Health Communism and other recent abolitionist writings show the massively negative impact of capitalist and eugenic ideology and methodology on our ability to have nice things. The ubiquitous caving to the assumption that there is simply not enough for everyone still mars efforts to defend education, health care, etc. The idea that providing more to all will only hurt the deserving and worthy core of society is always just a defense of the capitalist class’ presumed right to maximum extraction of value and profits from every aspect of society. Death Panel has an amazing aesthetic, from the show images to the merch to the ending music. These component parts are great in and of themselves, but they really come together to create a very coherent, intentional, and effective aesthetic. Before we go: How was this aesthetic developed, and how would you describe it? 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.” 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).

AV: Health-care discourse in the US—and to an extent globally—often relates so much more to the costs of care than to anything you might think was the real priority. For instance, we don’t often talk about someone’s experience of the health-care system or of getting the treatment they need without also discussing going into extreme debt, or, in the case of trans health-care, for example, of having to endure judgment that your care is somehow unnecessary or unworthy. Liberals often like to stop at demands for access; they want “access to affordable care” or “access” to universal healthcare. But this largely ignores the pressing issues with the political economy of health under capitalism, like the fact that for the most part, the process of “accessing” that care will bankrupt you. David Stark Murray, Why a National Health Service?: the part played by the Socialist Medical Association (London: Pemberton Books, 1971), 78. In Health Communism, [Adler-Bolton and Vierkant] 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. Charlie Markbreiter, Bookforum The book is an excellent read, though the shift from specific case studies to broader political analysis is not always easy to follow. Although well explained, the prose is dense with concepts and theories, so while relatively short, it is certainly not light reading. Ultimately, it is an exciting re-invigoration of radical approaches to health, which is ideal at a time of mounting discontent, and will hopefully inspire health activists and those oppressed by capitalist notions of health and normality who, as we know, are often one and the same.The distinction between deserving workers and irredeemable surplus is sociological. The authors argue that surpassing it—effectively achieving socialized medicine, in which class, money, race, ability, and gender cease to preclude distribution of care—is a condition of surpassing capitalism. Arguments for socialized American medicine have scarcely changed in the last century. However, the dependence of health upon capital has altered, and with it, the determination of debt and need. I’m grateful for the way you resist exceptionalizing COVID. And I think the show is key for looking at how pandemic discourse is produced and to what ends, and how this fits into a longer history of health capitalism. In Health Communism, you write that “health functions as capitalism’s host body.” Could you elaborate? What is “health”? Delegates of pharmaceutical companies visiting the Soviet Union found they had more physicians and medical staff than was expected and that in fact they were exporting their medical workers to less developed countries (39). Some suggested the US engage in a medical arms race against the Soviets as a form of colonial strategy. The authors rightly point to the fact that socialized medicine usually produces better outcomes than capitalist ones. I had slight reservations on some of their descriptions of Bolshevik Russia as “communist” but in the context of the book, this is perhaps a minor quibble, and I have no idea of what critiques of Bolshevism or Leninism they might have. 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.

The key concepts developed by the authors are those of ‘surplus’, ‘extractive abandonment’, and ‘health communism’ itself, which is contrasted to its contemporary counterpart, ‘health capitalism’. Thus far, the authors are clear as to what must be resisted—the social symptoms which maintain the dependence of the disabled—but vague as to what this resistance entails (particularly in cases where illness, even if socially produced or worsened, is irreversible). Here, their discussion of SPK’s goals illumines theirs: to center the self-directed care of the marginalized is to turn an “unconscious unhappiness” of their dependence into an “unhappy consciousness” of the mechanisms of this dependence. To sever one’s status as a patient from one’s status as a commodity is to sever health from capital. Health Communism first examines how capital has instrumentalized health, disability, madness, and illness to create a class seen as “surplus,” regarded as a fiscal and social burden. Demarcating the healthy from the surplus, the worker from the “unfit” to work, the authors argue, serves not only to undermine solidarity but to mark whole populations for extraction by the industries that have emerged to manage and contain this “surplus” population. Health Communism then looks to the grave threat capital poses to global public health, and at the rare movements around the world that have successfully challenged the extractive economy of health.It is important to contextualise this idea in relation to the disability justice movement of which the authors are a part: as both blind/partially-sighted and chronically ill, Adler-Bolton has been at the sharp end of oppression. An earlier subtitle of the book was A Surplus Manifesto, which gestured towards reclaiming a callous label for a group of people; indeed, the thrust of the book is a damning critique of anyone being deemed as such. This creative, wide-ranging book would be important under any circumstances since it helps readers understand widespread social processes that are genuinely violent in their operations yet often curiously bloodless in their ideological depictions. The book is especially urgent in light of the ongoing COVID-19 pandemic. Health Communism helps make clear both the fundamental social patterns that gave rise to the pandemic, and stresses that any real solutions to those patterns will require far-reaching social change. Nate Holdren, Theory & Event Health Communism is dedicated to the Socialist Patients’ Collective (SPK). For readers who maybe aren’t familiar with the group, what was SPK what is their legacy? How does your book draw from their work? Building on this is their concept of ‘extractive abandonment’. This is a synthesis of Marta Russell’s ‘money model of disability’ and Ruth Wilson Gilmore’s ‘ organised abandonment’. Adler-Bolton and Vierkant define extractive abandonment as: ‘the process by which [surplus populations] are made profitable to capital’. [11] Or as they put it otherwise: ‘In a political economy built on systems of extractive abandonment, the state exists to facilitate a capacity for profit, balanced always against the amount of extractable capital or health of the individual subject’. [12] Some people may be surprised to find that, in Health Communism, there’s not a gigantic chapter on COVID-19. But that omission is really intentional: we’re trying to make a hard point. A lot of people like to say that we’ve learned some very tough lessons with COVID, but that’s absolutely not the case. These are not new lessons. These are not new horrors. We’re looking at an acceleration of an existing political economic phenomenon that was already marking people for a slow death. What we’ve seen is the pandemic applying additional pressure to a system that was already unsustainable and in no way conducive to “good health.”

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). Essay: Beatrice Adler-Bolton and Artie Vierkant, Harvard Law Petrie Flom Center: We Haven’t ‘Learned the Lessons of COVID’ Until We Remake the Political Economy of Health (09/26/22) Even so, the pharmaceutical industry had a big hand in shaping US colonialism via the creation of capitalist global trade regimes and laws that ensured corporate control over who could produce and profit from vital medicines as well as ensuring scarcity as needed to guarantee higher profits for pharmaceutical companies. Today this regime, known as Trade Related Intellectual Property Rights (TRIPS), means that “in effect, twelve corporations made public law for the world” (90). Those countries not willing to play by the rules of TRIPS may be excluded from trade in and access to life saving drugs and treatments. This “global rationing regime” marks “entire nations as surplus” (78). The Mental Patients’ Union provides an historical example of resistance to carceral-sanism from the 1970s – they sought to overturn the power of psychiatrists. Without any funding, for three years, they provided services including providing a safe space to reside in times of emergency. At one point they ran three houses alongside support by telephone and letter as well as formulating one of the first directories of side effects of psychiatric medication (which were often denied by the psychiatric profession). In doing so they provided an alternative to the option of carceral-sanism which seeks to incarcerate us when we suffer mental health crises, subjecting us to the power of the state through the healthcare profession. Today, there is Stop SIM, who are campaigning to ensure that the police are kept out of community mental health teams in England. Mental illness is not a crime and should not be used as a way to withhold medical care from people in need.The core project of health communism is thus to ensure that nobody is ever deemed surplus, a situation that ultimately requires dismantling capitalism. This would see the convergence of patient-controlled healthcare and the equal distribution of health’s social determinants such as food, housing and education. Another example of resistance is the campaigning to close Manston detention camp where people seeking asylum were detained in the most horrendous conditions and subjected to violence. In response to pressure people were moved on, however there are reports of it still being used and the camp hasn’t yet been closed. In December 2022, an Iraqi man died of diphtheria whilst being detained. The struggle to close detention centres and stop deportations is paramount to health justice. This seamless book fills an urgent void in leftist theories of illness...the achievement of such a concise yet cogent framework (aided by the fact that the past years have only confirmed its conclusion) is a marvel. Selen Ozturk, PopMatters