Why Capitalism Needs Sick People

Photo-Illustration: Intelligencer; Photos: Getty Images

Sickness is an American growth industry. As industrial-manufacturing output has stagnated, services have picked up the slack, and health care is a special kind of service. Between 2003 and 2013, employment growth in health care outpaced general growth by a shocking ten times, 22.7 percent to 2.1 percent. For a capitalist society like ours, sick people have become very important, and under this system, some people will always be worth more sick than well. Sickness is less a question of individual bodies gone haywire, a set of problems that can be solved if everyone has access to the right care and behaves correctly. Here, sickness is a line to avoid falling below, like poverty.

In his 2021 book The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America, which chronicles how Pittsburgh went from a steel town to a hospital town, the scholar Gabriel Winant writes, “Because of the health care system’s fragmented, public-private structure — linking everyday, labor-intensive care provision to the profits of insurers, drug companies, and investors — and because of the system’s access to a market in the devalued labor of care workers, the health care system had the slack to accommodate rising demand for mass care.” That is to say: In America, there’s always more money in sick people. As capitalists have turned health care into their rainy-day supply of growth, they have inadvertently summoned a new opposing political formation, one that goes by the ominous name “health communism.”

Beatrice Adler-Bolton and Artie Vierkant, the co-hosts of the Death Panel podcast, approach public health with an emphasis on the “public,” joining a straightforward left-wing-policy analysis with uncompromising rhetoric and a for-us-by-us sense of sick solidarity. “STAY ALIVE ANOTHER WEEK,” reads one hat for sale in the Death Panel merch store, a portion of the pod’s sign-off message. Fed up with the consumerist approach to health, they’ve struck a nerve. When the lefty publisher Verso released their book Health Communism in October, the first printing sold out immediately.

Along with co-hosts Vince Patti and Philip Rocco, Adler-Bolton and Vierkant launched Death Panel in late 2018. Covid-19 made clear the frailties of the American health-care system, but it would be a mistake to see their success as a pandemic phenomena; Health Communism even goes so far as to ignore the topic. “This omission is intentional,” they write. “For all the horrors of the pandemic, we are aware of no actions taken during it by states or private industry that are not explained in full by the preexisting health-capitalist framework.”

For Adler-Bolton and Vierkant, these questions are all political in a personal sense. The couple completed an uncommon journey of radicalization from fine art to medicine as Adler-Bolton struggled with a rare and worsening autoimmune condition. There are no greater experts on the realities of the American health-care system than the many sick people who go to battle every day with an apparatus that, depending on the fulfillment of arcane bureaucratic requirements, may withhold or remit life-saving drugs and services. For them, Death Panel provides practical advice as well as policy analysis and theoretical context.

The story of Adler-Bolton’s simultaneous exclusion from the labor force as a disabled person and her new economic role as a job creator for doctors isn’t in Health Communism, but it is between the lines. “The political economy demands that we maintain our health to make our labor power fully available, lest we be marked and doomed as surplus,” the authors write. “The surplus is then turned into raw fuel to extract profits, through rehabilitation, medicalization, and the financialization of health.” It’s a radical perspective but one that may ring true to anyone who’s ever received a medical bill that’s larger than their annual household income and seen their economic value flash before their eyes. Investors have searched out reliable areas of growth in a glutted global commodity market, and they repeatedly landed on sickness.

As the health sector has become more important to capitalists, it’s become more important to the left, too. Independent projects with a similar focus and political bent to Death Panel have popped over the past years, like the newsletter Mental Hellth, the podcast Red Medicine, and the magazine Peste. These outlets share a view of health as intrinsically social, which is to say not just that sickness spreads, or even that it spreads unevenly, but that what it means to be sick is a concept constructed by people under particular historical circumstances. This is a Marxist account of health that goes deeper than the social-democratic impulse to redistribute wealth and smooth out market unfairness — it’s a way to interrogate the fundamental basis for that line that cuts the population in two. After all, each body has problems, but only some bodies become problems.

To approach the present moment, health communists are working through the left’s 20th-century experience with sickness. Looming large is the work of the AIDS Coalition to Unleash Power (ACT UP), which organized patients and allies to demand progress on all fronts: treatment, care, research, policy, awareness, and general respect. (ACT UP veteran Gregg Gonsalves has appeared on the show, and Health Communism quotes extensively from the ACT UP Oral History Project.) The Black Panther Party is an important inspiration too, with its grassroots community clinics and sickle-cell-testing programs, as is the radical wing of the 1970s and ’80s American disability rights movement, which made frequent use of direct action, including a multiweek takeover of the then–Department of Health, Education, and Welfare. Adler-Bolton and Vierkant dedicate their book and a significant number of its pages to the early-’70s SPK, the German Sozialistisches Patientenkollektiv, which questioned the doctor-patient division and planned to “turn illness into a weapon” against capitalist society. The group was suppressed by West German authorities after being suspected of moving from self-care to terrorism via association with Red Army Faction militants. Obscured to various extents by the triumphant end-of-historians, these collective experiments in care and resistance now provide examples for new cohorts of the sick and angry.

One virtue of the interview-podcast format is that it invites connections among different histories, traditions, and perspectives. One of the most influential academics on the health-communist view is Ruth Wilson Gilmore, the self-described communist geographer whose model of how prisons and prisoners provided a solution to unemployment after the collapse of the New Deal order is a close analogue for Adler-Bolton and Vierkant’s extractive health-care system: Both are deep pits of public-private demand, capable of absorbing practically limitless amounts of economic activity, whether the “customers” like it or not. In both situations, the system has found ways to get around people’s inability to pay for the overpriced services they’re compelled to need, and Americans have consequently accumulated tens of billions in court debt and hundreds of billions in medical debt. What’s being dug up in the process, the basis for this extraction? “It’s the extraction of their time,” Wilson Gilmore told Adler-Bolton on a recent Death Panel appearance, “just like it’s the extraction of cobalt, or copper or lithium that goes into circulation to produce the possibility for people to make their livings and their livelihoods based on the unfreedom or marginally lower freedom of others.” As capitalism changes, the Marxist analysis of capitalism changes as well and health communism and prison abolition name advanced (and quickly advancing) critiques of the present.

Almost five years into Death Panel, health communism is a discursive dark horse, shaping the conversation without the help of national op-ed pages. Scholar Jules Gill-Peterson started as a guest of the podcast focused on anti-trans policy and has moved over to the Panel side, where she helps make the show an oasis of facts in a media desert of misinformation. And as for COVID, the show has transcended the lockdown/open-up binary, playing host to critics like Dean Spade and Steven Thrasher. As the intellectual scene coheres, I expect it will become more directly influential — look out for a forthcoming volume on COVID from Death Panel co-host Abigail Cartus and guest Justin Feldman with the preliminary title How to Hide a Plague. If all these names don’t ring mainstream bells yet, then America’s continued sickening and the lack of coherent responses from official public-health authorities suggests they might soon.

“To write only of oneself may be to write of death,” writes Anne Boyer in her 2019 anti-capitalist cancer account The Undying, “but to write of death is to write of everyone.” Health communism is a new way to find the universal in the particular, which is the kind of thinking tool we are in desperate need of at the moment. Turning those ideas into practice is a greater challenge. Where to start? Health communists begin with a compelling vision of society not as divided between abled and disabled or sick and well but as a vast web of people, all of whom have both abilities to contribute and needs to meet.