and goals that make us sick, that disable us, and that put us in prison and put us in jail and make us unemployed and take our homes away and poison our air, these are all the social determinants of health, and they’re also the result of a bunch of discrete choices and values that have been deep seated, sure. But that doesn’t mean that they have to be there. It doesn’t mean that they’re dictated by law or nature, that they must be those values. We absolutely can, I think, do both at once. We can be practical and also be trying to work towards this bigger frame of not just building a world for ourselves, but how do we move forward in solidarity together in ways that doesn’t reproduce harm that works against these logics that we know we have to work with now, but we want to not have to work with one day.

KH: Personally, I believe that the fight for abortion access, specifically, has the power to reshape how we imagine and reimagine the fight for health care.

BAB: I think what’s going on right now in the fight for abortion is a really important reckoning with what the meaning of a right is. And this is something that I think is really important and maps really strongly onto how we think of health care, not just because of the framework and all of the hard work that’s been done towards the argument of framing abortion as health care, but I’m talking more about the framing of healthcare as a right.

Because I think ultimately, the way that we’ve seen the symbolic right to abortion as codified in federal law be eroded so much up until the point of this decision, that when Roe “fell,” what it didn’t mark was the kind of watershed moment of abortion suddenly becoming criminalized, but rather, it marked in expansion of what was already being criminalized. And so what I think we need to understand is that rights are highly subjective, and they’re highly conditional, and it’s not simply enough to assert that we deserve something because we have a right to it.

We have to, I think, be pushing for frameworks further than that. And right now, this is something that I think we’re really trying to grapple with around the abortion conversation, whether that comes in the framework of how do we deliver care outside of the “law.” These are things that I think are really important lessons that are not just part of the reproductive justice movement, but more also about the future of the health justice movement.

KH: While considering the future of the health justice movement, or any justice movement, I am always thinking about time. We are living in a moment when time feels very limited, due to the terrifying pace of climate change and other looming catastrophes. But I was really surprised recently, while reading a book called The Next Apocalypse: The Art and Science of Survival, to see the author emphasize the necessity of universal health care. Professor Chris Begley, who teaches outdoor survival courses, in addition to anthropology, stressed the importance of universal health care, both in terms of preparing for the next major medical disaster, and in terms of building a new society, if the world as we know it crumbles. Begley wrote:

Any recovery effort from a future apocalyptic event would benefit from the lessons learned during recent catastrophes. The ways in which insufficient systems of healthcare, housing, education, and food security exacerbated the disaster suggest the importance of working at this larger, structural level to create a community in which everyone’s basic needs are met. Leaving people out eventually costs everybody.

Universal health care wasn’t a topic I expected to encounter in a book about surviving the next apocalypse, but it was consistent with Begley’s broader theory of survival, which emphasizes that we will not survive an apocalyptic era by hoarding resources or excluding people. To survive, we will need to create inclusive systems that account for everyone’s needs. I appreciated that perspective, because we sometimes allow our imaginations to contract in the face of disaster. When things get so ugly that we cannot easily imagine our way out of a problem, like climate change or the right-wing overthrow of the electoral system or the fall of Roe, it can be easy to dismiss our own biggest and boldest ideas. That would be a devastating mistake in these times.

We are living in a moment when the need for universal health care could not be more glaring and immediate. According to a recent study, universal health care could have saved more than 338,000 lives in the U.S., from COVID-19 alone, over the course of the pandemic. We have lost over a million people to COVID-19 in this country alone, and more than 300,000 of them would still be here, if health care were structured around keeping us alive, rather than extracting profit from the sick and injured. In a more sensical world, we would have already forced the government’s hand on this issue, because the level of neglect we have witnessed, and will continue to witness, should be unthinkable. But it seems we’re not there yet.

BAB: I think right now, there is a moment, obviously, where we’ve just all been through the last two years, where we’ve seen countless examples of the ways that our current system of health finance is exacerbating the COVID pandemic, and not just the COVID pandemic, but all the other structural pieces that are part of this general fabric of “medical care.” And what we’ve seen is that insurance companies have made record profits. Patients who are chronically ill, who are immunocompromised have had a very hard time accessing care.

People have delayed their regular checkups and their regular screening. We have people who are being diagnosed with cancer at much later stages than normal as a result of this. We have seen that essentially, what has happened is that in a lot of these pandemic subsidies, which were meant to try and subsidize health insurance for people who were out of work, for example, the COBRA subsidies, what these were, were enormous wealth transfers from the federal government to private insurance companies. And what we’ve seen over and over is a commitment, such a clear and strong commitment, towards preserving institutions of health finance over towards preserving the health of the collective body, or even towards trying to better the health of the collective body.

I mean, health is not just an individual encounter that someone has with a doctor. Health is, in the case of communicable diseases like COVID that spread through the air, health is literally always going to be relative to the prevalence of that disease in the population and the level of virus that’s in the air around you. And that’s just the situation that we are in now. And this is much bigger than individual cases of COVID or individuals’ behavior. This is much bigger than just people. This is about society, the state. It’s about what social supports could be put in place so that we don’t abandon people when they get COVID, when they get the flu, when they get monkeypox.

And there’s so much more beyond these individual health finance encounters, I think, of the kind of ilk that we’re trying to intervene in with a policy for Medicare for All. I mean, Medicare for All is a really important first step, which is why we fight for it. But even as we fight in the U.S. for policies like Medicare for All, the real task at hand is one that is so much greater than one program could capture. I mean, what we’ve seen during COVID is that we need an American NHS. We need a system of provisioning resources across vast physical locales. We need ways to find resources and bring them into rural communities who have seen disinvestment over decades as a result of our managed care models.

And of all of the investment from private finance and venture capital and the consolidation of the hospital industry, what we’ve seen is just this acceleration of the political economy of health being more and more and more oriented towards extraction at every single level. And one by one, we’re going to have to tear these down. And there have been moments in the past where I think we’ve been on the cusp of having these health justice movements break past their individual reforms, and it hasn’t happened.

And part of the problem is that there is a pervasive and very long-standing narrative that has been crucial, that these insurance companies, that we need them to survive. And I think we’ve actually done so much more work now in the last 20 years at dismantling that myth than has been done in the previous 150 years, that it actually gives me a lot of hope, because I think that there is so much recognition that right now we have a climate issue, and that climate issue cannot be separated from reproductive justice or from health justice or from trans liberation.

These are all fights right now that are united. And what I think we’re seeing is that we need to be looking towards these expansive views of health that don’t stop at the end of the clinical encounter, but embrace the fact that health is a kind of matrix of a bunch of different intersecting phenomenon, a bunch of different political spheres, and that if we want a health justice movement, that this has to be something that happens in collaboration with a bunch of movements, most importantly with the movement towards mass decarceration.

KH: One thing I really appreciated about Health Communism was its emphasis on internationalism, because I don’t think most people are used to thinking about health care from an international standpoint. But at a time when borders and bordering are determinants of human disposability, we absolutely have to be internationalist in our politics, and that means exploring what that demands of us in relation to issues we might normally think of as local or domestic.

BAB: So one of the things we tried to do when we were writing Health Communism is really to, I think, push the left health care framing back towards something that was more resurgent in the way we thought about health justice and, in particular, psychiatric revolution in the ’70s but that kind of fell out of favor, which is one that really looks towards going beyond the bounds of borders.

So yes, we absolutely need policies like Medicare for All, but fixing health finance in the United States does nothing for our comrades in Mexico. It does nothing for our comrades in Canada, does nothing for our comrades who are all across Europe, who are in the Global South, who are in different situations which have been influenced by the American health finance model. So if we’re going to approach health justice in the United States, then part of approaching health justice is also knowing that the project is undoing health imperialism and undoing the ways that we have allowed companies like the American insurance companies to really go and transform the way that other countries operate their own systems of health.

And I think we’ve seen a kind of resurgence in, I would say, the recent decade or so of a kind of approach towards health justice that is looking much more beyond the borders of individual nations. And one of the things that I think we look to for inspiration a lot in the book and try and show it as a lesson of both how international solidarity is really important and what happens when it’s revoked, we talk about the anti-psychiatry movement and their interface, which it was a professional movement among people who were psychiatrists.

And there were also patient movements that were going on at the same time, one of which was in Germany, called SPK [Sozialistisches Patientenkollektiv], and there are two chapters about SPK in the book. And SPK is ultimately criminalized for their organizing, and they had been in dialogue and in collaboration with these academic philosophers and psychiatrists who were doing really cutting edge work. And ultimately, the sad thing is that when SPK was criminalized, that solidarity was revoked because a lot of the people that were in solidarity with them had professional interests that were jeopardized by SPK’s reputation as “criminal.”

So I think it’s a lesson that we need to learn from, that not only do our health justice struggles not stop at the artificial border at the end of the state, but also, they reverberate beyond not only our individual health into our community, but way beyond our borders, way beyond our own systems into the systems around us. Because ultimately, what we’re seeing is that all of these systems of extraction are always connected, so there’s no way to tackle one health industry without going for all of them.

KH: The chapters of Health Communism that were dedicated to SPK were, hands down, my favorite parts of the book. We’re not going to dig deeply into that group’s history today, because we sadly do not have time, but I found those chapters so fascinating that I would really like to have Beatrice back sometime just to talk about SPK.

The group, which was heavily persecuted by authorities, was a radical collective of patients and doctor-collaborators who sought to liberate health care from the clutches of a hierarchical system that treated patients as objects to be controlled by physicians. SPK also argued that mental illnesses should not be considered distinct from physical illnesses, and that such categorizations were about stigma, control and misdirection, rather than affording appropriate care. Using words that I think are as relevant in our times as any, SPK argued, “health is a biological, fascist fantasy, whose function . . . is the concealment of the social conditions and social functions of illness.” This idea of health as a fascist fantasy, in a society that’s making us all sick, was truly fascinating to me in this moment.

BAB: Health has no fixed meaning, right? Health is really a set of characteristics that we aspire to, right? We hope to be healthy, and we’re told often what the range of healthy things are, right? And that’s, let’s see, being thin, being white, being fit and exercising a lot, I don’t know, eating Sweetgreen or whatever, being employed, owning property, being heterosexual, being in a committed relationship, participating in consumer life.

These are all the things that we say make a healthy “individual.” And what that makes up is a very specific type of person, one that doesn’t include many types of people. And so that’s actually that kind of framework of health, actually, not as a state of being, but as a state that we have to aspire to, right, as a kind of thing that we are forced to go through these motions to try and get there, right, to try and lose weight in order to be taken seriously by a doctor about the symptoms that we are bringing to them.

We have these kinds of moments where I think we think of health as this good thing, but health is ultimately a kind of oppressive force. And it’s a force that what we see more than anything else is used to define people as not being part of that group. And we’ve seen this so much in COVID, I mean, with the framework of deaths pulled from the future that we’ve talked about a lot on the show, which has been used to explain away the deaths of vulnerable people. “Oh, it’s okay. They were already going to die. Maybe they were going to die in two years. What is it now that they’ve died a little bit sooner?” Right?

And so this kind of fantasy of health, right, what it does is it really only is there to create health as an exclusionary category. And biological health then becomes this kind of property quality, right? Like, “Can you possess health? You’ve got to possess health in order to get a job.” If you think about the ways that we present ourselves for job interviews, even, we try and look as healthy as possible. We try and look competent, productive, and we put on these masks of our best selves. And ultimately, health becomes, I think, more than anything else under capitalism, an impossibility, and also a sort of requirement for economic survival and participation.

And so under capitalism, you have to work, you have to earn your wage, and then you’re entitled to the health that you can buy and the health that you’re allowed as per your identity. And fundamentally, that is a sort of fascist fantasy of what the whole purpose of “health” is actually supposed to be about. This is the kind of cultural imaginary where we’re not healthy for ourselves, but we’re healthy to be good workers, to make good surplus profit for our bosses.

And this is the kind of way that it becomes also a necessary component of capitalism, because if too many of us are too unhealthy, there will not be the kind of body politic that is needed in order to extract from to keep the system running. So it’s a kind of impossibility, right, that we’re told we’re responsible for, and that we’re solely in charge of making sure that we provide and produce, and yet it’s also this kind of system requirement. But the greatest sleight of hand or game that goes on here is that it transforms from something that’s a collective requirement in order to facilitate production into a personal trait or characteristic that we have to individually aspire to.

KH: When the concept of health functions as means to exclude people, or signifying who has value to society, or even, who is deserving of medical resources, it becomes a weapon wielded against us. SPK argued that the solution was to make illness into a weapon, and to unite as a “sick proletariat,” to divorce care from capitalism. In this way, SPK believed that people in need of care, which is basically all of us, had the power to reorder society by prioritizing that care, decentralizing knowledge, and placing patients in collaboration with care providers, as opposed to being answerable to or controlled by physicians. Abolishing the hierarchy of medicine and decommodifying care are big dreams, but personally, I think we need big dreams right now.

But, as we have discussed, a lot of people are not dreaming big right now when it comes to health care. Rather than fighting for a system that would not allow hundreds of thousands of people to die unnecessarily, many people are simply accepting the idea that we will all just keep getting COVID indefinitely. For some people, that will mean long COVID and ongoing debilitation, and for some it will mean death. Rather than fighting for better ventilation systems or universal health care, a lot of people are sort of surrendering to the virus, because the media and the government have convinced people that this is all completely inevitable — even as they do nothing to avoid it.

BAB: COVID nihilism is, I think, a really resurgent dynamic right now that we’re seeing really dominate the conversation, not just the mainstream conversation around COVID, but I think it’s really a kind of dominant position that we’re seeing on the left, which frankly is surprising to me. But if you just follow mainstream media coverage of COVID or go from the comments of state officials, you would absolutely get the impression that the federal pandemic response is sort of reacting to this overwhelming wave of people who are just spontaneously done with COVID.

There’s no appetite for further mitigations, and therefore, all COVID protections are now this highly subjective series of personal choices. I mean, we hear constantly, right, “Oh, there’s no public appetite for mask mandates,” and that, “We should be expecting to get sick a couple more times a year than we’re used to. And if you want to protect yourself, protect yourself and make a plan for when you get sick.” What we’re hearing from every angle across the political spectrum, really, is that COVID is a personal problem.

And what we aren’t hearing is many on the left challenging that. Instead, across the board, again, that pandemic nihilism vibe is present coming from people of all political backgrounds. We see instead this affirmation of the message that COVID is no longer a collective problem. And I think a lot of the conversation about what to do about COVID gets boiled down to this productive framework about polarization and feasibility, kind of similar to, in many ways, the conversation around, “Well, how are we going to pay for Medicare for All? How are we going to pay for a Green New Deal?”

Some of the most prominent voices on COVID also say that it’s a kind of personal problem with the American people, as though it’s a problem of individual psychology or whatever. There are simply too many people who lack empathy or who are anti-vax or who are over masks or whatever. And I think that’s just absolutely not the case. And as we try and show in all of our work on “Death Panel,” and I think, frankly, as is pretty clear from the events that we’ve all lived through over the last two years, framing health as a personal responsibility doesn’t work. And it’s one of the greatest tricks that capitalism has ever pulled.

And what is actually happening right now is the state is allowing the spread of a disease. They are encouraging a disease to rip through the population as they retract and abandon the even few remaining meager social safety net supports. And I get why that inspires nihilism. And what we’ve tried to talk about on “Death Panel” with regard to pandemic nihilism is to say we want to speak about the pandemic and make demands of the pandemic response that reflect the goals that we’re oriented to, whether that’s feasible or not.

Namely, we’re trying to advocate for collective survival one week at a time. And so we’re not saying the issue is empathy. We’re not saying, “Go to your neighbors and yell at them about their behavior.” Don’t be that fucking white lady in your community trying to police everyone’s behavior. There are people who are acting like that. And even in their critique of the way the state is abandoning people, they themselves are also turning to personal responsibility rhetoric. And I get that. I mean, as we’ve talked on the show, people expressing their frustration about COVID, taking it out on people, that’s coming from a place of extreme grief.

It might be misdirected mourning, but it is mourning. And what we’re saying on “Death Panel” is that what we really need to do is we need to come together and reorient our focus back on the state. That’s the only way, I think, to undo pandemic nihilism, because the reason that COVID went so bad is not anyone’s individual behavior. The reason COVID went so bad is our political economy of health. Because our political economy of health is designed to be this kind of impossibility, right, this kind of fantasy of individual health under the political economic conditions of capitalism, this is the kind of framework that is preventing us from having a competent COVID response.

KH: Those of us in far left circles sometimes encounter debates about who is and isn’t part of the proletariat, or who has actual power or leverage in working class struggles. Some people believe that only workers have the power to challenge our oppression, by leveraging their labor power. That has never been my perspective, and I really appreciate the way this notion of a “sick proletariat,” or attacking capitalism by divorcing it from health, is a revolutionary vision that includes us all.

BAB: Something we kind of talk about in the book a little bit, but that I think is also a dynamic at play in COVID, which is this kind of way that you see workers and non-workers pitted against each other as well.

And I think when we’re looking at, whether it’s monkeypox, whether it’s access to COVID therapies, or whether it’s access to workplace accommodations or anything else, these kinds of zero-sum logics where people feel that their needs come at the expense of other people’s needs being met, these are the kind of regimes of artificial scarcity which are really meant to, I think, in a way, I think keep people trapped in this logic of the kind of inevitability of the political economy, right?

Because this is a kind of totalizing, crushing feeling of state abandonment that we have all experienced when it comes to COVID. And to see that no lessons were learned and that the monkeypox vaccine response has been, I would say, different but just as inequitable as the COVID vaccine response, is really telling. And it’s really telling, I think, who pharmaceutical products are supposed to be for. And I think one of the important things that’s a kind of through line in our book is this way that there’s been a class tension between the working class and the surplus population, this kind of category that we talk about in the book, the surplus population, which is initially used as a negative word to describe people who are cast out of society as non-productive laborers, non-productive workers, non-workers.

But I think what we sort of argue for is that in the separation of the surplus and the working class, that there’s a really productive tension there. And what that tension sort of hides is the fact that the treatment of the surplus class is used as a kind of way of perpetuating the terrible working conditions of the working class. Because if the prospect of becoming surplus is always going to be worse than the conditions of your shitty job, you’re incredibly motivated to continue to put up with those conditions.

It’s kind of the way that risk factors into our organizing efforts when we’re talking about, “How are we dealing with immediate threats to our communities? How are we dealing with immediate struggles that deal with maybe the site of the workplace right now,” which I think is a moment for a lot of people that’s causing a lot of stress because we’re in this point where we’re seeing the workplace accommodation landscape shift, and a lot of people who have been immunocompromised who have been able to work remotely during the first two years of the pandemic are being told, “Tough shit. The CDC’s director says we’re all going to get sick now. It’s time for you to come back into the office.”

And if there’s no way for your boss to ever be put in a position where they’re forced to reckon with what they’re making you do, if you’re an immunocompromised person being told, “No, you absolutely have to work in person no matter what,” that’s a kind of threat, right? It’s a kind of positioning of, “Okay, well, you’re going to have to do and put up with these kinds of conditions if you want to remain a member of the working class,” because otherwise, you become surplus, you become a non-worker. And with that obviously comes these kind of additional modifiers that become a threat to your survival, that become a way that restricts your ability to participate in the economy, et cetera.

And so I think what we’re seeing right now in terms of how scarcity is playing out, both in the way that we think about the way that resources are distributed, but also in the way that our policies are targeted towards certain populations, targeted to support certain populations and to abandon other populations, right, that this ultimately has a huge influence on so many different things. But at the end of the day, that worker/surplus binary is really false. I think we are all constantly at risk of becoming surplus.

And there’s no reason that we should be treating people who are in the surplus class like they are human waste, and yet that’s sort of where we’re at. And I think one thing we kind of argue for in Health Communism is towards the politics where we move away from things like the worker surplus binary and try to find ways to engage in worker organizing that don’t reject frames that can include the surplus class, that can go beyond the immediate locale of the workplace, of victories won for the productive workers only.

And I think in some ways, in the context of COVID where many more people may be a little bit disabled in the coming years as a result of their exposure to COVID in the workplace, this is going to be a really important concept for us to think through, because I think the line between who is a worker and who is surplus has become increasingly blurred as a result of the pandemic and as a result of the high levels of infection that are a direct result, again, from our political economy of health.

KH: We talk a lot on this show about the escalations in mass death and human disposal we are witnessing as capitalism continues to cut its losses to maintain the status quo, amid climate catastrophes, public health emergencies, and other disasters. We cannot resist disposability as individuals, because when we treat problems of health and illness as matters of individual responsibility, we are stuck in the system’s trap. The only way to fight the disposal of human beings, via the for-profit medical system, is to surrender nothing and no one. We must declare that no one is disposable, and that everyone must receive care, including abortions and trans-affirming care, if that is what they are seeking. We have to decide, here and now, that we are not willing to be bled dry by a system that makes us sick, brutalizes our bodies, and ransoms the care we need to recover or survive. We need to make some fundamental decisions about our politics and the world we want, and we have to fight for that world.

I want to thank Beatrice Adler-Bolton for joining me today. I had a great time and honestly, I could listen to her talk all day. You can preorder Health Communism from Verso books and you can check out “Death Panel” wherever you get your podcasts. I will be including links to some of my favorite episodes in the show notes of this episode on our website at truthout.org, so do be sure to check out the transcript. I also want to thank our listeners for joining us today. And remember, our best defense against cynicism is to do good and to remember that the good we do matters. Until next time, I’ll see you in the streets.

Show Notes

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