Someone said, on a post I reblogged recently, that we need a good anarchist answer to the tumblr question du jour about insulin and how it would be produced âunder anarchismâ.
I suggest the answer has already been written, and that if you read Kropotkinâs âThe conquest of breadâ (yes, itâs all Iâm banging on about at the moment) you can in fact apply the chapter on food to any essential of modern life that requires processing and is an immediate need.
Kropotkin was obviously writing at time when medicine was much less advanced than it is now, and I think it is necessary for modern anarchists to address the question directly. It does not apply just to insulin, but to many lifesaving drugs which are needed by people in the long term, as well as more short term medication, such as antibiotics, as well as preventatives such as vaccines. These are things that are essential in the modern world, and we should not accept that the revolution should not provide them, just as, as Kropotkin contends, the first concern of the revolution must be providing bread.
We cannot sit in our âtalking shopsâ and discuss the provision of medication whilst people die- to do so would be to doom the revolution to failure, just as the French revolutions that Kropotkin references were doomed due to their inability to provision the people with food.
Yet we must also acknowledge that right now, even in ârichâ or âcivilizedâ western countries, there are people languishing due to lack of medical care, lack of access to drugs, indeed, including insulin. At the moment, the American government is engaged in the question of whether to cap the price of insulin at $35 a month-at the moment, people have to pay up to $300 a vial, and die for want of insulin. Which is, perhaps, why it is an issue present at the forefront of peopleâs minds, right now.
Anyway, what is the solution to providing insulin and other drugs during and after the revolution?
Kropotkinâs plan for bread and food is relatively simple, and I believe without much difficulty it could be reapplied to medicine.
Assuming the revolution takes place in a western country, there will be an existing supply of insulin (or whichever drug) in that country. All the drugs, held in pharmacies and hospitals, would need to be carefully catalogued and identified, and held in common by the revolutionaries. This, I believe, would not be difficult to do- just as Kropotkin says that committees of workers can do this for food, then I think committees of workers, ideally with the aid of a pharmacist, could do this for medicine.
For clarity, we are not talking about seizing medicine held in private homes, just that held by pharmacies and hospitals. (This is perhaps more relevant to the bit where Kropotkin talks about coats, and how he does not want to seize peopleâs coats, though this may be attractive to the shivering).
Then, the medicine that exists can be distributed according to need (rather than according to who has the ability to pay).
This would deal with short term need in the immediate aftermath of the revolution, and would hopefully provide an adequate level of medicine for all. Would it provide perfect medical care for everyone? Perhaps not, but neither does any extant system under capitalism, and it would at least be fair- because it would be done by the people, for the people and done according to need, not wealth.
So, what then? How do we obtain, or make, more of each medicine?
The process of making a known medicine is, in general, not that difficult. One needs the correct equipment, and the right âingredientsâ but itâs a process that a lot of people can complete with relevant training. Many people will work in this industry without being degree educated, or having a high level of scientific knowledge- these people are by every definition âworkersâ and the hope of the revolution is that they would happily share this expertise with the rest of us, and we could all take a share in this sort of useful work.
If that seems naĂŻve to you, then I think further work is required on your part to understand what is meant by âanarchismâ and âworkerâ and ârevolutionâ and thatâs outside the scope of this essay.
A lot of the posts I see about this seem to assume all the infrastructure would be destroyed in the revolution- but thatâs not the aim of the revolution. Equipment might be damaged, but workers have the skills to mend it, or assemble a similar process in an equally equipped lab.
The aim of the revolution is not to destroy every laboratory or factory in the country or the world. If this happens, one might argue that the revolution has already failed. The aim of the revolution is to take over the means of production and use them for the good of everyone. I think many people are trying to argue about the production of insulin (or other drugs) in the post apocalypse, and this is not the same as post revolution. It is very important to understand that! However, personally, I would rather live in an anarcho-communist society post apocalypse, than in a individualistic one clinging to the old ways of capitalism- but again, that is outside the scope of this essay.
Therefore, we, relatively quickly, post revolution, are likely to have the means available to make many common medications and provide them to the people in need of them. I will talk, shortly, about how one obtains the raw materials needed for this, but let us assume that some quantity of the raw materials will be available in the places where these things are made.
I want to talk a little bit about work now, because yes, making these things will require a level of work. People already do that work, and are, of course, paid for it. I believe many young people who look to anarchism look for a world without work- but that cannot exist- even in the âfully automated luxury space communismâ of our memes, work would be needed of some kind.
The point is that the work would be significantly lessened and done for the good of all. The worker would be assured of good housing where they did not have to worry about turning on the heating, or using energy, with a supply of varied and interesting food, and all the basic things necessary for their wellbeing (think how many workers currently rent insecure and inadequate housing, think about the stories about nurses using foodbanks- this is no small gift).
Moreover, there would be many people engaged in what we might consider âuseless workâ in fields such as property or finance or âgovernmentâ or indeed the provision of services to the wealthy, who would now have no work to do. These people, many of whom are not wealthy, may be willing to spend an hour of their day, or a day of their week doing work that is useful and beneficial to someone, given that all their basic needs are provided for. And so, the lab worker, who was working for five days a week, for eight hours a day, now only needs to work for three days a week, then perhaps two, or only half days- and therefore their life is further improved.
I am not talking about forced labour here, but I do believe that people would do it- because it is necessary, and it would not be hard. We canât pretend that difficult jobs (and I think there are far more difficult or unpleasant jobs) would go away under anarchism. But I think if people knew they would have a good standard of living, and only needed to work for, say, 10 hours a week, they would do it. People would do it for the good of the community, because people are fundamentally good, and care about each other- âanarchy is for loversâ as it were. And again, if you donât believe this, then there are far more fundamental problems in your understanding of anarchism, and they are outside the scope of this essay.
So, we have dealt with the immediate provision of insulin and other medicines, and we have dealt with the question of work. However, there is, perhaps, a more difficult question about obtaining raw materials. Many medicines, and their packaging, which keeps them safe for use, are complex and require complex ingredients which need to be obtained, and may well need to be obtained from outside the country or the area where the revolution has occurred.
Again, we return to Kropotkin and his bread. Kropotkin imagines a revolution occurring at first in one city (Paris, because the Paris commune is his model). Paris has no means of immediately producing more bread, and in this model, the countryside is not yet part of the revolution. But Kropotkin proposes that the city can produce things that are useful to the peasant farmers of the countryside and trade with them for bread, or the ingredients of bread, essentially by barter, offering them things they previously could not afford. (This, in turn, helps liberate the farmers).
So, this is difficult in a globalized society, where ingredients may come from other countries, and the movement and supply is run by large companies.
Firstly, the job is to find out what ingredients are needed. There are people (many) who know this, and companies keep records.
Secondly, youâd see which materials you can produce yourselves, or recycle. In the case of insulin specifically, itâs actually produced by gene editing certain bacteria and harvesting the products. As long as you keep the extant bacterial colonies alive, the raw materials needed for production are relatively minimal, and the packaging is something that is relatively easy to produce. I think there are drugs where obtaining them would actually be far more complex than insulin.
Thatâs obviously a very short step for a very difficult process, but with the relevant scientists (and there are a lot of them) given all the resources and help possible (which is not what they get under the current system) I do believe that many creative solutions could be found. And there would be a high level of help available, including from many, many people employed in the pharmaceutical industry in previously redundant roles such as âsalesâ and âmarketingâ- who still, often, have relevant scientific qualifications.
So, what about the things we canât produce or recycle? Things we may need to obtain from an area outside of the revolution? Itâs true, here, things become difficult, and of course we have to consider the issues of other powers imposing âsanctionsâ on the area of the revolution, as happens to countries such as Cuba, and Venezuela, and so on.
I do think Kropotkinâs proposition of direct barter with workers has merit. It is more logistically difficult when larger distances are involved, of course, but itâs something to be attempted, and has the added bonus of undermining capitalism in the areas of the world where it still exists.
I think we know, unfortunately, without the optimism of the early 20th Century, that revolution is slow to spread, and will be resisted in the strongest possible terms by capitalist powers. Therefore, for those of us who live in Capitalist countries, I think there is a very strong duty to aid any country where revolution is taking place or has recently taken place and to resist any efforts of our own country to impose sanctions, etc.
That said, those of us in âwesternâ or wealthy countries have got used to depending on the resources of poorer countries- despite the fact that the empires of Europe are (largely) a thing of the past, countries still rely on system that is not so different to the colonial era. Some countries supply things to make other countries wealthier, whilst their own people suffer in poverty. This situation cannot be allowed to continue, and that is a problem that decentralized anarchist communities would have to grapple with. However, it may be, nonetheless possible for these communities to assist those in poorer communities and be repaid through a system of barter.
I do believe by the means Iâve described so far, most medication, and indeed most things considered essentials to wellbeing in modern life could be provided after the revolution, and in a better, fairer way than after capitalism.
However, perhaps we should talk about shortages. Itâs true, shortages may exist. Capitalism is no protection against shortages- however, under capitalism, there is a mechanism of distribution during periods of shortage. Those that can pay the most get the item. When there is a shortage, prices rise, the rich pay, and the poor do without (or die).
Under an anarchist system, or an anarcho-communist one, at least, resources will be allocated according to need. Those who need the thing the most will get it. If there are lots of people in need, and not enough to go around, then a system of rationing may need to be implemented. Is this perfect? No. But is it fairer? Yes.
And during that rationing of that thing, people will at least be provided with the other things that can be provided- that is to say they wonât be selling all they own, or taking on excessive debt in order to try and get the thing. And they will know that people, very many people, are working together to try and get them the thing which they need.
I donât believe itâs reasonable to hold any system set up in opposition to capitalism to the standard of perfection, certainly not in the immediate aftermath of revolution. The standard should be âsignificant improvement on capitalism for the majority of peopleâ perhaps- and I believe fair provision of medicines without cost to the person who needs it is much fairer than current systems which exist in many so called âdevelopedâ countries, where people still die directly of poverty related causes, whilst the rich have so much surplus. Â
Taking the specific example of insulin to, perhaps, a worse case scenario, it is possible to obtain usable insulin from the pancreases of cows and pigs. Obviously this is very, very far from ideal, and would only need to be used in extremis, due to short term problems with production, but as an option it does exist. In examples that assume widespread destruction, this seems the most practical way of getting insulin to tide people over in the short term, whilst we rebuild. But as I say, such widespread destruction is not the aim of revolution, nor necessary to remove capitalism.
But the point is that for insulin, and most modern medicines that exist, the work of making them is not so different to working in a factory. There are lots of people who do it, lots of people who know how to do it, instructions held by companies on how to do it, facilities to do it or that can be adapted to it, and so doing it post revolution is not such a difficult problem.
The difficult work, for insulin, has already been done- that work is a) identifying the problem that causes the illness, b) finding a cure and c) finding a way to mass produce that cure.
On January 23rd, 1923 Banting, Best, and Collip were awarded the American patents for insulin. They sold the patent to the University of Toronto for $1 each. Banting said: âInsulin does not belong to me, it belongs to the world.â His desire was for everyone who needed access to it to have it.
Under capitalism, one will note that desire has not been met.
But this is not some esoteric knowledge known only to a few. Itâs knowledge that is widely held, understood and accessible, and that post revolution can be taught to even more people. In the shortest term, immediately after the revolution, itâs possible that there may be some problems with the supply of some goods, and yes, that may include insulin. Itâs most likely, that in the medium to longer term post revolution, the production of insulin would increase, and it would be more accessible, not less- because it wouldnât be limited by patents, by private companies, there wouldnât be the desire for profit making. There would be work involved in its production, but the work would be shared fairly, the workers would live in comparative security compared to today, and the products of that work would be shared fairly, according to need.