The Politics of Care

by Boston Review

From the COVID-19 pandemic to uprisings over police brutality, we are living in the greatest social crisis of a generation. But the roots of these latest emergencies stretch back decades. At their core is a politics of a brutal neoliberal ideology that combines deep structural racism with a relentless assault on social welfare. Its results are the failing economic and public health systems we confront today-those that benefit the few and put the most vulnerable in harm's way.Contributors to this volume not only protest these neoliberal roots of our present catastrophe, but they insist there is only one way a new kind of politics-a politics of care-that centers people's basic needs and connections to fellow citizens, the global community, and the natural world. Imagining a world that promotes the health and well-being of all, they draw on different backgrounds-from public health to philosophy, history to economics, literature to activism-as well as the example of other countries and the past, from the AIDS activist group ACT-UP to the Black radical tradition. Together they point to a future, as Simon Waxman writes, where "no one is disposable."CONTRIBUTORS Robin D. G. Kelley, Gregg Gonsalves and Amy Kapczynski, Walter Johnson, Anne L. Alstott, Melvin Rogers, Amy Hoffman, Sunaura Taylor, Vafa Ghazavi, Adele Lebano, Paul Hockenos, Paul Katz and Leandro Ferreira, Shaun Ossei-Owusu, , Colin Gordon, Jason Q. Purnell, Jamala Rogers, Dan Berger, Julie Kohler, Manoj Dias-Abey, Simon Waxman, Farah GriffinA co-publication between Boston Review and Verso Books.

Genres: Essays

228 pages, Kindle Edition

Published September 15, 2020

Reviews

[Will Tucker · Rating 4 out of 5]

I especially recommend the essays in here by Amy Hoffman ("Love One Another or Die"), Sunaura Taylor ("What Would Health Security Look Like?") and Robin D. G. Kelley ("Getting to Freedom City").

[Aggrey Odera · Rating 3 out of 5]

I just spent a good chunk of the last couple of days reading and speaking about the National Federation Of Independent Business v. Sebelius case in my constitutional law class. Sebelius is a 2012 case where the Supreme Court of the United States gutted the provision of the Affordable Care Act mandating that states expand Medicaid access to low-income Americans at the risk of them (states) losing significant federal funding. I wasn’t aware that I’d read this book so soon after reading that case: I only picked it up because myself and a few other fellow, shall we say, very left-leaning students at my school have a meeting with Amy Kapczynski - swoon! - this coming Sunday night, and she suggested we read a part of this book as a primer to the conversation.

The essays ask a now seemingly over asked, but nonetheless very timely question: What would a model of “the economy” that places care and concern for the most vulnerable among us - staying home to avoid mass deaths in a pandemic, safeguarding healthcare workers, providing healthcare access to those of us who need it most-ahead of some fetishized conception of profit and productivity, look like?

The authors argue that what we must do to bring about such a model is to reject the neoliberal dispensation that has seen American leaders, both democrat and republican, put at risk the lives of the most vulnerable by installing “a profit driven healthcare system, a hyper carceral approach to migration and social dislocation, an austerity ravaged state that looks ever more like the neoliberal caricature, and a crisis of social reproduction”. We must instead, the authors argue, embrace “a broad-based vision of a politics of care”.

Covid-19 has even further exposed the disparities in the quality of healthcare coverage available to Americans. This coverage is often based primarily on what they can pay - which is often based on what they look like; what their immigration status is; importantly - on whether they have a job and if their health insurance is tied to it etc. The result has been that the country has found itself woefully unprepared to tackle a national crisis. Even those who, by virtue of their wealth and status, thought they would not be affected, have realized that what is necessary is a public health infrastructure that keeps ALL Americans safe.

Meanwhile, the CDC has seen its funding cut by 10% over the last ten years. 17 states - and the District of Columbia - have cut their healthcare budgets over the last few years. The CDC’s Public Health Emergency Preparedness (PHEP) program has been cut by one third since 2003. Since Obama decided that he needed big-pharma as an industry ally, drug prices in the U.S. have spiralled out of control.

All these conditions, the authors maintain, are “byproducts of a system organized by an insatiable concern with profit, and infected with a reflexive suspicion of the government". This is despite the fact that "government is the only mechanism that we have to invest in the long-term tools that we need to protect us in a pandemic”.

What next then? How do we connect the vision for a new politics of care to programmatic responses? The authors think we could learn a lot from the AIDS movement of the last 40 years (in which Gonsalves was a prominent player). Medicare for all, of course, but that’s just a start. What we must do, even further, is rebuild a social safety net geared towards protecting our health. We must institute mandatory paid sick leave; food and rental assistance. We must guarantee housing and prevent evictions - all things that are essential in a pandemic. What we need, and even the progressive wing of the democratic party, including the democratic socialists, miss this, is a New Deal for Public Health. This is what a politics of care calls for.

In a New Deal for Public Health, the public and its needs are to be fore-front, not the profit motive. Government must demand reasonable pricing of healthcare products. It must mandate that clinical trial data be open sourced as much as possible. Outside the federal level, we must extend care to those who cannot social distance because they live in prisons, in the streets, or in homeless shelters, especially to the elderly among them. Our politics of care must extend to victims of domestic abuse. All these cannot be handled by mutual aid and volunteerism: they require a coordinated governmental response. Further, we need to hold employers like Amazon and Walmart responsible for not keeping their businesses and customers safe - say, through an infection control brigade that coordinates all these.

In truth, the authors say, this is just a new form of an old idea - a Works Progress Administration (WPA) for an age of pandemics. “But the aim is larger: to bring us through the crisis by calling into being government as we wish it to be - caring for us, bringing us together, while also enabling us to live our different lives”.

There have been models for how this can be done: say, Massachusetts’ Partners in Health (PiH) program (underfunded though it is). Or take the so-called Community Health Worker (CHW) programs. Or even medical-legal partnerships (MLPs). All these organizations have emerged from the recognition that many times the costs of illness and healthcare are driven by factors outside the control of doctors.

Importantly, we should have a community health corp; one that demonstrates our concern not just in technological advancement in healthcare, but also our recognition for the need for close care within our communities. This would also create millions of jobs.

All these smaller resources should be integrated into a federally funded WPA. The costs for this may be large - especially as states are forced into austerity by plummeting tax revenues and balanced budget requirements - but such costs would be insignificant in comparison to the $2 trillion stimulus we are currently working with.

[Emma · Rating 5 out of 5]

I was expecting the inclusion of more essays from frontline organizers engaging in mutual aid, but still recommend this as a timely framing of the politics of care in 2020.