Liberatory

What would it mean to overcome or transform this? What have movements imagined, attempted, and built?

See the pedagogy document for what this lens does across all themes. The school does not resolve the disagreements among traditions. It puts them in front of the room and lets the room think.

Most rooms arrive at this theme already knowing what they think the answer is: everyone should have health care, and the fight is about how to pay for it. This lens exists to make that answer earn itself, because the three positions here disagree about something prior to financing, and two of them think the financing question is a distraction from the thing that is wrong.

The argument is not left against liberal. It runs inside the left, and it is about whether health is a good that has been badly distributed, or a machine that is working.

Anchor questions

• Is health care a good that some people are wrongly denied, or a system that is doing what it was built to do? What follows from each answer?
• If you nationalize the insurance and change nothing else, what happens to the person whose body will never work again?
• The Denver Principles refuse the word victim and the word patient. What is left, and why does it matter who chooses the word?
• Talila Lewis defines ableism through what a body is expected to produce. Does Medicare for All fail that test?
• Harrison says health was created as the antithesis of Blackness. If the category is defined by your exclusion, is demanding health the wrong demand?
• The Panthers built clinics. Is that a model or an indictment?

Materials

Free unless marked otherwise.

The document that starts it

• Denver Principles (1983). One page. “We condemn attempts to label us as victims, which implies defeat, and we are only occasionally patients, which implies passivity.” Written by people with AIDS, about themselves, at a moment when everyone else in the room wanted to speak for them. Every position below is arguing about who holds the pen, and this is people taking it. Free: actupny.org

Pole one: guarantee it

• Physicians for a National Health Program, interviewed in Jacobin (2023). Single payer at its strongest: health care is a good, it is criminally misallocated, other countries have solved this, and the fix is to guarantee it. Name the standpoint when you assign it: this is physicians and journalists arguing on behalf of patients, which is precisely the arrangement the Denver Principles were written against, and that irony is worth thirty minutes on its own. Free: jacobin.com

Pole two: it is not broken

• Beatrice Adler-Bolton and Artie Vierkant, Surplus (2022). The answer from the left: the health system does not fail the surplus class, it extracts from it, so universal access universalizes the extraction and changes only the payer. If they are right, Medicare for All is the humane administration of the same machine. Free, authorized: thenewinquiry.com. The book is paywalled at versobooks.com, and their free podcast Death Panel argues it weekly against live events.

Pole three: both of you have kept the criterion

This is the sharpest position in the lens and the easiest to miss.

• Talila A. Lewis, Working Definition of Ableism (2022). One paragraph. Ableism is a system that assigns value to bodies based on what they can produce, and it is rooted in anti-Blackness and eugenics. Hold that against both poles above. A health system that exists to return people to work has kept the eugenic criterion intact and merely changed the billing. Free: talilalewis.com
• Sins Invalid, Skin, Tooth, and Bone (2019) and the 10 Principles. Disability justice as the politics of people the system priced at zero and who declined the price. Anti-capitalist politics and recognizing wholeness are principles on the list, which is what separates this from disability rights. Free: the primer. Shared with the pedagogy theme.
• Mia Mingus, Access Intimacy (2011). What care feels like when it is a relationship rather than a service. No financing model produces it. Free: leavingevidence.wordpress.com

The demand built by the people the history was done to

• SisterSong, Reproductive Justice. Black women built this framework because rights language could not hold their situation: the right to have a child, the right not to, and the right to raise that child in safety. Read it directly after the sterilization material in the historical lens. Shared with the gender theme. Free: sistersong.net
• Da’Shaun L. Harrison, Belly of the Beast (2021). The hardest version of the question: if “health” was created as the antithesis of Blackness, then demanding health is asking to be admitted to a category whose definition is your exclusion, and the demand may need to be something else entirely. Paywalled: northatlanticbooks.com
• Dean Spade, Mutual Aid teaching guide (2020). What people do while the argument is unresolved: build survival infrastructure that neither waits for the state nor turns into a charity. Free: v.versobooks.com

Debates and disagreements

Three arguments, and this school resolves none of them.

• Is health a good or a machine? Medicare for All says the good exists and is criminally distributed, so guarantee it, and points at every other rich country as proof it can be done. Health communism says the thing being distributed is extraction, that debility is a product line rather than a failure, and that universal access would universalize the arrangement while making it harder to see. The first has the advantage of being achievable and having actually reduced suffering elsewhere. The second has the advantage of explaining why the achievable version keeps producing the same casualties.
• Disability justice knifes both. Take Lewis seriously and the two poles above share a premise: that the point of health is a body that works. A system organized around restoring people to productivity has kept eugenics’ criterion and changed only the payer, and neither single payer nor its abolition automatically fixes that. This is the position least likely to arrive in the room on its own and the one most likely to reorganize it.
• Who holds the pen? The Denver Principles were written by people with AIDS because everyone else was speaking for them. Then read the single-payer case, argued by physicians on behalf of patients, and the disability justice material, written by disabled people about themselves. That is not a detail about tone. Harrison’s claim, that health was built as the antithesis of Blackness, is a claim you can only make from inside the excluded category, and it is the claim that decides what the demand should be. Ask the room who is writing each of these documents, and about whom.

Status

First pass, and it may be a while before there is a second. It is built as an argument rather than a reading list. Its honest weaknesses. The single-payer pole is represented by its advocates rather than by its best theorists, and the school could not find a first-person patient statement of that position, which is itself a finding but not an excuse. Health outside the United States is absent entirely, which badly weakens the debate: the strongest empirical argument for the first pole is that other countries did it, and this lens does not let them speak. Psychiatry, mad studies, and the survivor movement are missing, and they hold the sharpest version of the who-holds-the-pen question. Contributions welcome, especially from disabled organizers, psychiatric survivors, and health workers.