A stethoscope tied around a pile of cash, with a pill bottle nearby. The pill bottle has cash and pills inside.

We Haven’t ‘Learned the Lessons of COVID’ Until We Remake the Political Economy of Health

By Beatrice Adler-Bolton and Artie Vierkant

Over the course of the pandemic it has been popular to claim that we have “learned lessons from COVID,” as though this plague has spurred a revolution in how we treat illness, debility, and death under capitalism.

Management consulting firm McKinsey, for example, writes that COVID has taught us that “infectious diseases are a whole-of-society issue.” A Yale Medicine bulletin tells us that we successfully learned “everyone is not treated equally, especially in a pandemic.” These bromides reflect the Biden administration’s evaluation of its own efforts; a recent White House report professes to have “successfully put equity at the center of a public health response for the first time in the nation’s history.”

We have learned nothing from COVID. The ongoing death, debility, disability, and immiseration of the pandemic are testament only to a failed political economy that pretends at magnanimity.

This is not to say that there are not lessons that can be learned from this pandemic. But to do so would require us to look beyond the immediate — and many — failings of our health, health finance, and public health systems, toward a fundamental remaking of our political economy of health. We will not be able to address the next plague, or “learn to live” with the current one, by tinkering around the edges of social policy to produce modest, incremental changes. Instead we will need to undo the ties that connect health with capital, that bind illness and health to the commodity form, and, in so doing, profoundly reshape our broader political economy itself.

In our forthcoming book, Health Communism, we write that “health” is an impossibility under capitalism. Under capitalism, to attain health you must work, you must be a “productive” and normative member of society, and only then are you entitled to the health you can buy. This is readily apparent when health is understood as a central tool disciplining the labor force: because health is used to define who is and isn’t allowed to participate in social and political life, the threat of “losing” that health becomes at the same time a threat to the working class of losing their status as worker, becoming a part of what we refer to in our book as the “surplus class.”

So, if there are lessons to be had from COVID, we find them here: in the moments where what could appear to be state failure are revealed as intentional sites of abandonment.

Already in this plague the state has overseen the addition of countless people to the ranks of the surplus. To draw attention away from the structural culpability of the state, officials have emphasized health not as the socially and politically constructed phenomenon we know it to be, but instead as a matter of personal responsibility. That state officials in the U.S. — from President Biden himself, to CDC Director Rochelle Walensky, to COVID czar Ashish Jha — have emphasized and carefully cultivated this language over the course of the pandemic offers a lesson in itself.

State personal responsibility rhetoric emphasizes the very logic and weaponization of “health” under capitalism that we seek to unmake. Under capitalism, health is socially reproduced as a personal trait or characteristic; as only a matter of the individual. We are trained to think of health as a consumer good, an aspirational, negatively defined quality we must each struggle alone to achieve if we wish to be valued by society.

Health becomes defined by the things it is not. No matter how well you fashion the idea of health as a commodity, there is no way to buy yourself a “perfect body,” or the ability for the body to withstand in perpetuity. The body as a consumer object is a good that is guaranteed to break down. And it is for this reason we say that health — capital’s own notion of health — is an impossibility under capitalism.

It is vital that we therefore recognize this: health is not a personal trait, it is an economic system. The political economy of health is a matrix of points where your body is commodified at every interstice where you would seek the supports you need to survive. We are forced to self-finance the maintenance of our labor power through this framework of health, to cure or repair ourselves, toward returning our bodies to work. When this bill comes due and we cannot pay it, or when the object finally breaks down, the economy moves on without many of us.

As we write in Health Communism, no one will have learned from COVID, or any such crisis, until we undo this fundamental, toxic relationship of health to capital once and for all. Doing so will not look like the introduction of a “more just” or “more equitable” program sitting atop our current political economy of health. It will not look anything like the capitalist political economy at all.

Beatrice Adler-Bolton is a blind and chronically ill disability justice activist and independent researcher. She is co-host of the Death Panel podcast and co-author of Health Communism: A Surplus Manifesto

Artie Vierkant is the producer and co-host of the Death Panel podcast and co-author of Health Communism: A Surplus Manifesto

The Petrie-Flom Center Staff

The Petrie-Flom Center staff often posts updates, announcements, and guests posts on behalf of others.

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