What is social ‘isolation’—distancing, quarantine? A paradox: isolation is an irreducibly collective phenomenon. This is so in two senses. First isolation depends on a vast network of cooperative labour that makes it possible. Goods continue to arrive at our door produced in fields and factories, packaged in warehouses, vented in grocery stores, and delivered finally through smartphone connected drivers and the postal service. Only this collective work allows us to ‘isolate’. Isolation is thus both an expression of the division of social labour and a class and racial phenomenon resting on specific material conditions: sufficient resources, security of income, independence of work. No room for moralism here.
There is also an experiential dimension to ‘collective isolation’. To be isolated among other isolating persons is an entirely different experience to that of being isolated among persons who are not isolated. Isolation is not the state of being alone. To isolate is to participate in an experience that is completely common. I feel paradoxically more connected to friends, family, loved ones even through the mediation of technology. (But is technology really so decisive? Certainly video-chats are nice, allowing for the recreation in cyberspace of a whole social life. But if we had only telephones, or the mail, would it be that different?) To be isolated when others were connected, would be horrible. This is some kind of different experience. Isolation is a form of group behaviour; to be isolated is to be part of a collectivity. Could there be a politics of ‘isolation’?
Isolation is also an expression of community, and care for the community. ‘The best thing you can do for your country is stay home.’ So enjoins the liberal press. Thus, an inversion. Sociability becomes an expression of pathological individualism, heedlessness, egocentrism. Isolation becomes a patriotic duty. (But too often its material preconditions are denied.)
Walking. Hegel taught that in the modern state one comes to recognize oneself as a citizen by recognizing the citizenship of all others in the political community. Citizenship is thus a mirror structure of mutual recognition. Coronavirus, however, imposes a new structure of recognition. The phenomenon is evident even in the most mundane activity: taking a walk. Walkers, whether in small cohabiting groups or as individuals, carefully maintain distance by orienting to all other walkers. If their paths could be traced, they would form an elaborate network of braids as streets are crossed and crossed again. But what structure of recognition is this that produces the ambulatory distancing of a walk in the age of coronavirus? First, it certainly is a structure of recognition. The walkers are much more attentive to each other than would normally be the case. The absent-minded, individual, solitary walker of the pre-virus age is nowhere to be found. These are walkers whose dispersion is mutually coordinated by a sustained collective effort. But what does each walker or group of walkers see in all the other walkers? Simply this: the threat of death. Every walker is a potential vector of disease. But, in homology to the mirror structure of citizenship, by seeing others as a vector each walker sees herself as a vector. Mutual recognition is not the mutual recognition of a political status, but a biological one. As such it is also completely universal. The consequence: the virus by underlining this totally universal common status also makes absurd all institutions that would confine, restrict movement or force contact. The prison, the border, the assembly line, the Amazon warehouse, how can any of these be justified in an age which forces us to face the universality of the human condition: virus incubator.
Soma. Can health care be a commodity? In the us every ‘service’ has its price. Conceptually the provision of health care in this system is thought of in the same way that the cafeteria restaurants that used to be popular in the 1970s priced and delivered food. (I still remember fondly the slightly pasty taste of ‘Blue Boar’ mashed potatoes whose flavour could never be reproduced at home with an actual tuber.) In any case the doctor is conceptually a ‘server’ who offers the ‘client’ a particular item. The sovereign patient/consumer can then choose among the options: would you like to have a side of nursing with your chemotherapy? It’s always nice to round out your treatment with an extra-helping of nutritionist advice. We have two different courses of treatment that you can follow: you are free to choose, just as you are free to choose the chicken, steak or fish at the cafeteria. But, of course, the commodity form is entirely inappropriate to the ‘service’ on offer: health. Why is this so?
First, of course, is that the ‘patient/consumer’ is fundamentally ignorant and stands in a relationship of lay person to expert in the context of health care. This is all obscured by the falsely demotic language of ‘empowerment’ which enjoins the patient to ‘take charge’ of her own care. But the entire reason that the patient seeks care is that doctors, nurses and specialists are experts: they are not offering ‘services’. Instead, they are presumably in a position to determine which ‘services’ have an actual use for the patient. But the commodity form undermines the expert/patient relationship by establishing a false sovereignty for the patients. (Inevitably this is reinforced by the ubiquitous customer satisfaction survey. Did you enjoy your surgical experience?) The sprawling apparatus of us health care is premised on the fiction of the patient as a sovereign consumer: the reality is anxiety and bewilderment.
The second problem posed by the commodity form is that health ‘services’ violate the concept of marginal utility. There is no reason to think that the ‘utility’ of an additional unit of health care will eventually decline as the number of total units of health care consumed increases. This is because ‘utility’ here is not a quantitative accumulation, but a qualitative state: health. This state cannot be reduced to any series of fungible units, which is why, by the way, the saying ‘health is wealth’ is absolutely false.