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. We are obviously living in a time when defending basic welfare state care programs is vital to our survival, but we also know they are not enough. To go beyond mere welfare schemes as found under capitalism, the authors want to deepen the meaning of what is called “the social determinants of health.” As defined by activists, the idea that health is socially determined means that housing, clean air, food, clean water, public sanitation, social supports, etc. are all forms of healthcare. Capitalist welfare systems contain the kernel of revolutionary care if “we can imagine the reformation of the political economy around the social determinants of health.” To do that will require centering the surplus populations with the goal of meeting “the social needs of all” (22-23).

The authors’ key claim is that regimes of biocertification are arbitrary and inconsistent, reducing individuals almost entirely to their capacity to work. Following Marta Russell, they view disabled workers as ‘canaries in the coalmine’, whose treatment is a sign of what threatens others after a workplace injury or a shift in what is deemed ‘healthy’ within society.

Reflections on the Coronavirus and Economic Crises

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. CHARLIE MARKBREITER: Some readers of Health Communism might be familiar with the ideas you discuss on the podcast Death Panel, which you cohost together. How would you describe that project? 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)

This fiery, theoretical tour-de-force, offers an overview of life and death under capitalism and argue for a new global left politics aimed at severing the ties between capital and one of its primary tools: health. There was a big influence from existentialist philosopher Jean-Paul Sartre who believed patients should be free to derive meaning from suffering and symptoms of mental illness and then develop away from those symptoms to realize a higher purpose in their lives (132). Generally, the anti-psychiatry movement believed that “madness was not an individual’s biological destiny but a socially determined phenomenon at the population level...” and that “madness was always political...” (131). The politics of health is especially important in a society in which the crisis of the NHS is proclaimed daily, where it can feel like little territory remains for the Left, other than the rearguard action of a dogged defense of ‘our’ health service. Adler-Bolton and Vierkant present not just a utopian alternative, but they offer a concrete politics that moves beyond the mere reduction of waiting lists and creation of more beds. Particularly welcome is the advocacy of patient control of and participation in care, a central demand of the SPK, representing a radical alternative to contemporary tokenistic notions of inclusion and consultation. The authors reference the research of Marta Russell, who has analyzed a “money model of disability.” They note that merely having state funding is not a guarantee of eliminating the cold logic of the market and cost cutting as “this market-driven money model of disability and elder care was only made possible through the mechanism of federal financing” (16). Care recipients do not get direct funding that would allow them to receive it at home. Instead Medicare focuses on institutional care, and many of those institutions are for profit care homes. Further explaining Russel’s model, the authors note that “nursing home residents are counted as assets in Wall Street evaluations of nursing home corporations, which are assigned a valuation in anticipated annual revenue per person” (15-16).The examination of the commodification of ill health is interesting as it shines a light on the need to divide the proletariat into ‘workers’ and ‘surplus population’. A poignant point is that eventually we all become ‘surplus’ either through illness, injury, changing economic conditions or old age, so distinguishing between ‘worker’ and ‘surplus’ does not help in the struggle for a better world. There is clearly a need under capitalism to

Azfar Shafi and Ilyas Nagdee, Race To The Bottom: Reclaiming Antiracism, (London: Pluto, 2022), 172. We set the productive forces free and control the destructive ones. We exterminate what is inferior and increase what is useful....anyone who makes the slightest effort can see what’s waiting in the future. It’s like a serpent’s egg. Through the thin membranes you can clearly discern the already perfect reptile.” 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, BookforumAnother 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. While canonical accounts of political economy begin with the “worker,” Adler-Bolton and Vierkant begin with the “surplus class.” In Health Communism , they 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. Society, Adler-Bolton and Vierkant show, “does immense work to forestall these two groups—the workers and the surplus population—from imagining themselves in solidarity.” In September, we discussed (per the show’s catchphrase) how to be in solidarity forever, and how to stay alive another week. 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.”

Cited: Canadian Dimension: Making the invisible visible - an interview with Megan Linton about the harms of the institutional system, COVID-19, and disabilityjustice (08/26/22) In Health Communism, Beatrice Adler-Bolton and Artie Vierkant first identify and provide an overview of the methods and ideology that have solidified into modern Health Capitalism.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. In this fiery, theoretical tour de force, Beatrice Adler-Bolton and Artie Vierkant offer an overview of life and death under capitalism and argue for a new global left politics aimed at severing the ties between capital and one of its primary tools: health. 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).