A Disability and Healthcare Revolution

By M. Peterson

What do we mean by a ‘Disability and Healthcare revolution’? This is a very wide- ranging subject since ideas about health and healthcare encompass everything we do in our lives. I will talk about this from a Marxist perspective and then we can have plenty of time to discuss ideas and issues together. The book ‘A very capitalist condition’ by Roddy Slorach opens with Slorach’s outline of historical views on disability. He found that throughout history, the existence of collective care and interdependence between people meant that there was no separate category of disabled people. It is only under capitalism that we begin to see the emergence of a distinction between ‘able-bodied’ and ‘disabled’ people. The drive to maximize profits has, under capitalism, led to the othering of ‘disabled’ people in unprecedented ways.

Marxism recognizes that the unsafe conditions of work under capitalism can often create disability through workplace injuries and accidents, leading to long term chronic health conditions. To maximise profit there has been an underlying expectation that the maximum labour be extracted from the worker toiling for the longest hours possible at the lowest wages. The early work of Marx was attentive to public health and understood that ‘health’ under capitalism referred to the capacity to work rather than a worker’s quality of life. Bosses are looking for employees that are seen as a good low risk investment and in terms of the value that can be extracted from their labour. As chronic illness diminishes one’s perceived ‘value’ as a source of labour power, collective health is actually critical for the growth of capital: we have all seen the consequences of widespread labour shortages due to Covid in recent times.

Although all workers are encouraged to treat one another as competitors under capitalism, the inherent contradiction of this competitive existence is that the system is oppressive for everyone. It is in fact in a worker’s best interest to show solidarity with other workers, whether able bodied or not. Any progress made in the workplace in giving worker’s more access to sick leave and allowing more flexibility in their work situation, including being able to work from home as we recently saw during the early stages of the pandemic, can be beneficial for many disabled people and their whanau and carers. At the same time, such momentary gains have been rapidly undermined in the quest for business to return to ‘normal’. Recent studies in the US and the UK show that that the number of people dropping out of the workforce due to long term illness and disability skyrockets after Covid protections have been dropped. In the UK, many people have had multiple Covid infections since protections were dropped in 2021. And it has 2.6 million people currently out of work due to long term illness – a staggering 7.8% of the workforce. In New Zealand there are estimates of between 150,000 and 300,000 living with long covid.

It was under capitalism that people with disabilities came to be seen as ‘surplus’ or a ‘burden’, in opposition to ‘good’, ‘productive’ workers. Lauren Pass in The Productive Citizen’ examines how ideology itself is the “production of ideas, of concepts, of consciousness,” and the ruling class has normative control over the ideological and cultural capital of society. In this way, the ideals of the ruling class became imposed within the public sphere (falsely, but nevertheless persuasively) as normative ideals. To quote Lauren Pass:

“A theory of productive time is helpful in elucidating why some minority groups have persistently received less political visibility than others. Limiting a minority’s participation in labour also denies the minority’s presence in productive time. Because physical disability often impacts an individual’s ability to work, persons with disabilities are especially vulnerable to exclusion from productive time. Thus, disabled culture is largely invisible within the prevailing culture.

Disability is an interesting minority perspective because it intersects all other minorities; it exists within and across all ethnic, gender, sexual, and religious identities and within all age groups in every part of the world. Perhaps due to its ubiquity, the unfortunate normative assumption is that “disabled culture” is not a real or valid cultural identity.”

Regrettably, disability rights movements in capitalist societies have often confined themselves to fights for limited reforms that act as an extension of capitalism and its logic of placing monetary value on human lives by justifying the inclusion of disabled people in terms of their added value to the profitability of corporations. This happened with the American Disability Act even though it started promisingly, with diverse groups of activists working together in solidarity with one another. It was passed into law in 1990 by George H.W. Bush and was widely seen as the gold standard for ending disability discrimination. While it did lead to definite improvements, it happened during the height of neoliberalism and even now it is still a struggle for disabled people to have their rights of inclusion upheld. We are currently facing struggles here in creating effective accessibility legislation in Aotearoa. This legislation has been advocated for by disabled people for many years but it still needs to be reworked to prevent public funds continuing to be widely used to create disabling barriers for many people.

Under capitalism, care work tending to disabled people is folded into the invisible, unprofitable, often unpaid labour of love usually done by women within nuclear family households. The undervaluing of this feminised work has led to isolated, impoverished living conditions for many carers as well as disabled people. There are currently a vast range of unmet or poorly met care needs in our communities such as daily personal care, social supports and extending to access to clean air, clean water and good quality food. To demand that these needs be met is to be in radical opposition to capitalism. A worthy revolutionary goal is to care for all people.

The privatization of healthcare globally in recent decades has created a false impression of scarcity in the provision of care while turning patients into commodities. Foreshadowing the forms of neoliberal ableism we can expect to see more of under the incoming right-wing government, ACT candidate Todd Stephenson was recently interviewed on TVNZ declaring that he believes “it is the role of politicians to set the policy frameworks” and that “Pharmac’s policy framework needs updating”. Stephenson says: “If your treatment can return someone to work faster, how does that benefit the whole of society? And then those bodies that are making those value judgments can decide whether that should be put into the equation.” According to activist Shaneel Lal, ACT is proposing to commercialize state-funded medication and treatment that could come at the expense of the disabled, ethnic minorities and women for the benefit of rich able-bodied people who live lives like Stephenson.

It is clear that solidarity between all patients and healthcare workers will be needed to overturn the oppressive system we find ourselves in. In 1845 Friedrich Engels wrote in The Conditions of the Working Class in England.

“When one individual inflicts bodily injury upon another such that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder. But when society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet; when it deprives thousands of the necessaries of life, places them under conditions in which they cannot live – forces them, through the strong arm of the law, to remain in such conditions until that death ensues which is the inevitable consequence – knows that these thousands of victims must perish, and yet permits these conditions to remain, its deed is murder just as surely as the deed of the single individual; disguised, malicious murder, murder against which none can defend himself, which does not seem what it is, because no man sees the murderer, because the death of the victim seems a natural one, since the offence is more one of omission than of commission. But murder it remains.”

These are words that are still very relevant today. Marx’s slogan “From each according to his abilities, to each according to his needs”, can thus be extended to include the different abilities of disabled people. Overthrowing capitalism is essential in the revolutionary movement toward worker’s autonomy and control over our own work and our ability to express our unique creative potential with sufficient time for leisure in our lives. In particular, the work of caregivers and healthcare workers of all kinds is of a much higher priority when people are valued above corporate profits.