...it's educational!

"UMass" by the Pixies

In the sleepy west of the woody east
is a valley full, full o' pioneer
we're not just kids, to say the least
we got ideas to us that's dear
like capitalist, like communist
like lots of things you've heard about
and redneckers they get us pissed
and stupid stuff it makes us shout
oh dance with me oh don't be shy
oh kiss me cunt and kiss me cock
oh kiss the world oh kiss the sky
oh kiss my ass oh let it rock
of the april birds and the may bee
oh baby
university
of massachusetts, please
and here's the last five
it's educational
it's educational
it's educational
it's educational
it's educational.

Health Care Reform Debate as Castration: Masculine Sexuation and Health Care Reform

Part 2 of “Health Care and the Community Economy: Towards an Ethics of Surplus and Geography of Sufficiency.”

The U.S. Health care reform debate centers on the question of whether care is a right or a commodity. Do markets exclude people from access to care or does competitive pressure work to make care progressively more affordable? Could the state guarantee access to quality care for all or would a national health insurance system mean equity of misery? With stunning regularity this debate between universal health care advocates and pro-market reformers has been restaged without being resolved. It is precisely this repetitiveness that has led me to regard the health care reform debate as a social fantasy whose aim is the conservation of the subject—the maintenance of an identity that is both formed and trapped by the impasse of this debate. How does this work?

Advocates of free market reform and those who champion a right to care share a common understanding of patients and providers—as rational, utility maximizing subjects through the economistic theories of moral hazard and demand inducement—patients are infinitely needy and providers are infinitely greedy. It is this a-priori conception of the subjects of care that installs an economy of scarcity as the master signifier in health care reform discourse. It is no surprise then, that private HMOs, Medicare and Medicaid bureaucrats have simultaneously developed similar approaches to constraining patient demands and controlling costs, regulating the enjoyment of patients and providers.

My argument here is that both sides of this debate speak a language of optimized care delivery—frequently drawing upon the industrial language of total quality management—when discussing the efficacy of captitated Medicaid payments in Utah, tort reform in New York, or automated record keeping nationally. It should be kept in mind, however, that these practices of miserliness produce the scarcity they presume. What happens to us when we accept this description of patient and provider motivation?

When we accept the premises of this debate—how subjects are conceived—we enter into a symbolic order that constrains enjoyment in a particular way. If both Medicare bureaucrats and HMOs use capitation and co-payments to control costs, they are directed to do so because this debate regards reproductive labor as a social cost that must be minimized in order to conserve capital for economic growth in productive sectors. We can enjoy some “social reproduction” only so long as capitalism’s access to capital remains unconstrained and unquestioned.

[I should note in passing that the policy directed bureaucratic form of this debate has its equivalence in the popular imagination: the search to find some extraneous enjoyment, some excessive demand whose curtailment—it is believed—will restore the balance. The anti-immigrant group the Minute Man has publicly stated that illegal immigrant demand for health care is an onerous and unnecessary burden placed upon the health care system that is responsible for rising health care costs. Indeed, if one were to visit hospitals in border regions one would find confirmation of this belief. However we must bear in mind Lacan’s scandalous proposition that a husband’s jealousy is still pathological even if his wife really is cheating on him. What we need to question here is not the empirical assertion that some portion of aggregate demand for emergency health care arises in the immigrant population (legal or otherwise) but rather the belief that eliminating this demand will be sufficient to fix the problem.]

Following Özselçuk and Madra's indispensible "Psychoanalysis and Marxism" we can recognize that it is the singular exceptional status of productive capital and the subordination of the sphere of social reproduction that allows us to recognize that health care reform is carried out in relation to a masculine or dynamic logic.

“There is at least one X that is not subject to the phallic function.”
Productive capital’s access to the surplus is unconstrained because all other claims (for social welfare) are subject to castration. It is the exception that allows the rest to be subject to the law of scarcity.

“All Xs are submitted to the phallic function.”
For Lacan, as for Kant, these cosmological propositions show a limit to the law language enunciates. In masculine sexuated discourse the failure takes the form of a contradiction that is ignored. The subject emerges at this point of failure

Preferred provider networks were seen as an effective strategy to control costs until the late 1990s when patient dissatisfaction led to legislation (patients bill’s of rights) that undermined their efficacy. PPNs were a stand in for a social order, a reconciliation of contradictory demands—that failed-us. The failure of masculine logic is a failure to embody. Preferred Provider Networks failed and Medical Savings Accounts (the new solution) will fail as bureaucratic responses to the perceived economic reality of scarcity—a reality which demands that we be happy with our castration. This partially explains Uwe Reinhardt’s (see left) observation that “we will always have health care reform, and it will always fail.”

Thus, as Joan Copjec the tenents of masculine sexuation are not antinomic propositions as they appear but are simply statements that exist in a state of simple contradiction that is disavowed. It is precisely this disavowal that allows for practitioners of believe, in all sincerity, that they have arrived at the solution this time only to have it fail.

(To be continued in Part 3.)

"United States of Alzheimer's"

On May 16, Studs Terkel turned 95. He is precious. You may want to listen to his interview with Amy Goodman on Democracy Now!. The first time I taught Introduction of Political Economy at the University of Massachusetts, thanks to Steve Cohn's sound advice, I used interviews from his Working:What People do all Day and How They Feel About What They Do to illustrate and give concreteness to the various class structures (slave-labor, wage-labor, serf-labor, independent, and cooperative) within which working people participate.

A strong feeling of nostalgia towards the New Deal, to the Works Project Administration permeates the conversation. At some point, he speaks of the New Deal as an Utopian moment:

And then came the New Deal of Franklin D. Roosevelt and Henry Wallace, especially. And here came the jobs, the WPA of Harry Hopkins, Work Projects Administration. That meant work for men, for shovels -- also arts projects. There were artists and painters and dancers and singers. And this was all part of the New Deal.

In a sense, this reminded me once more that it is necessary to begin to understand what the New Deal means for the American Unconscious. Perhaps, it is the intimate alterity, the extimacy that haunts the hegemonic capitalism in the USA. The Social Security and its pay-as-you-go system is only one of the many institutional components of this American style "communism." Perhaps, it is the only one that is remaining. It was the institutional architecture (constructed by the nameless social engineers trained in the tradition of Dewey, Veblen, Commons style American pragmatism/institutionalism) of the New Deal and not necessarily post-war Keynesianism that which helped capitalism get out of the Great Depression and laid down the social technologies that enabled the petroleum-fueled post-war "Golden Age of Capitalism" (or, to borrow Tim Mitchell's terminology, carbon capitalist democracy). The extent to which these institutions are entrenched within the social formation can be gauged by the inability of the neoliberal counter-revolution to fully dislodge its key institution, the Social Security.

How does Social Security (in its pay-as-you-go version) count as a communist moment at the heart of this carbon capitalism? Simply because it enacts (as if it is a most reasonable and practical idea) the very communist axiom of "from those who can (the workers and the corporations) to those who need (the elderly, the disabled, etc.)". Without doubt, this is not a type of communism that I will be satisfied with. And, my aim is certainly not to perpetuate a new New Deal nostalgia. Yet, at the same time, when Studs Terkel complains about the social amnesia produced by the so-called "liberal" media and re-names the States as the United States of Alzheimer's (humorously modifying Gore Vidal's the United States of Amnesia), it is impossible to not to think of the strange and evasive way in which the American public relates to the New Deal.

Perhaps a half a decade ago, while cooking together with fellow blogger bigbadbull at our then Northampton ("Soviet Graves 1") residence, in the heat of the moment I claimed that Liberalism, as it is understood in the United States and perhaps best embodied in the public spirit of the New Deal, is the far most left position that one can feasibly take within the American political landscape. This is undoubtedly incorrect and the remaining portions of this posting will make it clear why it is so. Nevertheless, today, I would still insist on proposing the following modified hypothesis: The New Deal Liberalism constitutes the very frame of reference of a broadly defined American Left (and dialectically speaking the American Right). I would count the civil rights movement as an extension of the New Deal Liberalism. (So does, I think, Lars von Triers in his Manderlay, the second installment of his American trilogy). Even the radical left in the US (e.g., the new left of the Sixties), in its critique of the Soviet model, in its distance from Eurocommunism, and in its awkward relation to Maoism is the shape that the New Deal Liberalism took within the context of the Vietnam War.

In this sense, it would not be far fetched to argue that the New Deal Liberalism holds a place that is similar to the one Kemalism holds in Turkey. Not unlike the New Deal Liberalism, Kemalism determines (and truncates) the very horizon within which left operates within the broader social formation.

Nevertheless, of course, this hypothesis is bound to be proven wrong. There are social movements and political positions articulated within the past and the present of the US that breaks from and is opposed to the State-Capital-Nation knot (to use Karatani's metaphor-concept) of the United States of Alzheimer's even when its is tied together by the ideology of the New Deal Liberalism. Preceding the New Deal, there are the indigenous (or Indian and not Native American as Zizek would prefer to refer to them as, if only to demonstrate once more the stupidity of European settlers-colonialists) movements of resistance (which are themselves could be categorized as communist) against the settler colonization of the continent and, slightly later on, the Shakers who established their Yankee Communes on the basis of radical egalitarianism among genders and races—much before the North decided that it is in its benefit to do so. Again after the Civil War and before the New Deal, there are the Haymarket riots and the anarchists like Sacco and Vanzetti (don't miss the recently produced documentary) who articulated a different vision of solidarity and resistance against the onslaught of capitalism. And then, there is the Black Panther Movement moving beyond the Civil Rights Movement. And then...

Perhaps the others can insert their examples of left movements within the history and the present of the US that articulated/articulates a position beyond and against the State-Capital-Nation knot—even when this knot is articulated within the idiom of the benevolent New Deal Liberalism.

A Shameful Act

This is a collection of brief excerpts from a recent lecture by Taner Akçam whose A Shameful Act: The Armenian Genocide and the Question of Turkish Responsibility (2007) is a good place to start to understand why the Armenian Genocide organized by the Young Turks is the link that explains the conceptual/ideological as well as institutional transition from the late 19th century social darwinian European nationalisms to the Jewish Holocaust.

Health Care and the Community Economy: Towards an Ethics of Surplus and Geography of Sufficiency. (Part 1)

Introduction

In a recent presentation entitled “Freud in the Field: Some Early Twentieth Century Encounters in Participant Observation,” critical geographer Laura Cameron argued that Bronisław Kasper Malinowski’s participant observation was inspired by Freudian psychoanalysis—the productive tension it creates between engagement and reflection. Though Malinowski later repudiated psychoanalysis as a result of a controversy over the universality of the Oedipus complex it was clear that he continued to have a great personal respect for Freud.

My own encounter with the subjects of my field research was less directed by a conscious commitment to participation, observation followed by reflection (self-analysis) than it was about the way in which people I interviewed in the health care field crystallized my comprehension of the psychoanalytic theory I was exposed to in the course of our seminars from 1999 through 2004. A principal theme that emerged from my qualitative research was that care providers, from physicians to informal caregivers, shared a common experience in the labors of care:

• A drive to care that we can recognize as ethical in the Lacanian sense—a non-pathological act that remakes the subject. (The key text here is Alenka Zupancic's indispensible Ethics of the Real: Kant and Lacan (Verso, 2000).)
  
• How attending to this act of care both involves self-transformation—and an attenuation of the boundaries between self and other in encountering the patient, a process that can threaten psychic and physical exhaustion or financial ruin in the case of informal care givers.
• This common ethical drive suggests the need to reconceptualize the process of health care reform as one that focuses on the centrality of this ethical drive in a way that allows caregivers to be transformed rather than undone by their efforts.

In the process of reflecting upon the themes that emerged from my research convinced me that the Lacanian distinction between the Analytical and the University discourse enables me to differentiate health care reform as a process that pays attention to an ethics of care from the bureaucratic process of “cutting.” From the perspective of the four discourses, late Elizabeth Wright, in her Psychoanalytic Criticism (Routledge, 1999) argues that the function of language is not communication but the creation of a common bond between subjects. The adhesive power of this linguistic bond is to be found in the dis-connection between the unconscious of the agent and the addressee and not in the transmission of knowledge.

Four Discourses

It is beyond the scope of my writing here to restate once more the matheme permutations that arrange the master signifier (S1) (asserted entry point), knowledge (S2), the object-of-desire (a) and the split subject (S barré), in relation to conscious/unconscious of the agent and the conscious/unconscious of the addressee. Suffice it to say the University discourse, in its exposition of knowledge (in this case how to regulate the allocation of health care), presents itself as an objective knowledge. What is unconsciously produced in the recipients of this knowledge is ambivalent identification with what is pronounced: does this speak to my desires or thwart them? What remains inaccessible in this communication is the foundational assumption (the master signifier) which sets the rules of the knowledge production in the first place. It remains in accessible because it resides in the individual/institutional unconscious of University discourse. In contrast, the effect of the Analytic discourse possesses the potential to dislocate this foundational assumption as the unconscious knowledge of the analyst unfolds in the course of the analysis.

I cannot claim to have fully incorporated the four discourses into my work, methodologically or analytically, but I have been inspired by others to think about the implications of their political significance. It strikes me that Yannis Stavrakakis’s (see his upcoming The Lacanian Left) approach is to see in the Analytical discourse the basis for formalizing radical democratic politics. My dear friend Ken Byrne sees in the Analytic discourse a topographical space in which we view the object (in his case, the education reform) from a different perspective—having traversed the fantasy that emerges as a consequence of University discourse’s failure to fully capture the subject or to justify its unconscious assumptions and beyond the hysterical objection, we arrive at the possibility of a new organization of the problematic (a new master signifier).

In examining health care reform discourse—spilling out in a flood of academic and policy press—it became obvious to me that that an economy of scarcity was the master signifier that informed all efforts at health care reform. Further, the failure to domesticate or contain the effects of this scarcity produced an ambivalent subject whose protestations formed the basis for the further enunciation of the University discourse of health care reform—just as Lacan argued that hysteria constitutes the basis for the further advancement of knowledge (Lacan Seminar XVII). In listening to this “knowledge” in relation to health care reform, what emerge are both its repetitive quality as well as those moments where it is clear that we might look at things in a decidedly different way. It is here that a methodological approach to qualitative research can be usefully compared with the analytic process. There are moments in the course of research—both archival and in interview—where this alternative perspective emerges as a clear and coherent alternative. One such moment was in watching an interview the Bernard Leitaer recorded by Ted White and Karen Warner in the summer of 2006. While watching this interview I had a moment where someone else clarified perfectly what I had been attempting to formalize in the course of my research and writing. Bernard Leitaer allowed me to see an approach to health care reform that is located beyond an economy of scarcity as a foundational assumption.


Bernard Lietaer is one of the principal architects of the euro and a prominent player in international currency markets. He has recently become interested in alternative currency systems, especially mutual credit systems like the Akipu in Japan which allows for adult children to accumulate credits by caring for older adults near their home and then transfer these credits to their parents in need of care to be redeemed through someone else’s efforts in the system. One should take note that this is a system where the capacity to care expands as more people participate in the exchange network. It is a system of care that aims at a sufficient response to the growing problems of an aging population. Lietaer argues sufficiency, not abundance or excess, is the true opposite of scarcity. Rather than being its simple negation, it describes a different relation between necessity, limits and capacity. The limit remains but it is experienced differently—its status is indeterminate rather than given a-priori. Looking at health care reform from the perspective of an indeterminate limit—it is possible to see the Akipu system as a limited response to elder care whose potential sufficiency grows as more people participate in this alternative system of production and exchange. It might create the conditions for cooperative relations of production and ethical relations of exchange called for in the conclusion of Kojin Karatani’s Transcritique.

This is the relationship with the process of health care reform that we need, but I am getting ahead of myself.

(To be continued in Part II)

The Testimonies of Azmi and Hrant

"One of the difficulties in discussing violence in the 1948 war is that “Palestine,” the site of violence, both persists and has ceased to exist. Its simultaneous presence and erasure occurs in part through the survival of Palestinians from the 1948 war in what has ceased to be Palestine. Their scattered yet persistent presence constitutes a thread with which one can return to that moment when Palestine was ruined. They embody the survival of Palestine, yet also stand for its death. This death continues both to impede their memory of what has happened in 1948 and to structure it. The memories of the Palestinian survivors constitute a challenge to another kind of thread (mis)leading us back to 1948. The war also resulted in a birth—of a new Jewish state attempting to deny the simultaneous death that gave rise to its creation."
"1948: Law, History, Memory" by Samera Esmeir

I cannot help but make the connection here between Azmi and Hrant Dink, as survivors who pose a challenge by naming this connection, and really the necessity of the connection, between the death and birth. They do so in such a way that exposes as ridiculous those who try to blur the connection in order to maintain current (dis)order.

I was brought to this by c-blok’s writings, and by reading through pages and pages of writings on the Armenian genocide, some of them replete with so many forms of denial that resonate intensely with the Zionist denials of the Nakba. In his The Ottoman Empire, 1700-1922, economic historian Donald Quataert writes that one of the main reasons why this is said to be genocide is that Armenians “died because of their identity, not because of their actions and beliefs” (185). He says this by way of introducing why he does not think it can be called genocide, why it was different than the Nazi genocide of Jews. I wonder, in what ways? How is it possible to divorce identity from actions and beliefs?

He locates the beginning of the problems, where “the story begins,” in 1914 with Russian Armenians who come along with other Russian invaders through the eastern Anatolian front. This follows an entire book which actually quite carefully and thoroughly maps the various ways in which Ottoman identities were formed over centuries, and changed and disrupted suddenly with the Tanzimat. In this way, we can see how the story begins much earlier in fact, in the way that Armenian identity, not just as a national identity but as an identity of the second largest millet in the Ottoman Empire, made them the exact targets for actions focused on cleansing and consolidating, incidental only insofar as the people killed were bodies that incidentally belonged to that identity. This is the same with Jews in the Nazi holocaust and Hannah Arendt does a very nice job showing this in The Origins of Totalitarianism by looking at how the Jew (rather than the Jews) played a very specific and very complex role in commerce and in social relations in Europe, and that it is not a coincidence that the “liberation” of the Jew ultimately led to the destruction of the Jew.

Quataert reports that in Istanbul and Izmir the Armenian communities “remained intact and in place, going about their business” (186) while the massacres were conducted in the East, i.e. that the absence of large-scale massacres in Istanbul and Izmir cancel out the massacres in the East. This is a position also taken by Zionist denialists, saying that some Arabs (Palestinians) did not leave (weren’t expelled from) their homes in 1948, and that some were even saved by Jews! This ugly rhetoric asserts that the exceptions prove the rule, and that if there was no killing of bodies, or rather, if all bodies were not killed, then a genocide did not take place.

What is similar in both situations, and why the term genocide is apt, is that the mass killing was not just the murder of people, but an effort to eradicate Armenian or Palestinian identity as such, so that those who remained would not be Armenian or Palestinian. The presence of Armenians in Turkey or the presence of Palestinians in Israel highlights this: as identities which experienced the genocide through survival, that is, a survival which became an extension of the genocide, their presence becomes a testimony. But a testimony to what?

The presence and the testimony of Hrant Dink and of Azmi Bishara stand both for survival and death, and this is precisely how genocide functions. It is not just the killing of people, as though that would not be enough, but more so, the structuring of that killing, not because it is premeditated or it uses modern technology, but because it is designed to kill an identity in order to make way for another. We are supposed to believe in the compassion of Zionism and/or Kemalism because it “allowed” for some Palestinians or Armenians to live, and even to stay in their home territories, but even those few who got to stay in the same house, were de-territorialized in a way that was just as violent. The process was to expel some out of their homes, and for the others, to expel their homes out of them, to make them strangers in themselves(as Azmi writes in his recent LA Times editorial: “When Israel was established in 1948, more than 700,000 Palestinians were expelled or fled in fear. My family was among the minority that escaped that fate, remaining instead on the land where we had long lived. The Israeli state, established exclusively for Jews, embarked immediately on transforming us into foreigners in our own country.”), to disorient them in such a way that it is not clear what home or identity even mean, and then to have them serve as the proof that genocide did not occur.

The power and the threat of Hrant Dink and of Azmi Bishara, and of all of the Armenians in Turkey and Palestinians in Israel, is that they refuse to be that proof, that they transform that survival from an individual bodily survival to a collective resistance.