The market of exceptions and Michael Moore's Sicko

I saw Michael Moore’s Sicko on the last day that it was showing in Northampton. Sitting by myself in the basement of Pleasant Street Theater, I had nothing better to do before movie began than to listen to the two elderly couples ahead of me discussing what they had heard about the film, their own medical woes, and how easy it was for them to see a doctor. Neither couple needed to use Medicare because in each case they had continuous coverage through their former employers. I could tell they thought of themselves as the fortunate ones. It turns out that they are not only the intended audience of the film but the subject of the film as well. For that matter, so am I.

Insurance as assurance

As he states from the outset, the focus of Moore’s film is not 45 to 60 million people who are excluded from access to care, rather it is a critique of the accessibility of care for those who think they are “covered.” His diagnosis seems to be that the private managers of care access consistently manage costs (and maximize profits) by ensuring that it is difficult to access care in the event that you actually need it. The more serious the ailment or injury the harder they try to impose constraints. Why are we surprised by this? Isn’t this the same sort of behavior (minimizing liabilities and maximizing gains) that we celebrate elsewhere in society? What would ever have led us to believe that things would be, or should be different in the domain of health care? I realize these questions bespeak a kind of naiveté, but I think these expectationsnot only have to do with caring labor itself but actually with the expectations/entailments that surround insurance. It is here what we expect and what we actually obtain diverge most widely.

Insurance, Uwe Reinhardt observed, is a socialization of risk whether it is delivered to us by the state or purchased from a private firm in the market. This socialization of risk, on a fundamental level, is simultaneously the creation of a fund that mitigates risk by entrusting the eventuality of illness or injury to an imagined community. The very nature of the service that “insurance” provides invites us to have faith that our needs will be met, that we will be taken care of, should the need arise. What Moore reveals is the chimerical nature of this social contract in the United States—this feeling of being “covered” lasts only so long as we do not need to actually access the health care system. Insurance is understood as the assurance that things will be okay. For many people, when the need actually arises, these assurances often reveal themselves as a cruel joke.

From “profit” to “surplus”

Part of Moore’s agenda is to challenge the idea that “profit” should have anything to do with health care or its allocation. I will return to this point at the end and argue that those of us who would like to see “profit” eliminated from health care must be equally insistent upon our support of an allocation of “surplus” for care. This is not a point that we can approach directly. The distance that separates “profit” from “surplus” is vast and must be traversed in precisely the way that Moore suggests—through a sort of “cultural” shift in perspective. By digressing into how the film (and Moore himself) has been received by critics I think we can brush in broad strokes the kind of cultural transformation Moore is attempting to produce in his films before addressing what might be missing from our perspective (as anti-essentialist Marxists).

In reading reviews of the film, two remarks seem to appear over and over again (though not necessarily in the same review). First, some argue that Sicko marks a point of departure in Moore’s cinematic career, that it was a sort of strategic move to the center. Unlike the preceding films—Bowling for Columbine and Fahrenheit 911—Moore seems to make a film here that had the potential to speak to the “insured” majority, even to those who would dismiss his documentary efforts out of hand as so much spin. The second common remark was that Moore continues to indulge in a sort of smarmy sentimentality—that he takes over the screen through his abundant corporeality and his willingness to stage an encounter between victims of the 911 rescue efforts and Cuban health care system and rescue workers.

In response to these observations, I would like to make the following claims. First, Sicko should be read as the third part in a trilogy and that its main argument entirely consistent with the themes that he explored in his previous two films. Second, Moore’s ‘sentimentality’, which seems to draw such a negative reaction—from “liberals” as well as “conservatives”—, stems from his effort to tell a particular story that makes both “sides” uncomfortable. In each of these films, he produces a complicated representation of the U.S. culture—particularly its tendency towards fear, aggression, and mistrust. This fear/aggression is inwardly directed in Bowling for Columbine and xenophobic Fahrenheit 9/11. In some ways, Sicko brushes up against this culture of mistrust in its most abstract form. The “fear” that this film seems to circle around is the fear that a national health insurance system would result in out-of-control demand—manifesting itself in long lines, higher taxes, and diminished personal opportunity. Moore does his best to allay these fears by interviewing a successful French couple, pointing out that physicians live quite well in the U.K, and that the wait for treatment in other countries in most cases is not too much longer than in the United States.

Ultimately though I think Moore realizes that these anecdotal examples and arguments are not going to be sufficient to produce the cultural shift in perspective that he is hoping for. This fear of the other(’s demand) is not so easily dispelled. It reflects a deep seated economistic belief in America’s “individualist” psyche. The telling moment in the film was when Moore casually asked the French physician if something similar to the French health care system could be created in the United States to which the Frenchmanautomatically responded with an emphatic “NO”. Moore’s hope is to somehow produce a counter-narrative U.S. history and culture, an alternative identity founded in a sense of hospitality and generosity. I think this effort, and its sometimes latent sometimes explicit patriotism, is regarded as hypocritical by his critics on the right and with hostility on the left because it breaks from the usual left-critical agenda. The usual charge that follows this is that Moore is a muddled populist who raises some good points but fails to deliver a comprehensive analysis (a.k.a., to make a documentary film that no one would actually watch).

At the risk of boring everyone in a different way [No Bigbadbull, you are not boring us. Editor.] I would like to take a different critical approach to Moore’s work. Rather than suggest that Moore is a smarmy opportunist, a hypocrite (and he may well be both of those things, I do not know the man) or that he is theoretically muddled, I think there is a way of reading his film in relation to contemporary theory which reveals a depth in the film. My approach here is to argue that Moore’s film reflects some of the decisive issues in contemporary social theory and that there is an attendant theoretical sophistication to the film that he may or may not have been aware.

Moore with Agamben

Moore’s trip to Guantanamo Bay was to demonstrate that the enemies of the United States get better care than the people who heroically attended to the 9/11 disaster (a dramatic move based on the false premise that the people confined there are actually receiving the care the government says they are). If it is not correct to say that enemy combatants receive better care than American heroes (though both parties would fare better under the Cuban system), than what is the correct relationship between the enemy combatants and Americans who are nominally insured but find themselves outside of the care system? This question got me thinking about Giorgio Agamben’s Homo Sacer and The State of Exception and their analyses of governance. What I would like to argue here is that beneath Moore’s false premise—that Guantanamo inmates have universal health care and we don’t—is a more startling truth that also comes through in the film when the film is read in a particular way.

Michael’s false start—his brief consideration of the man who needed to choose between his middle finger and his ring finger (I would have picked the middle, of course) and other examples of the excluded were truly unsettling. Moore lets know that these people—who also look like the average American to his audience—are not the focus of his film. This, of course, begs the question: Why not!?! I think Moore’s strategic decision to focus on the “insured” rather than the uninsured partially confirms a fear that I have about what the usual call for universal access logically implies to skeptics. Namely, if the system is already inadequate, how much will it be helped by extending coverage to 45 to 60 million more people? Of course, the easy way in which the current rhetoric around access has shifted to identify immigrant demand for health care as part of the problem reveals the extent to which the broader public is unconsciously invested in a logic of scarcity.

Here I am reminded of Agamben’s reflections on the role of both an excluded other (the terrorist) and the state that defines itself as the exception endowed with the ability and entrusted with the duty to suppress this disruptive power of the excluded. The logic of the constitutive exception and its counter part, homo sacer, work to define the parameters of citizenship—who is under the law’s protection and who is beneath it--but they function as a conceptual topology. The example Agamben gives us is that of the ban—in which a person is simultaneously outside of the law of one state while also being clearly defined by it—that what emerges here is a zone of indetermination where the banned is simultaneously inside and outside of the law.

[It's not just the identity of the citizen that is defined within this topological space but their rights as well. In some sense we can see already that a citizen’s right to care, is only secure so long as the rights of non-citizens are denied—though really we should not accept this at face value (most Europeans would insist on carrying travelers insurance within the United States but in other countries, the need for treating foreigners is more or less just seen as a cost that can be socially borne.)]

Zizek’s chilling observation is that the meaning of this zone of indetermination establishes the exception and the excluded other is precisely to be found in this conceptual indetermination, its expandability. We are all, potentially, homo sacer: A subject that can be killed without being sacrificed.

Linda Peno, in her testimony before congress, spoke precisely on this point. Working for a private insurance company she condemned people to death without it being deemed a murder but is instead a justifiable denial of treatment. I think Peno’s testimony brings something about insurance secured through a private company into relief. The “buyer” of insurance is not in a position to understand all the contingencies that might emerge in relation to choosing one particular insurance plan as opposed to another. It's true, access to medical care in countries with socialized medicine can be restricted to medicines and treatments with proven (as opposed to experimental) efficacy but the fact that this is done through the state means, in theory, there is political redress.

Consider for instance the following scenario. If I were to have Blue Cross medical and discover that I had a condition that required a treatment that they refused to pay for, it would, at that point, be too late to switch to another plan and would most probably be too large an expense to bear myself. Faced with such a predicament, it is usually understandable for the afflicted individual to exclaim—“Why did I bother with insurance when they are not, in fact good for anything?” There are two possible explanations for this. When we secure insurance (whether we purchase it ourselves or obtain it through an employer) we are not paying into a bank that will payout in our time of need, we are in fact paying for the insurer to act as a broker of sorts, effectively securing a rate of discount for us with a physician or hospital—paying these providers a certain amount and leaving the remainder for us. While insurance is, as Reinhardt says, a collectivization of risk, which risks are deemed “acceptable” and “worth taking” are not specified beforehand because they are at the discretion of the private insurer. The decision as to whether or not to pay for an experimental treatment for stage IV breast cancer is something an insurer decides—it is not, in a straightforward way, up for negotiation. Is it not the case then that the insurer acts as Agamben’s sovereign—as the entity that administers bare life?

Totalitarianism Insured

“Politics in our age had been entirely transformed into biopolitics was it possible for politics to for politics to be constituted as totalitarian politics to a degree hitherto unknown.” (Agamben, Homo Sacer, 120)

As the film underscored with several examples, this privately administered zone of indetermination that separates inside from outside, the insured from the excluded, is administered retroactively—the example of the woman who was denied treatment for a serious illness because she had failed to disclose an aspect of her past history (a yeast infection). It is easy enough to recognize the “totalitarian”/undemocratic way in which health care access is allocated. I am not sure however that this is the real scandal. My diagnosis is that, on a certain level, most people in the U.S. would prefer to have a bio-politics of administration than to wrestle with the difficult issues—ethical and economic—as it pertains to the allocation of care.

This freedom from worry and ethical responsibility has a price.

As much as I think Moore might be right that the U.S. culture is currently dominated by fear as well as a calculating mistrust of the other’s demand (for care, for work, etc.), I am not sure that the correct solution is necessarily to just remind Americans of their generous and charitable past. At the same time, I think what needs to be confronted more directly is our passivity. Just to speculate for a moment, what if the ideological comfort that insurance as it currently exists offers is that the anonymous bureaucrat does the wet work of sacrifice without our having to know about it?

There is another, larger question, that Moore raises without really pursuing it too far. Social security is a collectivized response to the problem of old age and the need to reproduce oneself after one has stopped working. As Hayakawa pointed out in the early 1940s, there is an important difference between how we understand social security and the way we think about various “social entitlements”—welfare payments, food stamps, and Medicaid. Social security is understood as a universal system that is not administered on the basis of need—rather it is a social guarantee that we can enforce because everyone is perceived as having “paid into” the system. In contrast, programs like Medicaid are a type of entitlement that accrues to some because of their indigence, but not to others. The recent declaration by President Bush that he would veto the measure to extend SCHIP (the program that insures children in families that earn up to three times above poverty) is a case in point as to how decisions get made in relation to needs-based entitlements—who gets it, how big is the entitlement, and how long should it last, lest we encourage the dreaded “dependence” are all relevant questions because of the basic way that we perceive these types of social reproduction.

In principle, of course, I do not have a problem with the ethical standard—“from each according to their ability, to each according to his need”. The allocation of care, social support, and welfare is always going to be conducted in relation to this ethic because the need for care is not evenly distributed and capacities—no matter how blessed we are—are highly contingent. Perhaps our resistance to thinking of health insurance as a type of social security—as something that all are entitled to regardless of need—could be overcome if we came to see ourselves as having already earned it.

I think there might be a number of ways of doing this that carry us beyond what gets represented and discussed in Moore’s films—though he comes closest in his interview with Tony Benn—and back to some of the very issues that Saint ymM represented in his post on the subject some weeks ago.

commercial crusades

Illegal Attacks is the new single from Ian Brown (of the Stone Roses fame) featuring Sinead O'Connor in the backing vocals. The video and the lyrics are below.

So what the fuck is this UK
Gunnin with this US of A
In Iraq and Iran and in Afghanistan

Does not a day go by
Without the Israeli Air Force
Fail to drop it’s bombs from the sky?

How many mothers to cry?
How many sons have to die?
How many missions left to fly over Palestine?
Coz as a matter of facts
It’s a fact, it’s an act
These are illegal attacks
So bring the soldiers back
These are illegal attacks
It’s contracts for contacts
I’m singing concrete facts
So bring the soldiers back!!!!

What mean ya that you beat my people (2x)
And grind the faces of the poor

So tell me just how come were the Taliban
Sat burning incense in Texas
Roaming round in a Lexus
Sitting on six billion oil drums
Down with the Dow Jones, up on the Nasdaq
Pushed into the war zones

It’s a commercial crusade
‘Coz all the oil men get paid
And only so many soldiers come home
It’s a commando crusade
A military charade
And only so many soldiers come home

Soldiers, soldiers come home
Soldiers come home

Through all the blood and sweat
Nobody can forget
It ain’t the size of the dog in the fight
It’s the size of the fight in the dog on the day or the night
There’s no time to reflect
On the threat, the situation, the bark nor the bite
These are commercial crusades
Coz all the oil men get paid
These are commando crusades
Commando tactical rape
And from the streets of New York and Baghdad to Tehran and Tel Aviv
Bring forth the prophets of the Lord
From dirty bastards filling pockets
With the profits of greed

These are commercial crusades
Commando tactical raids
Playing military charades to get paid

And who got the devils?
And who got the Lords?
Build yourself a mountain, drink up in the fountain

Soldiers come home (4x)

What mean ya that you beat my people (2x)
And grind the faces of the poor

Teoman Aktürel (1932-2007)

[Teoman Aktürel, poet and translator, passed away on the 13th of July, 2007. His formal education is in French Language and Literature and Economics. He was a family friend. While I was in high school, for a while every Sunday, before going to grandma for lunch, I would go to his small one bedroom apartment in Caddebostan, Kadıköy and practice French with him. Mostly, he would be just waking up, smoking his Birinci cigarettes. I would make him coffee and help him tidy up his perennially untidy apartment with piles and piles of books, journals, manuscripts, weekly and monthly literature magazines and newspaper clippings. Though I was not really a leftist then, I was begining to appreciate his left perspectives. At that period, I read his translation of Philippe Soupault's Charlie Chaplin (Şarlo) with fascination. His use of Turkish language was clear and sharp. While he insisted on using new Turkish words, he always did it gracefully, without sounding too obsessed with it. I really began to appreciate his poetry only later, in the early nineties, during my college years. For the Istanbul based post-punk, high-art to low-art fanzine Mondo Trasho (cannot remember which issue), I made a page using his poem "Devrim" ("Revolution"). I found this poem below in a collection of selected translations of contemporary poetry from Turkey.]


Poppies Bloom on His Poor Face

In the August heat, in Pergamon
I bent down and drank from the "Sacred Spring"
In the late afternoon
I watched the "Small Theater" in amazement

Opposite me, angry, hurt, sat Apollinaire
Shaking his bandaged head at me
In his mouth, that bitter tune "Au Prolétaire"
He moved to one corner, feeling very sad

Prisons are full up to to the brim
The number of licensed ladies is increasing
Olive branches, corn silk
The rich forever enjoying themselves

The truth is moaning under pressure
Mornings I'm on the sands, evenings on the Island Cunda
Wineglasses clink in Greek and in Turkish
Lover of love, I'm "both the dagger and the wound"

The sun sets, the moon rises in the gulf
Cheerful songs ring through the shimmering light
Women and men are all out in the open
Clapping hands, playing, dancing

The song-maker is searching for a rhyme
His eyes resting on the young girl's breasts
And he offers her some mint-candy
His heart inside the wrapping paper

Poppies bloom on his poor face.

Translated by Yurdanur Salman
"Zavallı Yüzünde Gelincik Açıyor" (unpublished poem)
as published in Contemporary Turkish Poetry: A Selection, edited by Suat Karantay, Istanbul: Boğaziçi University Press, 2006.

Refugees...Until When?

1 refugee camp, 20 kids, 11 villages, 8 of which are only remnants, or not even that. These are the stats of the Birthright Replugged trip that I helped run a few weeks ago. I’m not sure where to even begin to explain the significance of this trip.

The kids are all under the age of 16 and from the Jenin Refugee camp. The city of Jenin is in fact mostly the camp, housing refugees from the ’48 Nakba. The camp is massive, and was majorly destroyed in 2002 when Israeli forces besieged the city, entirely leveled flat huge areas, killed more than 50 people, and left more than 4,000 homeless (again). Temporary tents were set up to house victims after the siege, in the same exact place as the original tents of the camp from 1948.

Many of these children have never left the camp, and for some, sadly, it will have been the only time. When they turn 16, they will get a huwiyya, an id card, and will be subject to the travel restrictions on Palestinians, which means that they will not be able to travel into ’48 Palestine, and that their travel around the West Bank will be seriously restricted, and at times cut off at the whim of the Israeli military administration. This particular group of kids are all involved in the activities of the Freedom Theatre, and their families all come from 11 villages in the north of 1948 Palestine.

So why are these called “villages of origin?” Well, first of all, these villages continue to be identity markers for these children. They all know their villages of origin, often know so many stories of those villages, and in some cases, still carry the nuanced dialects of different areas. Their families often still have the keys or the land deeds to the original houses fled from in ’48. The elders know the land like it is their own bodies, and can tell you how many meters from the house was the well, how many steps to take to get from this tree to that.

But the children? They are 3rd generation refugees, and most of them don’t know any world besides their camps. The camps, once an amassment of UN tents, are now cities, albeit rough ones made of concrete houses tightly packed together. Some of the children have been displaced in their lives too, due to home demolitions, a favoured tactic of the Israeli forces to address “security issues” which can range from collective punishment for the family (or neighbours) of a resistance fighter, to making way for settlers or army roads to accompany the apartheid wall. But these kids do not “know” their villages of origin in ’48, they have never seen them, and as I said before, most of them are amongst the more than 400 villages destroyed in ’48. So what does it mean to take kids “back” to their villages? Indeed, the rhetoric of origins and return is loaded since Zionism has used that language to talk about Jewish “return” to its “origins.”

first trip to the sea
The Replugged trip has various goals and aims. One is to just help the kids get out of the camp, to see other settings, to visit the sea, to sleep a night without the sounds of Israeli incursions. Since the adults of the camp are prohibited from traveling, this is one thing that internationals can help with. But the main goal is to creatively work towards the right of return, as it will not come just through political negotiations (this may be the last step, if it is ever possible), but through maintaining connections, and freeing those connections from the confines of the memory in the camp, to allow for the children to start developing their own dynamic relationships to their grandparents memory, and to envision what the right of return means to them, what it will look like taking into consideration the facts on the ground.

It was nothing short of appalling to be on the bus with them and to arrive to their villages, of which they may have a clear picture in their mind, and then to find that it is a dog pound, a garbage dump, a military base, a JNF forest, or a Jewish only settlement. I witnessed such heartbreaking confusion when we rolled into a modern kibbutz with swimming pools and palm trees and the kids asked, is this our village? Are these our houses? Will they be our houses again one day? In another case, in the infamous town of Ayn Hawd, where the original Palestinian houses were taken over and “maintained” by Israeli artists, while some of the refugees settled only meters away on a hill, where they can see their houses and occupiers. One of our kids from Jenin went to her grandfather’s house, now occupied by a shirtless artist who told her unthinkingly that she can come back (to visit) anytime, and another child retorted “actually she will turn 16 next year, and will be prohibited from leaving the West Bank.” This exchange is typical of a liberal Israeli attitude towards Palestinian refugees, i.e. at our convenience you can visit, so long as you are otherwise caged into your ghetto.

So how can we follow up from such a trip? The kids are working on an exhibition with the photos they took on the trip, which will debut in Jenin and then travel to the U.S. to get their stories out. Outside of Palestine, we can support Palestinians working towards the right of return. This is one of the three conditions agreed upon by over 170 Palestinian civil society organizations in their call for the international community to boycott, divest from, and impose sanctions on Israel. And for the kids? They now have a new collection of images and a new set of difficult questions to guide them in their quest for return, and they

will be the new leaders of the movement to liberate Palestine armed with their experience, dreams, and their questions that will compel them forward.





Asma drums on the site of her village of origin, destroyed in 1948

Through A Glass Darkly

A few days ago, at a table, where ymM was also sitting, I dared to argue... it was a small gathering of four of us after having watched Cuaron's recent "Children of Men"; we were, you know, chatting on film and philosophy (how the latter shall be handled in the former), strangely lost somewhere around the discussion on the decadent environment in Turkey... Anyway, there, under these utterly hollow circumstances, in front of everybody, I dared to argue that Bergman is, to put it politely, not as important as people usually consider him to be.

Of course, it was just for the sake of provocation but the whole thing failed. No one at the table took me seriously, and the chat went on. Monsieur F., sipping his cold white wine, explained us why Turkey will soon turn into South Africa. Mobs will shot "blacks" on streets. We did not oppose, it was too late and too mellow, and too hot.

After two days, Bergman died. I cannot imagine a more terrible position that a self-proclaimed cinephile can put himself into.

But there is more.

After years of deferral, resistance to the urge of swallowing his filmography wildly, I had finally given up, the day before this small gathering, I watched "Smiles of a Summer Night" after breakfast, "Wild Strawberries" in the afternoon, with tea and biscuits, and finally "Seventh Seal", as it deserves, just before midnight. When I went to bed, completely baffled, it was different, i was able to say to Salkim. Dreyer, Tarkovsky, something; but different. Then during the weekend, we watched "Through a Glass Darkly" and "Winter Light" (the first two films of his famous trilogy; "Silence" which I haven't seen yet, is the last part). He was still alive then and we were falling in love with him. And he died.

***

Two personal reasons why I finally decided to "go back" to Bergman --you always have this bizarre "feeling", even if you haven't seen one minute of his films before, that you have to know his films if you want to think seriously on cinema-- were his constant engagement with the question of God (not "existing" yet always somewhere there) and that he chose the life of solitary artist, on a small island off coast of Sweden (Faro, which I believe he discovered for "Through a Glass Darkly").

humiliating work and the law

i'm trying to think through some issues raised by wilson v. monarch paper co., 939 f.2d 1138 (5th cir. 1991) and similar cases. in this case, a jury found, and the court system upheld on appeal, that the vice president of a company was entitled to millions of dollars in compensation for intentional infliction of emotional distress after being demoted to warehouse janitor. this raises many questions and thoughts that i'd like to explore on an ongoing basis. for now i'll put things in point form, since my thoughts are scattered.

- intentional infliction of emotional distress is not an easy kind of case to win, because the standards for abuse are pretty high. in wilson, the required standard was that the offending conduct (i.e. demoting wilson to janitor) be so outrageous that civilized society should not tolerate it.

- how widespread is the attitude that it is humiliating to be a janitor? do janitors think so? if not, are they simply in denial, or was the jury wrong?

- or is it a situation where the jury believed that the humiliation is not a general social fact but is particular to the former vice president, either because of his idiosyncratic personal beliefs or because of the beliefs prevalent in his social class? it seems unlikely that a jury would find IIED and a judge would uphold it based on beliefs particular to an individual or class, unless it is a class belief shared by the judge and the majority of the jury. not to mention the appellate panel of judges that upheld the finding.

- just what is it, anyway, that makes it humiliating for someone to be a janitor? are the factors purely social or is there something innate to humans that makes such work inherently humiliating?

- if, as i assume, the humiliation of being a janitor is entirely or primarily a social fact, why is such a social fact constructed? and why is a remedy for this humiliation offered in the narrow circumstances of executive demotion, but not in the broader setting of a society that assigns some people humiliating jobs on a career basis? in other words, how does the view that civilized society cannot tolerate the demotion of an executive to janitor reconcile with the fact that the same (presumably) civilized society assigns many people to be career janitors? what does this tell us about the relationship between law and society?

- all this assumes that what the jury found to be humiliating was the job itself, not, say, the fact that the person was forcibly transferred from one job to another, or the fact that someone was removed from a lucrative job. this seems to be borne out: we can safely assume that no jury would find emotional distress for someone who was transferred from janitor to VP, if the judge even allowed the case to proceed to a jury; and the law makes it perfectly permissible to fire a high-level employee for no good reason - certainly it's not considered outrageous conduct.

- one conclusion that can be drawn is that in the eyes of the law, it is much better for a vice president to be fired than to be forced to choose between working as a janitor and quitting, which is always an option. can the conclusion also be drawn that it is better for people in general to not work at all than to work as a janitor? advocates of "welfare reform" suggest that it is more dignified to do any work than to do no work at all. but if this is true, why is it abusive to make a vice president choose between working as a janitor or quitting, but not abusive to simply fire him?

- one possible answer is that we believe in meritocracy: it is not unconscionable to have a society in which some people are forced to have humiliating jobs, because our society allows the individual some agency in determining his or her ultimate circumstances: people who are meritorious (by some definition that we need not look into right now) are rewarded with non-humiliating jobs, while those who are not meritorious must accept humiliating jobs. what is abusive is to improperly assign a meritorious person like wilson to a humiliating job.

- the problem with this is that it is very widely recognized that whatever role merit plays in determining one's job prospects, it is far from the only factor, and circumstances of birth are a major determinant of whether or not one will end up in a humiliating job. and while this fact is lamented among liberals, it is tolerated by them, while illiberals seem to have no problem with it. would such illiberals on a jury not have found for wilson? or is this further confirmation that reactionaries lack analytical and/or moral intelligence?

Health Care Reform Debate and Feminine Sexuation: Passage to the Act

(Dear reader, sorry for the delay in posting--this summer has been one long emotional roller coaster ride so far.)

Part 3 of “Health Care and the Community Economy: Towards an Ethics of Surplus and Geography of Sufficiency.”

Feminine Sexuation and Health Care Reform

So far we have learned what it is like to fail in relation to economic imperative—to fail to balance social reproduction and economic growth … My qualitative research alerted me that it is also possible to fail in relation to one’s ethical commitments.


One interview that stands out in this regard was with Dr. Norman Haug of Del Norte Colorado—driving force behind the creation of The Rio Grande Hospital. Del Norte is a remote town in South East Colorado with a mostly poor rural farming population and a seasonal tourism industry. Like a lot of poor rural communities access to health care was a real problem. Norman was able convince HUD to provide Del Norte with a loan type 242 that allowed for the construction of a critical care hospital to serve the local community. To obtain the grant he had to prove to HUD that the hospital was economically viable.

First Norman needed to raise a 1.5 million dollars in order to qualify for the loan—the first of its kind to be provided by HUD outside of the NY/NJ area. In addition to solicitations large and small the land for the hospital—valued at 400K--was also gifted by a land owner. To prove that the critical care hospital was viable one argument Norman made was that it would serve the tourists that came to the area for hunting and other excursions. The decisive point proved to be the hospitals designation as a critical care facility by Medicare.

This meant that Medicare—the insurance form for 70% of the patients—would reimburse the Rio Grande on a cost basis rather than according to capitated formularies—in the absence of this arrangement, the hospital would lose money. One of the rationales behind the critical care hospitals is that they provide care in sparsely populated areas that would otherwise fail to constitute a viable market.


This leads some to dismiss the Rio Grande as a state charity case but Norman disagrees on two counts: First, We would not argue for the centralization of police or educational services on the basis of market demand… nor should we argue for a centralization of medical services. Second, once transport and higher overhead in urban hospitals are figured into the equation—critical care facilities and rural hospitals are cost effective responses to definite need.

Situating the Rio Grande in the Diverse Economy

It is useful to situate the story of the Rio Grande hospital in the context of the diverse and community economy diagram, with its partial typology of economic difference in the dimensions of exchange, compensation and organization. For those of you familiar with A Post-Capitalist Politics, it will be unnecessary to go over the way in which this representation of the economy as a space of open-ended heterogeneity describes an actually existing diversity of forms of exchange, compensation, and economic organization (the dimension of class). The Rio-Grande is a state capitalist enterprise that exists to serve a particular constituency. While it has clearly been enabled by a generous state transfer from HUD and its designation as a critical care facility by Medicare, it’s also clear that it exists as a community asset because of the generosity of local citizens. In turn, it is a context in which Norman and the other physicians are able to generously serve the care needs of the local and transient population—including legal and illegal immigrants. (45% of care is free care) and the market of insured patients.

Thus the Rio Grande is “viable” because of the support that it receives and because its mandated purpose is to service a geographically finite need. There is, of course, a limit to Rio Grande’s capacity but it no longer needs to be read in relation to infinite demand and self-interested practitioners.

Lacan’s counter-posed feminine logic becomes relevant here. In this view there is no constitutive exception—all are subject to the law, and yet no one is completely subjected. In the world of feminine sexuated logic limits remain, including limits to care, but they are seen as provisional. Here “scarcity,” and the need for “economic growth,” no longer act as over-arching imperative. In my view, it is this move towards the relational possibilities (and constraints) of a feminine logic rather than the fixed miserly injunction of masculine logic that allows us to re-imagine the politics of health care reform in relation to sufficiency.

Feminine logic, as Copjec says, “obliges us to recognize the finitude of all phenomena, the fact that they are inescapably subject to the conditions of time and space and must therefore be encountered one by one, indefinitely, without the possibility of reaching an end, a point where all phenomena would be known. The status of the world is not infinite but indeterminate.”

Health care reform will continue to fail us, but we will fail to arrange and allocate care in relation to an ethical imperative rather than a miserly economistic imperative. We need a language of partial subjection in order to produce a politics of ethical possibility. A sufficient response to definite need is something that is intelligible in the spatio-temporality of needs encountered “one at a time.” Likewise, the range of existing assets, and the generosity of the community—and here I include the state as simply a part of community—needs to be encountered in their particularity also. While this indeterminate mobilization of social surplus, generosity and ethical commitment is what allows for the Rio Grande to succeed—the success of community health centers elsewhere would depend on the identification of definite resources (and constraints) that occur in any given area.

Fifty years ago people took the risk and they built these hospitals, we need to do it again. And we just need to get it done… Get the hospital built and let the person whose going to be here ten years from now worry about it. I mean that sounds callous but that’s what it amounts to. (Norman 2005)

Derrida taught us that an act can only be considered ethical when the outcome of the act is uncertain. What is clear from his statement here is that Norman truly is not clear what the outcome of his efforts will be but he is willing to act anyways. Perhaps Norman’s status as an ethical agent—his willingness to take the risk in order to “get it done”—allows us to see the typical mainstream approach to health care reform, as mired in a masculine sexuated logic of impossibility, as an imaginary solution whose elegance and inevitable failure leaves things exactly as they are. The imagined social harmony between the conservation of capital and the equitable allocation of care is never arrived at and this failure is symptomatic of a castrating approach to health care reform.

In contrast, Norman’s capacity to meet the needs of the immediate community, his adoption of the standard of a sufficient response in relation to definite pressing needs, is sustained not by the idea of a final/fantastic end point but a spirit akin to what Zizek describes as “enthusiastic resignation.” Through Norman we can come to see the difference between the failure to embody (the reconciliation of equitable health care allocation and continued economic growth) versus a failure in relation one’s ethical principles (to care and accept whatever comes as a result of this commitment).

How is that Norman came across this affective disposition, this willingness to pass to the act?

labor unions in the U.S. fight for apartheid!

a recent story in the forward reports that leaders of american labor unions are stepping up to support israeli apartheid by undermining opposition to it by british unions.

many union leaders have signed on to a letter by the jewish labor committee bashing* the growing movement for anti-apartheid divestment, boycotts and sanctions by the british labor unions. these signatories unfortunately include ron gettelfinger, the head of my old union, the UAW. it also includes major unions like the AFL-CIO, right-wing unions like the IBEW and the teamsters, and some allegedly progressive unions like UNITE-HERE. notably absent are the SEIU and the left-wing unions such as UE, who tend not to join the frenzied mob when israel gets challenged.

my old local, by the way, UAW local 2322 in western mass, overwhelmingly - in fact, unanimously, if i recall correctly - approved a resolution to support divestment back in 2003. unfortunately, in the UAW the wishes of the rank-and-file bear little resemblance to what's expressed by the leadership.

this wrongheaded approach by U.S. unions contrasts with their positions during the apartheid era in south africa, where unions worldwide took a stand against apartheid. it also contrasts with union attitudes in the rest of the world, even the english-speaking world. in britain, a number of unions have passed resolutions calling for private sanctions against israel, or for encouraging their branches to consider sanctions. in canada, a major public-sector union in ontario, CUPE, voted unanimously for sanctions.

and of course, south african trade unions, whose membership has directly experienced apartheid and remembers the solidarity of international unions, is far in the lead in opposing israeli apartheid. as willie madisha, president of COSATU, south africa's congress of trade unions, says:

As someone who lived in apartheid South Africa and who has visited Palestine I say with confidence that Israel is an apartheid state. ... workers and democrats of the world ... heeded our call when we struggled against apartheid. Boycotts, disinvestments, and sanctions against the apartheid regime in South Africa hastened our march to democracy. Why should it be different for Palestinians?

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* otherwise normal people often go crazy when israeli racism is challenged. at some point i may tell the instructive story of the hysterical reaction to the umass divestment campaign, including by many people who are considered respectable and who consider themselves progressive.

academy fights: round 2 to the fascists

this past june, professor norman finkelstein was denied tenure by depaul university thanks to a concerted effort by alan dershowitz. yesterday, the university of colorado fired tenured professor ward churchill thanks to an effort by the horowitz-ACTA crowd.

i remember long ago reading an essay by stephen king in which he instructed his readers how to act when they've heard of a case of censorship: to immediately get the censored material and read it. censorship usually targets interesting and relevant ideas. finkelstein and churchill have not been censored, but they have been punished for their political views by a system that is supposed to reward intellectual accomplishment and protect the academy from political intimidation. for the enemies of critical thought, actual censorship is not a viable short-term goal, so they are instead making inroads into a more manageable goal: distorting academic debate by intimidating faculty who are independent-minded and critical in tone.

in the case of finkelstein and churchill, i happen to have read extensively of both of their works, and i recommend them without reservation. they are two of the sharpest analytical minds that i've ever read, and they both write clearly and engagingly on important topics. it is partly for these reasons that they are being targeted by the enemies of intellect. for these reasons i suggest that the appropriate response to this particular attack on critical thinking is to read these authors.

neither decision was plausible on its merits. in finkelstein's case, there was no pretense of applying the universal standards for tenure - quality of teaching and research. he was denied tenure for his "tone". if this seems like a subjective non-standard, that's because it is. he was denied tenure because conservatives don't like what he writes, and because twice he's made the conservative intellectual establishment look very, very foolish. first as a graduate student, by exposing joan peters' anti-palestinian propaganda tome "from time immemorial" as a fraud; then by demonstrating the extraordinary stupidity and absence of merit in alan dershowitz's anti-palestinian book "the case for israel".in churchill's case, there was a pretense of applying a reasonable standard - he was accused of research misconduct. but the pretense is transparent. the president of the university who recommended his termination is a right-wing ideologue who belongs to ACTA, a highly ideological group, founded by lynne cheney and joe lieberman, dedicated to opposing critical thinking in the academy about history and politics. when it became public knowledge a few years ago that churchill had written a highly inflammatory essay about 9-11, the university president promised to subject churchill's writings to an extraordinary level of scrutiny, and convened a committee that did so. in a report that is itself subject to complaints of misconduct (but has not been investigated), the committee concluded that churchill had plagiarized and falsified information relating to native american history, though not in any scholarly writing. the faculty panel charged with making a recommendation recommended against dismissing prof. churchill. as prof. gary leupp has suggested, if "boards of regents in this country were to investigate and punish the falsification of Native American history by scholars, or if society in general were to investigate such falsification in the media, popular culture and political discourse, we’d all be in for a very time-consuming process resulting in a whole lot of people out of jobs." the president, however, overruled the faculty's recommendation and recommended dismissal to the university's board of regents, which rubber-stamped his recommendation 8-1, with no public debate.

these attacks on the academy can't be seen separately from the ascendancy of fascism generally, including the bush administration's war on civil liberties, the erosion of institutions and laws intended to protect us from centralized power, and the increasing concentration of wealth and centralization of power, in this country and worldwide. follow my recommendation, do yourself and the world a favor, and read finkelstein and churchill.

dissertation title #36: David Lynch, or the Feminization of Alfred Hitchcock

the saint, as always, proves inspirational