Medicine, AMR, and lack of healthcare is a reflection of the inherently broken capitalist system

The development of antibiotic resistance is closely tied to the capitalist system of medicine. The overuse and misuse of antibiotics by pharmaceutical companies and healthcare providers seeking profit has led to the proliferation of resistant bacterial strains. This can be seen as another manifestation of the violence inherent in capitalism, where the pursuit of profit takes precedence over the well-being of individuals and communities. The commodification of healthcare has led to the creation of a system where medical treatment is often driven by profit motives rather than by the needs of patients. The links between biowarfare, biopower, and capitalist medicine suggest that addressing antibiotic resistance and improving health equity requires systemic change beyond the biomedical sphere. It requires addressing the underlying power structures and ideologies that enable and perpetuate these issues, including neoliberalism, colonialism, and white supremacy. This systemic change can only be achieved through the destruction of existing legislative, economic, and biomedical institutions, the creation of more equitable healthcare systems, and the promotion of cultural humility in healthcare practice. These changes can lead to a more equitable distribution of healthcare resources, whilst mending out close to irreparable relationships with the bacterial species.

Chapter 4

The Predicament of Capitalist Healthcare

Within a system of capitalist model of production, those spheres that promote rapid capital accumulation, through enterprises in the financial spheres of capitalism, are given precedence over sectors that do not favor capital accumulation, such as public education and healthcare for the poor. Thus, effective demand and the expected realization of all the value components contained within a certain commodity can influence not only its distribution, but also what is produced, researched (cosmetic surgery for the wealthy versus basic medicine for communicable diseases that often disproportionately affect poorer countries and individuals), and where services and medical personnel are located (Kenneth, 2017). When a healthcare system is privatized, the goal becomes not only the provision of healthcare and the advancement of science and technology to better that end, but also the maximization of profit for shareholders. In the Global South, privatization and a rolling back of state services (promoted often through loan conditionality clauses from international financial institutions) have increasingly led to many non-governmental organizations (NGOs) trying to fill the void in healthcare provision (Kenneth, 2017). While many NGOs are filled with honest people who are sincerely intent on alleviating poverty, illness or other social ills, others actively promote a neoliberal agenda. This can take form through engaging in privatization of state welfare functions, or fostering institutional reforms to facilitate market integration of marginalized populations. Arguments made by right-wing think tanks, neoliberals, and supporters of privatized healthcare (and neoclassical economists in general) are based on the assumptions that the public sector is notoriously inefficient and that government ownership (and even regulation) stifles innovation and 30 undermines quality in general (Turshen, 2019). Thus, the reasoning goes, private ownership and control are preferable to public ownership and control across the economy in general and in healthcare in particular. These organizations promote a “consumer choice model” that conceptualizes patients as consumers and relies on the invisible hand of the market to eradicate both inefficiency and poor quality. In spite of these overly confident affirmations, significant cracks in the support for the for-profit healthcare model have appeared even from commentators within the business press itself, at times going as far as advocating a 100% single payer health care plan for the United States, arguing that privatized healthcare is neither good for society nor sustainable for capitalists (Turshen, 2019). Since the 2008 global financial crash, there have been significant pushes for austerity measures across nations like Spain (and in the United States), with many of the cuts in social spending leading to partial privatizations of the health sector (Calvo, 2013). Much of the ideological support for austerity is based on the neoliberal/conservative positions outlined above, particularly on those that claim that public healthcare systems are unsustainable. Their central claim is that unlike government/public healthcare systems, private (for-profit) systems are self-sustaining. To examine this claim it is necessary to delve into some concepts neglected by neoclassical economics. The neoclassical economic paradigm would have believe that there is no such thing as value, and that exchange value has no intrinsic substance (i.e., socially necessary labor time in the production of a given commodity), and that price is all that is real, which is formed solely according to marginal utility of the goods in a market. This convenient distortion of human labor as the essence of value and the erasure of value as the central element around which price hovers due to imbalances in supply, demand and competition has both a distinct class character and real impacts concerning long-term economic sustainability. Karl Marx in Volume III of Capital demonstrated how the 31 surplus value produced by social labor is divided up between the industrial capitalist, merchant, financial sector (through the extension of credit and the collection of interest and speculative activities) and the landowning class (Marx, 1867). Since Marx’s time, as capitalism has progressed, the relative strength of the financial sector has increased significantly, leading to their capturing of a greater proportion of societies produced value and the further expansion of the illusion that value creation arises from where it does not; i.e., that it arises from circulation or financial ingenuity. This illusion is fortified since the financial sector has grown wealthy relative to the industrial sector. In reality, value is merely siphoned from the sector where it is produced to the commercial and financial sectors.

Capitalism Doesn’t Care about Your Health

So, where does healthcare fit into the picture? Healthcare forms part of the “necessary means of subsistence” of society and the worker and, like education, helps provide society with labor power, in addition to being a human right in and on its own terms. Healthcare provision is essential for the development of labor power, social reproduction, and the functioning of capitalism (Fernandez, 2015). It is a part of a set of investments (such as roads and expensive infrastructure) that individual capitalists prefer to externalize to other firms (when profit can potentially be made) or to the state (if it cannot). This reflects a tendency within capital to first bring all costs to a minimum and deal with the resulting problems later. Since taxes are also viewed as an infringement on capital available for valorization, the corporate sector lobbyists are avid to keep those to a minimum as well, and fear that any form of socialized healthcare will lead to an increase in taxes. Hence, the existence of socialized healthcare in a given society is due to societal compulsion resulting from past and present class struggles/balance of class forces. 32 What experience generally shows to the capitalist is a constant excess of population, i.e., an excess in relation to capital’s need for valorization at a given moment, although this throng of people is made up of generations stunted, short-lived and rapidly replaced human beings, plucked, so to speak before they were ripe (Fernandez, 2015). Capital, which has such “good reasons” for denying the sufferings of the legions of workers surrounding it, allows its actual movement to be determined as much and as little by the sight of the coming degradation and final depopulation of the human race, as by the probable fall of the earth into the sun, and public health issues like AMR fall under this umbrella. In every stock-jobbing swindle everyone knows that some time or other the crash must come, but everyone hopes that it may fall on the head of his neighbor, after he has caught the shower of gold and placed it in secure hands. ‘Aprés moi le déluge!’, an expression of selfish disregard for problems that may occur in the future, is the watchword of every capitalist individual and of every capitalist nation. Capital therefore takes no account of the health and the length of life of the worker unless society forces it to do so. Marx concluded Chapter 15 of Vol. I, stating that Capitalist production, therefore, only develops the techniques and the degree of combination of the social processes of production by simultaneously undermining the sources of all wealth—the soil and the worker (Marx, 1867). Hence, when capitalist logic is applied to healthcare systems (the sphere of mental and physical labor whose services are essential to social reproduction and to the capacity of humanity to labor), the tendency is for these services to be provided in inverse proportion to need. This is all the more true, since both the efficiency of industry and the global reach of capital have made access to cheap labor power abundant. In spite of Keynesian warnings of undermining effective demand, capital does not shy away from the immiseration of the working classes globally (since profit can be supply driven, as well as demand driven, particularly so in 33 the case of export-driven production). Capital risks undermining the essence of the very source of value creation: human labor power.7 Thus, the health of the working class as a whole is essential to the production of profit itself by protecting the actual value-producing substance of society itself (i.e., the life of the worker). That this reality has rendered itself invisible to the individual capitalist and to neoclassical economics should not come as a surprise. This is a consequence of the denial of the category of value itself, and of living, alienated, value-producing labor (both mental and physical) as the creator of exchange value. The confusion is deepened since surplus value not only does not accrue to the direct producers (workers), but also is siphoned from the industrial capitalist by the commercial (i.e., the relation between Wal-Mart and textile workers in Bangladesh or the relation between the Ethiopian coffee growers and Starbucks), and financial sectors (Martín-Moreno, 2015). So, what is the result of the privatization put forth as the solution to the “sustainability” crisis of socialized healthcare? When healthcare is treated as a commodity and becomes part of the private sector it becomes progressively more subject to the instabilities inherent within the logic of capital.