DP x S23: Health and Capital (Session 1)
Earlier this month we collaborated with the organizers the Socialism Conference to put together five sessions at this year’s conference on the political economy of health and disability.
In this session, "Health and Capital (Intro)," Beatrice and Artie discuss some ways to think about the intersection of healthcare, disability, and left politics, and introduce each of the rest of the sessions.
Timecodes:
0:00 - Introduction to session recordings and thanks from the Panel
4:50 - Session recording begins
Thanks to Han Olliver for our Death Panel x Socialism Conference 2023 poster image, which is being used as the cover image for this episode on platforms that support it. See the full poster below, and find and support Han's work at hanolliver.com
Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)
DP x S23: TRANSCRIPT
Health and Capital
[Beginning of transcript]
Abby Cartus 0:12
Okay, it's 5:00. So I think we can get started. First of all, thank you so much to everyone who is here. It's great to see so many people at the session.
This is the Health and Capital session, hosted by and featuring some of the co-hosts of the Death Panel podcast. We thank you all for being here. Yeah. There are just a few housekeeping announcements that I want to make right at the top here. And I'm going to try to do that quickly so that we can get right into the discussion as fast as possible.
First off is our COVID and community safety announcements. I'm going to read from some text from the conference policy. Reminder, all Socialism Conference attendees are required to wear masks fully covering the nose and mouth while indoors in conference spaces, including hallways and meeting rooms. It is the conference policy that speakers in the front of the session may remove their masks in order to deliver their presentations, but only while actively speaking.
However, we are going to remain masked, because I mean, you know, this is the Health and Capital session [laughter] but we don't want to, you know, initiate any transmission of COVID or anything else via the microphone, so we're going to remain masked. Audience members are still required to wear masks even while asking questions or making comments. The mask policy, once again, is in place to protect all of us, especially the immunocompromised from the risk of contracting COVID-19.
Additionally, the conference community safety plan relies in part on badge checkers at the door of each room. And all attendees are expected to wear their conference badges at all times to enter conference meeting rooms. Please respect the badge checkers and know they are here to support a safe conference, and you can see registration if you have any problems. So in short, today, we are here to talk about health, capitalism and disability. My name is Abby Cartus, I'm just going to be kind of the chair and facilitator of this session. I am one of the co-hosts of the Death Panel podcast. And our featured speakers today are Artie Vierkant and Beatrice Adler Bolton. And I will turn it over to them to introduce themselves to the room and to start the presentation.
Artie Vierkant 2:26
Hi, everybody. So as Abby mentioned, my name is Artie Vierkant. This is Beatrice Adler Bolton. I would say also -- so in addition to hosting the Death Panel podcast, which we do with Abby, Bea and I are also the authors of Health Communism, which came out last year from Verso. And I'm just gonna set up really quickly what we're going to be kind of talking about in some kind of brief, prepared remarks that Bea and I have before we get into the discussion portion, talking to you all about your relationships to health and capital. And then Bea is also going to talk in a second, after I introduce what we're going to be talking about, Bea is going to talk about what other sessions we have organised over the course of this weekend, because this is kind of the introductory session to -- I believe, is it five? Four other ones. So four other sessions that we have coming up this weekend, that Bea will be talking about shortly.
So in short, in today's session, we would like to have a discussion with all of you, where we try to dig deeper, or dig down together into the root of the very important and we think quite fundamental role that health plays in the reproduction of capital. So first, we're going to talk about how healthcare is often siloed as its own issue, or as a separate kind of issue from things like climate, housing, carceral abolition, education, economic justice, labor, and so on. Although also sort of about how even the way that capital structures healthcare also sort of segments it up into certain things that we choose to call healthcare and what we choose not to. But how ultimately, health and healthcare is not a silo. So today, we want to talk about how health is actually bound up in everything, sort of both positive and negative. Healthcare is central to all of our lives, our movements, our organizing, etc. And on the flip side, it is also of crucial importance to the state, to imperial and corporate powers, and to labor discipline. And so, towards that end, we also want to kind of talk about how or about why the capitalist approach to healthcare isn't just inadequate, or simply -- you know, I think a lot of even elected politicians talk about it as like a work in progress towards equity or something, but instead that capitalist solutions to healthcare will never -- to health and healthcare and disability will never work.
Health is an impossibility under capitalism. No matter how many little tweaks we make, to sort of tidy around the edges and blunt some of capitalism's extractive cruelty, yeah, no -- period, end of sentence, sorry. Beyond that, in our current political moment, being an overlapping series of crises, catastrophes, all mixed up, and intertangled with one another, healthcare is at the same time, one of the central growth sectors of the capitalist economy itself. And so I hope that today, we can basically set up some of these ideas that we'll work through, lay some important foundations, not only for what we'll talk about today, but for the sessions that we have coming forward, which Bea is going to tease in a second. Anyway, so I'm gonna pass it to Bea. And let us sort of dive right in, so that we can kind of get towards the discussion.
Beatrice Adler-Bolton 5:52
Thanks Artie. So there are a lot of different ways that we can approach health and capital, or health and disability. And this is the first of five sessions, as Artie said, that we've put together, but we kind of only are able to touch on a few aspects of this. And what we really hope is just, you know, whether you're coming to one session or all five, that we can have like a really great conversation together that builds over the course of the session. So, you know, this is our intro session.
Tomorrow is a session called How Capitalism Kills: Social Murder and COVID-19, which has Artie and Abby on it, and Nate Holdren. So they're gonna center Engels' concept of social murder in our current moment and try and talk about the role that COVID has played, and continues to play, in sacrificing the presumed healthy working class for the economy.
And then after that, we have a session called Resisting Carceral Sanism with myself, Liat Ben-Moshe, and Leah Harris, and the three of us are going to talk through the recent resurgence in forms of carcerality that contribute to the targeted oppression and removal of mad or mentally ill populations under the guise of treatment or care.
And then on Sunday, we have two more sessions. The first is called Decolonial Disability Politics and the Left and that is, again, myself and our co-host, Jules Gill Peterson and we will be joined by our guests, Shira Hassan and Jasbir Puar. So we're gonna be talking about debility and empire and the ways that neoliberal framings of disability can often exclude people seen as undeserving.
And then at the end of Sunday, our fifth and final session is called The State, Austerity, and the Politics of Healthcare. And that is with our Death Panel co-host, Phil Rocco, who will be joined by Salonee Bhaman and Gabe Winant, to talk about how the healthcare struggles of the last century have really been profoundly shaped by artificial constraints that are imposed to produce policy in the mold of austerity. It's not simply that this is the way it is because it has to be that way.
So broadly, the theme of these sessions is to really spend some time thinking together, you know, about what the central role that health and disability play in our political economy, how what we think of as health has been fully captured and articulated by capitalism. And this, of course, also then shapes what we call disability. And it's important to keep in mind that just like capitalism, our current conceptualization of health is transient, and destined sooner or later to give way to something else.
And this weekend, I hope that we can all talk together about what that something else should be. So as I said, today, we're gonna sort of talk about the way that health and capital are actually really not two discrete things. And, you know, as anyone who's ever had to use the healthcare system, which is all of us, can tell you, it's not a system at all. It's a vast and layered series of markets and economies that are specially designed to monitor and assess and repair and certify our labor power. And of course, the care always comes second to that, if it ever comes at all.
The healthcare system is not a system of care, but a system of intersecting struggle. So patients, the organized working class, potential patients, healthcare workers, are all constantly in struggle with health. Healthcare workers triply so - in your job functions, in the sites of extraction from your work, and the kinds of sites of extraction that pop up around medical facilities. The places where you spend money on lunch, things like that. Your own health, your labor power and the conditions of your work. This is kind of, in a way, like we think of health as our own personal responsibility, but you cannot separate what happens to your body and what your health is from the world around you, in the context that you live in. So this is why when we approach our work, we're not struggling to like improve the healthcare system. We're struggling to wholly reshape the entire political economy of health, all of it.
The idea of the political economy of health is something we use often. And that's what we're really talking about a lot this weekend, it's really helpful to use that as a lens to approach health, disability, in your own life, in your organizing, in your work. But to improve the healthcare system would mean just tinkering around with the racist, extractive, and exploitative systems of care that we have. Without focus on actually reshaping the values and the ideology that are embedded in our systems and structures of care, that make it so brutal and racist and cruel in the first place, we really can't do much towards providing care or liberation or even guaranteeing health to -- well, some people in the population can access it, but only to those who can afford to buy it.
So the fact is that the political economy of health is a way to sort of see past the ways that health is hidden behind these layers of personal responsibility. When we start to sort of peel that back, you see how health is a really important concept that helps to hold the hegemony of capitalism in place. It also helps to foreclose on other possibilities of organizing our lives, our survival, and of production. And the fact is that to look at the political economy of health, rather than to look at the healthcare system, is how we can see past these incredible barriers that are put in place, that make it seem like these things are way too big to ever change, or destabilize, etc. So what's important to understand is that how we produce and distribute resources among the population impacts what we perceive to be individual health,. That might seem really basic, but it's a really important idea. The way that we distribute and provision for care shapes your individual health more than any of the choices that you could ever possibly make about things that are good for you, or healthy for you, or whatever.
Now, if you believe what many of us are told, day in, day out, about our health, our health is in our own hands, right? Personal responsibility. But that's a lie. It is a clever cover for capital. And it's trying to hide the ways that our health overlaps with each other. And ultimately, the idea is to hide how political and economic domains interact and shape the individual and population health, by framing the whole thing as just a series of choices that each of us as individuals have to make, abstracted from and wholly separate from the economy, right.
You know, one of the most famous definitions of what health is comes from the constitution of the WHO. Does everyone know this line? [pauses for participants’ reactions]
Okay, so, the constitution of the WHO opens with:
"Health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity."
It continues,
"The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition."
Okay, now, realistically speaking, that is literally so unattainable for so many of us. And here's where you really can see the true cruel face of what health is. As Artie and I put into the beginning of our opening, and he alluded to, we sort of start the book by saying that health is an impossibility, right? How can we ever -- how can we ever find a complete state of physical, mental and social wellbeing under capitalism? How? It just doesn't work, right?
And health ultimately serves as a gauge of your capacity for work. It's not about, are you having a good life? What is your quality of life? How does your body feel? Are your needs met? It's about, are you a good worker? Are you a safe worker? Are you a good investment as a worker? Are you going to be a malingerer who requires all this time off from work, right? It's ultimately -- you know, it kind of represents the perceived value that can be pulled out of every one of us in a day of work. Like every single individual's health is ultimately, more than anything else, what your value is to your employer. So you know, repeated or chronic illness that requires time off from work, that diminishes your value, that makes it difficult to manage you as a laborer and to train and indoctrinate you in the sort of culture of work.
And the fundamental thing is that our collective health is critical for the reproduction of capital. Without population health, there is no reproduction of capital. Reach a critical mass of workers who are suddenly sick, right, as we've seen, production will falter, grind to a halt. This is really, you know, something that I think a lot of the -- and this is something that we'll touch on in the session tomorrow with Abby and Artie and Nate, you know, the early origins of Marxism actually have so much to do with public health, right, and have so much to do with the critical role that our labor actually plays in the maintenance of capitalism.
So, you know, due to that really critical importance of health, and consequently, also healthcare, to each person's role in capitalism, then the delivery of medical services symbolizes the compassionate aspect of an otherwise imbalanced or fragmented society. So it's like a supreme manifestation of state empathy, the idea that like the state will provision for care and rescue people from mortality. But for everything to remain the same in society, for the maintenance of the status quo, it's really important that people in that society believe that that society can take care of their fundamental needs, like providing good and compassionate health care. So this belief can compensate for so many other things that might be wrong with the system. And this is why we absolutely cannot tinker around the edges of our so-called healthcare system in the hopes that it pops out something like fair, humane, ethical, liberatory, et cetera.
You know, right now, what we think of as healthcare, or as standards of care, is filtered through insurance companies, formularies, calculations that conflate identity and race with inherent risk, marking whole populations for extraction, whole populations for diversion, whole populations for abandonment, in merely just setting the terms of like what is and isn't reimbursable care.
So it's really important to just remember that the care we have now is limited, so severely limited by health functioning this way. And it's precisely because health and the care that is required to maintain it operates as a kind of collective labor maintenance and certification system, as I said, sorting people, marking them as good or bad workers, reliable or unreliable, good or bad people, it's really precisely because of this function of healthcare and how it relates to the control we have or don't have over our labor power, that it's so important that we not accept the version of health that we've all been given, and not accept the fact that the responsibility for our health and the maintenance of our labor power is ours alone. It's important to sort of think through, you know, if we're talking about like reformist reforms, the kind of reforms that reinforce, relocate, restructure the systems of repression and subjection that we're fighting against, then what we need to do is make sure that all of our movements for liberation are embracing the role that health plays in work, from a critical perspective, and that we're not thinking of, you know, creating socialist islands in the middle of the capitalist state, which is sort of a famous way of the NHS being described.
Artie Vierkant 19:21
So to that end, and from the perspective of looking at this from, again, this idea of the political economy of health, Bea spoke a little bit about how capital sort of structures health in a way that really divides up populations, and does all of these things that she mentioned in terms of assigning types of inherent -- of putative inherent risk. One of the other really important aspects that we wanted to touch on really quickly is, again, this idea of what ends up being called healthcare and what we do not call healthcare. Because this is one of these things where when you look at this, it becomes very clear to see sort of what's going on in the overall political economy of health and how the priorities, I suppose, of the system are revealed. The really obvious one of these is kind of the thing that I'd say like, you practically explain to anybody who's had any sort of interaction, especially with the US healthcare system that like vision and dental are not considered to be healthcare. Again, that's sort of the baseline obvious one. But there are two other really important categories that we also kind of treat in the same way. One is mental healthcare broadly. Obviously, there are a lot of terms for that. And we're not going to get into that quite as much here necessarily.
But the other, which I do want to touch on, is what we call long-term care. So the term, longterm care, for those of you who are not maybe familiar with it, is this sort of stand in for a vast network of interrelated and often confusing to differentiate terminology, whether it's long-term services and supports, nursing homes, psychiatric and rehabilitative facilities, in home care, memory care, hospice, and others. Obviously, a wide field and a number of things, some of which are -- obviously there's a spectrum there, right? Nursing homes and things like psychiatric facilities, that's more on the carceral end of what we call long-term care, and stuff that we broadly try to reject. But this sort of framework of long-term care, it's important to think of this more as what we call long-term care is sort of this catch-all term for a largely, again, exploitative set of industries that exist, because simply put, there are care needs that are not met by our institutions of healthcare, or by what is covered by what we broadly call health insurance or most of the health finance system.
Long-term care is, generally speaking, assistance with things that fall under the umbrella of what are sometimes called activities of daily living, right. Things like bathing, toileting, eating, clothing. These are some of the forms of care that are absolutely essential to so, so many people, especially disabled people and elders. And our political economy just makes no room for them. And so the reason that we want to focus on this, and that this is such a big -- this is something that we're trying to bring in not just to this talk, but some work that we're kind of actually currently still trying to think through, which is one of the reasons we want to discuss this with you all a bit, is of course, to understand these things, this thing that's kind of siloed off as something that we don't call healthcare, but it's sort of part of the same healthcare system. It's long-term care, right? Represents this sort of, again, vast unmet care need. And that unmet care need itself, I think, opens up space -- understanding that there is this unmet need opens up the space for understanding how what we choose to call health, what we choose to call healthcare is so, again, structured by the current political economy.
And when we look at these other unmet needs, like how, for example, I think there's a broader understanding now than there maybe was a few years ago on the left of like how housing is healthcare, but also how these other sort of social infrastructural aspects of life, not just housing, but clean air, clean food, clean water, virus free air, social supports, and again, these things we call long-term care, like in home aid, for example, all of these have this gigantic impact on what we call an individual's health or life chances, just as much if not more than the things that we call healthcare do. And so, at the same time, though, when we look at sort of the heart of why we don't have these things, you know, why these care needs are unmet so often, I mean, truly the answer really is the capitalist economic system.
And so if you think about that question, you know, again, what do we decide to call healthcare, and what do we not? The clear next question, I think, is why do we not call these things healthcare? Why, for example, you know, if one has a nurse come give them medicine and help them bathe is that called long-term care and not health care?
And this means that I think we as a left can take one very clear lesson about the politics of healthcare away from this and away from this sort of political economy of health perspective, which is that the meeting of these -- of all of these vast array of unmet needs, under our systems of healthcare and health finance, demanding the meeting of these needs, is a fundamentally radical thing. A fundamental -- and fundamentally, actually, a threat to capital. If we're able to to reorient the goals of our political economy away from what Bea is talking about, the preservation of labor value, away from subsistence and towards abundance, if the goal of our system could not be, again subsistence, but what we could call quality of life above all else -- although obviously, that's a complicated term in itself. Because a lot of people like to measure the quality of life then.
But, you know, this is trying to imagine all of these currently unmet needs being met, I think truly is a worthy horizon of liberation to be looking towards. And this is why we try to frame our conversation about our demands regarding health, healthcare, disability as all care for all people, right? Not austerity, but abundance. Not judgment, means testing, and carcerality, but instead care in whatever forms, sort of done, delivered, instead of withheld. As Micha Frazer-Carroll said in an episode of Death Panel actually that we just released on Thursday, "What if care is not just this drug or that therapy? What if care could be anything and everything? And what if healing could be everything? Not this question of, does care come from this or that institution, or the community? What if it could look many different possible ways?" And so this is what I hope we can speak more about.
Beatrice Adler-Bolton 26:24
Yeah, and I guess just to sort of wrap us out here, and then I'd love for us to open it up for discussion. It's important to remember that from the perspective of the government, and the controlling elite, the state, publicly managed healthcare and our health is money spent that is needed to maintain the workforce. What is an ACA subsidy? What is Medicaid, what is Medicare? Any kind of the care needed. Like Medicare is a great example. Medicare took a lot of pressure off of unions that couldn't afford to take care of their members, as they retired with the dues they were pulling in from their current members. So like the care that we are getting, the only care that we're being given, is the care that they feel we need to maintain the workforce, right.
But simultaneously, the arrangement and allocation and provisioning of medical services provides an important arena for capital accumulation. In recent years, there's been this massive, massive divestment in the employer sponsored insurance market. So insurance companies have like been lamenting, like growth is stagnant, nobody wants to get their employees' healthcare anymore. Even the rising unionization efforts across the United States are not going fast enough to make the healthcare companies happy, right? Like the kind of idea so often with a lot of our movements is that we have to sort of fight these siloed battles. One plan here, one plan there, it's a game of Whack a Mole, right? And because too few people in the US are now getting their healthcare through their job, that's not an attractive market anymore. So like, where the fuck are these parasites gonna go, right? Well, they are flocking to public insurance. They are flocking to public insurance, through insurance company -- you know, insurance companies getting into public insurance is not new.
Most of Medicaid is all run through private insurance plans that are contracted and paid by the state to administer. We've seen huge growth in the private Medicare market over the last 50 years. This year is a really grim milestone in that this is the first year, for the first time ever, we have passed the threshold that over 50% of the people on Medicare are on private Medicare Advantage plans, which are infamous for manipulating people, denying them care, right? All prescription drug plans for Medicare Part D are also private. I haven't had my medication since April because of my Medicare Part D plan. They found a loophole and they're fucking me just because they can. So this is the really sort of worrying thing here, right, which is if we were to stand up a public option, and it gets contracted out to say like Aetna CVS, the way that we contract Medicaid, then we've actually made things worse, not better. That's a reformist reform. It won't touch capitalism. It won't threaten it. It won't even come close to destabilizing it.
So to truly be rid of these bloated private health finance giants who really engorge themselves on various health care markets, like for profit tapeworms, you know, sucking us until we have no blood left, we must really fully abolish the industry of private health insurance to sever this parasite from the host, which is all of us, right. And so, you know, all of what we talked today will run through all the other sessions that we're sponsoring for the remainder of the weekend. And I hope that as we sort of open it up to discussion right now, we can start a conversation today that we can continue throughout the weekend.
I think it's really sort of not enough to say, listen, you know, there's a huge chance that a lot of the reforms that we've been fighting for, or individual changes that might make our lives a little bit better and less cruel in our own workplaces, that those are potentially dangerous and more harmful. What's important is to say, okay, if that's true, where the fuck do we go from here, right? How do we actually achieve all care for all people? And so this is the conversation that we really sort of want to talk to you all about. We want to sort of -- you know, the needs that, for example, Artie talked about with long-term care, you know, these are needs that we all have.
We talked to a good friend of ours, Dr. Bill Bronston, who helped to liberate people from the infamous Willowbrook institution on Staten Island, which is like the most like infamous medical incarceration site of children in US history. And 1,200 of the people that he helped freed, are still alive. And they and their parents are now being reinstitutionalized in nursing homes. So this is the sort of reality and this is the full circle here. So I'll just sort of leave it there. I'll pass it to you Abby, so you can open it up and take stack.
Abby Cartus 32:20
Something that, you know, it kind of inscribes the social relations of capitalism in our biology in very interesting ways. And I think that that's something that you draw out very well in your book, which I neglected to plug at the beginning. You know, I think about this a lot because what your book draws out really is kind of these like, fractal economies of extraction within sort of the broader capitalist healthcare system. …
[End of transcript, remainder of the session focused on discussion between panelists and participants which has not been shared to preserve privacy of participants]
Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)