Health Communism on an Inflamed Planet

Two recent books, Health Communism and Inflamed: Deep Medicine and the Anatomy of Injustice, offer counterarguments to the abandonment of public health, calling for more expansive understandings of human well-being and its interconnection with all of our social and environmental conditions. 

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The Biden Administration's plans to end the pandemic emergency declaration and related programs means not only the end to free vaccines and tests and the chance for Big Pharma to raise vaccine prices exorbitantly. It also means ending telehealth options and depriving some 15 million Americans of access to Medicaid--including nearly seven million who will still be poor enough to qualify but are unlikely to be able to meet the paperwork requirements.  It means ending supplemental food support programs, even though food banks have been hard pressed to meet people's needs even with the additional federal support.

 It continues a process of abandoning the spirit of public health that has been under attack from officials at least since the CDC told us that those who are vaccinated need not wear a mask and that one-way masking will protect individuals. 

To be clear, the end of the emergency declaration does not mean the end of the pandemic, which is likely to become even more damaging, as it continues to spread with even fewer checks, and thus to evolve ever more variants of unpredictable severity. What we can predict is that the effects of this pandemic--and the next ones sure to come--will inflict most damage on those already disadvantaged. 

As is well known, people of color have experienced higher levels of infection and death from Covid-19. Women and trans people have been more likely to experience long covid--the persistent symptoms that can last week, months, or years after the initial infection.  These disparities are not the effects of some inherent weakness or failure in oppressed groups (despite what fascist health supremacists might suggest), but the cumulative impact of suffering that oppression. 

In their 2021 book Inflamed: Deep Medicine and the Anatomy of Injustice, authors Rupa Marya and Raj Patel draw a series of analogies between the body and the planet as they explore the systemic inflammation resulting from capitalism and colonialism. The book explains that when tissues are damaged or threatened, our immune system sends cells and molecular messengers that attack invaders, repair damage, and restore the body to health. Sometimes, “the response doesn’t switch off, and the result is a chronic inflammatory state. When that happens, the body’s healing mechanism is transformed into a smoldering fire that creates ongoing harm.” Leading causes of this chronic inflammation include malnutrition, environmental toxins, and stress. That is, lack of adequate food; proximity to toxins, for instance, because of dangerous workplaces or the siting of toxic dumps near black, brown, indigenous homes; and stress--the result of suffering the effects of structural, institutional, and interpersonal racism, sexism, and other oppressions--lead to chronic inflammation, which contributes to cancer, heart disease, diabetes, colitis, asthma, and other illness. Marya and Patel argue that individuals can be healthy “only when the entire community is also healthy…this is achievable only through social, economic, political, ecological, and cosmological spheres working in an integrated fashion for the benefit of all.” 

As the pandemic has continued, some have suggested that the impact on the labor market and the increasing difficulty of reliably staffing any business with an ever-more debilitated population will eventually cause a shift in public policy toward ensuring a healthy workforce. That argument might have stronger historical basis if we look at the military, since, for instance, some of the nutrition programs in western nations resulted from the discovery of how much of the population was too malnourished from the Great Depression to fight World War II.

But I think a more persuasive account of the current political economy of healthcare can be found in Health Communism, the recent book by Beatrice Adler-Bolton and Arnie Vierkant, co-hosts of the Death Panel podcast. Adler-Bolton and Vierkant argue that capitalism makes a fuzzy and unstable but crucial distinction between two populations: the workers and the surplus, and capitalist healthcare is the system of managing the surplus, the “unwanted, discarded bodies viewed as waste.” We can see this division being made in the way that disability is defined, for instance, when Social Security Disability Insurance uses the simplified metric of how a particular illness or condition impacts an individual’s capacity to work. 

Moreover, those in the “worker” category constantly face the threat of falling into the latter category, as they will, since the surplus includes ex-workers who are no longer able to produce capital, whether because of age or other factors. But while this system treats certain populations as surplus, as waste, it also depends on these populations to exist. The surplus also become a source of extraction and profit, with various industries developing to extract value from them, whether through policing or through care. 

In April 2020 as the pandemic took hold in the US, as hospitals were overwhelmed with covid patients and health workers were hailed as essential and heroic, 1.4 million hospital workers were laid off.  As the New York Times put it at the time, "plunging revenues from canceled nonemergency medical appointments have forced hospitals to furlough or cut the pay of doctors, nurses and other staff" (and I note that "forced" is the language of the Times) tossing many of those workers into the surplus category. Meanwhile, as Eric Reinhart recently noted in a Times opinion piece about the demoralization of medical workers,  "ostensibly nonprofit charity hospitals have illegally saddled poor patients with debt for receiving care to which they were entitled without cost and have turned large profits by exploiting tax incentives meant to promote care for poor communities. Hospitals are deliberately understaffing themselves and undercutting patient care while sitting on billions of dollars in cash reserves." 

Adler-Bolton and Vierkant describe this process as "extractive abandonment," a concept they develop by drawing on Ruth Wilson Gilmore's work on imprisonment and the notion of "organized state abandonment" and Marta Russell's work on Capitalism and Disability. For Wilson Gilmore, this abandonment appears as a withdrawal of the state but is actually a strategy of racial capitalist state formation to exploit vulnerable communities, and it signals the process of governing populations through callous yet purposeful neglect, framing many humans and other lifeforms as surplus to the contemporary political economic order. 

Health Communism also draws on “Marta Russell’s money model of disability" which "theorizes that while the disabled—the surplus population—are widely regarded as a “drain” on the economy, in truth over time capital and the state have constructed systems to reclaim this lost population as a source of financial production. Russell situates these systems as manifesting through charity fundraising, the prioritization of care aimed toward the “repair” of disabled people to become workers, and through policies that grow the private sector through for-profit private nursing home care paid for by publicly funded, means-tested state health care programs.” 

Ultimately, the authors of Health Communism call for left projects to center the "waste," because “deviants, the surplus, and the sick form the central class that can bring about the fall of capital.” They argue that “It is not necessarily the case that we are all sick. But none of us is well." "Health" is "a biological fascist fantasy" "a subjective dream of an unattenuated 'wellness,' a body state [they] deny any being has ever known." "Capital has emphasized and corrupted the delineations between surplus classes for its convenience; it is immeasurably threatening to capital to see a group of those it has deemed to be waste come together in solidarity. ” "The truth of the distinction that capitalist states draw in their demarcations of worker/surplus is that in the eyes of capital, we are all surplus." 

 

Happy Superb Owl Sunday

VDOC003-004 from Joel Sartore on Vimeo.

denouncing the horrors

 

So, the US House passed a resolution "denouncing the horrors of socialism."   

 

Note that it came from the Finance Committee, and that

Several Democrats who voted against the resolution expressed concerns regarding the future of Social Security and Medicare. They noted that Republicans on the Rules Committee rejected an amendment proposed by Rep. Mark Takano (D-Calif.) which sought to clarify that opposition to the implementation of socialist policies in the U.S. does not include federal programs like Medicare and Social Security.

 

(Emphasis added).  Or, as someone suggested on social media, when they denounce socialism it means they are coming for your pension.  

 

It's also an example of how bourgeois liberalism facilitates the rise of fascism (more on that another time, probably).

Some years ago, my older brother was in town visiting, and we went to some socialist event, and he made some disparaging comment about socialism.  Now, my brother is a good guy, and I figure he grew up in a more intense phase of the cold war than I, and there was no point in debating whether the merits of things like "liberation theology" or "catholic worker" derived from the first or the last word in the term.  

 

And I imagine that dissecting that wacky resolution is kind of pointless, in that those who see the problems with it don't need them spelled out, and those who don't see the problems will not be convinced.  But some of it is truly stunning.  It's got distortion, questionable selectivity, and lots of pot-meet-kettle. So here goes. 

 

They write:

"Whereas socialist ideology necessitates a concentration of power that has time and time again collapsed into Communist regimes, totalitarian rule, and brutal dictatorships;"

 

l "Socialist ideology" encompasses a very diverse set of beliefs, as indicated, for instance, by the sheer volume of texts available via the Marxists Internet Archive.

 

l  Socialist ideology does not necessitate concentration of power, as we can see outlined, e.g., in Hal Draper's Socialism From Below. 

 

l On the other hand, capitalism does tend to involve concentration of power, and has also collapsed into brutal regimes of fascism, and we now increasingly face the brutal inequality that was briefly alleviated during the "30 glorious years" (See Piketty and glosses thereon) after WW2, created by capitalist regimes' need to stave off revolution through providing some of the social supports people were seeing in socialist countries  (See Klein, The Shock Doctrine).

 

They write,

    "Whereas socialism has repeatedly led to famine and mass murders, and the killing of over 100,000,000 people worldwide;"

l  Capitalism has of course also led to mass murder.  Indigenous people of the Americas, the Africans kept in chattel slavery, colonized people around the globe, and anyone with resources desired by multinational corporations might have a very different assessment than the House does of the relative body counts. 

 

l We might also note that it is capitalism, with its structural drive for profit above all, that has led to the climate crisis that now threatens all planetary life.  That's a very massive murder.

 

They write:

   "Whereas many of the greatest crimes in history were committed by socialist ideologues, including Vladimir Lenin, Joseph Stalin, Mao Zedong, Fidel Castro, Pol Pot, Kim Jong Il, Kim Jong Un, Daniel Ortega, Hugo Chavez, and Nicolás Maduro;"

l This heterogeneous list lumps together figures with quite different ideologies and histories, and of course omits world criminals of other stripes (e.g., Hitler, Pinochet) as well as socialist (even mildly socialist or redistributionist) victims of the CIA and allies (Allende, Mosaddegh).

 

They write: 

    "Whereas tens of millions died in the Bolshevik Revolution, at least 10,000,000 people were sent to the gulags in the Union of Soviet Socialist Republics (USSR), and millions more starved in the Terror-Famine (Holodomor) in Ukraine;

    Whereas between 15,000,000 and 55,000,000 people starved to death in the wake of famine and devastation caused by the Great Leap Forward in China;

    Whereas the socialist experiment in Cambodia led to the killing fields in which over a million people were gruesomely murdered;

    Whereas up to 3,500,000 people have starved in North Korea, dividing a land of freedom from a land of destitution;"

 

l On gulags, consider the rate of incarceration in the US and the horrific conditions faced by those incarcerated. 

l On starvation, see also the Irish Potato famine and the rate of hunger in the USA.  

 

l  On murders, see also the rate of US police killings, the murders of environmental activists at the behest of fossil fuel and other industries, and the general incidence of gun violence in the USA.

 

l And again, it's capitalism, with its structural drive for profit above all, that has led to the climate crisis that now threatens all planetary life.

 

l  More rebuttal to the numbers via WSWS.

 

They write:

    "Whereas the Castro regime in Cuba expropriated the land of Cuban farmers and the businesses of Cuban entrepreneurs, stealing their possessions and their livelihoods, and exiling millions with nothing but the clothes on their backs;"

 

l Woah, why is the expropriation of land listed here as though it is the same as starvation and murder?

 

In the pre-revolution latifundo model, much of the land was owned by US investors, and 1.5% of landowners held almost half the agricultural land.  Much of the Cuban population were sharecroppers.  Under land reform after the revolution, 70% of farm land was taken from foreign and large to medium sized landowners and returned to the population who actually worked the land. 

 

Nota bene,  "In 1974, the General Assembly of the United Nations affirmed the right of states to nationalize properties, declaring that nationalization is an indispensable precondition for national sovereignty over natural resources.  It further declared that no state should be subjected to coercion in response to its exercising this right of nationalization." 

 

They write: 

    "Whereas the implementation of socialism in Venezuela has turned a once-prosperous nation into a failed State with the world’s highest rate of inflation;"

 

l Even USAToday knows there's more to this story.

 

They write:  

    "Whereas the author of the Declaration of Independence, President Thomas Jefferson, wrote, “To take from one, because it is thought that his own industry and that of his fathers has acquired too much, in order to spare to others, who, or whose fathers have not exercised equal industry and skill, is to violate arbitrarily the first principle of association, the guarantee to every one of a free exercise of his industry, and the fruits acquired by it.”; 

    "Whereas the “Father of the Constitution”, President James Madison, wrote that it “is not a just government, nor is property secure under it, where the property which a man has in his personal safety and personal liberty, is violated by arbitrary seizures of one class of citizens for the service of the rest”; and"

 

l   It's worth noting here that Jefferson owned over 600 enslaved people, Madison owned over 100 enslaved people, and both men also supported the project of "indian removal." So the "industry and skill" these guys exercised was in seizing the land and bodies and labor of others. 

 

They write:

    "Whereas the United States of America was founded on the belief in the sanctity of the individual, to which the collectivistic system of socialism in all of its forms is fundamentally and necessarily opposed: Now, therefore, be it

         Resolved by the House of Representatives (the Senate concurring), That Congress denounces socialism in all its forms, and opposes the implementation of socialist policies in the United States of America."

 

l When the United States was founded, the only individuals granted sanctity were adult white men who owned land.  Details of voting requirements varied by state, but there were also often religious requirements.  Maryland, for instance, waited until 1828 before allowing Jewish men to vote. Chattel slavery was legal, and even white women could not own property, vote, control their own money, or sign legal documents.

l Policies that have been denounced as socialist include the New Deal, Social Security, farm price supports, bank deposit insurance, independent labor organizations, and progressive taxation. And, as even Harry Truman noted, "almost anything that helps all the people."

(Truman  understated the case, in fact, since many social  programs were designed not to help all the people --the Social Security act of 1935 excluded agricultural and domestic workers, who were mostly brown and Black, but it was still called socialist).

 

So, yeah, when they denounce socialism, they are coming for your pension, your health care, your public school, your county library, your liveable environment. 

 

I am in favor of all those socialist things (and then some). 

cpcs, nifla, & scotus

image via exposefakeclinics.com

Although, as the Communist Manifesto observes, "The executive of the modern state is but a committee for managing the common affairs of the whole bourgeoisie," the conflicts within the ruling class and the pressure of activism have at times created opportunities for the state or its branches to intervene on the side of the people.  In the past, for instance, laws have provided and the Supreme Court has affirmed the right to equal education and accommodation, to voting rights, to access to contraception and abortion care.

 

At present, of course, things are different.  In an interview on Truthout,  Saqib Bhatti, co-director of the ActionCenter on Race and the Economy (ACRE), answers the title question of Whose Agenda is the SupremeCourt Carrying Out?  by pointing to “the corporate class” and “white supremacists.”  In recent decisions the Court has upheld Trump’s Muslim ban, taken away fair-share fees from public sector unions, and ruled that crisis pregnancy centers can lie to people. 

It’s the last of those decisions I want to give a bit more attention today.   It reflects longstanding organizing by the patriarchal religious right, and it is also racist and a gift to capital power.

The case is NIFLA vs Becerra.  NIFLA is the National Institute of Family and Life Advocates, an anti-abortion legal group that provides legal services and advocacy for what are known as Crisis Pregnancy Centers, anti-abortion counseling centers that usually present themselves deceptively as fake health-care clinics.  Their goal is to intervene with those who might be considering terminating a pregnancy and to persuade them instead to give birth.  In pursuing that goal, CPCs will usually not only advertise themselves deceptively, but often provide misinformation, anti-choice propaganda, and shaming and intimidation.

The religious right typically believes that sex for pleasure without procreation is wrong.  They fear the possibility of losing the private, caring labor that mothers and other women have historically provided, because they see no larger framework for communal care and social provisioning.  

 

Thus, right wing groups in Oregon are hoping to put on the November ballot a measure to amend the state constitution to ban using public funds for health insurance that covers abortion.

 

Typically, CPCs offer free pregnancy testing (the sort of thing you could find yourself at a pharmacy)  and sometimes they offer ultrasounds—especially in states where an ultrasound is now required before an abortion.  Sometimes these centers provide referrals to social service agencies or themselves offer some things like free baby clothing. 

But a series of investigations reveal that they also frequently lie about the dangers of abortion, suggesting it will lead to cancer, sterility, mental illness—none of which is true—in fact abortion is one of the safest medical procedures.  It's far safer than carrying a pregnancy to term, but fake clinics won't provide information about the dangers of pregnancy, or the fact that  “childbirth is 14 times more likely than abortion to result in” the pregnant person's death. 

These fake clinics may lie about the gestational age of a fetus or the likelihood of miscarriage or the laws on reproductive care, all in an effort to delay action until it is too late for a pregnancy to be terminated. They may lie about the possibility that the birth of a child will change an abusive partner into one who is not abusive.  They may lie about the effectiveness of contraception in protecting against pregnancy or sexually-transmitted diseases.  All such lies can of course be dangerous to health.  "Information-related delays in qualified healthcare negatively affect [not only] women seeking to terminate their pregnancies [but also] women carrying their pregnancies to term, with delays in qualified prenatal care causing life-long health problems for infants.”

Moreover, these fake clinics are often targeted at low-income women and women of color, who are at greater risk of maternal mortality and morbidity when they do give birth.  And these centers are five times more numerous than are clinics that actually provide abortions.  

But these fake clinics have had support from lawmakers, who in some states have provided public funding for them or have mandated they be included among the referrals provided to those who are pregnant.

In response, a number of jurisdictions have passed laws that prevent misleading advertising and that require CPCs to disclose the limited nature of the services they actually provide.  Becerra is the attorney general of the state of California, which in 2015 passed the Reproductive Freedom, Accountability, Comprehensive Care, and Transparency Act. California’s FACT Act required unlicensed centers to post notice of their unlicensed status, and required licenced centers to post visible notices that free or low-cost abortion, contraception, and prenatal care are available to low-income women through public programs, and to provide the phone number for more information.

NIFLA challenged the act on the grounds that it violated the right to free speech in some way that is not true of laws requiring doctors to tell pregnant people that their "unborn child is a whole human life that was a human life at conception."  The so-called informed consent laws requiring such a statement—that one’s from Missouri—were upheld in the Supreme Court’s 1992 decision in Planned Parenthood v Casey, which held they did not violate the first amendment (even though currently some of them  may be unfounded and unscientific, like that one from Missouri).

Clarence Thomas’s argument for the Supreme Court’s majority decision suggests that it’s okay to allow the fake clinics to lie because they aren’t really providing medical services, wheras real clinics that do provide medical services can be compelled to provide scripted information (even dubious information). 

But  as Justice Breyer notes in his dissent,  “If a State can lawfully require a doctor to tell a woman seeking an abortion about adoption services, why should it not be able, as here, to require a medical counselor to tell a woman seeking  prenatal care or other reproductive healthcare about childbirth and abortion services?"

Breyer’s dissenting opinion, in which he is joined by the three women on the court, Ginsberg, Sotomayor, and Kagan, dissects in legal detail the many problems with the majority opinion. 

Aside from the problems a layperson might notice, Breyer also points out that the grounding Thomas provides for the majority opinion not only ignores information provided to the court, draws on less-than-relevant case law while ignoring more relevant precedent, and rests on distinctions that lack “moral, practical, and legal force.”  The majority’s approach also, Breyer notes, “in suggesting that heightened scrutiny applies to much economic and social legislation,” places “ordinary disclosure laws” and “much securities law or consumer protection law at constitutional risk,” and “at the least threatens considerable litigation over the constitutional validity of much, perhaps most, government regulation.”

That is, like Citzens United and debates on college campuses, this decision is part of the right-wing project of weaponizing the notion of free speech against the interests of the vulnerable majority.
The decision not only makes it legal for these fake clinics to lie to their clients, it also sets up a ruling that may lead to challenge and overruling of other laws that require companies provide customers with adequate and truthful information.

Imani Gandy at ReWire suggests one place that invitation to litigation is likely to show up soon is in right-wing challenges to attempts at banning so-called conversion therapy—since it's no more deceptive to say that beating a kid will make them not be gay than it is to say that an abortion will give you breast cancer.  Neither is true, but those currently in power don’t seem to think these lies should be illegal.   

In short, and not surprisingly at this point, although California may and should come back with a rewritten FACT Act, we can’t rely only on the legal system to address the problem of fake clinics and women’s needs for reproductive care.

Fortunately, there are informational and activist resources available online. 

The site “expose fake clinics dot com”  has a wealth of resources including a database of fake clinics, organized by state—and the listing includes some in Portland and the surrounding area.  The activists who made the site propose providing Yelp reviews for local fake clinics, alerting Yelp users to the real scoop.  The site “ReproAction dot org” has more suggestions about what to do about fake clinics in your area; they offer a webinar and a direct action toolkit for organizing protests at fake clinics, speak-outs and teach-ins involving those who have been victimized by these groups, and getting the word out through letters to the editor, op-eds, and petitions for investigation into use of public funds. 

Some folks with the local feminist caucus of the Demoratic Socialists of America have taken an interest in this issue, so that would also be a place to find out more and connect with others interested in exposing fake clinics.

It's probably not a bad idea to learn menstrual extraction and other useful skills, but perhaps that's a discussion for another day.