Health Communism: A Surplus Manifesto

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You argue that surplus populations are used to stave off broad reforms that would otherwise be destabilizing to capitalism. Usually, however, “common sense” argues that that the surplus population constitutes a twofold burden to society—that is, a eugenic burden and a debt burden. Historically, how has this rhetoric shaped arguments for and against socialized medicine in the US? A searing analysis of health and illness under capitalism from hosts of the hit podcast “Death Panel”

Why should we spend money for a fool, for a hopeless ill person, if I can do with the same money so much good for a poor peasant's kid..." 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.

What about those who could not be rehabilitated? Not to worry! Capitalist alchemy could still transmute that surplus population into gold via “extractive abandonment” (xvi). As Marta Russell has shown, “capital and the state have constructed systems to reclaim this lost population as a source of financial production.” Spencer Green: We’re used to seeing the language of health commodified. It’s used to sell things; it’s used to promote specific ideas about bodies and minds and how they should be or shouldn’t be. What do you mean by health in the book? 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). He was an anti-socialist race-scientist and a representative of the Prudential Insurance Company at the turn of the twentieth century, very much an “industry stakeholder.” His approach to healthcare focussed on defending the capitalist system.

The SPK produced a manifesto “To Make an Army out of Illness” along with other writings. Their critique of psychiatry was pro-illness. They saw capitalist production as destroying life. It is made up of destructive industry that creates ill health, and rehabilitative industry that then cures ill health. This is “not a collective regime of population health, but instead systems of wealth transfer generating surplus profit from the system of care.” The SPK model of inclusion meant embracing the “spoiled identity” (as a member of a surplus population). Rather than trying to “fix” the symptoms brought on by capitalism, the goal was abolishing it to undercut the causes of those symptoms (149-150). Hoffman was an early professional voice against socialized healthcare, but that resistance became entrenched in one of the most powerful medical institutions in the US, the American Medical Association (AMA). Wikipedia currently lists the AMA as having “one of the largest political lobbying budgets of any organization in the United States.” The AMA led the efforts to defend the capitalist mode of healthcare in class solidarity with other industry groups (33). They lobbied strongly against President Truman’s 1948 health insurance plans. Various physicians groups set about associating socialized medicine with communism, the Civil Rights Movement, and the Soviet Union as scare tactics to discredit any reforms that would threaten their professional hegemony in running a privatized, for profit healthcare system. That coalition of private organizations wanted to guide the state to carry out their own interests (34). The number of Americans without health insurance has been on the rise since 2016, and every year tens of thousands of people die because they are uninsured. Twelve percent of Americans have significant disabilities; this group is more than twice as likely to avoid care because they can’t afford it. Nearly seven in 10 Americans support a public option. Over half support Medicare for All. But you’d hardly know it, given conservatives’ fierce opposition to any threat to private insurance and the Democrats’ inability to rally behind significant changes.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. 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 sociologically ingrained binaries is the abolition of capitalism possible. The contours of capitalism have formed around health, to the point that they have come to appear inextricable from each other (xii).