I am thrilled and humbled to share that my first book, Health Communism, coauthored with my partner Artie Vierkant, will be released Tuesday, October 18th from Verso Books. It's the culmination of a massive amount of work, independent research, and collaboration we've been engaged in over the last five years, and we're so excited that Health Communism will finally be out in the world!

If you're able to preorder the book, or order a copy once it’s out, please do! Preorders are a huge deal for first-time authors like us, so if you can, we would greatly appreciate it. (You can also request a copy from your local bookstore, or for your local library!)

Order Health Communism

[Image description: Rendering of a blue book with white text reading “Health Communism” next to praise for the book from Dean Spade, Jules Gill-Peterson, Jasbir Puar, Gregg Gonsalves, and Sophie Lewis.]

All Are Not Well, All Are Not Safe

If you just follow mainstream media coverage, or the comments of state officials, you might be under the impression that the federal pandemic response is now over. It’s been declared that this end is natural, simply the state reacting to a huge wave of people who are just spontaneously done with COVID, there's no appetite for any further mitigations, and thus, the state has obliged and the “pandemic is over.” And therefore, all COVID protections are now a highly subjective series of personal choices, health behaviors, risk calculations, and individual actions. But as Nate Holdren wisely said on a recent episode of Death Panel, since when does the state just do things because people “want” it to be true? Since when does it respond to things that the body politic is simply “tired” of?

We hear constantly, there's no public appetite for masking. And that we should expect to get sick a couple more times a year than we used to, and if you want to protect yourself: Make a plan for when you get sick. What we are hearing from every angle, across the political spectrum, is that COVID is a personal problem. And what we aren’t hearing is many on the left challenging that. Instead across the board, again the pandemic nihilism vibe is present coming from people of all political backgrounds, we see affirmation of the message that COVID is no longer a collective problem. However it is not physically possible to wish away the things that make us sick.

A lot of the conversation about what to do about COVID gets boiled down to this reductive framework about polarization and feasibility. Since when was it ever a good idea to limit our demands to the realm of the possible?

Some of the most prominent voices on COVID, say it's a fundamental problem with the people, as though through some viral pathology we have all suddenly ceased to care for one another as we should. That it's a problem of individuals; there are simply too many people who lack empathy, too many who are anti vax, too many who are over masks, too many people who don’t care about the vulnerable. I find myself wondering what golden age of caring that our current moment is being compared to, as if there was a point in time where we did “respect each other enough to care”—organized abandonment is not an aberrant phenomenon—it is how we have chosen to structure society under our capitalist political economy for decades.

Artie Vierkant — Preorder HEALTH COMMUNISM, 10/18 @avierkant

If you have ever felt forced back to work sick, knowing going back may well make you sicker, this book is for you versobooks.com/books/4081-hea… .

As we try to show in all of our work on Death Panel, and is frankly quite brutally clear from the events we have all lived through over the last two years: framing health as a personal responsibility is one of the greatest tricks capitalism has ever pulled. And what is actually happening right now is the state is allowing the spread of a disease, they are encouraging a disease to rip through the population, as they retract and abandon even the few remaining meager social safety net supports. And the left is not yet broadly rising to challenge that. I’m trying to change that, but I fear that in my own advocacy trying to center the medically vulnerable and immunocompromised, and make clear how the Biden Administration is showing just how little regard it has for our collective survival, I have contributed to the pervasive myth that COVID is only a problem for demonstrably vulnerable people like me.

What we are trying to show in Health Communism, what I hope we can achieve is to help people realize that vulnerability is not some inherent, intrinsic, individualistic quality that can be readily verified and measured. It is a constantly changing and fluctuating necessarily undefinable group: Because we are all vulnerable, not just to COVID but to slow death, fast death, administrative violence, maiming, debility, illness, sickness, economic precarity and abandonment. Our political economy of health is designed to be an impossibility. Under capitalism, to attain health you must work, you must be productive and normative, and only then are you entitled to only the health you can afford or “access.” This fantasy of individual health under the political economic conditions of capitalism only ever exists as a state one cannot be, to which one must always strive. This is one of the central arguments of Health Communism. And it is one of the central consistencies of the state’s response to COVID.

Artie Vierkant — Preorder HEALTH COMMUNISM, 10/18 @avierkant

If you have experienced state abandonment during covid and wondered how we could treat people like this—was it really like this before covid? how could we treat people like this?—this book is for you versobooks.com/books/4081-hea… .

As Lauren Berlant wrote, slow death describes populations “marked for wearing out,” and this wearing out becomes a feature of how those marked for slow death understand their identities, the values that society foists on them, their place in the world, what they are owed. Berlant was very critical of describing the violence of racial capitalism as a crisis, insisting that slow death was not an occasion that people either respond to heroically or fail to. They took issue with the conceptualization of slow death as event, arguing that to consider crisis an event is a misunderstanding of how violence is experienced not just in big dramatic moments but masked by the banality of the everyday.

Berlant talked about crisis not as an event but as a constant, arguing that “the language of epidemic is often used to mask that which is endemic”—offering people few options for subjectivity that rejected slow death, itself in many ways a pathologization of the anxieties of empire. Berlant argued that sometimes in the face of slow death, we engage in thoughts and behaviors that are cruelly optimistic: “A relation of cruel optimism exists when something you desire is actually an obstacle to your flourishing.” Lateral agency is what Berlant felt most often manifested in response to our protracted experiences of crisis and abandonment, it is an agency which is not concerned with heroic acts of resistance against the regimes of capital but rather one that seeks to soothe or cope with the compounding forces of subjection that we all experience, whether we think we are vulnerable or not.

I find myself wondering if Berlant were still with us, would they ascribe the many people who are “over COVID” as merely acting on their lateral agency? Buying into the myth that the state can be made up of a body politic of perfect bodies? Berlant’s argument about lateral agency is made with a sweeping dose of anti-fatness, though an attempt at compassion, Berlant articulates an example of lateral agency which reproduces myths about so-called “obesity” which rather than countering the eugenic norms they wish to challenge reproduced them.

Health Communism against “health”

Health is not just an individual encounter that you have with a doctor. Health is, in the case of communicable diseases that spread through the air, always going to be relative to the prevalence of that disease in the population, and the level of the virus in the air. That is the situation we are in now. There is no going back: COVID is just one of many things all around us that make us sick, either directly or via systems of extractive abandonment. And this is much bigger than casting your individual experience of COVID as lateral agency in the face of accelerated slow death. This is past the person, past optimism, cruel or otherwise, this is about society, the state, what social supports we could put in place so that we don’t abandon people when they get COVID, or something else. When they need to care for someone with COVID, or anything else. Your health is never about just you, health is about the collective body, it's about environmental factors, economic factors, social factors…to resist COVID precautions is not to exercise lateral agency but to engage in an act of fantasy that you, as an individual, possess health.

As Artie and I argue in Health Communism, “Capital has been allowed to define the meanings, terms, and consequences of “health” for long enough.” In our book, which is out tomorrow (October 18th), we propose a radical reevaluation of our political economy that “seeks to undo capitalism’s definitions of health by laying bare the violent political economic assumptions at its foundations.”

Artie Vierkant — Preorder HEALTH COMMUNISM, 10/18 @avierkant

If you have ever had to realize that the social safety net we imagine our welfare programs to be drops more people than it catches, this book is for you versobooks.com/books/4081-hea… .

One of the things that we were working on before the pandemic was already developing this lens, through our project Death Panel, of looking at how health policy materially manifests in people's lives—how we economically feel the impact of the ways we have decided our care is supposed to be paid for, what care is supposed to be, how political will limits what we're entitled to in terms of housing, education, healthcare, or even broader—taking into consideration climate catastrophe: clean air, clean water, empire, racial capitalism, extraction.

And, when the pandemic happened, as soon as it happened, it was immediately obvious that the worst things that we had already been talking about on our project Death Panel—were coming to pass. For example: myths seeped in austerity logic like: that the idea of the threat and moral hazard of healthcare overutilization is a serious problem that needs to be dealt with before we can socialize medicine, or, the idea that people need to feel some pain financially when they receive care to makes sure they really value it, essentially these are carceral approaches to constructing health—and, these preexisting logics were indicative of the direction of where the pandemic was going to go, you didn't need to be Cassandra to see how this was going to play out. I’m blind but I can’t see the future. This is why we do not argue for reformist reforms, or simply health care or pandemic policies—but a revolutionary new political economy of health.

Artie Vierkant — Preorder HEALTH COMMUNISM, 10/18 @avierkant

If you’ve ever wondered what the left could and should be demanding beyond Medicare for All, this book is for you versobooks.com/books/4081-hea… .

Health Communism is an essentially internationalist approach to reclaiming health, not just for workers but also for those marked as surplus, for all people. And that is because “we will not separate health from capital by fighting for minor reforms that perpetuate the segmentation and policing of state borders and boundaries.” There are a lot of different words for all the different things which actually at the end both define what “health” is and also commoditize it. health becomes defined by the things it is not. Health under capitalism is an impossibility. Under capitalism, to attain health you must work, you must be productive and normative, and only then are you entitled to the health you can buy. This fantasy of individual health under the political economic conditions of capitalism has made it appear as if health and capitalism are inextricable from each other.

As we describe at length throughout Health Communism, the idea that the worker is not a part of the surplus populations, yet faces constant threat of becoming certified as surplus, is one of the central social constructions wielded in support of capitalist hegemony. It limits worker demands, and to fight it we must unite the working and surplus classes.

Extractive abandonment and the surplus class

One of the things we hope people can draw out of Health Communism is a framework for seeking greater demands and thinking more expansively of how broad our transformations of the political economy must be if we are to defeat capitalism. Central to this is our assertion that if we are to win health communism, our political projects must center the populations capital has marked as “surplus”: unwanted, discarded bodies viewed as waste that nevertheless have become the subject of capital accumulation. We are all surplus even if only via our proximity to state sanctioned vulnerability.

The fundamental truth is though—and this is pretty key in the context of COVID and Long COVID—health actually is a very violent architecture, an economic system, not a personal trait, but a kind of matrix of different types of things that become points where your body is commodified in the way that it interacts with the things that it needs to survive. We are forced to self-finance the maintenance of our labor power under the myth of seeking health, to cure or repair ourselves for the purposes of returning a body that is out of work back to work at any and all costs to survival or “a good life.” The production of death under capitalism is well understood. This book is about how capitalism keeps you alive, and to what end.

Artie Vierkant — Preorder HEALTH COMMUNISM, 10/18 @avierkant

If you know better things are possible, but have a hard time imagining how to break the endless cycle of austerity and abandonment, this book is for you versobooks.com/books/4081-hea… .

The surplus populations have become a source of capitalist profit generation through a process we define as “extractive abandonment.” The term extractive abandonment is a very obvious riff on Ruth Wilson Gilmore's theory of organized abandonment, which is an idea that she talks about perhaps most famously in her book, Golden Gulag, which is about how the state makes itself through the expansion of carceral practices. Organized abandonment is the state's capacity to enable the organization, disorganization, or “outright abandonment” of “various factors of production.”

State power, responsibility, and purpose become defined by the ways it counts, sorts, organizes, and disorganizes both its surplus labor power and its surplus populations—creating jobs, whole industries, and diversified revenue streams from these non-workers who capital putatively no longer wants.

As Ruthie writes: “The state makes things but it is also a product of what is made and destroyed.” The state is a process, and while many may respond to being marked for slow death with lateral agency or cruel optimism, many more respond with righteous anger, grief, rage, and a tremendous capacity for resistance. In Ruthie’s first book Golden Gulag, she talks about the way the state changes, not just in negative ways but also in positive ones. That is important to remember, struggle is neutral, as is change and the way the state changes: it can be good or it can be bad. It can slow slow death, or hasten it.

We owe a great deal to Ruthie’s work—I had the immense privilege of interviewing her recently, if you have not yet heard that episode—it’s a must listen. And this is just sort of one of the main ideas contained within organized abandonment, but it's important to underscore the state is not static. As Ruthie explained in our conversation: “we can say that states have agencies for education, for health, for tax collection, for policing, for infrastructural development, for the Treasury in general. So all of these agencies have, you know, certain structures that change over time of course. They have certain capacities that have been won through struggle whether that struggle is legislative, administrative or otherwise. And then at any given moment, a particular state, which is to say the agencies of that state are enlivened by the personnel, by the kind of ideological predilections of whatever…government might be in charge to do things in particular ways, given the general capacities, that those institutions have to conduct certain projects using fiscal and bureaucratic abilities. And that lead to but don't necessarily, in a mechanical way, result in an outcome that is determined by the institution of the state itself.”

The state is a constantly changing creation: reproduction and destruction through the principles of abandonment that become embedded not just in institutions but in systems, and more broadly even in logics and entire frameworks for seeing and understanding the world. And as organized abandonment shows us, these decisions to make the state through the abandonment of some populations, to the benefit of others, flourishes under political and fiscal austerity. But are not immune to other political economic frameworks for the valuation of life, and other logics with which we can both destroy the old and build the new.

Artie Vierkant — Preorder HEALTH COMMUNISM, 10/18 @avierkant

If you’re looking for a starting point toward a radical politics that recognizes our collective impermanence, our collective precarity, as a weapon against capitalism, this book is for you versobooks.com/books/4081-hea… .

And so in this very obvious and intentional engagement with Ruthie’s work and theory of “organized abandonment” we sought to take this idea and unite it with an idea from a scholar of Marxism and disability named Marta Russell, called the money model of disablement or the money model of disability. Our hope is to push beyond thinking about administrative violence and abandonment in terms of capacities, disability, or surplus profit toward an attempt to understand the construction of health itself. And what people are engaging in when they “give up on COVID” is participation in the construction of what SPK called “the biologic fascist fantasy of health.”

Extractive abandonment is the way in which we choose to reproduce our political economy through the optimization of the population at a demographic level. As we argue, “Profit lives in the interstitial spaces between bodies, in the counting of bodies, in the measuring of bodies, in the creation and destruction of bodies, in every locus where capitalism touches illness, disease, disability, and death…. This relation, in and of itself, is not intent to harm; instead, it is the capacity to levy harm at the population level…. In a political economy built on systems of extractive abandonment, the state exists to facilitate a capacity for profit, balanced always against the amount of extractable capital or health of the individual subject. We argue that, at the intersection of these forces, there exists a core relation of health to capitalism called extractive abandonment—that is, the means by which the state constructs ‘health’ culturally, politically, and institutionally. And in the process of constructing, destroying, and reconstructing health, the state itself is made.”

The problem is also that it is impossible for any person under capitalism to be “healthy”—not just those already sick, ill, mad, or disabled. None of us are well, none of us are safe. It is crucial that we do not forget this in the context of the pandemic or any other connected struggles for collective leverage over the ways that our bodies are ripped, maimed, injured, sickened, extracted from or destroyed. All are not sick, but all are not well. And we will never be healthy under capitalism. Health communism now, solidarity forever, stay alive another week.