Best of 2025: Deny, Defend, Depose: Health Struggle After "Luigi" (DP x S25)

(upbeat music) (upbeat music) - Hi everyone, welcome. My name is Beatrice Sather Bolton. The session is called Denai Defend Depose, Health Struggle After Luigi, with Artie Beer-Cant and Vicki Osterwiles, my co-presenters. And today we're gonna talk about where and how we fight for care, under a regime that is escalating, it's assault on the most vulnerable. Together we're gonna ask what kind of politic this moment demands, we'll discuss resistance and survival under health fascism and health capitalism and we'll look towards the horizon of all care for all people. So I'm gonna start by reading the announcements on COVID and community safety and then I'll introduce the speakers and we'll begin. At the Socialism Conference, all participants play a role in keeping one another safe and making sure that folks feel supported and comfortable over the conference weekend. Before that end, I'm sharing a few important reminders. First, remember that conference attendees are required to wear N95 or KN95 masks while indoors in conference spaces. Speakers in the session will remain masked throughout the session even when speaking. And audience members are also required to wear masks even when asking questions or making comments. So, thank you all for masking and keeping each other safe. And huge thanks to Hey Market Books and their phenomenal team for organizing this huge conference. We're very grateful for this space that they've built for the thought and for struggle and for the chance to all imagine otherwise together. As I mentioned at the top, my name is Beatrice Adler Bolton. I'm the co-host and co-founder of the Deaf Panel Podcast, which is sponsoring the session and the co-author of Health Communism, which comes out in paperback at the end of the month, and I'm supposed to tell you all that you can get the book in the bookstore. (laughs) I'm honored to be joined today by my comrades, Artie Birkant and Vicki Osterwild. Artie is also the co-author of Health Communism and a co-host co-founder as well as the editor and producer of the Deaf Panel Podcast. Vicki Osterwild is the author of "Indefensive Looting," a riotous history of uncivil action and the forthcoming "The Extended Universe," how Disney killed the movies and took over the world, which is coming out from Hey Market in 2026. She writes about revolved history, culture, and our key in technology. As a founding member of CAH, a worker owned anarchist journal of arts and culture, and you can also pick up "Indefensive Looting" in the book store, it's a great book. I want to begin just by expressing deep appreciation for my co- presenters, Vicki and Artie, comrades whose work pushes all of us to think more clearly and fight more boldly for what care could truly mean. I'm humbled to share this space and conversation with them as I am literally every time we get the chance to speak. So first, I'm going to turn it over to Artie, who's going to open the conversation before ironically stepping away to care for Artie Born, at which point Vicki and I will carry on. And thank you, Artie, for managing and balancing these two vital and conflicting commitments with Grace. All you. - Great. Good morning. So, as we mentioned, I'm going to speak first. And as the title of this panel refers to the person I'll just call allegedly Luigi. I want to start with a few words about the event that I'm sure is top of mind for many of us coming here today. The morning of December 4th, the end of last year, many of us woke up to incredible news. An unidentified individual had shot the CEO of one of the largest private health insurance companies in the US and one of the most ruthless. Even more incredible, and I'm using that word literally, in the sense of extraordinary, was that the following days were filled with an outpouring of support for the act from across the political spectrum. People left and right cheered on a new folk hero. Even on Ben Shapiro's YouTube channel, when he first tried to cry foul about the event, his own right-wing viewers left comments in support of the act and telling him to read the room. Seemingly, the only people in public life who are willing to be upset about it were opportunists like Shapiro himself and dependably reactionary cable news talking heads who mostly, by the way, directed their eyeer at the people. How could we possibly be celebrating this? What has come of this society? But what this mass response demonstrates is just how fundamentally the experience of state abandonment is to anyone living in this country because we all know why he did it. No one has to ask why. For all the pearl clutching that has happened in the month's sense, for all the spectacle of Eric Adams personally perp walking allegedly Luigi, not one person has to ask why. Everyone in this room knows that having health insurance to not care kills. Just as I'm sure everyone in this room who's a health care worker has seen again and again, the choices people have to make when they can afford their care or they're already buried in medical debt or they've had to avoid care altogether for so long that they've become more sick. So many of us know all too well what it feels like to choose between going to the doctor and paying rent. We're going to the doctor and being able to eat. And for many of us, even that choice would seem a luxury. We can't afford the rent, we can't afford to eat, and we certainly can't afford to be sick. The state and the ruling class know this. They just call it something detached sounding like financial toxicity, a real term for the added likelihood of death for people who have a serious illness, like cancer, who cannot pay the extraordinary ransom or society demands that they pay to buy their own survival. Health insurance companies are financial institutions that act as middlemen, siphoning profit off of our misery, doing social murder and calling it social good. Health insurance companies produce capital from slowly killing us. There is no place for them in this society. They are also just one part of one part of a massive system. The healthcare system from who pays for healthcare to the sites where healthcare happens, who does the caring, who is cared for and who is abandoned, is a massively distributed beast. And intentionally so, the massive distribution of the healthcare system is truly the main reason we have yet to be able to tear it down. When we fight for health and disability justice, so often we have to first choose a field of struggle. He is our target who pays for healthcare. If so, who are we organizing and who are we organizing against? Do we pick a single health insurance company that is a particular bad actor in a field of exclusively bad actors? Is our target the state? If so, which part of the state payment architecture? Medicaid, Medicare, the VA, the regulations on ACA plans, the IHS, if it's Medicaid, how do you form alliances across state lines when Medicaid is so hyper-fragmented state by state? Or even within states? When I posed this very question recently to our friend and collaborator and death panel co-host Phil Rocco, he talked to me about how the state of Wisconsin's Medicaid program is not actually one thing, but as he put it, an archipelago of 24 separate programs operating within the state. And note here that I've only just addressed insurance and who pays. You can do the same with hospital systems, pharmaceutical companies, electronic records companies, the list goes on. This is what I mean when I say that this massive distribution is intentional. This is an architecture of counterinsurgency. It is designed to make us feel powerless. It is designed to seem to be too big to fail, which is what makes the events on the morning of December 4th all the more extraordinary. All of us are used to being thrown around by the health system and having care denied by seemingly faceless companies. In this one act, we are reminded the system does have a face and it has many. So this brings me to the central question I want to leave us with for the rest of the panel and the rest of our discussion today. Where is the site of struggle in healthcare? Or rather, what are the sites of struggle? Where can we act? Because as we meet here today, we are at war. We are assailed on nearly every front of the health struggle. The state has been captured by a movement that is enacting a health fascist agenda. What do I mean by that? I don't have to explain to anyone here why or in what way MAGA is fascist. But the reason I say health fascism to refer to the eugenic wellness arm of the MAGA movement is because there is a fundamental difference between this second Trump administration and the first one and we almost understand it if we hope to defeat it. Because for the first time in decades, the right has managed to create for itself an ideology around health and healthcare that has allowed it to seize the narrative on health. And there are two aspects to this. One is the Make America Healthy Again Agenda. Beatrice will be speaking about this more and how we defeat it. But suffice it to say that promises to move from a sick care system to a wellness society in Robert F. Kennedy Jr.'s words is an actually existing agenda for cutting programs that provide treatments or fund research, cutting public health and cutting health, labor and environmental regulations of all kinds that exist explicitly to slow social murder. And explicit in RFK's claims about wanting to reduce the population of people with chronic disease or reduce the amount of people who take medication is an eliminatory impulse that is more about pushing the sick out of society than it is about raising all of our collective quality of life. The second aspect, converging to form the health fascist agenda is what I would call simply old-fashioned Republican austerity politics. We are speaking together on the 4th of July. Exactly seven months from the events of that December morning. And today, Trump and the fascist right are celebrating the passage of what has been appropriately derided as the GOP murder bill. Last I read, Trump plans to hold a signing ceremony today at 5 p.m. It is a bill that will strip an estimated $1 trillion out of Medicaid instead piling a truly catastrophic sum into ICE and mass detainment and deportation. As one immigration policy analyst noted, it will make ICE the single largest federal law enforcement agency in the history of the nation with more funding for detention than the entire federal bureau of prisons. The $1 trillion out of Medicaid, the health care program for the very poor, the program of last resort. Medicaid also far in a way the single most important provider of long-term care for disabled people in this country. Hens of millions kicked off the program, causing by one estimate 50,000 additional deaths a year just from creating new uninsured. This bill has the same death burden as the average influenza season. Taking so much money out of one of the biggest sources of health coverage in the US that entire hospitals and health clinics will close, deepening existing crises of under-resourcing and under-staffing. One example that has already happened, Vicki will be talking about, actually. And all this coming just years after the Medicaid unwinding under Biden, where millions more were kicked off of Medicaid before the unwinding is recently as March 2023, 95 million people were unmedicated, fully one quarter of the US population, and adding work requirements to Medicaid, a draconian, unres and unnecessary additional means test that would have been politically unthinkable just years ago, all to fund the expansion of the American Gestapo, to fund a wealth transfer from poor to rich, and to keep sending bombs to the genocidal settler colony. But again, this is just one front. We have also seen ongoing brutal cuts to health agencies and basic research, central figures who did consent manufacture for endless COVID spread joining the federal government in top administrative roles, while at the same time, state, local and federal officials pushed for mask bans and criminalized mutual aid. Something that represents the state equally targeting ongoing COVID and long COVID organizing, as it also targets movements and solidarity with Palestinian liberation. Major attacks on trans life and trans healthcare from the Supreme Court's recent decision in Skirmetti to trumps HHS manufacturing anti-trans research to the fact that the budget that they just passed had a totalizing, high-demandment-style ban on Medicaid covering trans care in it up until the very last moment, and we cannot assume that they will not go back and circle back for it. Also, the castigation of the Disabled and the Sick with people like CMS Administrator and Forward TV crank, Dr. Oz, admonishing us of our patriotic duty, in his words, to be healthy specimens of the body politic because, quote, "healthy people do not use healthcare resources." Ongoing threats to massively expand psychiatric incarceration from trumps campaign promises to reopen the asylums, to New York Democratic Governor Kathy Hokel, holding up her state's budget bill for weeks this spring in an effort to secure an expansion of involuntary commitment and a mask ban. The attempted pitting of migrant organizing against healthcare, organizing in the Trump administration telling states to withdraw coverage from undocumented people, at the very same time as this administration sends ice into hospitals, which the healthcare workers here in this room and listening to this must be on the front lines of resisting. And I could go on. There's a word for this historically and that word is eugenics. The fantasy of health that has always drawn its boundaries along lines of race, class, madness, disability, or whatever the state decides is deviant in a particular moment, including political beliefs. Thus, why we see all of these explicit attacks on poor people, disabled people, trans people, and further anyone who doesn't support their fundamentally white supremacist vision of the American state. And it's worth saying, of course, that this doesn't come out of nowhere. This is an escalation. And it's an escalation that's been enabled by years of Democrats embracing the idea that waste fraud and abuse is a bigger problem to solve in healthcare than our ability to obtain it. And enabled by years of the Biden administration, trying to hide a mass disabling event, the COVID pandemic in plain sight. And by years of liberals and major media organizations like the New York Times laundering anti-trans propaganda under the guise of just asking questions. And it's an escalation in the sense that this type of abandonment is a fundamental component of capitalism, a feature, not a bug. B&I's book, Health Communism is in large part and attempt to trace this historical arc as a bedrock of capitalism, something that existed by other names long before the 19th century brought us this term eugenics that a fundamental part of capitalism's architecture is social murder and that capitalist states always operate somewhere on the spectrum of eugenic policy before it even had that name. I say all this because it is important that we are clear what we are up against. We are not just up against the current administration, ripping and tearing through the federal government. We can't just fight to reset the baseline to a pre-Trump health regime. To beat health fascism, we will need a new liberatory politics of health that gives no quarter to the health politics of the past, which has remained obsessed with deserving this and keeping costs down. You cannot defeat fascism with a tax subsidy on Obamacare plans. You cannot defeat fascism by simply converting police into mental health police. And the complexity of this system can make it seem almost impossible to act. Again, that is the point of the system. To make healthcare workers worry about risking their license and class position if they stand in solidarity with patients, to reinforce that if a young Lord's style hospital seizure happened today, somewhere in an office in Wisconsin, Epic would remotely shut down access to key records and functions of any new people's hospital, to reinforce that they will always find another Brian Thompson. Just maybe the new one will have to dye their hair to obscure their appearance as one United Health Executive did at the end of last year. (audience laughing) But it is not impossible to act. What it will require, however, is that we take tremendous risk together. Even as we fight to defend Medicaid, even as we fight for Medicare for all, we can fight to topple the system and at the same time work to articulate what our actually liberatory vision of health would be. And at the same time build survival programs that are almost certainly going to be what is required in the immediate future of our struggle under health fascism and a bedrock for what we want the future of collective care to be and a way that we can start practicing that new vision today. And so as I prepare to pass it on to Beatrice and Vicki, I wanna reiterate my questions from earlier. These are questions equally for our discussion together today as they are for each of you. By which I mean, these are questions I want us all to be asking ourselves today and beyond as we try to think bigger about what we can do together. Where are the sites of struggle? Where can we act? What can I do from the position I'm in? Whatever that position is. What is a skill that I have that I can offer outside of the system as it currently exists even if it means taking on risk? What do I need to survive? What does my comrade need to survive? Can I give it to them? Can I mix estrogen? Can I distribute N95s? Or just start wearing one again in public if I ever stopped? Can I learn to do home care to keep just one person alive? Can I teach my friends to do the same? What can I do to keep my comrades from being put in a cycle? I could go on. These are all sites of struggle just as important as our fight against big systemic federal policy changes. And many of them are things that we can take action on today. We must provide care to each other by any means necessary. Thank you. [APPLAUSE] Thank you so much, Arty. So when we talk about the site of struggle in health care, we're trained to look inside the machine. Hospitals, state houses, Congress, policy memos, think tanks, spreadsheets. We're taught to believe that change comes from adjusting the inputs, streamlining and balancing formularies, refining incentives, expanding coverage, gradually, one bill at a time, of course. We're told that the struggle for health justice is a matter of expertise, of lobbying, of back room negotiations, of merely tweaking the funding mechanisms. But building on what Arty said earlier, I want to offer us a provocation of points as in a different direction. What if the site of struggle is not inside the system at all? What if it is in the refusal to accept the system's supposed limits in refusing the legitimacy of those limits? To answer that, we need to start by asking a question that is deceptively basic and is, in fact, incredibly hard to answer. What is care? Not care is it appears in the dogma of reimbursement codes or metrics, statistics, clinical workflows. Not care is an eligibility or compliance, but care as people want to experience it, as they imagine it, as they need it to be, and as we long for it to be. Care is an active mutual responsibility. Care is a relation. Care is a commitment. Care is a set of material conditions that are met, and in so doing, life is made possible. Because the truth is, most people hold an expansive vision of what care ought to be, and they are right to. We imagine care means being tended to when sick, receiving support in moments of crisis, living with dignity. We imagine care means being seen, believed, held, and treated. We imagine that care is widely available, that it can heal, that it offers answers and transparency, that care is ours. But the reality, our healthcare system is an engine of abandonment. It is a bureaucracy of denial, wrapped in the language of compassion. Its extraction, masquerading, is benevolence. We get rationing disguised as triage, exclusions justified by rigged cost benefit analysis. It does not protect us. It withholds and punishes us. It profits from our suffering, and it turns our longing for care, into a transaction that you can afford, and even fewer can rely on. The more in need you are, the more disposable you become. The reality of care is the ambulance you don't call, because you're worried about what it will cost. The diagnosis you don't get. The meds you ration or go without. The surgeon who is out of network, the wait list you'll never live to see the end of. The nurse who doesn't have time to listen. The care worker working two jobs burned out, and blamed means testing, worker requirements, step therapy, denials, appeals, ghost networks. And yet we still cling to the dream of care. And we must, because people know what care should be like, what it should feel like. Not because we are naive, but because we're right. Because even in the wreckage, we remember what care should feel like. We know it deep in our bones, and that memory is powerful. That fantasy is revolutionary, and it tells us something important and often overlooked. Our demands are not too big, they aren't big enough. Now is the time to revive the call for Medicare for All. Not as an nostalgic slogan, but as a reasonable demand grounded in urgency, clarity, and collective power. The pandemic tore off whatever was left of the myth that our health system works. Millions have been abandoned. Labor conditions for the healthcare workforce have deteriorated, disabled people, elders, young people, migrant and low wage workers. Teachers were all sacrificed for the economy. All the while, the poor profit insurance companies raked in record profits while the healthcare system caught in the chokehold of private equity continues to consolidate and cannibalize itself in the name of efficiency. Medicare for All offers us not a final solution, but a mere foundation. One that if done with precision and resolve could immediately end the tyranny of employer-based insurance, eliminate medical debt, and deliver universal coverage while creating new possibilities for organizing beyond the limits of the current system. It is often talked about like it is just too much to ask, but Medicare for All is the most winnable, most transformative, and most basic policy demand on the table. That is why I end every episode of Duck Panel with Medicare for All now, because we need it urgently, materially. And yet we cannot mistake it for any kind of finish line. Medicare for All is the floor, not the ceiling. It is the beginning of something not our distant and shared horizon. It is merely a tool, not any kind of goal. We need to reinvigorate the fight for it, not because it will fix everything or anything, but because it cracks open terrain. Yes, it gives access to more people, but it gives access to a system that still doesn't work for most people. It softens the blow, but it doesn't transform the logic. It routes care through the same institutions, systems, and values that make care so cruel in the first place. Redesign the funding, but leave the gears unchanged, and the machine will grind on without mercy or redemption. We can grease the wheels with gold, but the rusted engine of power will still spew oppression. The problems we face are deeper in than access. We are living under a regime that extracts value from illness, that disciplines need, that disposes of the surplus, it does not need to be fixed. It needs to be confronted, dismantled, and replaced that something rooted in solidarity, not scarcity. If we want to win real health justice, we have to say clearly, we cannot let the system define the limits of our demands, and we cannot accept a vision of health reform that leaves the most vulnerable behind in order to win the middle. Elder care is crumbling. Long-term care is treated like a fiscal liability instead of a basic social good. People are dying in nursing homes that operate as decentralized, austerity-driven warehouses. In-home care remains unfunded, undervalued, and excluded from every "serious" conversation about health care. Drugs developed with public funding are locked behind patents and price-like luxury commodities, and maximized for shareholder profit, not survival. We're told that innovation requires this cruelty, but we all know better. In the end, our elders slip into oblivion beneath flickering fluorescent lights, while care workers crushed by impossible demands and invisible chains stand as quiet witnesses to this cruelty. Their exhaustion attestimate to a system that profits from their sacrifice. All the while, the architects of this atrocity toast their dividends with blood-stained hands. And we cannot afford to wait. Just as we've long said in the fight for Medicare for all, we needed it yesterday. Because what we face today isn't just neglect, or the rot of profit-driven incentives. It is the rise of health fascism, tightening its grip, as we speak. The rise of Robert F. Kennedy Jr.'s Make America Healthy Again campaign has stirred up a lot of energy and concern. On the surface, maha sounds like it's about healing, about fixing a broken system, but the reality is far more complicated and far more dangerous. Its appeal is rooted in a widespread and deeply felt experience of abandonment by our health care system, a system that feels extractive, feels cruel, feels expensive, and overall indifferent to our everyday suffering. People are angry, and that anger is real. But maha redirects it away from the structural forces that create this crisis towards conspiracy and scapegoating. Maha is seductive because it speaks to real pain. The pain of being abandoned, but it offers no solidarity, only self-management, not justice, only blame, not transformation, only cruelty, disguised as wellness. Maha says, don't change the system, change yourself. Purify your body, deny your kid vaccines, blame the sick for their sickness. It's magical thinking for a carceral state. The problem is not that simple, I wish it were. As already said, we're talking about a massive decentralized system that is organized by competing logics and contradictory incentives that ultimately is most efficient at extracting profit from sickness, while abandoning those who need care most. The collective reality of health under capitalism is that we are not all sick, but none of us as well. Wellness is not an individual achievement. It is a social condition shaped by work, housing, food, environment, and care or the lack of it. But what would it actually take to make people in this country healthy, not temporarily, not personally, but systemically? It would take everything. It would take housing, clean air, clean water, food, rest, reproductive autonomy, trans care, elder care, child care, long-term care. It would take freedom from policing, incarceration, borders, and medical debt. It would take climate justice, labor justice, racial justice, and the abolition of for-profit care. In other words, it would take transformation, not optimization. In the world that we live in, health is a commodity. Our system of care tears apart the connections between patients, health care workers, public health, scientists, researchers, and communities. It pits workers against patients, patient against patient, and divides care into market transactions, erasing the collective labor that makes life possible. This extractive abandonment is structural violence, both material and epistemic. It is social murder. As Engels wrote, "One 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 necessities 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 inevitable in the consequence. Knows that these thousands of victims must perish and yet permits these conditions to remain. Its deed is murder, just as surely is 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 offense is more one of a mission than a permission, but murder it remains. So what is the antidote? It has to be bigger than a program. It has to be bigger than reform. The antidote is health communism. And what I mean by health communism is this, a refusal to let the system define who is worth caring for. It's an insistence that all care for all people is not a dream. It is our demand. Our demand right now, not 15 years down the line today. And the good news is that we don't need to invent this world from scratch. It's already being built. Let me tell you where care lives right now today and where our struggle continues. A trans person gets HRT from a friend of a friend. Someone helps a teen get planned B across state lines. Someone else ships abortion pills to a lockdown state. A mutual aid crew delivers some leftover meds to someone post-surgery. A community clinic runs out of a church basement and doesn't ask for ID. A long hauler crowdsources treatment protocols because their doctor won't listen. A disabled person builds a spreadsheet network to redistribute mobility aids, medications, and groceries. An insulin-sharing group chat, an overdose reversal coordinated over text, a harm reduction team walking the encampment at dawn, handing out clean syringes and checking wounds. A healthcare worker refusing to let ice kidnap their patients. A sex worker organizes a peer health clinic. A rural town with no clinic, but with an entire informal network of aunties and retired nurses keeping each other alive. It's community fridges, land and water defenders, global clinics, street medics, home visit networks, meal trains, gray market meds, DIY air filtration. It is not the kind of care that makes it into policy briefs, but it's what keeps people alive. And this is not theoretical, this is real. Most of it is not legal, none of it is covered, and yet it is functioning, it is life saving. Nothing is recognized as care by a system that I just mentioned. But it is care, and this is the site of struggle, not only inside of institutions, but in the shadows that they cast. It is in every act of defiance that says we will care for each other anyway. The site of struggle is in that gap just as much as it is on the floor of Congress, the back and forth of prior authorization, or the streets of New York in the early hours of morning in December. So what do we do with that? If the site of struggle must go beyond merely making the system better, but also to build what we need despite the system, how do we fight? First, we fight by demanding more than what is politically acceptable. We cannot let the boundaries of what is feasible or electable define our demands. We don't need means, tested scraps or access to broken programs. We need universal care, no strings attached. Because if we let the system define the terms, we'll always be asking for the permission to survive. We'll be told to settle for coverage, not care, inclusion instead of transformation. Care is not a reward for good behavior. It is not merely a line item in the budget. It is a non-negotiable condition of life. And the truth is that people already believe in this. Most people want everyone to have what they need. What's missing is not public will, it's political imagination. And that is our job to make the horizon visible, to remind each other every day, day in, day out, that we deserve more than what we've been told to expect. To fight like we actually believe that everyone deserves to live. Second, we fight by recruiting defectors from inside the house. This is a call to healthcare workers. Betray your training when you're training demands cruelty. If it means someone gets what they need to live, betray your bosses, your licensing board, your EMR and your scope of practice. Care is not your credential. It is your calling, your skills, your knowledge, your access and your obligation to your community. And sometimes that obligation will mean and require disobedience. If we are to build the world that we need, we need you on our side, not on the side of your administrator. We need you willing to take risks, not just for your reputation, but for the material survival of those around you. The struggle is already here, and you can either enforce the harm or interrupt it. We need class craters and scrubs. We need insurgent care. And we needed it yesterday. If you have access, class it on. If you have knowledge, share it, weaponize it. If you have creativity run with it. This is where the real transformation begins. Not just in asking the system to care, but in also building the world we wish we lived in. A world where care is not determined by billing or zip code or citizenship or employment status or formulary or diagnosis codes. A world where no one is surplus, where illness is not a source of shame or debt or punishment, but simply a part of life and a part of being and feeling cared for. They want us to think that care is something we have to qualify for, that it belongs to the insured, the compliant, the deserving. But we win every day when we reject all of that. When we remember that care is a promise, older than any institution, more powerful than any system, we win when we remember care is a practice. Passed hand to hand, when we claim it is ours together without apology. All care for all people, that is what health communism is. Not a slogan, not a party line, but a strategy, a way of understanding that help is the terrain, not just the issue, that it's the lever and the battleground, that it's where capital extracts value and it's also where we can begin to sever its hold. Thank you. (audience applauds) - Thank you so much, be an arti, and thank you all so much for being out here. So yeah, I, building on what both of them have said, I want to propose a question which is, should we consider what Luigi Mangioni allegedly did care? Should we consider the murder of the coward, Ryan Thompson, an act of care? Is it less an act of care than the work that that CEO did every day when he went to work to guarantee the flow of profits to share holders by the denial of health and medicine and all other forms of extremely important life saving procedures to disabled and poor and people of color, was he more caring? We think about care and mutual aid and many of these other concepts, in a frame often dominated by polite politics, by working within the system, by reform, by non-violence. One thing that has happened, which I think is a great trend recently in the way that we talk about and think about in the '60s, is people will refer to the Black Panther Party's survival programs, and they will talk about that the BPP ran, you know, sickle cell anemia, education and testing sites that they put up ambulances, that they fed children, and they educated people. This is all really important, and I think it's a valuable revision. It was introduced as a valuable revision to the way that '60s militancy got talked about often, which was extremely macho, you know, just leather and guns and not caring about anything, right? But in valuing the mutual aid that they did, we also forget that they funded that stuff with bank robberies. Were those bank robberies acts of mutual aid? If you steal a bank, if you steal a bank, that would be pretty impressive. If you empty a safe at a bank, with the goal of using that money to feed, educate, and heal your community, is the robbery, the fact that you violated property law and rights, the important act, or is the care that you took that risk for, what's really happening? What is that act? What is the nature of that act? I was gonna do this talk when we first talked about it, and planned it. I was gonna speak to a lot of historical examples. Like that, I was going to talk about, as Arty mentioned, the young lords take over of a hospital in the '60s as well in New York, which I think is a model we really should all be looking at all the time. But I think like many of us here, the news yesterday sort of distressed, and confused me, and now I'm operating without a script, and I apologize. I hope it's going okay. But anyway, so I wanted to talk, I wanted to apply these same lessons to the present extremely directly, because I think that's what we need to do with our time here. And like, things are getting more and more desperate. I mean, literally this very day, right? That they're gonna shut down two-thirds of the plan parenthoods in the country with this bill, right? They're gonna, it's a nightmare, and luckily I don't have to talk about it 'cause I already covered it. I think it's good. Thank you already. So yeah, it's really, really bad. And one thing that happened yesterday that we noticed while we were, if you were like sort of watching online, is that a health clinic in Nebraska, a rural county in Nebraska closed already. As soon as the bill was signed, they closed, 'cause they knew that there was no way they would have funding. So a clinic in an incredibly small rural Nebraska town, one which went to Trump, has already closed before the bill has even been signed into law. Never mind, it's, you know, it's things being enacted. It's cuts being enacted. If you're first response to that, you know, I hope that everyone knows that if you're response to that as well, they voted for Trump, they got what they wanted. Like, you're also a fascist. I hope that's really clear. But what I wanted to think about is, instead of talking about historical examples, which we often tend to hold up, and which are very important, I want to think about the people who are in that Nebraska town right now, and who are probably a hundred miles, you know, dozens of miles away, excuse me, from the nearest care. And now there's this building there, and there's doctors and there's nurses still in the community. Why did it close? What materially changed about that hospital? Nothing. Nothing changed about the knowledge that the carers had. Nothing changed about the patients, and the levels of care they needed. Nothing changed about what they specialized in or what the painting on the wall, the children's word looked like. Nothing changed. What would it take for that community to keep that hospital open? Okay, so we start thinking through this, and I want to start thinking through this because I think that these solutions are going to have to come harder and harder. We're going to have to make these moves together, bravely, fearlessly, but it's actually really doable. Whatever you want to say about what Luigi Mangiani allegedly did, he just did something. He's just a guy who just did something, and it changed a lot for a lot of people. So basically, so I started answering this question last night, and yesterday, so I had to just be really clear. I was at this incredible, there's this incredible reproductive justice organizing meeting yesterday morning. It's so great, I'm like having to be really inspired by all the work people are doing, and I start having a pots flare up. And I have to go back to bed and lie in bed the whole rest of the day. And I'm looking out the window on the conference, on that very almost like a dystopianly modernist plaza with the grass, and there's no shade. And people are trying to make the most out of it, and looking at this conference that is happening, and all these people who are gathered, who I know, I've just talked to, are doing incredible work. And I'm stuck inside, and I'm looking at social media, and everyone is freaking out. Obviously, it's full-dume. And spontaneously, I felt hopeful, and I just wanted to try and think about what was happening in my head, and reproduce that for you a bit, because that felt really powerful in a moment when there's so little hope. So I started thinking about that hospital in Nebraska, what would you have to do to keep it open, right? So okay, so you wanna have the doctors and the nurses, they need to be able to still practice on some level, right? So you wanna at first organize with them, and see if they'll keep seeing people, right? And maybe they'll do that for a short period of time, but somehow you're gonna have to fund them doing that, right? And you're gonna have to figure out how they're gonna be able to live in the community. Now, you could try and fundraise, mutual aid, that seems like a short-term answer, or you could figure out a way that they could all go on rent strike together, or a mortgage strike if they're a doctor, and you can stop paying the banks. Now they live for free, and now that's gonna require a lot of struggle from the community to keep them from being evicted, to keep the police from coming in, but it's possible it's going on all over the country right now, successful rent strikes are happening. Okay, so you've got them cared for it, and how are you gonna get transport patients, right? Oh, people are gonna need to be able to move them to, you know, if the ambulance drivers aren't available. So you start answering those questions logistically, people start volunteering 'cause they drive or in a community that's rural, they all have cars, they have to start figuring it out, they start organizing that, but timing on it is difficult 'cause people have to go to work. And so then people start figuring out ways to keep each other in the community, living without having to go to work in the same way, because taking people to the hospital and taking people to the community is important enough that like that should be supported as work, right? Each of these questions that you wanna answer, how are we gonna get the medicine? Well, luckily there's a compounding pharmacist in the community who knows how to make stuff, right? And she has been doing this for ages, and she's actually like pretty cool. She's a little kooky, but like we like her, you know, Janet's great. And like, you know, and she, you know, she just needs the RAWs, and you need to figure out a way to do it. Well, there's these, there are these gray market websites that like the trans people, that your trans cousin who lives down in over in Portland knows about. And so you order some esters from there, you order the RAWs, and suddenly you've got a DIY pharmacy, and it's actually way cheaper. It turns out it's significantly cheaper at source. And then some people, and then that, you know, that pharmacist works with some folks who studied chemistry, and they start thinking about how to start producing their own basic medicines. All of these things, and this is very fantastic, would've been incredible Nebraska town, right? I mean, holy cow. But like, but I'm using all these examples, and I could continue for a long time, on the basis of things that I have seen people doing in the struggle over the last two and a half years. People are making their own HRT. People are DIY-ing Epipens. People have DIY compounded insulin out there. There's folks who have cracked the patents on hepatitis medicine, on HIV medication, on vivants, right, on neurodrugs, and there are people building systems that are capable of building them at home. The point being that there are all of these responses that we can do, that are forms of care, that are immediate, if we are willing to stop paying money for things, if we are willing to take care of each other in a holistic way, to combine all of these things together. But the thing that is so incredible about it, and I think is so important about Luigi, and why we're talking about this now today, is that those actions immediately spiral up towards massive questions. When you start thinking about how would you keep a hospital open, suddenly you're thinking about not paying rent. Suddenly you're thinking about housing, you're thinking about food, you're thinking about the very material creation of all of the things that we need to live in our everyday life. And health is such a successful form of control and of social domination, because it is ideologically held up as inaccessible. You need to go to med school for seven years. If you want to learn this stuff, you have to be one of the smartest scientists in the world, you need the incredible amounts of funding, you need sci-fi level labs that are locked down and perfectly sterile environments that are only achievable with the most expensive equipment. And then you look at what they're doing, and there was just this story that broke, that didn't get a lot of attention a few weeks ago, there's been a lot of news. But the Biden administration had the FDA under Biden had known that a bunch of pharmaceutical factories in India and China, where we were sourced most of our pharmaceuticals, had such terrible safety practices that they were sending medicines to the US that had like rotten black. They were sending absolute, like you know, like the Boris had stuff, right? If you remember last year, Boris had like this level of contamination, and there was a special body in the FDA that formed to override the FDA from stopping those medicines from arriving. So there was an active, you know, at the top level, process to make sure that tainted medicines could come into the US. When we talk about safety, care, looking out for one another, we so often think about these big, expensive, complicated systems of hospitals and sterile laboratories and five years, seven years, 10 years of education, and the most cutting-edge research and millions in funding and global logistics networks. But when you look at what they're doing with that, they're making a sicker. They're making money. And if we actually look out for one another and take care of one another, it's so much more important that I, if I'm in that Nebraska town, don't poison Jeff the mailman. 'Cause everyone will know I did that, you know, like that's me on the line. When we take care of each other in a communal way, we are capable of so much more and so much of that belief about medicine is ideology. 30% of the medical knowledge we have is the most important, incredible discoveries made by humanity and 70% is absolutely violent gatekeeping bullshit. And so often with stuff like Maha, what happens is that the people who critique the bullshit are actually offering you worse bullshit. They're offering you real sickness. They're offering you eugenics. And so we have a reflexive desire to defend science. In this house, we believe. And but the thing is when we're defending science, we are, we are talking about that 30%. We're talking about the incredible magic of 0.2 milliliters of liquid injecting into my thigh once a day and giving me like a great rack, right? That's what we're talking about. That's really cool, but what we're not talking about when we talk about science are the transphobic chasers who like tell me in fact that like I'm not trans enough to get more medication. And in fact, I have to go on blockers that give me terrible, have terrible interactions with my disabilities, right? We're not talking about me having to work full time in order to be able to afford every six weeks to go to the pharmacy and pay for my only partially insured injection, which is magical, except it doesn't feel so magical because I have to work one day out of every month just to pay for it. The science that we have and can take of care is incredible. And maybe it will include us making medicines for each other and you know finding solutions to get each other to travel for abortion care and trans care. And maybe it will involve the murder of cowards like Brian Thompson. But whatever it involves, that science is ours. And they hide it behind intellectual property and behind the state and behind their laws and their criminal stealing of all of our value. And we can take it back. We made it and it's all there for taking. So thank you all so much for coming today. [APPLAUSE]