Health Communism
Beatrice Alder-Bolton and Artie Vierkant, Verso 2022
“It is not necessarily the case that we are all sick. But none of us is well” (183)
Interesting book that focuses on the relationship of capitalism to the “surplus population”. This is variously defined as those who are out of work permanently or temporarily out of work
The authors rightly say that the capitalist “goal of healing was to return the ill to their prior productive status as a working member of the capitalist political economy” (50)
Human centered health and capitalism are in conflict, hence the need for Health Communism.
Is Exploitation of Workers Central?
“workers for private corporations under government contract are the ones who are exploited.”
As with other recent books, the emphasis is not on the exploitation of the working class directly. Instead, it is on the exclusion of sections of the population from exploitation to reinforce those who are exploited.
Unfortunately, the authors confuse the most important dynamic of capitalism, exploitation.
“Russell’s’ money model. creating wealth from the exploitation of these “unproductive” non-laborers.”(15)
This leads to a political strategy:
“Our political projects must center the populations capital has marked as “surplus” … that nevertheless have become the subject of capital accumulation” (xvi)
These statements say that accumulation comes from exploitation of the service recipients. In fact, workers for private corporations under government contract are the ones who are exploited. This process is analogous to private parties buying services on the market from a corporation. The providing corporation makes its profit by not paying their workers the full value of what they produce for the corporation. In this case, the government pays the subcontracting corporation more than is necessary to pay its expenses. The excess is its profit. The only difference in this case is that the buyer is the government. The same relation of exploitation continues.
If the government provides the service directly rather than subcontracting it, there is no direct creation of surplus value. However, the workers are still producing more of a service than they are paid for, so are indirectly exploited. In either case, it is the workers who are exploited.
New Centers of Capitalist Exploitation?
“The state provides social programs to maintain the stability of the system and to keep a reserve population for later exploitation.”
The authors correctly see the definition of the surplus population as a way to reinforce exploitation of workers who directly produce surplus value. They also see the treatment of the surplus population as creating new centers of capital accumulation. They imply that there is a general ruling class economic motive to government programs aimed at the disabled etc.
The economic explanation seems wrong. The state does not provide these programs to develop new centers of capital accumulation. The state provides social programs to maintain the stability of the system and to keep a reserve population for later exploitation. The overall motivation for these programs is political, not economic. Spending on social programs can provide profit to particular capitalists. They will of course lobby for these programs. However, to the majority of the capitalist class, these programs are a drain. They will resist paying taxes to fund them more than what they feel is needed to maintain stability. This is why the level of this support depends on working class and other social struggle. The capitalist state provides social programs to the extent that it fears not providing them.
The authors correctly argue that strict definition of the surplus population favors capitalist interests. The state wants to ensure the largest possible potential working-class population for exploitation. Since the time of the Poor Laws, the state wanted to ensure that no potential worker was discouraged from working for an employer. They felt “excessive” benefits would sap the incentive to be exploited. All social programs are set up to encourage people to enter the work force. Ironically, this undercuts the authors’ argument that a motivation for social programs is independent capital accumulation.
The authors seem to argue two contradictory positions: strict definition of who is benefit-eligible is important to maintain the largest possible exploitable workforce and:
“ ..the surplus population has become an essential component of capitalist society, with many industries built on the maintenance , supervision, surveillance, policing, data extraction, confinement, study, cure …and care of the surplus”( 5)
This argument is akin to others on related issues. Why does the U.S. spend so much on the military, or prisons for example? Some commentators blame the “Prison-Industrial Complex” or “the Military Industrial Complex”. The authors seem to be blaming a “Surplus Care Complex” for spending on these issues. This analysis sounds radical. It seems to assert the mantra “follow the money”. It exposes bribery and improper economic and political influence. But it ignores a key factor. State action is primarily determined by the perceived needs of capitalism as a whole, not by lobbyists and bribery. The perceived needs of U.S. imperialism not the military industrial complex are the key factors in military spending. Likewise, the “care complex” is not the main source of spending on these programs.
Obviously, capitalists who subcontract care from the government provide that care based on capitalist principles. They try to squeeze out as much profit as possible by cutting corners. The government programs are set up to allow maximization of profit by private companies. The capitalist nature of these programs however is not in conflict with the overall political motivation of enacting these programs in the first place.
Drain on Society?
“For workers and the poor, higher social benefits for everyone including the ‘surplus population’ are positive.”
The authors have good intentions. They resist the idea that the surplus population is a “drain on society” (5). Unfortunately, they do not adequately apply a class analysis to “society”. For workers and the poor, higher social benefits for everyone including the “surplus population” are positive. The more solid the social safety net is, the higher the floor is under wages. The less pressure there is to work for a boss, the more bosses have to pay to obtain workers. Higher social spending yields higher wages. Higher social spending also creates a better quality of life for workers and the poor. The class interest of workers in having better social benefits is the best political motivation for winning them to oppose right wing austerity arguments. The other related motivation is that life under capitalism is precarious. Anyone, including currently healthy people may need social benefits at any time.
The interest of capitalists is the opposite. The lower social benefits are the less capitalists have to pay to entice workers to be exploited. The authors are correct that benefits to the surplus population are not a drain on society in the abstract. They are however a drain on the profits of capitalist in two ways: they can increase taxes on the capitalists, and they raise the cost of labor power.
The authors rightly see that socialized medicine cuts against the interests of the capitalist class. However, they may exaggerate when they say:
“the severing of health from capital will mark the end of capitalism” (23) and “socialized medicine can bring communism” (37)
The closer to socialized medicine we can get, the better. A movement for it can improve the lives of the working class and threaten capital. However, as a stand-alone , it will not usher in communism. If it is really the threat the authors say it is, the capitalists will prevent it as long as they have power. Only a revolution will allow socialized medicine. Instead of socialized medicine bringing communism, only communism will bring socialized medicine.
The chapter on “madness” is excellent in showing the arbitrary definition used under capitalism, the development of the treatment of those with perceived mental issues, and how capitalist industry profits off psychological interventions.
The authors explain that Health Communism needs to be international. They explain the relation of imperialism to health. They excoriate corporations for their anti-human use of intellectual property. They also attack the U.S. government including the Biden administration for reinforcing the work ethic and specifically targeting Puerto Rico.
They also present an important case study of psychiatric patients taking control of their treatment and how threatening this was to the state.
“the group has been pathologized as terrorists for their emphasis on emancipatory, patient-led, anti-capitalist care… political activity as pathology” (167)
The political strategy of focusing first of all on the surplus population rather than workers who are exploited is wrong:
“the sick form the central class that can bring about the fall of capital “ ( 182)
However, the goal of uniting these groups in the struggle against capitalism is essential. The authors correctly argue that:
“Breaking the mirage of worker versus surplus provides a revolutionary opportunity to unite the surplus and worker classes in recognition of a better truth: safety , survival and care are best ensured outside of capitalism. This revolutionary potential has been divided, discouraged and criminalized.” (57)
Overall, this is a thought-provoking book that stimulates thinking on connecting the fight for communism with the struggle for a humane health system.
