Sam Kelly runs Red Medicine, a podcast about health, medicine and politics. The podcast’s new project, the Anti-Self-Helpline, invites listeners to submit their emotional struggles within political organising. Beatrice Adler-Bolton and Artie Vierkant – alongside Phil Rocco, Jules Gill-Peterson and Tracy Rosenthal – are cohosts of Death Panel, a podcast about the political economy of health. Adler-Bolton and Vierkant’s book, Health Communism (Verso, 2022) draws on the history of capitalism and health to present a case for the total reimagining of care.

SK Overwhelmingly, the discussions we hear about health and healthcare are about personal responsibility, scarcity of resources and austerity. We have this idea that health and illness are individualised phenomena, and we should deal with them ourselves. With Death Panel and Red Medicine, we are both trying to cultivate a more collective understanding of health, situated within an analysis of the political economy. Could you both describe how Death Panel has become a place to challenge these mainstream discussions about health, illness and wellness?

BAB I always start with thinking, why does it matter? That’s partially because the individuation of health is such an awful experience. In our systems, suffering is isolated and individuated, and it can be really crushing to be sick. To feel like it’s your fault can be so alienating, which is a structural issue, but it is easy to feel it’s personal. That’s why it is important to build solidarity with other people, to not feel so alone. You’re not “bad” and you haven’t made a mistake, even though that’s what the system is trying to tell you, because that’s a much easier way of writing off the structural problems that contribute to health. That your asthma is your fault, it’s not a problem with the air, pollution, housing, work conditions or the care you receive. It’s an important analysis because it’s correct historically, materially and politically, but it also gets at the emotional burden of health individually.

AV We started Death Panel in 2018 at a time in the United States when there was a growing conversation about Medicare for All, and a public movement for it. But the prevailing liberal project around health was centred on defending Obamacare, the Affordable Care Act, and expanding tax subsidies for health care. In other words, not changing anything fundamental about the system, which has been broken fora long time – the UnitedHealthcare CEO shooting happened last year, but it could have easily happened at any point in the last half-century. But so much of the discourse around that liberal project of health is centred on what capitalism tells us about health, that it’s a burden on society as a whole. This burden is described in two ways: both as the “eugenic burden”, the idea that the sick or disabled are a blight on humanity itself; and also the idea that the sick are a financial burden that must be rooted out and restricted. This is the ideology that lets the state cut benefits and abandon people to premature death under the mantra – “waste, fraud and abuse”. When we started Death Panel in 2018, we were trying to fight back against this fundamental agreement across the political spectrum where the priority was not whether people were having their needs met, but whether we were adequately punishing an imaginary class of “undeserving” poor. Since 2018, Death Panel has built a coalition who reject this politics of abandonment and disposability. That eugenic and extractive logic has only further calcified in the political mainstream.

The “One Big Beautiful Bill”, as it has been labelled by Trump, was passed by US Congress in May 2025 and signed into law in July 2025. It poses cuts to food benefits used by 40 million low-income Americans and cuts to MedicAid of about $930 billion, whilst increasing the US military and ICE budgets by $150 billion and $100 billion respectively.

BAB In 2018, the wider political conversation, especially in the United States, was that health care costs too much. That perspective ignores the cost of people’s care needs and is never going to cost any less. Since then, there has been a proliferation of projects and organising that interrogates what it takes to be healthy, not just individually, but systemically. As [prison abolitionist and prison scholar] Ruth Wilson Gilmore says, it is a question of having to change everything.

SK While it has been bleak in the US for a long time, the current Trump administration seems to be operating in a different capacity compared to 2017, with terrifying developments happening in relation to Immigration and Customs Enforcement (ICE), which is not unrelated to healthcare. Figures like RFK Jr. are central to this project – he’s been assigned the role of Secretary of Health and Human Services and is fronting this project to “Make America Healthy Again”. How would you describe the transformations in the Trump campaign, and why is health and wellness central to the project?

BAB The United States is bleak – it doesn’t just fail people, it actively abandons, immiserates and bankrupts them. Understandably, frustration, rage and despair build, and that’s the desperate soil in which RFK Jr. planted his “Make America Healthy Again” campaign. People want health care that works, and they don’t want to have to choose between taking their kid to the doctor or paying rent that month. RFK Jr. is offering a fix: if you do everything right, you won’t really need health care. But it’s all smoke and mirrors. You can’t simply use raw milk and vibes to free yourself from the obligation to need health care. With cuts to Medicaid and the imposition of work requirements, they’re making things worse at an emotional and effective level; avoid seed oils, don’t vaccinate your children – everything becomes an empire of choice.

Ruth Wilson Gilmore is a prison scholar and prison abolitionist. She’s currently the director of the Centre for Place, Culture, and Politics, and Professor of Geography in Earth and Environmental Sciences at the Graduate Centre of the City University of New York. Her most recent book, Abolition Geography (2022), compiles her work on abolition from the past three decades.

AV The particular confluence happening in the US right now among the right within health politics is not a coalition I would have imagined could have found quite as much power and cohesion as quickly as it has. Liberals have yet to fully reckon with it. There are two parts of the coalition currently, which have allowed the right to dominate the narrative on health in the US. On one hand, there is the individualistic slogan “Make America Healthy Again”, fuelled by eugenicist language that we’re fundamentally healthy and somehow not capable of being disabled. On the other, when the culprit is systemic, it’s the idea that beneficial health interventions like vaccines are harmful. Both distract from the systemic injustices that harm us, like environmental devastation or capitalism itself. This then hybridises with the second part of the coalition, a kind of run-of-the-mill Republican austerity, where the intention is to strip the remaining welfare state for parts. A few weeks ago, the “One Big Beautiful Bill” passed, which will strip approximately $1 trillion from Medicaid. It was presented to the public as a removal of people from Medicaid who did not deserve it, and to pay for a catastrophic expansion of ICE detention. You can see very clearly what the broader political project is here, seizing on health and welfare and who is “deserving” of these programmes, in order to draw boundaries around who is a legitimate citizen of the US. It is a fantasy of who belongs as part of the body politic and who doesn’t. This is also something that will sound familiar to people in the UK who have been hearing similar rhetoric about the NHS.

SK I want to pick up on the profound despair, sadness and pain that capitalism produces in all of our lives. The reactionary formulations of illness and wellness provided by RFK Jr. create a situation in which these experiences of despair can be recuperated by the very people at fault for causing them. In the UK, Labour, the Conservatives and Reform present themselves as being in opposition to each other, yet there is always an underlying agreement around austerity and individual responsibility. We need different ways to contextualise, politicise and make sense of despair. A few years ago, you interviewed Ruth Wilson Gilmore who, I think it’s fair to say, is a shared intellectual lodestar for all three of us. You quoted from an essay of hers called Restating the Obvious (2013), which she co-authored with Craig Gilmore. It reads, in full:

“A state is a territorially bounded set of relatively specialised institutions that develop and change over time in the gaps and fissures of social conflict, compromise and cooperation. Analytically states differ from governments, if states are ideological and instrumental capacities that derive their legitimacy and material wherewithal from residents, governments are animating forces, policies plus personnel, that put state capacities into motion and orchestrate or coerce people in their jurisdictions to conduct their lives according to centrally made and enforced rules.”

There’s a lot going on in that quote, but the more I read it the more clarifying I find it. It offers a starting point for an analysis which could allow us to make sense of experiences of despair, illness and vulnerability. Gilmore does this by making a distinction between governments and the state, illustrating how when you’re in the throes of these systems, it’s very difficult to tell the difference. Anger at the state can be directed into anger at the government. In the US, there’s a sense that Trump and the Republicans are evil, and we need to return to a liberal conception of the state. But as you outline, despite the horror of Trump’s actions, there are consistencies between the two projects. Does distinguishing between government and state give us a way to respond to experiences of despair and pain with something more substantial than seed oils and creatine?

Amid the Covid-19 pandemic in May 2021, Rochelle Walensky, the Director of the US Centres for Disease Control and Preventions, warned, “Your health is in your hands.” In the UK in July, Wes Streeting, Secretary of State for Health and Social Care of the UK, released the Labour Ten Year Health Plan that emphasises individual patient responsibility, promising to “encourage citizens to play their part” through “expanding self-referral routes”.

BAB   Politicians in the UK and US have tapped into the efficacy of conditioning a person to see themself as an isolated economic actor responsible for their own fate. This is a problem that goes way beyond strategies of governance – it’s getting at the heart of the state itself and the conceptualisation of citizenship. One of the things that we hope to offer people with our work is a chance to train ourselves out of these norms that are imposed on us from cradle to grave, and then to move that analysis towards action. We can build mutual aid in our communities and organise to provide each other with care. But if we’re still moving through the world trained as neoliberal subjects, we’re going to reproduce the same oppressive dynamics – rebuilding the same broken house, brick by brick. To break free we have to change ourselves to be able to change everything, and not in a self-help, wellness way.

AV    “Social murder” is a term from the German philosopher Friedrich Engels to describe who, in society, is made subject to negative health outcomes and premature death. We really try to chart how social murder is a fundamental component of the capitalist state, not different governments, in our book. The Biden administration prioritised the economy and private capital value by prematurely declaring an end to the Covid-19 pandemic. We often see in the governance of the state as the reorganisation of social murder, as we’re seeing now with Medicaid cuts and increased ICE raids.

BAB   Changing our perspective on these issues is crucial, because they make solidarity impossible. With the fights over Personal Independence Payments and the Department of Work and Pensions, people are taught to see others as competitors for scarce resources, rather than comrades in a struggle. It’s not just that these frameworks are wrong and bad, it’s that they make it impossible to organise for the world that we want.

SK   Definitely. Once the state develops the capacity to inflict widespread vulnerability – social murder – different forces will put that capacity to work in expansive ways when it suits them. It’s worth noting that reactionary ideas around self-help and wellness have huge appeal because they come with a whole set of social practices, and those practices can be tied into bigger stories that make life feel meaningful and make someone feel like a “good person”. After both of Trump’s elections, there was a scramble for a left-wing version of self-help, ranging from serious proposals to sillier ones. How do you think we can offer a rebuttal to this ham-fisted idea that we need a left-wing version of self-optimisation?

The Black Panther Party instituted multiple school-based mutual aid programmes, notably the Free Breakfast for Children Programme – one of 60 community programmes that provided free daily breakfasts to children across multiple US cities. Twenty thousand children were fed in its first year, 1969. The Young Lords Party of Chicago and New York also initiated significant mutual aid programmes, including bringing door-to-door tuberculosis testing to Puerto Rican communities in East Harlem and the Bronx in the early 1970s.

BAB Self-help is compelling to people because it offers a sociality, albeit a parasocial and distributed form of connection. Part of Trump’s success came from tapping into that wellness angle – it’s clear that connection played a significant role in his election. The real problem is ideological: we are still caught up in this belief of self-sufficiency. If our aim is to build working-class power, fight capitalism and defend universal goods, we’re up against a system that sees universality as inherently wasteful. Self-help and wellness are part of that ideology. We can’t simply appropriate them – we need to understand what actually appeals to people about wellness. That’s often the promise of answers, of making daily life feel less brutal. We need collectivisation, not individual personalisation. No cops, no bosses, no flattering illusions of self-sufficiency.

AV Exactly! So much of normative political discussion is focused on the electoral cycle, which has a counterinsurgent effect. But if the left wants real change, it requires taking risks together – the kinds of risks I won’t specify in print – building on histories of survival programmes and mutual aid, engaging in networks and projects that practise care as we’d want it delivered, not as it’s currently defined. That’s one reason groups like the Black Panthers and The Young Lords were persecuted: many of their actions were a rebuke of disposability that the state found threatening. Without taking risks, we will reproduce the exclusions and austerity seen in the NHS. We are facing “health fascism” in the US, and the antidote isn’t technocratic tweaks or pseudo-psychological solutions. The antidote is health communism: care for all people, by rejecting disposability at its core.

BAB  Projects like ours and Red Medicine have an advantage: we can meet people where they are, addressing alienation and helping people solve tangible problems. That’s what I see you trying to do with the Anti-Self-Helpline.

SK   That goes back to Gilmore’s advice about the election cycle and keep your eyes on the prize – the state. In the UK, it’s easy to imagine a Reform government enacting policies similar to Trump’s. We’re only going to be able to challenge rising austerity if the organised left can meet people in moments of despair – not by peddling the same individualistic answers as wellness culture, but by embracing vulnerability as a starting point for collective struggle. The Anti-Self-Helpline allows people who are engaged with political struggle, whatever that means to them, to write into the podcast with the emotional or psychic aspects of their experience. The Anti-Self-Helpline is about making time to think and talk about how those experiences feel. The idea draws on Hannah Proctor’s book Burnout (2024). Hopefully readers of this discussion have experiences they can write in with. .