The final chapter ‘Host’ suggests that health capitalism can only be overcome by severing the relationship between health and capitalism. The key to this is a radical politics of solidarity, where the struggles of the mad, disabled and other people deemed ‘surplus’, are not seen as merely narrow issues of minority groups, but are centred as a means of transforming society itself. The politics of health communism involves recognising that ‘surplus’ is not a specific group, but rather an operation of capitalism, a means of reproducing itself by destroying us and our bodies. BEATRICE ADLER-BOLTON: One of the things that we were working on before the pandemic was developing a lens of looking at how policy affects people’s lives in material ways. How do we economically and materially feel the impact of laws that dictate what care is and how care is supposed to be paid for? What are we entitled to in terms of housing or clean air or clean water? As soon as COVID began, it was obvious that these kinds of questions were indicative of the direction the pandemic was going to take. You didn’t need to be clairvoyant to see how bad this was going to be. Capital accumulation structures precarity and pathologizes unproductivity. While the surplus may be disabled, mad, or chronically ill, it is not their condition that renders them precarious but their dependence upon the medical-industrial complex. These “burdens” upon the state are essential to its profit. After all, disabled patients bear more GDP in a hospital bed than they do at home. The authors define this capital accumulation from surplus bodies as an “extractive abandonment” process. Written by cohosts of the hit Death Panel podcast and longtime disability justice and healthcare activists Beatrice Adler-Bolton and Artie, 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. 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

I don't know enough to say whether or not some of the reformists were for winning reforms now with the long haul strategy of more radical change, but in the book some of the justification offered by reformers was getting whatever they could as people all around them were dying, even if it meant leaving the corrupt, eugenic, capitalist healthcare system intact. Ultimately, Adler-Bolton and Vierkant argue, we will not succeed in defeating capitalism until we sever health from capital. To do this will require a radical new politics of solidarity that centers the surplus, built on an understanding that we must not base the value of human life on one's willingness or ability to be productive within the current political economy. The SPK view was that “health is a biological, fascist fantasy, whose function … is the concealment of the social conditions and social functions of illness” (152). For Huber, there wasn’t much difference between the standard psychiatry of the 1970s and the Nazi eugenic model of a few decades earlier in Germany. Patients were not only still categorized as surplus based on disability, but they were ranked as undeserving of care based on economic status, often pathologized due to homosexuality, using (illicit) drugs, and even based on having done political organizing (140-141). The book doesn't go into the AIDS Denialist factions that arose in some ACT UP groups. The main split they discuss has to do with those groups that focused mainly on collaborating with the pharmaceutical industry while applying political pressure to create a cure vs. those who wanted a deeper challenge to the structure of health care that they saw as the capitalist root of the problem. The "polite collaboration with the enemy" was the strategy of the breakaway Treatment Action Group (TAG). It seems like a case of reformist vs. revolutionary strategies.

1%? Up yours! We need health workers' and patients' power!

Des Fitzgerald et al, ‘Brexit as heredity reduce: Imperialism, biomedicine and the NHS in Britain, Sociological Review, no. 68 (2020): 6, 1170. 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? The call to revolutionise the political economy of health, is a call to revolutionise the left. To move from imperialist social democracy to a decolonial communism. Breaking with the hegemony of the Labour Party allows the opportunity to rethink the NHS, to rethink health, just as engaging critically with the NHS, from the perspective of health communism, provides an opportunity to weaken the hegemony of Labour and its workerist, racist politics. The myth of the Labour Party is at least in-part entangled with the history of the NHS. The invocation to save the NHS is not dissimilar to the rallying cry to save the Labour Party – but whilst the latter should be left to rot, the former shouldn’t be abandoned as a ground of struggle. Indeed, health communism is an expansive project that can coalesce multifarious struggles to come together and build a new society out of the ruins of this one. Whilst defensive measures to resist state violence are needed, health communism can link struggles together and provide a positive vision that we can fight for. 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.”

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? Against that logic of separation, the authors propose that “to win health communism, our political projects must center the populations capital has marked as ‘surplus’: unwanted, discarded bodies viewed as waste that nevertheless have become the subject of capital accumulation” (xvi). 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.” Huber was critical of the American model of psychiatry, especially the way it failed the lower classes. He saw capitalism itself as a hurdle to patient care, with the class system dividing patients and doctors, but also precluding access for those who could not afford it. The model of treatment he developed with his patients was called “therapeutic political education” a blend of anti-psychiatry and anti-capitalist politics (140).

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Ultimately, Adler-Bolton and Vierkant argue, we will not succeed in defeating capitalism until we sever health from capital. To do this will require a radical new politics of solidarity that centers the surplus, built on an understanding that we must not base the value of human life on one’s willingness or ability to be productive within the current political economy.