Health Communism: A Reading Guide (Part One, Introduction)
"There is nothing to wait for. There is no better time."
[Image Description: Blue background with white text and printers registration marks. The white text reads “Health Communism” and is stylized like the text on the cover of the book. The word health is in serif font and the word communism is in all caps sans serif font on the next line.]
Health Communism: A Reading Guide (Part One—Introduction)
October 18th, 2024 marked two years since the release of Health Communism. In that time, the world has only further spiraled into interwoven crises of care, austerity, slow death and violence, empire, and yet deeper structural and personal abandonment. As we reach this grim milestone, we feel little inclination to celebrate our book release anniversary considering it comes amidst such brutal times and over 400 days of sustained and escalating eliminatory eco-genocidal violence against Palestinians in Gaza.
But over these last two years, we’ve received many requests inquiring about study or reading group materials to accompany the book, so I’ve slowly written a series of essays on each chapter in an attempt to fulfill that request—with the idea of offering an accessible entry point for Health Communism followed by brief discussion questions that are useful as both individual writing prompts and for group discussions. These are written with new, first time readers and also returning readers in mind, as accompaniment for a first pass or through deepened engagement for those already familiar with the work.
Health Communism is not just a critique but a tool for understanding, surviving, and organizing against the violent systems of “health” that we dissect in its pages. Two years on from publication, the stakes of naming an alternative vision to our narrow reality of health capitalism are higher than ever: the imbrication of capital and health more cemented through the ongoing state abandonment which characterizes year five of the Covid pandemic, ongoing genocides, and a coming second Trump administration in the United States.
The need to separate capital from health and dismantle the capitalist system and ideology is ever more urgent, and we (Artie and I) hope that we can offer yet more ways to use the work of the book as we are firm believers that it is only possible to liberate ourselves from the fascist fantasy of “health” if we thoroughly understand the way it shapes all of our lives from birth to death.
For practical purposes, here is some information about the discussion guide and how it was written to be used: There is a guide for each chapter, once they are all posted here on Blind Archive, I will release the full guide as a PDF. Each chapter guide contains four parts, a summary, a section breaking down a few key ideas and themes from the chapter in more depth, a concluding reflection, and, finally, a section with discussion questions / writing prompts followed by definitions of key terms from the chapter. This can be used for individual or group study, and can be read before or after reading the chapter. The discussion questions are best used after the chapter and guide has been read but can be useful to skim in advance of reading the chapter of Health Communism, because they will offer some guidance as to what ideas you might be able to get out of each chapter.
1.1 Summary, Introduction
The introduction to Health Communism lays the foundation for a radical analysis of health under capitalism, arguing that though we think of health as an individual trait, it is instead a population-scale phenomenon that has been weaponized by capital and framed as an individual trait to control and exploit populations. In a system where human worth is measured by productivity, those deemed unproductive—such as disabled, chronically ill, elderly, and marginalized people—are cast aside as a “surplus class.”
This surplus class is not merely abandoned; rather, they are subjected to a process of “extractive abandonment,” where the medical-industrial complex, pharmaceutical companies, and various state institutions, among many others, continue to profit from populations that capitalism has deemed disposable while claiming these populations do nothing but draw on collective resources as a burden.
The introduction argues that any genuine pursuit of health and care cannot occur within capitalist structures, as these systems are designed in ways that make them incompatible with fostering human well-being at both an individual and collective scale. Instead of prescribing reformist approaches that tweak existing systems, Health Communism advocates for a revolutionary restructuring of society, centering the needs and leadership of the surplus class as a starting point for how to create the possibility of well-being for everyone.
The introduction challenges the notion that only the working class should lead revolutionary movements or that the surplus class is indeed separate from the working class, arguing that the liberation of the surplus class is crucial for dismantling capitalism’s hierarchies of worth and productivity. Through this lens, the Introduction calls for a world where care is a universal and collective good, unmoored from capitalist interests and lays out the other ideas that are explored in the rest of the book, each of which make up part of the larger picture of how capital is imbricated with health.
1.2 Deeper Discussion of Key Ideas and Themes, Introduction
A) Health = Capital’s Weakest Point
In the introduction to Health Communism, we begin by asserting that health is capitalism’s vulnerability. This is not a metaphor or a rhetorical flourish, we mean this literally. Health is capitalism’s vulnerability because the system relies on a healthy, ‘productive’ workforce to sustain profits and maintain economic growth. When large segments of the population suffer poor health, it diminishes labor productivity and increases healthcare costs, threatening the pace of capital accumulation and challenging capitalism’s myth of endless exponential growth.
Additionally, the Introduction argues that the commodification of health has pressure points, which expose the fragility of capitalist structures—particularly when crises arise. This is sometimes in the context of public health crises like Covid, or it is in more diffuse circumstances not normally considered a crisis by many, like the norms governing the ownership and production of pharmaceuticals. Ultimately, a society that prioritizes profit over creating capacities and circumstances that support well-being, and which denies most people the material conditions necessary to be well, creates compounding conditions where a concentration of health disparities can quickly destabilize an entire economic system.
Health—both the biological and social constructions of it—is fundamental to capital’s ability to reproduce itself. Without a laboring class that is managed, surveilled, and maintained, capital cannot function. And yet, health is precisely where capital’s contradictions are most glaring, the facade shielding these contradictions from view is the idea that health is an individual phenomenon, not a collective condition. The fantasy that health is a purely personal, individual biological concern is one of capitalism’s greatest lies. Health, as we argue, is a collective landscape, a site of extraction and control—a tool used by the state and capital to organize life, death, and labor, lay blame, recoup losses, and avoid accountability.
From the outset, we make clear that health under capitalism is always conditional. You are only ‘healthy’ if you are able to labor, to be economically productive, and then buy the means and conditions that allow well-being. As I’ve put it in the past, “Under capitalism, you work, you earn a wage, and then you’re only entitled to the survival you can buy.” The healthy worker becomes the ideal, while disabled, chronically ill, or otherwise ‘unfit’ people are cast aside as less than (literally worth less) and thus marked as surplus populations, no longer of central importance to the system. These populations—what we call the surplus class—are more than mere passive and disorganized groups of people, and asserting that is central to our analysis.
We argue that the surplus class, while frequently referred to as merely a population of surplus people, is, in fact, a class because it consists of individuals who, due to systemic economic structures, are deemed unnecessary or expendable within the capitalist mode of production yet are still intimately and necessarily a part of it. This class includes those who are unemployed, underemployed, disabled, or otherwise unable to contribute to capital accumulation, and their shared experiences of marginalization, disposability, and deprivation create a collective identity and social condition that specifically relates to their position relative to the ownership and means of production—therefore in formal marxist terms surplus people are not outside of the working class, though both in practice and theory they are often explicitly excluded from it.
In the next essay for this series, on the first chapter of Health Communism, called “SURPLUS,” I will expand upon why we argue that the surplus are a class and not just a population, secondary or extraneous to the working class. For now, what matters is to think about how those deemed surplus, extraneous, or unnecessary to capital, classified as burdens and marked as waste, worth less than a worker, are indeed still central to how the world around us functions, and key participants in many industries as a consumer or even as a passive product that wholly constitutes the fundamental condition that drives the need for labor in that industry (think nursing homes, hospitals, medical research and pharmaceuticals, home care, education, etc).
B) The Biological, Fascist Fantasy of Health
In Health Communism, we draw heavily on the work of the West German radical patient group called Sozialistisches Patientenkollektiv (also known as SPK or the Socialist Patients Collective), who in the early 1970s described health under capitalism as a “biological, fascist fantasy.” This is not hyperbole; it is a statement of plain fact which underscores the brutal realities of how capitalism manipulates health to uphold its own values and interests. This phrase reflects the notion that capitalist societies impose narrow, often eugenic standards of health that prioritize certain bodies over others, promoting a view of health that is entwined with fascist notions of productivity, worth, and social hierarchy.
Fascist notions of productivity, worth, and social hierarchy are authoritarian concepts of labor value, human worth, and social stratification, and revolve around the belief that certain groups—often defined by race, ability, and economic status—are inherently superior and thus more valuable to the state and society. In this framework, productivity is equated with national strength and collective progress, leading to the exclusion, devaluation, or extermination of those deemed ‘unproductive’ or ‘deviant.’
Worth is determined by one’s ability to contribute to the state’s goals, reinforcing a rigid social hierarchy that prioritizes conformity and obedience while marginalizing those who do not fit within its narrow definitions of health and human value. This ideology not only justifies systemic inequalities and violence against marginalized people and groups but also fosters a culture of competition and exclusion, undermining the principles of solidarity and collective care as worth less because they are antithetical to the individualist fantasy of health as a pure, intrinsic, and measurable state of being.
Health as it exists under capitalism, is a violent construct—a normative ideal that justifies the control, discipline, and abandonment of those who fall outside its narrow boundaries and borders. The healthy, productive worker is the idealized subject of capitalism, while those who are sick, disabled, or otherwise ‘unfit’ are pathologized and discarded. SPK rejected any attempt to reclaim health from its capitalist context, but this is where we diverge from SPK in our refusal to abandon the concept of health entirely.
We argue that health can and must be reclaimed—not just for workers but for surplus as well. Health communism as an idea is the project of freeing health from its status as a commodity, a condition of labor, or a privilege for the deserving or chosen among us only. It is about creating capacities and systems where care is universal, where no one is abandoned or left to die because they do not fit the narrow definition of ‘healthy’ that capitalism imposes.
This is not a reformist project. It is not about tweaking the system or making it more equitable within the constraints of capital. It’s about dismantling the entire edifice sustaining the fascist fantasy of health and not replacing it with a facsimile of the original. Health, as we understand it, must be freed from the logics of productivity and deservingness in order to make well-being for all possible.
Under capitalism, health is always conditional, always dependent on your ability to contribute to the market. Under health communism, health becomes a collective good, a benchmark, shared horizon, goal, or task to be accomplished together—something that belongs to us all, human and nonhuman alike, irrespective of work, value, ability, or status. It requires taking responsibility for each other, which is antithetical to the fascist individualist fantasy of health as a pure biological state that some people deserve and some people don’t.
C) How Socialized Medicine is Also a Capitalist Tool
In the introduction to Health Communism, we also take aim at the idea that true socialized medicine can exist within a capitalist state. We reject the notion that state-run healthcare systems, as they are currently conceived, are sufficient or even radical. Socialized medicine, in its current form, still operates within the logics of capital—it still separates those deemed worthy of care from those who are not.
Even in systems like the United Kingdom’s National Health Service (NHS) or Canada’s decentralized, province-based Medicare system—comprising 13 separate and unequal publicly funded health care insurance plans—the goal is to prop up capitalism not challenge it. While these systems represent vast improvements over the United States’ for-profit health care system, they still do not disturb the fundamental relationship between health and capital. These systems, acting as socialized islands within capitalist seas, still rely on distinctions between the deserving and the undeserving, the productive worker and the surplus.
That does not make socialized medicine bad, it's certainly a large step above the status quo in the United States, however it is not revolutionary to simply blunt the damage of a system which is designed to make true health impossible for all but the ruling and owning class. As some UK based scholars like Lesley Doyal have effectively argued for decades, socialized medicine is what an abolitionist would call a reformist reform—something which blunts the harm of a system while ultimately still perpetuating it and thus helping to continue to sustain that particular structural capacity to go on harming for generations to come.
Health communism, as we envision it, goes much further. It is not about equitable distribution within a capitalist framework but about radically transforming the political economy of health, and in so doing dismantling the structures and systems that make capitalism what it is. Health communism demands a system where care is truly universal—where the sick, disabled, and surplus are at the center, not the margins, not afterthoughts. It demands a system where care is not something earned but simply given, because to be alive is to be entitled to care. This is not a call for expanded healthcare or incremental reform; it is a call for the complete abolition of capitalism and the commodification of health.
To continue the metaphor of socialized medicine as a socialized island within a capitalist sea, if we are each out here treading water alone in the capitalist sea, the socialized medicine island is there to offer some amount of respite from the treading for those who can no longer tread water on their own. The island is not a safe harbor or shelter in a permanent sense, merely there to get you back to treading water as soon as possible. It does not save us from the predicament of being in the capitalist sea, under the conditions that made it impossible for whatever reason to keep treading water.
Systems like the United States on the other hand are one large sea with no island even for temporary respite, we merely have a giant capitalist sea with various floating debris. When one is in need of respite, there is no island to swim to, merely debris, makeshift rafts, and a few clever schemes. Some of us stay afloat by clinging to the debris to keep our heads above water, these are various programs like the ACA, Medicaid, CHIP, or the largest but still rickety raft made of debris, Medicare.
Some of us stay afloat by passing debris around, either in an organized way like church giving circles and charity care, or in a more direct way like crowdfunding and mutual aid. Then there are those who scheme to stay afloat through group formation (we call these employer sponsored insurance plans) where small groups have agreements to link up and keep each other afloat—up until a point of course.
Meanwhile in both seas, there are many who never make it to that temporary respite, who can’t reach the socialized island, or are denied entry at the shore. In the US capitalist sea with no island to swim to, many of us drown clinging to debris, or when that debris slips through our fingers. We drown desperately reaching for the makeshift raft of Medicare, or working our way up to labor conditions that might have a scheme to save us. But we all drown in the capitalist sea just the same, those of us with a socialized island to swim towards and those of us without.
The point is not to add more places to stop and catch your breath when your chin begins to slip under the water, it is to give everyone what they need to float together and fundamentally reshape the conditions of the sea by taking responsibility for finding a way to stay afloat together rather than buying into the fantasy that we alone can brave the sea and tread water long enough and strong enough to never need help catching our breath.
To achieve health communism, we must dismantle the structures that perpetuate exploitation, exclusion, and inequality, reorienting our societal values, systems of care, and the institutions that train care providers towards the idea of collective responsibility, direct support, and community care. This transformation requires an active refusal of capitalist principles that frame care as a commodity rather than a fundamental and communal necessity.
We must cultivate systems that prioritize community health and well-being, redistributing resources and care-related education based on need rather than market demand, or perceived productivity and worth. We must envision, practice, steal, and build decentralized health, public health, research, and pharmaceutical development and production networks that place decision-making power in the hands of those who are most impacted, and we start by challenging the authority that the state and corporate interests have in dictating our health outcomes as well as the conditions which produce them.
While the path forward is difficult to see from our current vantage, we can create autonomous systems of care that are rooted in cooperation and shared responsibility. In moving forward together toward this horizon, even if there is no clear plan before us showing us step by step instructions for how to get there, we can not only confront the violence of health capitalism but also cultivate a new understanding of health—one that embraces, rather than rejects, our interconnectedness and affirms the inherent value of every living being in the struggle for a world where the “biological, fascist fantasy” of health becomes a tangible thing of the past.
D) The Surplus Class and Extractive Abandonment
At the heart of Health Communism is our analysis of how the surplus class is instrumentalized and key to sustaining health capitalism. The surplus—those which capitalism has deemed unnecessary, burdensome, or even dangerous—are central to how our modern means of production function at the pace that they do.
These are disabled, chronically ill, incarcerated, migrant, elderly, and un- and under-employed people or those whose labor exists in the context of a shadow economy—the people whose lives are seen as devoid of value because they do not contribute to the formal production of capital. But as we argue, capitalism does not simply discard these populations it alchemizes them into a raw resource—as much as it likes to pretend that it doesn’t need us, we the surplus are the glue that binds capitalism together.
As we argue, instead of abandoning the surplus, capitalism subjects them to what we call extractive abandonment. The surplus is then mined for profit in new, ever more insidious ways. Through the medical-industrial complex, prison-industrial complex, pharmaceutical industry, nursing homes, psychiatric institutions, and many more sites and systems, capital continues to extract value from the surplus even as it abandons them.
Health, in this sense, becomes a site of extraction not a bodily state. The sick, disabled, and surplus are subjected to regimes of care that are designed not for their well-being, but for the generation of profit. Whether through the commodification of illness, the warehousing of surplus bodies, or the extraction of labor from incarcerated people, capitalism continues to find ways to exploit even those it has deemed so worthless as to not be worth exploiting in the context of the labor market. The surplus are rendered excess, but they are also a key source of ongoing profit for capital in many ways beyond the traditional straightforward pathway of extraction of labor power from a worker.
Extractive abandonment operates through the logic of economic efficiency, where the lives of the surplus are viewed not as individuals with inherent worth but as potential revenue streams. Moreover, this process of extractive abandonment is reinforced by state policies that criminalize poverty and disability, framing the surplus as threats to social order. Institutions such as prisons and psychiatric hospitals are designed to manage and control these populations rather than to provide care, treatment, or rehabilitation of any kind, perpetuating cycles of violence and neglect while creating lucrative revenue streams and jobs for the benefit of those deemed ‘fit’ and ‘productive’ to build and grow wealth off of.
In this political economy, health becomes synonymous with market forces, where access to care is not a right but dictated by one’s perceived value. Thus, the material reality of health under capitalism is impossible, health is a landscape where exploitation and commodification reign supreme, further entrenching the marginalization of the surplus class and the inherent injustices of warehousing within our systems of care.
1.3 Reflection, Introduction — Toward Health Communism
The introduction of Health Communism concludes with a clear call to action: the fight for health communism is the fight to dismantle capitalism itself. Health, as it is currently constructed, is a tool of control, a mechanism for extracting profit from birth, life, death, and every moment in between. To win health communism, we must start by tearing down the systems, institutions, laws, policies, and logics that encourage the commodification of care, the abandonment of the surplus, and the maintenance of violent extractive health systems. This is not just a fight for better healthcare or more equitable distribution within capitalism—it is a fight for the abolition of capitalism all together.
As we reflect on the passage of two years since the release of Health Communism, the urgency of our arguments has only grown. The crises we analyze in the book—crises of care, of austerity, of abandonment, of criminalization, of pathologization—have deepened. But so too has the clarity of our task: to dream, to desire, to organize, to fight for, and to win what we need to make sure no matter where you live care is universal, health and well-being are possible, interdependence is embraced, and no one is fuel for capital accumulation.
In the coming weeks, there will be essays on each of the chapters of Health Communism: SURPLUS, WASTE, LABOR, MADNESS, PHARMACOLOGY, BORDER, CARE, CURE, and HOST. We put this together over the last two years to humbly offer some accessible entry points into the book for new readers, facilitate group discussions, and provide those returning to the text with new ways to engage with its lessons.
As we write in the end of the introduction to Health Communism:
It is our hope that Health Communism can be used by movements against capitalism and for liberation that can move us far beyond the scraps we have been fighting for in left health movements for over a century. The systems and capacities of health and capital that we describe in this account have, as will be made clear, only grown worse and more violent with time. There is nothing to wait for. There is no better time.
1.4 Further Study — Discussion Questions and Key Terms, Introduction
Discussion Questions for Introduction:
The introduction of Health Communism asserts that “health is capitalism’s vulnerability.” How does this framing shift your understanding of the relationship between health and capital? In what ways does capitalism depend on the commodification of health?
How does the concept of “health” under capitalism differ from a more collective or communal understanding of care? What would or could health look like if it was freed from the constraints of capitalist productivity and deservingness?
The introduction challenges the limitations of socialized medicine within capitalist systems. What are the dangers of framing socialized medicine as a solution while maintaining the structures of capitalism?
How does the introduction complicate the distinction between “workers” and “surplus”? Why is it important to center the surplus class in the fight for health communism?
Is it even possible to achieve the WHO definition of health (health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity) under capitalism?
Key Words, Ideas, and Terms, Introduction:
Health (Health Communism definition): Health is understood as a construct shaped by capitalist forces to enforce productivity, compliance, and stratify populations according to perceived economic worth, marginalizing those who do not fit within these parameters and weaponizing care to uphold capitalist values.
Health (WHO definition): According to the World Health Organization (WHO), health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.
Imbrication: The tight overlapping of social and economic systems, such as how health, capitalism, and the medical-industry are deeply interwoven phenomena under capitalism, influencing each other’s functions and often portrayed as fundamentally inseparable. The formal dictionary definition of imbrication offers some insight into why we felt this word was the right one to use— imbrication [ im-bri-key-shuhn ] noun 1) an overlapping, as of tiles, scales, or shingles. 2) a decoration or pattern resembling this. 3) Surgery. overlapping of layers of tissue in the closure of wounds.
Contradictions: The internal conflicts within capitalism—such as the need to maintain a healthy workforce while simultaneously abandoning those who cannot work—that ultimately lead to instability and potential system breakdown.
Means of production: The facilities, tools, and resources (such as factories, land, and labor) used to produce goods and services in an economy, controlled by capitalists in a capitalist system and central to class power dynamics.
Health Capitalism: A term describing the current state of things (which often goes unnamed and therefore is perceived to have no existing alternative), in other words: capitalist system’s use of health as a tool for profit generation, where health care and services are commodified, prioritizing economic gain over actual well-being and turning individuals’ health needs into sources of capital extraction.
Health communism: A revolutionary framework aiming to dismantle health capitalism, advocating for a global system where health and care are universally accessible, not tied to productivity or economic worth, and liberated from the primary goal of extraction, control, and exploitation by state and/or empire.
Extractive abandonment: The process by which capitalism exploits populations—both surplus and not—by structuring health systems to extract profit rather than ensure well-being, thus shaping health itself as a tool of exploitation. This dynamic impacts all people by embedding health policies and institutions with mechanisms that prioritize profit over care, ultimately abandoning genuine human needs in favor of economic gain.
Surplus class: Populations considered unnecessary to capitalist productivity, including disabled, chronically ill, elderly, and unemployed people, as well as minors and incarcerated people, who are systematically marginalized and denied power on the basis of the lower value of their personhood or labor, but nonetheless are still exploited as a source of surplus profit under health capitalism like laborers are.
Commodification: The transformation of goods, services, and even human needs (such as health and care) into commodities that can be bought, sold, and exploited for profit within the capitalist system.
Austerity: Policies implemented by governments to cut public spending, often in response to real or perceived economic crises. In practice, austerity measures frequently lead to reductions in social services like healthcare, education, and welfare supports. These cuts disproportionately impact marginalized and low-income people, thereby reinforcing inequality and social vulnerability while also laying blame on those most impacted. In the context of the UK this also refers to a specific policy programme implemented following the Great Recession in 2010. When we use “austerity” we are referring to it as an idea generally not to the specific UK policies.
Biopolitics: Biopolitics is the intersection of politics and life, focusing on how power structures regulate, manage, and control the biological aspects of human existence, such as health, reproduction, and population. It examines how political strategies, institutions, and technologies shape and govern life itself, not merely by responding to biological forces but by actively constructing and organizing life in ways that serve state and capitalist interests. Biopolitics challenges the idea that biology exists independently of politics, positing that life is both an object and an effect of political processes, where the value and quality of life are often determined by power dynamics, social hierarchies, and economic imperatives.
Social murder: A concept from Friedrich Engels that refers to conditions created by the ruling class that knowingly lead to suffering, illness, or premature death among vulnerable populations. Engels argued that by structuring society to benefit the wealthy and neglect the poor, the ruling class effectively "murders" the disadvantaged through systemic neglect and exploitation, especially in imposing various health, housing, and work conditions.
Eugenics: A set of beliefs and practices aimed at "improving" the genetic quality of the human population, often through exclusionary and oppressive policies targeting marginalized groups. Historically, eugenics sought to prevent reproduction by individuals considered “unfit” based on disability, race, or economic status.
Privatization: The transfer of public services, like healthcare, into private, for-profit ownership, making access to services dependent on the ability to pay and driven by market interests rather than public need.
Pathologization: The process of defining behaviors, characteristics, or identities as pathological or diseased, often with the intent of justifying exclusion, control, or intervention.
Political economy: Political economy, in a descriptive sense, refers to the ways in which economic systems, institutions, and policies are shaped by and, in turn, influence political power and social relations. It describes the interactions between economic practices—such as the production, distribution, and consumption of goods and services—and the political structures that govern them, including laws, governance, and state power. To use “political economy” to describe something rather than just “politics” or “economy” alone, e.g. the political economy of health, highlights the interplay between economic forces and political power in shaping what that thing is, emphasizing that economic structures are not neutral but are deeply embedded within and influenced by political dynamics. Political economy is also a field of study which examines the relationships between political institutions, economic systems, and the distribution of resources and power in society. Political economy blends elements of economics, political science, sociology, and history to understand the ways in which laws, and social and economic systems (such as capitalism, socialism, or feudalism) are organized and how they affect social hierarchies, labor, wealth distribution, and governance. It also explores how power and inequality are embedded in systems and how those with economic power shape political agendas to maintain the status quo.
Wow! Thank you for this!