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Capital, Surplus Classes, and Health Reform

Summary: A communist perspective on health pushes the boundaries of reform. For many progressives, it’s too much. But it’s a legitimate and valuable part of the discussion. Let’s meet in the Town Square to see how we can reconcile our perspectives, unite our caring, and agree on a solution.

Health Communism
By Beatrice Adler-Bolton and Artie Vierkant
Verso 2022

Excerpts

Capital has been allowed to define the meanings, terms, and consequences of “health” for long enough. We articulate how health is wielded by capital to cleave apart populations, separating the deserving from the undeserving, the redeemable from the irredeemable, those who would consider themselves “workers” from the vast, spoiled “surplus’ classes. We assert that only through shattering these deeply ingrained binaries is the abolition of capitalism possible.

Some readers may be surprised to find little attention devoted in Health Communism to the question of health insurance. We understand health insurance companies for what they are: principally, they are financial institutions, concerned as they are only with payments for services rendered and the endless, bureaucratic, deadening, management of risk. There is no place for them in society.

It is important to recognize that, even as we fight in the US for policies like Medicare for All, the task at hand is much greater than one program could capture. It is the total reformation of the political economy of health, and in so doing, the total reformation of the political economy.

Capital has emphasized and corrupted the delineations between surplus classes for its convenience; it is immeasurably threatening to capital to see a group of those it has deemed to be waste come together in solidarity.

We are each of us ripped and maimed, strangled and buried by capital, in one way or another. That entire industries exist in plain sight to see us along this vast process of endlessly iterative life chances, to then subject us to extraction when we are surplus and no longer of use, and to eke out slivers of profit from our eventual deaths, is capital’s greatest sleight of hand. We are all surplus.

The host-body relationship of health and capital can be understood through an analysis of the social determinants of health and their direct relationship to the broader political economy. It is present in each of the accounts we have demonstrated throughout Health Communism; with each stage, with every evolution of the political economy of health, capital has come to occupy and replace more and more components of its host. But capital cannot kill its host body, or it would have nowhere to hide, nothing to exploit, a barren universe. It is for this reason that capital only fears health. It is up to us to separate them.

Comment by: Don McCanne

There is a great need to increase communication on the concepts that will bring health care justice to all. The title and rhetoric of Health Communism may not seem like it would fall in line with this goal, but it clearly does. Understanding the views of those who sincerely care about the health of all of us is important, and so it is important for us to make a sincere effort to understand those views no matter what ideological and rhetorical frames they adopt.

What about understanding the views of those who don’t seem to care? The capitalists. Rather than not caring, it is much more likely that they communicate amongst themselves, distracted by payment methods and the like, developing modes of behavior and rhetoric that merely suggests that they don’t care. Maybe we should be having more conversations with them, asking them questions that would bring out answers to show that they really do care.

Maybe it’s time to agree to meet again in the Town Square and bring all of our ideas together so that we can develop that system that will work for all of us. Of course, if we’re all there to ensure health care justice for all, it is likely we would end up with a universal social insurance system: single payer. We would also address the social roots of health inequity. And as we have suggested before in HJM, Medicare for All may not be enough: we may need to take on capital interests more broadly. That’s a tough but necessary conversation in the Town Square.

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