Who shall live?

Welcome to Health and Capital

In 1965, NBC aired a special documentary program called “Who Shall Live?” centered on the public debate over the administration of dialysis to people with kidney failure. New dialysis machines had been proven to work, and to save lives, but were enormously expensive. The question at the heart of the debate was a simple one that will be familiar not only to everyone who has experienced the United States’ health finance system, but to anyone who has lived through the current coronavirus pandemic. Who deserves to live, and whose responsibility is it to see that they do?

The documentary is credited with drawing increased attention and urgency to the national debate over dialysis patients. To watch it now it is easy to see why. The program focused on a “Life and Death Committee,” known colloquially at the time as a “God Committee,” deliberating on how their limited capacity for dialysis treatment should be rationed. Committee members are shown only as anonymized silhouettes, in a manner that will be familiar visual language to any true crime viewer. The terms of their debate focus largely on each individual patient’s potential future value to society, should the committee elect to treat them.

Public outcry over the existence of these committees ensued. By 1972, Congress acted to cover patients with kidney failure under Medicare. This effectively guaranteed that dialysis machines would bloom in availability, for reasons I expect to cover in more depth in future posts. But this highly targeted approach is emblematic of the way that public policy in the United States has been leveraged to make systemic injustices appear to be an aberration rather than a norm. In short, the way that American health finance and the particularities in its manifestation of Federalism interact with the health of its population deeply expose the contradictions in capitalism.

For as much energy as liberal thinkers have spent joking at the expense of the “Death Panel” talking point from the right, they have spent comparatively little energy trying to undo the policies and prejudices that make a “Death Panel” or a “God Committee” a rhetorically effective attack.

We make these decisions all the time. The debates had by a committee like the one featured in “Who Shall Live?” happen at every level of the United States’ political economy, and arguably with less careful thought. To borrow from an often-repeated joke on left twitter, “capitalism is the real death panel.”

Health and Capital will make these questions its focus. The coronavirus pandemic, and the subsequent boom in public and academic focus on the intersections between health and capitalism, provides the ideal moment to demonstrate in real time how much our entire political economy must be rebuilt. Posts will largely concern how these factors interact during the pandemic and how the contradictions they highlight existed long before the pandemic. As such posts will often be reactive to studies or legislation, and may occasionally examine historically relevant events of the past. Each post could be considered research notes toward an explication of the broader thesis articulated above.

I expect topics discussed in this series to frequently overlap with and be informed by conversations I participate in on the Death Panel podcast. Death Panel is an independent and exclusively listener-supported program that addresses similar topics. If you enjoy Health and Capital, I highly recommend you subscribe to the Death Panel as well. I host it alongside co-hosts Philip Rocco (Prof. of Political Science at Marquette University), Beatrice Adler-Bolton (current graduate student in CUNY’s Disability Studies program, and also my partner), and Vince Patti. We do two episodes per week, each usually between one and two hours long. You can support that show on Patreon here.

Finally, if you enjoyed the content of this post or others, please subscribe to this substack, share it or the Death Panel podcast, and let me know what you think. My ability to continue this series as a long-term project will largely be dictated by the reaction to it, and whether readers find the information in it valuable. As this is the first formal post on this substack, I will update it accordingly to add links below to recommended posts for new readers curious to get a sense of the information and perspective offered here. For now, please stay tuned for new posts in the coming days.

Artie Vierkant