Health Communism

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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.

BAB: SPK was a patient liberation organization that formed in 1970s West Germany in a hospital in Heidelberg and only existed for a very short period of time. There are people still using the name SPK today, but we are talking about their original historical formation. Two of the final chapters in the book, called “Care” and “Cure” are, to our knowledge, the most comprehensive English language account of the activities of this group, perhaps outside of their own manifesto. Their work marked an important moment, not only for disability history or patient liberation, but also in left political thought. We wanted to make sure to tell their story for what it is: a story of the pathologization of political dissent. Their manifesto came out in 1972 and is still not widely known, but many of their ideas are common in leftist thought today. They were talking about what we would now call the social determinants of health. They were saying, we have mental-health diagnoses, don’t put us in congregate facilities, we need supportive housing. We want to study ourselves and do self-directed therapy. You introduce a term that I found extremely helpful, called “extractive abandonment.” What is the intellectual genealogy of this idea?

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. 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. It is telling enough that the metric of eligibility for state social welfare programs today is not the severity of illness or impairment but the effect of these upon the applicant’s relation to work. This conflates health with labor power. The authors argue that the social construction of madness was integral to the certification of ability. The legitimation of psychiatry at the dawn of the 20th century depended upon its separation of the curably ill from the incurably disabled. At any rate, the authors explain that drug companies capitalized on national sentiments during the Cold War to tell “the drug story” in which only capitalist economies could advance pharmaceutical science, while “communist” economies could not (39). Given the sad state of US healthcare, the massive inefficiency and cost redundancies, the stranglehold of private insurance companies able to crush political attempts at socialized medicine, these Cold War statements that only capitalism brings medical advancement are absurd. Heath Communism is not "well-behaved": It is not interested in sober consideration, dry pontifications. It thrives through a sense of optimism. There is a joy to a manifesto that sits alongside its anger. If it is birthed from complaint and fury, these emotions are funneled through a hope that things could be otherwise-most of all, an optimism for a new collective. Jon Venn, Full Stop

The call to revolutionise the political economy of health, is a call to revolutionise the left. To move from imperialist social democracy to a decolonial communism. Breaking with the hegemony of the Labour Party allows the opportunity to rethink the NHS, to rethink health, just as engaging critically with the NHS, from the perspective of health communism, provides an opportunity to weaken the hegemony of Labour and its workerist, racist politics. The myth of the Labour Party is at least in-part entangled with the history of the NHS. The invocation to save the NHS is not dissimilar to the rallying cry to save the Labour Party – but whilst the latter should be left to rot, the former shouldn’t be abandoned as a ground of struggle. Indeed, health communism is an expansive project that can coalesce multifarious struggles to come together and build a new society out of the ruins of this one. Whilst defensive measures to resist state violence are needed, health communism can link struggles together and provide a positive vision that we can fight for.I don't know enough to say whether or not some of the reformists were for winning reforms now with the long haul strategy of more radical change, but in the book some of the justification offered by reformers was getting whatever they could as people all around them were dying, even if it meant leaving the corrupt, eugenic, capitalist healthcare system intact. The difference between a liberal and a communist view of social determinants of health is similar to the difference between a bourgeois and a social revolution. The former ushers in a new more progressive ruling class, while the latter abolishes class divisions, private property, and waged labor entirely redesigning the social relations of production. The capitalists’ half analyses pathologize the poor to then designate them as surplus for extractive abandonment while the health communist analysis places the surplus at the center of the revolution.

Review: Roberta A. Winter, New York Journal of Books, Health Communism: A Surplus Manifesto (10/20/2022)

Coopting the language of the left at the pro-life march on Washington

Artie Vierkant points out that “this could have been the new normal for medicaid or the beginning of something much bigger or better...” While he sees the necessity of fighting against these massive cuts, he reminds the listeners that “Just like everything else with Covid, this is a signal for the importance of a movement to totally sever health from capital.” Health capitalism is a system where health is an impossibility: a state one cannot get to, but to which one must always strive. It refers to the way capitalism has intertwined itself so completely with health to make the two seemingly inseparable; its definition of health as ‘able to work’ seemingly unquestionable. 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. American politicians and pharmaceutical companies set out to prove the inherent inferiority of healthcare in the nations they deemed communist. Spreading capitalist healthcare to the world was framed as a humanitarian mission, but also used the language of cost effectiveness and maintaining efficiency in production. In 1957, Senator Hubert Humphrey told the Pharmaceutical Advertising Clubs that the reason they had to spread capitalist health care globally was because “there is a growing awareness of the fact that disease-ridden populations are unproductive and therefore a drain upon national economies and upon the world economy. This in turn becomes a drain on our own economy” (38).