1AC

1AC R1

Jacob Perrin 13, MA in Bioethics from Wake Forest University, December 2013, “Are We Forgetting
Someone? Undocumented Immigrants and Health Care,”
https://wakespace.lib.wfu.edu/bitstream/handle/10339/39129/Perrin_wfu_0248M_10508.pdf

On September 9th in 2009, President Obama addressed a joint session of Congress in support of the
pending health reform legislation.1 At one point in the speech, President Obama addressed the implications of
healthcare reform for undocumented immigrants (UIs)— immigrants who either entered the U.S. without valid documents
or who are living outside the terms of their visa—saying, “There are also those who claim that our reform effort will
insure illegal immigrants. This , too, is false —the reforms I’m proposing would not apply to those here
illegally.” In one of the more memorable moments of the health reform debate, Congressman Joe Wilson of South Carolina
yelled out, “You lie!” upon hearing the President’s words. Was Wilson right? What kind of healthcare do UIs have? And
most importantly, what kind of healthcare should UIs have? These are the kinds of questions I hope to address throughout this thesis.

Ironically enough, this public moment of dissension between Wilson and Obama was, in reality, one
of the few tenets of the law upon which Republicans and Democrats could agree . Although
the Patient Protection and Affordable Care Act (ACA) will make a considerable dent in our uninsured population,
UIs[undocumented immigrants] are unlikely to be among the newly insured. The ACA continues to

restrict Medicaid access for UIs[undocumented immigrants] and explicitly bars them from participating
in the new health insurance exchanges, even if they are willing to pay with their own money. Because of this,
UIs[undocumented immigrants] will comprise an increasingly disproportionate share of the uninsured.

This post-reform climate seems to be an opportune time to consider whether or not our general
indifference to the healthcare of UIs[undocumented immigrants] is justified, or whether we need to
reevaluate our position .

The fear of noncitizens gaining access to healthcare from the Affordable Care Act was
always unfounded, precisely because American health care policy has been structured
by a discourse of false universality that equates “health care for all” with “health care
for U.S. citizens.” Reforms like the ACA have only worsened the exclusion of non-
citizens from the health system, calcifying social stratification
Vinita Andrapalliyal 13, J.D., Emory University School of Law, 2013, “ARTICLE: "Healthcare for All"?
The Gap Between Rhetoric and Reality in the Affordable Care Act,” UCLA Law Review Discourse, 61 UCLA
L. Rev. Disc. 58

According to its proponents , the passage of the Affordable Care Act (ACA) n1 "enshrined . . . the core principle
that everybody should have some basic security when it comes to their health care." n2 However, the
ACA does not ensure healthcare coverage for many groups. Indeed, projections indicate that 27 million uninsured
Americans will remain even after enactment of all of the ACA's provisions. n3 Most sizeable among these groups are certain

classes of noncitizens , including but not limited to undocumented immigrants.

Why does the statutory reality differ from the lofty, expansive language used by the ACA's
proponents in Congress and the White House, especially with respect to noncitizens? A parsing of the ACA's legislative history,
particularly the congressional floor debates over the bill, reveals two possible answers. Both answers are instructive to advocates
hoping to extend access to health insurance coverage to all noncitizen groups. First, at least some legislators implicitly qualify the
notion of healthcare for all with the requirement that beneficiaries of the law must pay taxes Second, at least
some legislators seem to exclude certain noncitizen groups from their definition of "Americans," which is

used interchangeably with the terms " everybody" or "all " throughout the legislative history of the ACA.
Part I of this Essay examines the ACA's statutory and accompanying regulatory language, identifying three noncitizen groups that receive
reduced or no protections under the law: (1) recently arrived legal immigrants; (2) noncitizens present under temporary nonimmigrant visas,
known as nonimmigrants; and (3) undocumented immigrants. Part II explores the legislative [*61] history of the ACA and the idealistic
statements repeatedly made by legislators about the idea of healthcare for all. It identifies similar statements made by proponents of previous
versions of healthcare reform during prior presidential administrations, suggesting a historical pattern of disconnect.

Part III concludes that implicit normative and economic arguments legislators made against the expansion of healthcare coverage to these
excluded groups, particularly the undocumented, offer a partial explanation for the gap between the rhetoric and reality of the ACA. It also
critiques these arguments and offers suggestions to advocates for expanded healthcare coverage in overcoming these implicit arguments
against true healthcare for all.

I. THE AFFORDABLE CARE ACT AND EXCLUSION OF CERTAIN NONCITIZEN GROUPS

This Part distills a general outline of the ACA's contours before analyzing how recent legal immigrants, legal nonimmigrants, and undocumented
immigrants are not protected under the new legislation. The ACA is both voluminous and complex, clocking in at nearly 1000 pages and
containing various provisions that will not go into effect until later this decade. n4 Multiple constitutional and political challenges to the ACA,
the most significant of which the U.S. Supreme Court resolved only in June of 2012, n5 slowed down the states' implementation of the bill. n6
Further, the U.S. Department of Health and Human Services is still promulgating regulations in accordance with the statute's decrees more than
two years after the bill's passage. n7 All of this uncertainty over the ACA makes it difficult to analyze the ACA with a high degree of specificity.
However, even a general summary of the law demonstrates the notable absence of the three groups identified above from all of the ACA
benefits.

[*62] A. General Outline of the ACA

A brief political history of the ACA provides context for the mechanics of the ACA. President Obama campaigned on the promise of healthcare
reform and made the issue a legislative priority when he assumed office in 2009. n8 The ACA was first introduced in the U.S. House of
Representatives in October of 2009 n9 and signed into law in March of 2010. n10 The ACA passed both chambers of Congress with largely
Democratic support; at the time, Democrats controlled both the House and the Senate. n11

The ACA contains multiple components aimed at expanding healthcare coverage for Americans. The primary components are: (1) the insurance
mandate, also known as the individual mandate; (2) state-run individual health exchanges; (3) federally run high risk pools; (4) premium credits
and cost-sharing subsidies; and (5) expanded Medicaid coverage for families earning up to 133 percent of the federal poverty line (FPL). n12

A broad overview of these components will suffice for the purposes of this Essay. The individual mandate requires all citizens to purchase
health insurance or pay a penalty. n13 Individual health exchanges are intended to be state-run marketplaces in which individuals may select
private, federally subsidized health insurance plans. n14 High-risk pools are temporary federal health exchanges that will cease in 2014 when
states begin running their own health exchanges. n15 Premium credits and cost-sharing subsidies allow individuals making up to 400 percent of
the FPL to receive either (1) tax credits for their insurance premiums if they purchase healthcare plans outside of the health exchanges or (2)
federal subsidies if they purchase plans within the exchanges. n16 These credits and subsidies [*63] are calculated according to a sliding scale.
n17 Finally, the ACA expanded Medicaid from a program that only served certain groups such as poor children, parents, and pregnant women
to one that serves all eligible individuals who earn up to 133 percent of the FPL. n18 It did so by threatening to withhold federal Medicaid
payments to states that refused to expand their Medicaid coverage according to the ACA. n19

Critics of the ACA challenged its constitutionality, and the U.S. Supreme Court ruled in June 2012 that the ACA's individual mandate was lawful
under Congress's taxing and spending power. n20 The Court, however viewed Congress's threat to withhold Medicaid funding from states that
failed to expand the program to eligible individuals making up to 133 percent of the FPL as coercive. n21 The Court struck down the ACA's
Medicaid expansion enforcement mechanism, holding that such coercive action exceeded the scope of Congress's spending powers. n22

B. Reduced Protections for Recently Arrived Legal Immigrants

One aspect of our healthcare system the ACA does not change was the noncitizen eligibility
requirements for the Medicaid program. n23 Under President Clinton's 1996 welfare reform law, most legal permanent
residents (LPRs) must wait for five years after they establish residence until they are eligible to receive
Medicaid benefits. n24 Refugees and asylees must generally wait seven years to become eligible. n25 Some states
provide limited exceptions for pregnant women [*64] and children. n26 While recently arrived LPRs, nonimmigrants, and
undocumented immigrants may avail themselves of the federal emergency Medicaid program for immediate and severe medical
emergencies, they are unable to access preventative and nonemergency care under this program. n27

Because the ACA left the five- and seven-year bars to Medicaid unchanged and because all lawfully residing U.S. residents are subject to the
individual mandate, n28 low-income and recently arrived LPRs must search for health insurance on the private market or through health
exchanges, regardless of whether their states expand Medicaid coverage under the ACA. While these immigrants may be eligible for premium
tax credits and cost-sharing subsidies, those making less than 133 percent of the FPL bear significantly higher financial burdens in complying
with the individual mandate than U.S. citizens and LPRs who are eligible to receive Medicaid. This is especially unfortunate given that newly
arrived LPRs "are statistically the least likely to have employer provided coverage and tend to earn less than citizens or immigrants [who] have
been in the country for longer periods of time." n29

Moreover, the
ACA reduces federal funding for immigration status--blind emergency medical treatment,
which negatively impacts the ability of non-Medicaid eligible legal permanent residents to access
emergency healthcare particularly in geographic areas with high concentrations of recently arrived LPRs, nonimmigrants, and
undocumented immigrants. n30 The cuts also burden emergency rooms (ERs), which are required to treat all patients regardless of immigration
status and ability to pay, because poor individuals without access to Medicaid must use ERs for healthcare as a last resort. n31

[*65] C. Reduced Protections for Legal Nonimmigrants

The ACA also fails to offer full protections to the nearly two million nonimmigrant residents in the United
States. n32 Nonimmigrants, who are present in the country on temporary visas and include university students, skilled and
unskilled laborers recruited by U.S. employers, and family members of U.S. citizens or lawful permanent residents, n33 are often a

forgotten group . n34 Yet many of these individuals lawfully reside in this country for up to several years. Many of them
undoubtedly require access to healthcare at some point during their time here.
The ACA is perhaps at its murkiest when attempting to determine the extent to which nonimmigrants benefit from the legislation. Moreover,
very few policy analysts have elucidated the ACA's impact on nonimmigrants, further exhibiting how this group is often ignored. It is still
unclear, for example, which portions of this group are subject to the insurance mandate. n35 On the other hand, nonimmigrants who have not
overstayed their visas are considered "lawfully present," which is a requirement for participation in high-risk pools and health exchanges. n36

What is clear, however, is that the ACA does not change federal Medicaid access requirements for
nonimmigrants. n37 Under the 1996 welfare reform law, nearly all nonimmigrants are ineligible for Medicaid coverage, among other
federal benefits. n38 The ACA's cuts to federal funding for emergency medical treatment irrespective of immigration status will presumably
negatively affect nonimmigrants, and emergency rooms, particularly if this group is not eligible for premium tax credits, participation in health
exchanges, and cost-sharing subsidies available to recently arrived LPRs. n39

[*66] D. Reduced Protections for Undocumented Immigrants

Finally, the estimated eleven million undocumented immigrants in this country n40 are specifically excluded
from virtually all of the ACA's protections As one commentator summarizes:

Congress took pains to clarify that health reform will not help those who are not lawfully present . . . .
[T]he Affordable Care Act explicitly prohibits those who are not "lawfully present" from (1) accessing temporary high-risk pools for those with
preexisting conditions; (2) enrolling in special state-created plans for low-income individuals not eligible for Medicaid; (3) enrolling in new
health care cooperatives; (4) receiving cost-sharing subsidies or premium tax credits to purchase health insurance; and (5) purchasing policies in
the newly created exchanges, even without the benefit of government subsidies or credits. n41
No other group's exclusion from the ACA's protections is so complete . n42 The law does not even spare
those granted deferred action under President Obama's high-profile directive this spring to protect many immigrants who arrived in
the United States without papers as minors from being denied access to healthcare. n43 Undocumented immigrants will make
up approximately one-third of the estimated 27 million Americans who will remain uninsured after the ACA
takes full effect. n44

While the ACA did not make lawful immigration status a requirement to access Emergency Medicaid, the ACA's cuts in funding for that program
n45 impact undocumented immigrants more than the other groups. Unlike recently arrived LPRs and nonimmigrants, undocumented
immigrants are not eligible for any of the ACA's alternative means of obtaining health insurance and are thus more dependent on emergency
healthcare. Further, a majority of the approximately $ 5 billion per year in uncompensated emergency healthcare costs are [*67] mostly
generated by undocumented immigrants. This number and proportion is likely to rise as Emergency Medicaid funding decreases, as the
undocumented immigrant population ages, and as the majority of the undocumented remain without access to health insurance. n46

II. LEGISLATIVE HISTORY OF AND RHETORIC SURROUNDING THE AFFORDABLE CARE ACT

The ACA deliberately refrained from extending full access to healthcare for recently arrived LPRs and nonimmigrants. The ACA also excluded
undocumented immigrants from all, or virtually all, of its protections. Yet, as this Part demonstrates, the
ACA's statutory realities
appear to belie the expansive language used by the ACA's advocates, who repeatedly defended the idea

of healthcare access to "everyone" or "all Americans " in the sponsor statements, floor debates, and signing statements
associated with the bill. n47 This trend is a continuation of history, as policymakers who pushed previous iterations of
healthcare reform during previous presidential administrations also employed universal language in publicizing their efforts.
Yet policymakers did not include groups like the undocumented in their policy proposals. The result is an
apparent, longstanding tension between the ideas of healthcare for all and healthcare for
noncitizens .
A. The Legislative History of the ACA

The House of Representatives took up a version of what would ultimately become the ACA in October of 2009. n48 House Speaker Nancy Pelosi
presented the bill to the public along with eight other Congressmen, including House Majority Leader Steny Hoyer and the bill's principal
sponsor, John Dingell. n49 All [*68] of the Congressmen who spoke at the presentation interchangeably stated that the bill embodied the idea
that "all Americans," "all," or "everyone" deserved access to healthcare. n50 Moreover, Representative Dingell made mention of the 47 million
uninsured Americans at the time, a number that includes the undocumented. n51

In floor debates over the bill, the conflict between healthcare for all and healthcare for noncitizens becomes apparent. Proponents of the
bill were adamant: The legislation would extend healthcare coverage to nearly all "Americans " n52 or
"everyone ," n53 filling an important hole in the nation's social safety net. One of the chief arguments made by the bill's
opponents, however, was that undocumented immigrants might benefit from the bill. n54 The bill's
supporters emphatically responded, and the statutory language of the ACA corroborates, [*69] that no additional
protections were extended to the undocumented under the bill. n55
Representative Louise Slaughter's seemingly contradictory statements are indicative of this paradox. Representative Slaughter called up the bill
for a vote and in her remarks stated:

Mr. Speaker, this is a wonderful, exciting day for us and the culmination of nearly 100 years of work that we will join the community of nations
that believe that the people who live within them are deserving of decent health care, all of them, regardless of their financial situation. n56

Earlier that very day during the same floor debates, however, she answered Representative Poe's claim that the bill would benefit illegal
immigrants with the retort, "[T]hat's not the way it is. There are no illegal aliens in this bill who get anything at all." n57

The legislative history of the bill is less clear, however, about the reasons for offering diminished protection to newly arrived LPRs and
nonimmigrants. Only one congressman made a floor statement about the plight of newly arrived legal immigrants under the bill.
Representative Honda lamented that the bill did not "lift the 5 year bar on legal immigrant participation in Medicaid. Legal immigrants are tax
paying [sic] citizens in waiting who work hard and contribute. It is only fair that we afford them equal access to the benefits of Medicaid." n58
Meanwhile, no floor statements, committee reports, or other statements made by lawmakers suggested that legislators were preoccupied by
the fate of nonimmigrants under the bill.

Finally, after the bill passed both Congressional houses and landed on President Obama's desk on March 23, 2010, the president also
used expansive, even universal, language when referring to the beneficiaries of the ACA:
[P]erhaps the greatest--and most difficult--challenge is to cobble together out of those differences the sense of common interest and common
purpose that's required to advance the dreams of all people--especially [*70] in a country as large and diverse as ours . . . . [W]e are blessed by
leaders in each chamber who not only do their jobs very well but who never lost sight of that larger mission . . . And we have now just
enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care. n59

B. History of Healthcare Reform Advocacy in America

The ACA was an unprecedented overhaul of our nation's healthcare system. It was the product of decades of advocacy for expanded access to
healthcare for Americans that germinated in Theodore Roosevelt's presidential administration nearly a century ago. n60 As healthcare costs
and the number of uninsured in the United States continued to balloon, the political will to reform the system strengthened. And just like with
the ACA, the idea that "all Americans" deserved access to healthcare animated the political discourse through Republican and Democratic
presidencies alike in the last hundred years, though the concrete proposals failed to extend protection to all noncitizen groups. The ACA's
repetition of history may be instructive in understanding why legislators persist in leaving out certain noncitizens from their conception of
universal healthcare.

Presidents Franklin Roosevelt, Harry Truman, Richard Nixon, and Jimmy Carter all attempted to pass legislation ensuring universal healthcare
coverage but failed to do so. n61 Lyndon Johnson came the closest to this goal in creating the Medicare and Medicaid programs, which
established a healthcare safety net for the elderly and the poor, respectively. n62 He too failed to pass universal healthcare. n63 And of course,
the first years of Bill Clinton's tenure were consumed with Hillarycare, the doomed healthcare reform bill of which first lady Hillary Clinton was
a chief architect. n64

[*71] The rhetoric past legislators and policy advocates used to push for such legislation also centered around the notion that "all Americans
deserve healthcare." For example, Mrs. Clinton and other advocates of her plan 1993 Health Care Reform Plan made such statements as "If we
do not have universal coverage . . . we do not have health care reform." n65 And yet, past iterations of healthcare expansion legislation, such as
the 1993 plan, did not cover undocumented immigrants beyond already existing emergency Medicaid protections in the event of immediate
and severe health crises. n66 In the past, as in the present, a gap existed between the ideals that animated the push for healthcare reform and
the substance of the proposals ultimately put forth with respect to noncitizen groups like the undocumented.

III. IMPLICIT RATIONALE FOR THE GAP BETWEEN REALITY AND RHETORIC: THE DEFINITION OF "AMERICAN"

It is, of course, impossible to definitively explain how the entire 111th U.S. Congress rationalized the exclusion of the three noncitizen groups
identified above. Parsing the legislative history--particularly the floor debates--reveals implicit economic and normative social assumptions
legislators made about the role of undocumented immigrants in particular. Perhaps these assumptions explain, at least in part, the
inconsistencies in the statutory language of and legislative history about the ACA explored in this Article. This Part explores these potential
economic and social rationales, critiques them, and offers ways for healthcare reform advocates to overcome them.

A. Concerns About Economic Freeridership

Most of the comments made by legislators concerned the potential for undocumented immigrants to
benefit from the ACA are economic in nature. Time and time again, legislators opposed to the bill mentioned
the fear that undocumented immigrants would benefit from free healthcare at the (presumably legally present)
taxpayers' expense n67 and "open[] the floodgates" to [*72] millions more of the undocumented who would further burden our welfare
system. n68 News reports suggest the floodgates argument also partially explains why legislators declined to lift the Medicaid residency and
immigrant status requirements in the ACA for legal immigrants and nonimmigrants. n69 A plausible way this fear qualifies the seemingly
unconditional healthcare for all is the idea that legislators actually mean healthcare for all who pay into the system.

While this modified notion of healthcare for all may explain how some legislators subjectively reconcile the tension between the ACA's
statutory language and the descriptive language used by its proponents, it fails to justify the complete exclusion of undocumented individuals
from the ACA's benefits objectively. First, many undocumented immigrants do pay into the system. For example, undocumented immigrants
paid an estimated $ 6 billion to $ 7 billion into our Social Security program and another $ 1.5 billion into our Medicare program between 2000
and 2005 through paycheck withholdings, even though they currently cannot ever access benefits from either program. n70 Further, in 2005
alone, nearly 2 million taxpayers filed federal tax returns using individual taxpayer numbers instead of Social Security numbers, the vast
majority of whom are believed to be undocumented immigrants. n71 Finally, millions of U.S. citizens currently pay no federal income tax for
various reasons, n72 yet benefit the most from the ACA. n73
Second, the floodgates argument is also specious. The number of legal immigrants and nonimmigrants would not increase with expanded
access to Medicaid because the United States has caps on the number of immigrants and nonimmigrants who may enter the country each year.
n74 Further, many immigration [*73] analysts argue that undocumented are primarily motivated to enter this country due to the presence of
brighter economic opportunities, especially in the unskilled and low-skilled sectors, where the supply of U.S. citizen workers is low. n75
Whether healthcare benefits are available is ancillary when compared to whether upward social and economic mobility is possible through
available jobs. n76 The decrease in the number of undocumented immigrants during the past four years n77 as the American economy
underwent a recession and a slow recovery n78 supports this view of immigration.

Finally, some studies have shown that giving all individuals access to preventative and nonemergency healthcare is ultimately more cost-
effective for the nation as a whole. n79 In support of this point, it is worthwhile to note that the undocumented population is generally younger
and healthier than the American population as a whole, n80 and adding them into insurance risk pools may lower premiums and costs of
emergency healthcare for all. n81 It is true that other studies claim that the federal government may not gain money from subsidizing so many
Americans' health insurance. n82 It is impossible, however to deny the longterm gains in economic productivity and reduction in emergency
room and emergency Medicaid costs that would result if all people--including recently arrived LPRs, [*74] nonimmigrants and the
undocumented--had health insurance. n83 The possibility of realizing such gains would seem to merit seriously considering expanding
undocumented immigrants' rights to access healthcare.

Perhaps most who opposed the ACA covering undocumented immigrants generally oppose the concept of the ACA. It is true that those who
mentioned the potential economic burdens that undocumented immigrants would create by receiving benefits under the ACA were opposed to
the ACA as a whole on other grounds. This includes the idea that the ACA was too redistributivist. n84 This counterargument, however, fails to
explain why those who supported the ACA and the idea that wealthy taxpayers pay more taxes for all less wealthy Americans' health insurance
also supported excluding the noncitizen groups identified above from the bill.

If indeed some legislators were motivated to deny undocumented immigrants, recently arrived LPRs, and nonimmigrants access to full
healthcare benefits under the ACA because of economic concerns, those who advocate for expanded healthcare coverage for these three
noncitizen groups may do well to make two primary economic arguments supporting coverage. First, these groups, particularly the
undocumented, contribute to federal tax revenue. Second, the national economy and federal government would benefit from an expansion of
coverage for all three groups.

B. Healthcare as a Privilege of Citizenship

Another argument legislators made against extension of ACA benefits to undocumented immigrants emphasized the idea that the right to
healthcare is reserved to "Americans," as opposed to literally everyone living in the United States. Therefore, the three noncitizen groups
examined in this Essay fall outside the legislators' definition of "Americans." n85

[*75] Public officials use universal terms such as "everyone," "all," and "everybody" when referring to
whom universal health coverage should apply, n86 most notably President Obama in his signing statement. n87 It is possible,
however, that these seemingly expansive terms are imprecise references . Previously failed attempts at healthcare
reform in the past century n88 described healthcare for "Americans," n89 an arguably more limited term. n90 For example, Representative Hal
Rogers distinguished between illegal immigrants and "Americans" when he accused the ACA of "open[ing] the floodgates . . . for illegal
immigrants to abuse the system and obtain free government health insurance--all on the backs of law-abiding Americans." n91 Moreover,
Representative King dismissed the idea that there were 47 million uninsured Americans at the time of the debates over the ACA by subtracting
the number of undocumented immigrants from that calculation. n92 Escalating
levels of antiimmigrant rhetoric n93 and social
conflict between immigrants and native-born Americans n94 may feed into the perception that recently arrived legal
immigrants, nonimmigrants, and undocumented immigrants are not "American." n95

This us versus them mentality towards certain immigrants has deep historical roots. n96 Unfortunately,
however, allowing the millions of newly arrived immigrants, nonimmigrants, and undocumented immigrants to live in this
country without socially or politically including them in the term "American" already has harmful
social consequences. n97 This two-tiered system will continue to tear at our societal bonds. This exclusionary way of
thinking can calcify [*76] socioeconomic stratifications , creating an underclass, n98 and lead to "prejudice,
stereotyping, discrimination, hatred, conflict and violence," all common problems associated with labeling groups in a
particular society as an "other." n99

Of course, not all legislators may implicitly exclude the undocumented from their definitions of "American." n100 Further, the ACA's legislative
history does not clearly answer the question of whether any legislators also exclude other noncitizen groups such as recently arrived LPRs and
nonimmigrants from their definitions. n101
To the extent that legislators do regard "Americans" and certain noncitizen groups as separate entities , those
who advocate for expanded health coverage for these groups face a difficult task. One solution is to push for comprehensive immigration
reform (CIR) with a path to citizenship for the undocumented n102 in order to turn large swaths of the undocumented into lawfully present
individuals. Presumably, turning previously undocumented individuals into legal immigrants would bring them within the definition of
"American" discussed in this Part. Further, becoming lawfully present would mean that these individuals would be able to benefit from the ACA
as currently written. n103 Successfully pushing through CIR in the current political climate, however, may rival the effort involved in passing
healthcare reform in terms of complexity, strategy, and uncertainty of outcome. n104 Further, even if CIR passes, some legislators may still seek
to withhold healthcare benefits for newly legalized immigrants, at least for a period. n105

Another solution to overcoming legislators' exclusive definition of "American" is to expand the

definition of "American" in the political discourse to [*77] include the noncitizen groups in question. This task
would be no less Herculean, as it requires changing long-held views on the role of immigrants in the United States. n106 This effort, however,
would have the added benefits of staving off the desire of some legislators to oppose CIR efforts if and when that mantle is again taken up by
public officials and of preventing legislators from potentially limiting the benefits to which newly legalized immigrants are entitled.

A close examination of the ACA's legislative history suggests two possibly interrelated ways that legislators reconciled the competing concepts
of universal healthcare and fewer healthcare protections for noncitizens in crafting the ACA. Perhaps understanding these rationales will allow
healthcare advocates on behalf of noncitizens to redouble their efforts to obtain equal access to healthcare for recently arrived legal
immigrants, nonimmigrants, and the undocumented.

CONCLUSION

Despite the rhetoric of universal healthcare and healthcare for all that pervaded the healthcare
debate, the ACA does not fully protect certain legal immigrants or nonimmigrants and fails to protect
the undocumented at all, leaving millions of Americans still without access to health insurance. The legislative history of the ACA
suggests that legislators' biases towards these noncitizen groups , particularly with respect to the economic impact of
insuring them and the idea that they are not "American," may explain this gap. Advocates for universal healthcare
must combat these biases , push for comprehensive immigration reform, or, preferably, employ both strategies in order for
rhetoric to meet reality in the concept of healthcare for all .

Social movements for single-payer health care are consolidating and gaining influence
now---the twin crisis of ACA failure plus the horror of GOP repeal efforts make single
payer the inevitable result
Michelle Chen 17, contributing editor at In These Times, a contributor to Working In These Times, and
an editor at CultureStrike, 3/7/17, “Amid GOP Attacks on Health Care, the Movement for Single Payer Is
Growing,” http://www.alternet.org/personal-health/amid-gop-attacks-health-care-movement-single-
payer-growing

Though hailed as Obama's keystone policy achievement, the ACA has deepened the health care crisis in many ways, by
providing subsidized insurance expansions while plunging patients into a "free marketplace" that often makes
survival prohibitively costly . Meanwhile, the ACA still excludes millions, including undocumented
immigrants and people too poor to afford the premiums and fees of the available insurance plans, even with federal
subsidies.

Meanwhile, Trump's newly appointed head of Health and Human Services, Tom Price, wants to shred Obamacare and push a
massive deregulatory agenda across major federal "entitlements," possibly bringing total privatization or defunding of fundamental public
health care programs for seniors and poor households.
So the country lurches between two health care crises -- on one side lies the A ffordable C are A ct 's "free
market " of half-baked, overpriced insurance schemes; on the other side Congress faces an insurance cliff, hurtling toward a repeal
that could shove millions out of essential coverage and plunge countless families and medical providers into social turmoil. At the same time,
the political havoc clears the way for a radical cure: why not "socialized medicine"?

The single-payer system, though

often dismissed as irrationally idealistic, now looks like the nation's last
hope for a democratic, universal health care solution. And the Trump-induced health crisis could
become an unforeseen opportunity for single-payer advocates : The combined trauma of Obamacare's
bureaucratic dysfunction, along with fear of the Republican agenda's privatization assault, just might spur
a mass movement for a comprehensive government-run plan liberated from insurance markets: a single payer providing free,
equal access, regardless of health or economic status.

Tragically, it might have taken a fatal crisis to spur an emergency response from policymakers. Still, advocates hope Washington's
political disruption can break through single payer's perennial obstacle , the issue of branding. Conservative
ideologues, the insurance lobby and the American Medical Association have long stifled serious debate about single payer, even though it
parallels nationalized health care systems in nearly every other rich industrialized country, by vilifying the idea as a draconian, economically
unsustainable socialist bureaucracy.

Ronald Reagan's avuncular Cold War red-baiting now seems quaintly stale in the wake of an election that pushed a self-proclaimed socialist
near the top of the Democratic ticket during the primaries. And with polling that strongly favors the concept of government-
supported national universal health care, "socialized medicine" is facing an unexpectedly positive prognosis.
"If public support passed legislation, we would have had single payer a long time ago," says Benjamin Day, a Boston-based organizer with the
pro-single-payer campaign Healthcare Now.

Day, like many other single-payer champions, got converted as a survivor of the twin crises of mental health problems and health care costs.
During his graduate studies in 2005, he experienced an onslaught of anxiety attacks, leading to hospitalization and a traumatic financial dispute
with his insurer over his crushing medical bills. The ordeal pushed him out of school and into full-time organizing for the one policy solution he
thinks can break the political stalemate and the medical cost curve that upended his life.

Day acknowledges that the ACA, by combining insurance plan expansion, public subsidies and widening eligibility for Medicaid for low-income
households, did expand coverage for more than 20 million people. But he also stresses that it deserves criticism for soaring premiums and fees
and uneven quality of "market-based," often mismanaged, plans. Consequently, even many of those who've gained insurance under
Obamacare have realized it was a thin bandage rather than a cure for a broken system.

Recent Pew Research surveys

show more than half of respondents, both Democrats and Republicans, favoring a
government-guaranteed program of medical coverage for all, and about 30 percent explicitly supporting single-payer
health care.

"People have adopted this value," Day says, "but they're not willing to accept the one policy that will actually protect that right [to] universal
health care. ... We're
just going through the political struggles of getting to what you actually need to do to
make that happen."

The struggle now centers on Congress , with mounting panic percolating at district offices where ACA beneficiaries have held
rallies to protest potential loss of their insurance. Many of them might have been attracted to Trump's populist rage against the ACA on the
campaign trail, but for all their frustrations with rising premiums, because Republicans have no meaningful replacement plan prepared, they'd
still prefer substandard care to losing coverage altogether.

Despite the potential shock of a mass termination of ACA plans, Trump has vowed to pull the plug on the ACA as soon as possible and replace it
with some sort of "great" national universal plan, but details remain elusive. And though Republicans have long hungered for Obamacare's
destruction, so far they've fumbled on assembling a financially viable surrogate for its more than 20 million beneficiaries.

This could be the moment that the country finally comes to its senses on single payer , according to Dr. David
Himmelstein, cofounder of the advocacy network Physicians for a National Health Plan (PNHP).
Facing the inevitable collapse of an unsustainable system, "now there's much more ... appetite for
addressing the fundamentals," Himmelstein said.

But, even the most radical proposals for single payer are founded on the exclusion of
non-citizens---the demand for “Medicare for all” still depends on an idea of who
constitutes “all” that’s fundamentally exclusive
Amanda Michelle Gomez 17, Health reporter at ThinkProgress, 9/14/17, “Defining the ‘all’ in
‘Medicare for All’,” https://thinkprogress.org/while-attention-turns-to-health-care-for-all-lets-talk-
about-coverage-for-immigrants-d1d5724cc743/

As progressives consider proposals to implement universal health care, it’s important to define the
principle that’s driving them. What unites Democrats right now is the idea that health care is a right
afforded to all. If that’s the self-imposed litmus test, it’s essential to define “all” when discussing
universal health care.

Millions of people who live in the United States are currently uninsured. High costs remain a major barrier to
coverage; 46 percent of uninsured adults said costs were a primary reason according to a 2015 Kaiser Family Foundation poll. Proposals by
Sens. Bernie Sanders (D-VT) and Brian Schatz (D-HI), who are advocating to expand public programs like Medicare and Medicaid, respectively,
strive to make care affordable.

But even if rising costs to care were miraculously resolved, one group of people would still be
excluded .

In 2015, 23
million non-citizen immigrants resided in the U nited S tates, which accounts for 7 percent of the
population. (Non-citizen immigrants account for both lawfully present and undocumented immigrants.) Non-citizen immigrants
are significantly more likely than citizens to be uninsured. Seventeen percent of lawfully present immigrants and 41
percent of undocumented immigrants are uninsured, compared to just about 9 percent of U.S. born and naturalized citizens.

A single-payer system addresses health care financing, and a single public or quasi-public agency organizes
care. Often, the progressive mission (universal health care) and the method (single payer) are
conflated. But single-payer is hardly the only avenue to reach universal health care. In the various
Medicare-for-all bills floating around Capitol Hill, not everyone — especially undocumented people and
Deferred Action for Childhood Arrivals (DACA) recipients — living in the United States would be guaranteed government-run health
coverage.
Founding member of the consumer advocacy group Families USA Ron Pollack wrote about viable alternatives to single payer, as progressives
strive for high-quality, affordable health care for everyone. He outlined four ways to inch closer to universal coverage, none of which promotes
scrapping the current system but instead expands upon existing plans. One suggestion: extend care to immigrants who currently are ineligible
for insurance.

Under the Affordable Care Act (ACA), people with various immigrant status qualify for the marketplace coverage. Lawfully present
immigrants can buy subsidized care, but undocumented and DACA recipients are unable to. Immigration
status as well as mixed-status families, where one person is undocumented, largely prevent people from obtaining insurance.

Providing preventative health care to all immigrants — regardless of status — is as politically

controversial as single payer . In the Better Care Reconciliation Act, Republicans looked to bar certain immigrant
groups that gained coverage under the ACA. Only permanent residents and asylum seekers qualified for care under the GOP
bill.

As Medicare-for-all advocates discuss its highly ambitious health policy proposal, know that this is
guaranteed universal health care for lawfully present immigrants only . Perhaps for now, that’s enough, given that
key details — like the bill’s funding language — are delayed.

Sen. Bernie Sanders released his vision for universal coverage Wednesday. Sanders
wants to scrap the current employer-based health
care model and implement a Medicare-for-all national health insurance program. Under the “Medicare for All Act of
2017,” residents would be provided a universal Medicare card upon enrollment. Here is who would gain coverage under the bill:

1 TITLE I—ESTABLISHMENT OF

2 THE UNIVERSAL MEDICARE

3 PROGRAM; UNIVERSAL ENTI-

4 TLEMENT; ENROLLMENT

5 SEC. 101. ESTABLISHMENT OF THE UNIVERSAL MEDICARE

6 PROGRAM.

There is hereby established a national health insur-

8 ance program to provide comprehensive protection against

9 the costs of health care and health-related services, in ac-

10 cordance with the standards specified in, or established

11 under, this Act.

12 SEC. 102. UNIVERSAL ENTITLEMENT.

13 (a) In General.—Every individual who is a resident

14 of the United States is entitled to benefits for health care

15 services under this Art. The Secretary shall promulgate

16 a rule that provides criteria for determining residency for

17 eligibility purposes under this Act.

18 (b) Treatment of Other Individuals.—The Sec-

19 retary may make eligible for benefits for health care serv-

20 ices under this Act other individuals not described in sub-

21 section (a), and regulate the nature of eligibility of such

22 individuals, while inhibiting travel and immigration to the

23 United States for the sole purpose of obtaining healthcare

24 services.

The transition to the single-payer system only allows “an alien lawfully admitted for permanent
residence” to buy into Medicare, as under the ACA. But once single-payer is fully implemented, the
discretion of which immigrant qualifies is ultimately left to the White House, leaving the fate of every
immigrants’ care in the hands of whoever is president .
During Sanders’ news conference on Medicare for All Wednesday, Sen. Mazie Hirono (D-HI) said “all the people in this country should have
health care,” including the 11 million undocumented and nearly 790,000 DACA recipients. She was the only lawmaker who connected
universality to immigration status.

Wednesday’s bill is hardly its last iteration, and has largely been framed by proponents as the start of the conversation. As
lawmakers
litigate this bill and bills similar to it, the question of who is “all” in Medicare-for-all will arise. For political
purposes, it’ll be tempting to separate immigration and health care ; although, for those affected, it’s hard to do
that. Perhaps a comparable solution is to leave it to the states , which have largely taken it upon themselves to do so
already.

California, the District of Columbia, Illinois, Massachusetts, New York, and Washington use state money to provide care to the undocumented.
California, where almost one quarter of the nation’s undocumented immigrants reside, expanded coverage by innovating two existing health
care systems. First, the Health for All Kids Act provides undocumented immigrant children with access to coverage through Medi-Cal, the state
Medicaid program.

Second, My Health LA, which is a Los Angeles County based health program, extended coverage by not defining who’s eligible. The idea is,
anyone who is ineligible for anything else should go to a contracted clinic; this is not insurance. County officials pushed for the program and
said it would cut down on the use of emergency rooms by uninsured immigrants, which is costly.

It’s unclear what the aforementioned health care plans would look like under Sanders’ bill. Presumably
they’d be deemed unnecessary as the health care system is streamlined . And there are a host of other concerns to
address when discussing single payer, said Community Clinic Association of Los Angeles’ Cynthia Carmona. “During the four year transition, we
will face significant challenges,” she told ThinkProgress. Namely, how do you phase out health plans, that know the U.S. system, for all its
fragmented ways to provide care for lawfully present and undocumented people.

CCALAC has come out in support of universal health care and has worked hard to ensure that undocumented immigrants in California have
access to health care. Carmona recognizes, from a provider perspective, that the devil is in the details. “Just because you
create a bill like this [Medicare for All], doesn’t mean you create access ,” she said.

Exclusion of non-citizens from the health system compounds the violence of migration
and institutionalizes vulnerability and devaluation of life. Our linkage of health and
solidarity with non-citizens broadly contests the system of sovereign global
governance and radicalizes the potential of health politics
James Smith 16, Homerton University Hospital NHS Foundation Trust; and Leigh Daynes, Executive
Director of Doctors of the World UK, February 2016, “Borders and migration: an issue of global health
importance,” The Lancet Global Health, Vol. 4, No. 2, p. e85-e86

As Grove and Zwi2 observe, increasingly

complex measures used to deter refugees and other individuals
fleeing conflict, socioeconomic inequality, and other manifestations of structural violence have placed
an emphasis on protection from the refugee above protection of the refugee. As a result, both the
humanitarian and welfare aspects of migration are superseded by the desire to restrict the movement
of people.3

Such skewed priorities have a catastrophic effect on health ; UNITED for Intercultural Action has attributed a
conservative 22 394 deaths between January, 1993, and June, 2015, to the policing and border control measures in place across Europe.4 These
tragic statistics draw attention to a migratory process that is fraught with danger.5 Conflict, internal displacement, poverty, and chronic health
inequities are often responsible for substantial predeparture morbidity. During the transitory phase, tighter border controls and associated
programmes of involuntary detention have forced people to attempt extraordinarily dangerous border crossings.2 In desperation, an increasing
number of people have attempted to enter Europe by sea, despite frequent reports of suffocation and physical injury in crowded vessels,
dehydration and hypothermia secondary to prolonged exposure to extreme temperatures, and drowning.2
Irrespective of the chosen route, or of an individual's migratory status, violence
perpetrated by border officials, and the
stress and psychological trauma associated with the experience of migration, is often compounded by an
inability to access basic medical care and other essential services.6 The repeated exposure to institutionalised
mechanisms of marginalisation and discrimination in turn generates what has been described as a cumulative
vulnerability .6
The negative health effect of Europe's protectionist policies is so dramatic that humanitarian organisations have launched their own emergency
programmes across the continent, from Calais in northern France to the Greek islands of Kos and Lesbos in the southern Mediterranean. In
Calais, Doctors of the World's medical teams have treated patients with complex psychological issues; a multitude of minor injuries, fractures,
skin problems and scabies; diarrhoeal diseases; acute and chronic respiratory infections; complications secondary to exposure to tear gas; and
more. In southern Europe, the organisation has also documented a growing number of displaced women and children, many of whom will
inevitably require specialist paediatric and obstetric care if present conditions persist.

The adverse effect on health of both the violent policing of borders, and the exclusion of vulnerable
groups once they have crossed such borders, is a matter of grave global health significance . Increasingly broad
theoretical interpretations of global health, and the recent introduction of a framework for planetary health, have largely skirted more
meaningful engagement with the relation between borders, sovereignty, policing, and health. Notable exceptions include the 2014 Lancet–
University of Oslo Commission on Global Governance for Health, which emphasised that an “increase in irregular migration
reflects policy choices and legal definitions poorly adapted to present realities”,5 and a provocative
commentary authored by Frenk and other prominent global health advocates7 earlier in the same year, which drew on globalisation and
our resultant interdependence to call for a “global society”, which in turn would transcend the
inherently reductive nation state .

Europe's ongoing refugee crisis and the under-reported injustices endured by other crisis-affected communities worldwide, are indicative of a

system of global governance that does not place equal value on human life . In a world in which
capital and commodities flow more freely than compassion and humanity, a fundamental friction
exists between the expression of solidarity and the protection and promotion of sovereign interests.
Only with a radical reimagination of the practice and study of global health, and of the systems and
ideologies that remain a threat to health, can we ensure that the needs of the most vulnerable are
prioritised above all else .

Violent and exclusionary responses to migration are strangling the globe with borders
and walls, creating lifeboat states and death-worlds. Contesting border regimes
requires a radical politics of explicitly pro-migrant policy that refuses mere liberal
inclusion of non-citizens in falsely idealized societies, but rather attacks the idea of
shared social space as a lifeboat where our existence depends on winning a zero-sum
contest for survival
Ethemcan Turhan 17, postdoctoral researcher at KTH (Royal Institute of Technology) Environmental
Humanities Lab; and Marco Armiero, KTH Royal Institute of Technology, Environmental Humanities Lab,
2017, “Cutting the Fence, Sabotaging the Border: Migration as a Revolutionary Practice,” Capitalism
Nature Socialism, Vol. 28, No. 2
Needless to say, we live in a time where neoliberal capitalism’s honeymoon with democracy is well-over—a time where overlaps
of
mass migration flows, economic meltdown and global environmental crisis fuel authoritarian populist
fire for an even bleaker future ridden by uncertainties on all fronts. The present circumstances cause as much
shock and awe as they provide apertures for us to seek new radical possibilities . The times when walls were falling
and barbed wires were removed seem long gone today. Everywhere the rich (and sometimes the poor agitated by fear and
blinded by nationalism) are trying to isolate themselves from the waves of fellow humans fleeing from war,
poverty, persecution, and disruptive environmental changes. Xenophobia, racism, and nationalism are gaining
ground, all of them proliferating inside a toxic narrative that externalizes class conflicts. It is a remarkable success that global elites can
convince large portions of the working class that the worsening of their lot is caused by immigrants and not by the unequal distribution of
wealth, the attack against labor rights and the neoliberal erosion of the welfare state. The rise of terrorism in major Western cities (as if similar
attacks do not happen almost daily in the under-reported rest of the world) has added even more inflammatory rhetoric to this xenophobic
narrative. An exotic name does all the work here—as Edward Said would have agreed—of obliterating the fact that often the assailants were
born and raised in the West.

Rather superficially, but still with a good degree of accuracy, it can be said that nowadaysa radical leftist approach to
migration requires an explicit anti-xenophobic, pro-migrant welcoming policy . In this short piece we argue for
a radical perspective on migration which goes well beyond the liberal notions of inclusiveness,
cultural diversity, migration governance and eventually creation of a new reserve army of precarious
labor. Welcoming immigrants and cherishing diversity are plausible practices that should always be in place in democracies everywhere.
Nonetheless, a radical perspective should not take Western democracies (if any) at face value. It should
indeed aim to change and challenge them. First: it must be clear that migration is often an externality of
military interventions, proxy wars, imposition of structural economic reforms, multi-causal destruction of livelihoods
both by rapid and slow violence through environmental change, establishment of enclosures, and corporate imperialism that have
dispossessed and continue to dispossess people in different corners of the world. Making sense of migration and its causes is therefore
probably the first duty of a radical politics that aims to demolish the mainstream narrative blaming immigrants for the worsening of working-
class conditions. This is the stark difference between a charitable welcome and an internationalist
welcome: a generic and moralistic sense of guilt for being rich versus a trans-border class solidarity that
connects the locals and the newly arrived soon-to-be locals with the exploitation and resistance against it
occurring simultaneously .
Secondly, a
focus on the praise of multiculturalism, while providing intellectual ammunition against the rise of xenophobia,
might also convey the idea that the point is to integrate the newcomers in some kind of a perfect society,
making it even better by adding some exotic touch. Instead, a radical left approach to migration
needs to foster a revolutionary transformation of society everywhere: fighting against capitalism,
exploitation, oppression, patriarchy, sexism, and racism—all the things which are as problematic in migrants’
destinations as in any point on their way and in their original points of departure. Finally, a truly radical perspective cannot but see the practice
of trespassing borders as a revolutionary act per se, sabotaging the state’s control, questioning authorities, and rejecting the legitimacy of laws
and regulations which protect and facilitate the movement of commodities but not of people. Standing against the depoliticization of the
migration debate and mere reduction of this radical possibility to numbers, hotspot maps, borders and fences, in what follows we argue for an
all-encompassing radical welcome.

Borders of the Apocalypse

As Rebecca Solnit eloquently expresses, borders must be inscribed into the imagination as much as into the landscape in order for them to work
(Solnit 2008). It is the fortified border that makes the garden whereas a broken fence makes a common. From a xenophobic perspective any
crack on the wall seems like a leak which will gradually contaminate the garden. Yet the idea that migrants are responsible for the ecological
deterioration of the "national environment" is not a new one (Coates 2007; Rome 2008). Especially in recent times the interlocking of nativism
and some kind of conservative environmentalism has become stronger. Hartmann (2013) speaks of a rise in "greening of the hate," referring to
greenwashing of the anti-immigration discourse by blaming environmental degradation on migrants. Similarly, Pellow and Park (2017) depict
vividly what they call "nativist environ mentalism" that shifts the blame for ecological disruption from the richest elites to the poor immigrants.
In their account of the super-sustainable town of Aspen, the ultimate resort for rich Americans, Pellow and Park illustrate that borders are
not only for the outside, protecting the community or even the nation, but also oriented towards the inside,
following the fault lines of race, ethnicity, gender and , needless to say, class . It is again a tale of two cities, even if
sometimes the "other" city is not just on the opposite side of some wall but somewhat blended within the city of the elite. The residents of this
other city are mowing our lawns, cleaning our houses and offices, repairing our roofs, bringing us food at the table, as in China Mieville's
intriguing novel The City and the City (2009), where the two cities live simultaneously in each other without ever being able to see one another,
constantly controlled by the fear of a "breach."

As we have previously argued (Baldwin, Turhan, and Armiero 2015), a progressive approach to migration needs to sink
the “lifeboat ethics ,” which only guarantees the safety and well-being of the affluent, and to strive to ensure an
inhabitable planet for all. Lifeboat ethics, in Out of the Woods collective's words, ''beget lifeboat states and the
death-worlds of their border regimes' " Yet, drawing on the boat metaphor may still be telling. Swyngedouw (2013, 17) suggests
that aboard the Titanic "a large number of the first-class passengers found a lifeboat; the others were trapped in the belly of the beast." The
majority of the poor passengers of the Titanic traveling in third class cabins died without even being able to access any lifeboat. Those in these
cabins were the desperate hopefuls setting sail for a new life elsewhere just as much as were the thousands of migrants who lay lifeless in the
depths of the Mediterranean today. Testifying on why he had fired his revolver during the contusing final hours of Titanic's voyage, Fifth Officer
Harold Lowe declared to the US Senate:

I saw a lot of Italians, Latin people, all along the ship's rails—understand, it was open—and they were all glaring, more or less like wild beasts,
ready to spring. That is why I yelled out to look out, and let go, bang, right along the ship's side.7

Lowe's account is interesting not only in that it reminds us of Cavafy's (1992) moving verses in "Wailing for the Barbarians." The story of the
Titanic also reminds us of the impending (though not inevitable) disaster- while making clear that those in power will use any means to police
both the visible and invisible borders that protect them.

Time and time again we are reminded that moving around the world does not occur in the same way for
everybody. While some are entitled to a first-class lounge experience, the others are rendered disposable and invisible
vagabonds (Giroux 2006). Against the double-edged sword of, on one hand, rendering migrants invisible and disposable and on the other
relying on exploiting their bodies, labor and environment, we call for an eco-socialist politics to cut the fences. As Nail (2015,235) argues, rather
than viewing migration as the exception to the rule of political fixity and citizenship, there is a "need to reinterpret the history of political power
from the perspective of the movement that defines the migrant in the first place." This observation holds true for an entire human history
characterized by mobility, to which thousands of years of nomadic experience attest. All these points require those of us on the political left to
think and act on building migrant solidarities across territorial, political, juridical and economic domains today.9

Climate of Fear, Climate of Hope

On the flipside the temptation to reduce everything to some ecological truth might be strong among those who believe that nature matters in
human affairs. Wars and poverty, two crucial causes of migration, can also be explained as consequences of environmental or, more
specifically, climatic changes (see also Correia 2013). Is this a task for radical scholars working on society and environment? Are we supposed to
concur that migration is caused by environmental factors? We believe that rather than isolating and searching for the supposedly evident
environmental causes of migration, the real challenge is to transform the political processes laden with inequalities, exploitation and
oppression that in turn may lead to short or long distance mass migration. Moreover, if migration is a defining human condition that cannot be
used as a political bargaining chip, then the challenge remains for us to sabotage the physical and mental borders of exclusion. At this point we
cannot but agree with Felli and Castree (2012, 3) that approaches such as "migration as adaptation" are often instrumentalized not to advocate
a "policy of open borders but instead one in which migrations are encouraged as well as monitored and managed." Ultimately, why should
those of us on the left adapt to all the mess of the world under the given rules of the international capitalist system with no possibility of
changing these very conditions in sight (2012, 3)?

A good example of what we mean for a non-environmentally obsessed understanding of migration is Donald Worster's Dust Bowl (1979). In his
seminal hook Worster, influenced by Marx, explains the Dust Bowl and the migration of thousands of farmers from the Great Plains as a
phenomenon caused by both the economy and the ecology of the region. In other words, those people who tied were climate-induced
migrants (the Dust Bowl was indeed created by long-lasting drought and wind) as much as they were capitalism-induced migrants (since
according to Worster it was precisely capitalistic agriculture that caused the Dust Bowl). In order to take the environment seriously, radical
scholars should not be obsessed with proving that migrations are driven by environmental changes as opposed to social ones (Armiero and
Tucker 2017). Rather, our approach must provide a radical alternative to the seemingly progressive dominant paradigms seeking lo distinguish
among political, economic, and environmental migrants as if those were parallel universes and not the intertwined socio natures of which our
world is made.
Now Here or Nowhere

The fences are also inside us. Interior borders run through our atomized minds and hearts, telling us we should look out only for ourselves, that
we arc alone. But borders, enclosures, fences, walls, silences arc being torn down, punctured, invaded by human hands, warm bodies, strong
voices which call out the most revolutionary of messages: "You are not alone!" For we are everywhere. (Notes from Nowhere 2003, 20)

In a controversial essay Zizek (2015) made the point that Norway does not exist, in the sense that the dream country migrants wish to reach is
not already somewhere out there but instead must be created through struggle. While Zizek's argument can stimulate debate in retraining
radical perspectives on migration beyond the liberal paradigm, we believe that he is missing the main point, that is, the arrival of migrants in
Norway can in itself be a revolutionary opportunity. It can have demystifying power: by the very act of trespassing into the country migrants
reveal that Norway (or any country in the West) does not exist as such, exposing the naked emperor for everybody. As Dale (2015) forcefully
argues in his critique of Zizek: "But if the refugees are driven by utopian longing, so what?" The
complete void of solidarity, the
volatility of social, labor and environmental rights, and the violence of authorities are only a few of
the revelations that the presence of migrants make visible. Thereby one might argue that migrants come to
rescue us from the illusion that the best possible life is the one we already have . The very act of being on the
move today is a call for arms against the world's rich nations dividing the world into standing pools of labor to be drawn upon when needed or
establishing economies in-exile "producing for the European market" (Collier 2015). Pro-migrant solidarity is about taking
back the political control of our lives (Russel and Reyes 2017), not about establishing "safe havens" of
sweatshop refugee camps somewhere far away as the likes of Collier and Betts (2017) suggest.10

What is a progressive eco-socialist response to a planet in crisis adorned with barbed wires and
electrified walls from end to end? What are the possibilities and means of overcoming Malthusian narratives of scarcity and
territories of fear and replacing them with spaces of hope? The answer, we argue, lies partly in the radical possibilities that an accelerating
convergence of environmental justice movements around the world with the global labor and migrant struggles entail. While providing an
aperture to experiment with alternative ways of life beyond the crippling Washington consensus and stinking nationalist populism, current
migration waves have also become a litmus test enabling us to separate friends from foes. The
"alternative facts" of Trump and his favorite bedfellows —from Putin to Erdogan, Wilders to Orban and beyond—challenge us
to respond to the tyranny of borders and exclusion in more radical ways. Just think about how indigenous climate
justice groups like the It Takes Roots coalition stood in solidarity with migrant groups at their visit to the Vincennes detention center—the site
of an historic uprising following the death of a Tunisian man held in custody in 2008—during the COP21 protests in Paris (It Takes Roots 2015).
Just imagine
how exciting experiments on new imaginative geographies (Dawson 2013) can be embodied
somewhere between Black Lives Matter, climate camps. Standing Rock and the Calais jungle in
moving us from a climate of fear towards a climate of hope defined by justice, inclusiveness,
openness and equality (see also Pellow 2016).

The friction is between a liberal way of dealing with migration as a temporary crisis that can be
managed with the likes of the EU-Turkey migrant deal and a revolutionary perspective that embraces migration as
an opportunity to break away from border-bound definitions of citizenship and create a truly
cosmopolitan, responsible and welcoming solidarity. Overcoming this friction also requires particular
attention to going beyond locking migrants into victimhood by opening space for new voices. As Bleakney
(2009. 28) reminds us,

victimhood ultimately hinders our collective capacity to hear immigrant and refugee voices, to move beyond
charitable approaches to a place of real solidarity . In the end it reproduces the hierarchy that continues to
paralize us with many of the same voices, no matter how well-intentioned, doing the talking.

Along similar lines we argue it

is only by embracing the radical possibilities that migration and
"transnationalism from below" (Rosewarne 2004) can enable an eco-socialist alternative to flourish in a
world strangled and blinded with walls and borders. This includes a praxis11 of "nomadic utopianism " that is,
in Ursula K. Le Guin's words, both now here and nowhere at once (see Bell 2010). At a time when " the apocalypse is
combined and uneven " (Swyngedouw 2013), the way to take sides would be by cutting the fence and
sabotaging the border once and for all .

Thus, the United States Federal Government should provide universal health insurance without regard
to citizenship or legal residence.

The 1AC advances an ethic of solidarity and relationality toward non-citizens,

premised on the idea that while everyone is universally subject to conditions that
make life precarious, the condition of precarity is distributed unequally through access
to institutions like health care. This ethic challenges sovereign notions of selfhood and
political community, preserves difference rather than effacing it, and actively builds
outward toward a larger criticism of the very logic of borders and sovereignty
Rosine Kelz 15, Ph.D. in Political Theory from the University of Oxford, 2015, “POLITICAL THEORY AND
MIGRATION: CONCEPTS OF NON-SOVEREIGNTY AND SOLIDARITY,” http://movements-
journal.org/issues/02.kaempfe/03.kelz--political-theory-migration-non-sovereignty-solidarity.html

This contribution seeks to engage on a normative level with political networks of solidarity between non-
migrants and migrants with insecure residency status. While most Western political thought considers
responsibility in relation to relatively stable categories of community (i.e. as one’s responsibilities for fellow members
of a family, clan or nation), I propose a notion of responsibility for ‘others’ – for non-members – as incentive to
create more open forms of political and social association. This challenges the notion of sovereignty ,
central to early modern thought about the individual and the state, and highlights the importance of non-sovereignty as
both a factual reality and a normative concept.

The first part of this essay outlines the concept of the non-sovereign self and shows how it may relate to an infinite responsibility for others. I
will briefly discuss Emmanuel Levinas’s notion of otherness as constitutive of the subject, before turning to Judith Butler’s psychoanalytic
interpretation of the Levinasian idea. Finally, I discuss how Jacques Derrida’s reading opens up the possibility to think about the relationship
between self and other in terms that are transferable to issues of migration. Derrida introduces the idea of unconditional hospitality, a concept
that calls the possibility of just, sovereign nation-states into question. Relating the notion of the non-sovereign self to concepts of non-
sovereign forms of political association, the second part of this paper concentrates on the heightened importance of solidarity in societies
where precarity and securization are closely interwoven with forms of governing. The paper closes with a short exploration of how notions of
responsibility for ‘others’ and solidarity can be exemplified by a more concrete discussion of political networks that seek to support migrants
without secure residency status.

THE CONCEPT OF THE NON-SOVEREIGN SELF

Recently, non-sovereign concepts of the self have played an increasing role in political thought. In
difference to the notion of the
sovereign or modern subject, where the individual’s abilities to think and act autonomously stand in the foreground, non-
sovereignty stresses human relationality . The following short introduction concentrates on interrelated theoretical approaches
where the self is understood as non-sovereign because of its constitutive relationship to the other. While Levinas argues that our very
understanding of the world is indebted to our relationship to the other, in Butler’s engagement with his argument the bodily and psychic
dimensions of human existence come to the fore. This
enables us to understand the relationship to the other as one
that stresses the universally shared conditions of bodily existence without eradicating the
separateness or uniqueness of each being. Derrida’s formulation of the self’s relationship to the other via the spatial terms of
welcoming and hospitality shows why concepts of non-sovereign selfhood are specifically fruitful for thinking
about the ethics of migration.

The notion of non-sovereignty implies that the subject can only be thought in connection to another
subject. On an abstract level, Emmanuel Levinas has proposed such a concept of subjectivity. Making a pre-ontological argument, Levinas
aims to establish ethics as the basis that enables our very ability to perceive the external world. He argues that humanity’s understanding of its
own existence is based on, and limited by, its relation to an outside or other. Importantly, Levinas’s concept of ‘the other’ does not only, or
even primarily, signify another person, but a transcendental idea. ‘The other’ might be interpreted as the ineffability or incomprehensibility of
God. ‘The other’ can also be taken to express the idea that there is always ‘something’ that escapes language and human comprehension – that
the human ability to know the world and express oneself in language is limited. The awareness of this elusive otherness grounds and enables
moral consciousness. The self, as Levinas asserts, “cannot find meaning within its own being-in-the-world” (Levinas 1986: 23). Only by
perceiving a transcendental other can human beings grasp their own existence in space and time. Levinas thus understands the subject as
established by the address of the other, an address that puts an ethical demand on the subject. That the other is before the subject — not in a
spatial or temporal, but a logical sense — makes the demand of the other unavoidable. To put it differently, because the subject only comes
into being via the other it has a general debt towards the other. When responsibility is understood as following from a debt that is not caused
by any specific or willed activity of the subject, the ethical relationship to the other is no longer of the subject’s choosing. In this sense, the
address of the other is an imposition upon the subject that denies its freedom, but at the same time establishes the very possibility for moral
agency and selfhood.

The moral importance of Levinas’ thought might become clearer when we turn to the link Levinas establishes between the transcendental
notion of otherness and concrete encounters between human beings. In these encounters a universal, ethical demand is expressed by the face
of the other person. Surprisingly, Levinas’ concept of the face does not depict the singularity of another person with specific, unique features.
Instead, what the face reveals is a universal, infinite alterity. While I might appreciate a casual acquaintance’s specific, unique mimicry in a
personal encounter, seeing the anonymous face of the other reveals a universal vulnerability. The perception of this vulnerability is
accompanied by a moral injunction against killing the other. The transcendental concept of otherness, and the ethical demand that it makes on
the self, are thus shown in the fundamental vulnerability all singular faces expose. Any particular other person could reveal to me her universal
‘face’ that signifies her existential vulnerability. Therefore, one’s moral relationship to another person does not depend on any historical
precedent. The notion of ‘the face’ signifies an ethical demand not to kill or let the other die that is independent not only of who the specific
other person is, but also of who I am and in what relationship we stand to each other.

Judith Butler has taken up the Levinasian notion of the address of the other. She combines it with a more concrete narrative of human
dependency and precariousness, by drawing on Laplanchian psychoanalysis (see Butler 2005). Here, non-sovereignty,
dependency
and responsibility follow from the psychic and bodily dimensions of human existence. As embodied
beings, humans are not born as unchanging, sovereign subjects. Instead, they come into the world
prematurely, in the sense that they need the care of others for their bodily and psychic survival. The
infant depends on adults, whose actions it neither fully understands nor controls. Helplessness and need force the infant to develop an
emotional attachment to its primary caregiver(s). In this sense, there is no choice but to love the (adult) other who, similarly as in Levinas’s
formulation, is prior to the existence of the self. This
insight of the priority of the other is important for Jean
Laplanche’s project, which seeks to decenter the status of natural drives in psychoanalysis . In difference to
Freud, Laplanche claims that inherent drives are not the decisive factor in the development of the infant’s relationship to the
primary caregiver. Instead, it is the other, in the form of the overbearing and enigmatic adult, who first addresses
the infant. The unconscious develops in response to this address, an address the infant cannot avoid,
but which it finds inscrutable and overwhelming. As the infant is unable to understand what the other wants it represses
these excess demands. This first act of repression, however, is a deed that precedes any doer. The ‘I’ only emerges because of this primary
repression and will thus always retain traces of the enigmatic foreignness the infant encounters in the address of the other. In
this
formulation, the self’s desires are the consequence of the internalisation of the enigmatic desires of
others.

Turning to Laplanchian psychoanalysis thus allows Butler to argue that the

self comes into being via its unavoidable
relationships with others. The relational self remains, even as an adult, at least to an extent unknown to itself,
unable to account for its own emergence. It is therefore non-sovereign . In other words, one’s becoming a subject,
that is, a person who can communicate, is capable of acting in accordance with social rules and is recognized by others as a bearer of rights,
depends on one’s enigmatic and uncontrollable relationship with concrete other persons. Moreover, throughout their lives human
beings
remain non-sovereign, not only because their knowledge (and thus control) of themselves and others is limited, but also because
they are vulnerable and mortal beings, who depend for their survival on far-reaching and often
incomprehensible social, political and economic networks .
As this notion of ongoing dependency on an outside makes clear, Butler understands the self as incorporating otherness at its core. Moreover,
she argues that the relationship to the other challenges the external boundaries of the self. Its bodily and psychic
needs establish the self as expansive and ecstatic. This notion draws on Butler’s reading of the key scene of recognition in Hegel’s
Phenomenology as a narrative of a consciousness that is perpetually outside itself. Because negativity is seen as “essential to self-articulation”,
the ecstatic subject must “suffer its own loss of identity again and again in order to realize its fullest sense of self” (Butler 1999: 13). For Butler,
in the Hegelian scene of mutual recognition, the subject never returns to itself free of the other from whom it sought recognition. In this sense,
relationality, the connection between the self and the other, becomes constitutive of what the self is. Butler thus argues for an ecstatic notion
of the self, which from the start emerges as non-self-identical and differentiated, outside of itself. Translating the scene of recognition into our
every-day emotional attachments to other people, Butler maintains that it is in moments of love, desire or loss that we overstep our own
boundaries and realize that the relationship to another person can unravel our tentative sense of bounded selfhood. It is from this
understanding of the constitutive character of the other that Butler develops a notion of our ethical responsibility for the other, similar to
Levinas’s.

This emphasis on personal relationships and emotions, however, at first sight appears to create a
problematic imbalance between one’s personal bonds to singular others and a broader
understanding of unknown ‘others’ one would encounter in political interactions . When Butler combines
Levinasian, Laplanchian and Hegelian notions of otherness, ‘the other’ emerges as a concrete other person in the first place: someone the self
has an intimate, emotional relationship with – the primary caregiver of the infant and, later in life, close friends, lovers or family members.
Those relationships have the power to unravel the self in ecstatic movements of love, desire, anger, grief and mourning in which the self comes
to understand itself as overwhelmed and undone by the other. It remains unclear, however, how one gets from these personal relationships to
an acknowledgment of responsibility towards others who are foreign to oneself. The
question is then how one would explain
an assumption of responsibility for those with whom one has no affective relationship . In other words, it
remains unclear how to get from the personal to the political realm – from the ‘me’ and ‘you’ to the ‘third’.

Butler seeks to circumvent this difficulty by turning to the universality of emotional attachments that are
revealed most sharply in the experience of loss and mourning. While the experience of being unravelled by grief is unique
and personal, it is nevertheless an experience that all people who have lost someone they loved share. Thus, loss and grief are at the
same time deeply personal and universal. By assuming that all human beings mourn when someone
close to them dies or disappears we can relate to the experiences of strangers who have lost their loved ones.
In this sense, Butler argues, bonds of solidarity with those affected by the wars waged in ‘our’ names
could be formed . To understand war deaths not as anonymous, but in terms of personal tragedies would make it possible to relate to
those affected globally by violent assertions of state-sovereignty. Those faceless others, lost in the wars waged by
western powers in the name of defending sovereignty, might then be understood as lives mourned by
their relatives and friends in the same way as citizens of Western states would mourn their loved ones
lost to violence. The experience of loss here becomes the possibility to create ties that bridge over regional

and cultural distances .

The universality of loss brings the concept of precariousness – as a universal condition – into focus. Butler understands
precariousness as a socio-ontological dimension of all embodied beings. Precariousness highlights that, as
relational, vulnerable and finite beings (both in the sense that we are mortal and that our knowledge of the world, others and
ourselves is necessarily limited) we depend on others in innumerable ways. While we are all precarious beings,
however, precariousness does not make everybody equal. While it is a shared condition, the ways in
which people are exposed to precariousness differ. As Isabell Lorey explains, precariousness is neither an unchangeable
way of being nor an existential sameness, but the multiple insecure constitution of bodies, which are always socially contingent. As shared, that
is, at the same time separating and relating, precariousness signifies a “relational difference” (Lorey 2012: 33-4). By turning
to precariousness, Butler thus formulates an ethical appeal that seeks to overstep the boundaries of one’s community or personal affiliations.

While Butler stresses the importance of personal emotional bonds and the conditions of embodiment, Jacques Derrida’s engagement with
Levinas tries to mitigate the violence and inequality that seems to be implied in Levinas’s concept of otherness (see Derrida 1997). In Levinas’s
language the other is not only before the self, it also persecutes and accuses the self. Derrida seeks to reinterpret this relationship in terms of
‘welcoming’. The scene of address in Levinas is pre-ontological, which means it is set outside of, or prior to, the notion of time and space. This
makes it possible to understand address and response as simultaneous – that that is, not in terms of an overbearing, threatening other who is
there before the self and thus places the self in a purely reactive position. Moreover, the interweaving of the ontological and the pre-
ontological also signifies the moment of address and response as, in a certain sense, ongoing, or an interruption of temporal linearity. The ‘I’
receives or welcomes the other at the same time as it is addressed by the other – it comes into existence (and remains as ‘coming into
existence’) as an ‘I’ through this very act of invitation. Address, response and constitution of the subject cannot be thought as temporally
distinct, separate phases. To understand ‘self’ and ‘other’ as interrelated positions that need each other for their very existence makes the
scene of encounter one of reciprocity. In this understanding, the self comes into being by simultaneously occupying the site of the other and
welcoming the other into its space. By mutually overstepping their boundaries, the positions of self and other are established as non-sovereign,
as depending on their relationality. One does not start from a pre-given substantial identity that would constitute the basis for a capacity to
welcome, but the welcoming of the other, hospitality itself, comes to define and constitute the subject. The subject is this openness to the
other.

The spatial connotations the term ‘welcoming’ implies, however, opens up a question regarding inhabitation and belonging. We
might
object that the notion of welcoming presupposes a sovereign subject that inhabits a ‘place of its own’
that belongs to the subject and from which it originates. Only when the subject possesses such a space, could
it welcome the other into it (in the sense that I need a home to welcome a stranger as a guest into my house). Indeed, when Derrida
discusses this notion of welcoming a guest into one’s home he appears to set limits to the idea of unconditional welcoming. Derrida warns
against a situation where, when the host relinquishes his or her sense of ‘being a master in one’s own home’ the relationship between host and
guest turns hostile. Then “[a]nyone who encroaches on my ‘at home’, on my ipseity, on my power of hospitality, on my sovereignty as host, I
start to regard as an undesirable foreigner, and virtually as an enemy.” (Derrida / Dufourmantelle 2000: 53–55, my emphasis). Derrida is thus
clear in noting that relinquishing one’s sense of sovereignty is a difficult feat and linked to the acceptance of
heightened vulnerability. To avoid the perceived danger brought by the outsider or other the host needs to establish conditions on,
or laws of, hospitality. This introduces a seemingly irresolvable tension between laws that condition
hospitality and the unconditional demand for welcoming. Unconditional hospitality appears
impossible if it is not bound by formulated laws that limit access to one’s ‘home’ and bind the guest to
certain rules he or she has to obey during the stay. However, conditioning that which is supposed to be
unconditional threatens to undermine and deprave it. These two schemes, therefore, are simultaneously
antinomic and inseparable .
Derrida’s discussion of laws of hospitality versus the demand for unconditional hospitality is often referred to in order to highlight the
complicated situation of European states which have to fulfill humanitarian obligations towards refugees at the same time as they seek to limit
access to their territories (see, for example, Stronks 2012). Such an account, however, encounters several difficulties. First, when Derrida
engages with Levinas, he denies the philosophical or ontological basis for sovereignty and belonging, and thus challenges the necessity to limit
the capacity for welcoming. Instead, Derrida argues that the space of the self –- one’s home -– is only constituted by
the act of welcoming and thus through an act of dispossession. The notion of originary dispossession
implies that there is no ‘home’, no space where the self is before the arrival of the other. To establish a self
then could be understood as the transformation of an originary dispossession into a possession – one becomes a self by claiming ‘one’s place in
the world’. This claim, paradoxically, relies on the understanding that one shares the world with others. One claims a space as one’s own by
offering to share it with someone else. This understanding of welcoming as what constitutes the self, calls into
dispute that we have a right to own a part of the world – to something that belongs to us more than to any other
person. There is no ‘home’ but only places we pass through. These are places where we welcome the other and through this very act of
welcoming make a claim to being there.

Second, establishingan equation between ‘home’, in terms of something that belongs to someone exclusively, and ‘state’
is complicated, especially if we take into account the malleability of both the state-boundaries and rules of membership. Given the
ontological and historical problems we encounter in discourses of belonging and the often violent
ways, in which state-borders are drawn and redrawn, we might be wary of any claims from a particular
group or government to have an exclusive right to a territory.

Third, it might be misleading to think about migrants as ‘guests’ who are in an unequal relationship to
a ‘host’ . It is not only unclear who would play the role of the host, the state and its institutions or the citizens in the communities where
migrants live; most migrants are also not guests. A guest, by definition, stays for a relatively short, circumscribed period. The guest is therefore
not included into the decision-making processes of the host on how to run her home, because these decisions would not affect the guest in the
long run. The guest analogy might thus be more fitting for tourists than for migrants. Many
migrants are looking for a new
home and make a claim to become members of the ‘host’ community. The issue is then whether those
who make a claim to membership should have a say in how membership is defined. Seeing migrants as
potential members, rather than perpetual outsiders, also changes the context of the threat of violence Derrida refers to in terms of the ‘guest’.
While our engagements with others indeed harbor the danger of violence, this danger cannot simply be put in terms of a communal ‘inside’
threatened by an ‘outside’. As we have seen, the
notion that there is a sovereign self, at home, free from the other
is illusory and our necessary engagement with other people always reveals our vulnerability. While
boundaries between ‘self’ and ‘other’, as well as the boundaries of community are indeed in constant need of negotiation, this negotiation
might be more fruitfully thought as a reciprocal conversation between all who are affected, than as limited by laws of conditional hospitality.

As my short discussion of Levinas, Butler and Derrida suggests, an abstract moral argument can be made for why ‘we’,
as citizens of
affluent Western countries, should critically interrogate our exclusive right to a given territory .
Moreover, understanding the ‘other’ as constitutive of the self allows us to understand responsibility as
independent of our prior knowledge of the other person. What counts is not so much who the other is and in what
relationship she or he stands to us, but that the other is vulnerable. If we recognize that the self is permeable and harbors
‘otherness’ at its core, we might also come to question the philosophical foundations of state-
sovereignty. This, in turn, could enable or underwrite a critique of political practices of control designed to
defend borders against uncontrolled migration . By understanding that our living conditions are enabled
by and entangled with the living conditions of people from politically and economically less stable
regions, a valid argument for freedom of movement can be made. As Derrida points out, we have an ethical
obligation towards others that goes beyond the boundaries of nation-states and citizenship, but such an ethics of ‘infinite hospitality’ cannot be
thought within the framework of the nation-state (see Derrida 2002: 100). However, a politics that does not refer to unconditional hospitality
loses its reference to justice, because it is unable to take the other into account (see Derrida 2005). In the next section, I will explore how these
insights can be useful in thinking about the possibility to establish forms of political and social associations which operate beyond or parallel to
existing state-institutions. By bringing the notions of non-sovereignty and responsibility to bear on the question of how solidarity with migrants
might inspire open forms of political activism, we will elucidate these concepts in a more practical context.

FROM PRECARIOUSNESS TO PRECARITY AND A POLITICS OF SOLIDARITY

An ethics of non-sovereignty demands that citizens of Western countries declare their solidarity with
undocumented migrants and refugees . We still have to ask, however, whether a sense of responsibility for others in this rather
abstract form is enough to establish political connections between people who do not necessarily share a social identity (such as class, gender
or ethnicity). Instead
of understanding the lack of a binding social identity as a drawback, however, we might
understand it as the opportunity to establish political connections that do not eradicate difference. In
the absence of a shared identity a more open and creative political sphere can be established. If a
community is based on shared identity, the definition of identity often predetermines political goals
and the forms political actions are supposed to take. If no pre-established formulation of shared
identity is available , this might provide the possibility to establish new, creative forms of political
engagement, whose final goals are not defined a priori. This, however, requires a different
understanding of connectivity that highlights the role of solidarity as a political sentiment one
establishes towards an ‘other’. Such a formulation, stresses the possibility for political association
that does not seek to eradicate difference or heterogeneity . One possible route such a reformulation could take is to
move from the general concept of precariousness, as a universal ontological condition, to the political concept of precarity. As we have seen, all
humans experience precariousness in the sense that they are vulnerable and dependent living beings. Moreover, appreciating the concept of
universal precariousness might allow for the insight that we all have experienced mortality as the loss of a loved one. Therefore, even as
citizens of relatively secure Western states we might be able to empathize with other human beings who have lost friends or family members
through war, extreme poverty, or during flight. While
precariousness is universal, risks, however, are not equally
distributed. The concept of precarity highlights the ways in which political, social and economic
structures organize precariousness. While precariousness is ontologically given, precarity is produced
by social structures, where the individual interacts with the state and economic systems, for example via
the organization of working conditions. Personal levels of precarity are thus defined by one’s access to institutions
or social networks that safeguard a person from dangers by providing education, health-care or secure living and
working conditions.

As Isabell Lorey argues, the distribution of precarity through economic stratification and political measures is
an important hallmark of the modern welfare state. The promise of security entailed in citizenship in a
Western welfare state is intrinsically bound to the fear of the dangerous and precarious other. This
discourse protrudes a disciplinary power, where citizens seek to avoid becoming ‘othered’ themselves
by fulfilling social expectations. Fear of precarization and the perceived need for protection thus become
important aspects of the subjection of citizens, where a bond between the individual, society and the state is established
(ibid: 24).

Lorey sees neo-liberalism as an intensification of the governing function of precarity and the accompanying
discourse of securitization inherent to the modern capitalist state. With the ‘withering-away’ of the welfare function of Western nation-states,
precarity has reached the ‘core’ population. While previously forms of precarious employment or insecure health-care have been restricted
largely to the global south or the ‘fringes’ of Western European societies, today delineation from the precarious other becomes increasingly
complicated. In this context, precarization becomes a mechanism of heightened control within the social mainstream. This shows itself for
example in the fear of a relatively privileged and well-educated workforce to become redundant – a fear that produces an incentive for
increased self-government or self-exploitation. The demands of an insecure and flexible labor-market appear as potential forces of de-
politization, where the growing preoccupation with self-marketing and discourses of self-responsibility cover over common political interests of
laborers (Lorey 2012: 85). Moreover, the growth of economic precarity also transforms the role of the nation-state. Where
the role of
the state as provider of welfare and social provisions is minimized, the state redefines itself by
concentrating on discourses of security that involve its military and police functions . In this context,
disciplinary techniques of control and surveillance increase in importance (ibid: 86). Discourses of
‘others’ are cultivated, where the other either appears as a potential threat (the criminal, the terrorist) and/or
as the one who would unfairly benefit from the state and thus needs to remain excluded from
systems of care and protection (the anti-social freeloader, the economic migrant). The interplay between processes of
securitization and precarization provides at the same time a justification for the necessary incompleteness
of sovereignty and the rationale for the ongoing efforts to establish sovereignty .
While the discourse of precarity stresses how a feeling of insecurity spreads towards the centers of relatively wealthy states, we should,
however, not succumb to the temptation of evoking a new time of generalized or equally shared risks. Even though we can in a certain sense
speak of a ‘democratization’ of precarity, those
who were previously ‘othered’ or are now identified as security-
threats remain more vulnerable to new processes of precarization, as the situation of undocumented
migrants and asylum-seekers demonstrates. The heightened perception of insecurity, both on an economic and geopolitical
level, has increased the demand to secure national borders in the name of the securing of the ‘native’ population. The accompanying
criminalization of migrants and ethnically and culturally laden discourses on terrorism further redefine those who appear as visibly ‘other’ as
potential security threats. Even though borders can never be closed completely, new measures of border-control further restrict the autonomy
of migration with the effect that the act of migrating for many becomes increasingly perilous and deadly. Moreover, not only are precarious
labor conditions still strong push factors for migration, when migrants reach economically stronger countries they are disproportionally
affected by the precarization of labor (ibid: 92). Migrants
and refugees not only suffer from often insecure residence
permits, their residency status also determines access to labor markets, education and medical care ,
thus heightening their precarity.

Nevertheless, more widely shared experiences of precarity can function as an incentive to create new forms
of political action and establish networks of solidarity . Many perceive the pressure of the neo-liberal work world as
isolating, for it leaves no space, energy or time for shared resistance. For some, however, the spread of insecurity in all aspects of life provides
an impetus to create new connections that replace lost or weakened societal bonds traditionally provided by social and state institutions. The
weakening of the rigidity of former social and work relations can provide an opportunity to
challenge inflexible institutional
forms of political organization and provide an incentive for social change. The increasing flexibility of
social structures can enable unforeseen openings for new social spaces where networks based on an
apprehension of shared precariousness and the inadequacy of state institutions are formed. In an emerging
‘politics of care’ collectives take on some of the previous state-functions. Here, the transgression of spheres
(between work, political and private life), fostered by post-fordist working relations can be redefined as chance for flexible forms of political
organization to appear. The emphasis on insecurity and securitization as ongoing and accelerating processes requires that political activists to
envision less static and durable forms of political associations, and new forms of political activism, which can also be more inclusive. The
creation of flexible political networks makes it possible to react to an increasingly fast-paced social world as well as to changing forms of
governmental control.

In this context, one could argue that a growing awareness of the more widespread effects of precarity in the ‘core population’ has helped to
shape the forms of organization and action that come to play in social networks of solidarity with migrants. As members of the No Borders
network describe it in an online-manifesto, political action becomes reinscribed as the attempt “to create strong networks to support free
movement across Europe’s borders” by establishing an infrastructure that helps to provide at least a minimum level of security to those who
live with precarity, while at the same time recognizing migration as a social force within an increasingly flexible and unpredictable social and
political world. Migration highlights the importance of social and personal networks as an answer to precarity and exclusion. While political
activists can only play a small part in these processes, they can “play an active role in bringing such connections together across national and
cultural boundaries” (ibid). The
political sphere becomes reimagined as “a pool of formal and informal connections,
a web of solidarity” where the provision of basic services such as food, housing and basic health-care to
those excluded from citizenship rights and state welfare becomes a political act of resistance . Some ‘No Borders’
activists thus see themselves in the tradition of previous resistance movements, such as the French Resistance during World War II and the
‘underground railroads’ that helped runaway slaves in the U.S. They argue that, just as the outcomes of these movements were unforeseeable,
activists today cannot foresee which processes and developments their activities will set into motion
and which future forms of political spheres they might thus help to create. To acknowledge that
precarity is politically and socially stratified means to be aware that the intention to create a political
space where actors can meet as equals is not enough to make differences ‘magically’ disappear . The
manifesto thus stresses the need for No Borders “to be an open and diverse movement” which has to “tackle the borders within our movement
too”. They “need to constantly address different forms of privilege, whether based on people’s legal
status, language, education, gender, race, class, or simply people’s other commitments and abilities to
face different levels of risk”(ibid). They also emphasize that political action should not be motivated by identity or life-style choices, a
danger they see within the European anarchist scene in which they have their roots.

This description of political activism suggests an understanding of solidarity as a political affect that connects
people without eradicating difference . Instead of invoking the need for close bonds within a clearly defined and limited group
of people, the concept of solidarity stresses the importance of maintaining open political associations .1 This
reaffirms the political significance of concepts of non-sovereignty and otherness . To elucidate the connection
between solidarity and otherness, it helps to recall our discussion of the non-sovereign self. As we have seen, the self is not only constituted by
the address of the other. It also retains otherness at its core. Moreover, as Butler stresses, the self is ecstatic, constantly overstepping its
boundaries towards the outside or other. This ecstatic relationship does not necessarily stop at preconceived community boundaries. We do
not only establish relationship with those we perceive as similar to us, or to those we think we share certain
identity-traits with, in complex societies weare also related, in innumerable ways, to people who appear different and
who remain strange or unknown. Thus, we might promote a political stance towards our ‘own’
community that understands this community as permeable . Just as the self constantly oversteps and redefines its own
boundedness in its relationships with other people, a community can establish solidarity with those ‘outside’ of its
(internal and external) borders, with strangers, non-members or non-citizens, and in this process
renegotiate its own understanding of identity, boundedness and cohesion. This, in turn, opens up the
possibility for the establishment of non-sovereign political assemblages, where the impossibility of
self-identity is taken as an asset. Solidarity does neither presuppose that we find things we share with
others, nor that these others eventually become members of ‘our’ political or social group .
Therefore, even though this understanding of solidarity draws to a certain extent on Hegelian notions of recognition, we need to be careful to
differentiate between these two concepts. Connecting solidarity to recognition, we could fall into a position which,
as for example in Axel Honneth’s formulation, defines solidarity as a process based on symmetrical appreciation
between relatively autonomous individuals (Marchart 2010: 357). Such a position would be difficult to
maintain, if we recall the concrete situation of activists involved in movements of solidarity with undocumented migrants.
Here the differences of positions (concerning risk, but also relative political and cultural visibility)
between activists who have secure residency and/or citizenship status and those living with the constant
threat of removal are obvious . Understanding solidarity in terms of reciprocity would make little sense in such a context. This
asymmetry can also be expressed in ethical terms. As the notion of infinite hospitality should make clear, the
specificity of the ethical appeal to solidarity with migrants is that we are not dealing with a
symmetrical relationship. Migrants’ need for protection is asymmetrically weightier than concerns of
citizens about the strain an influx of migrants would allegedly put on welfare systems and the cultural
homogeneity of receiving communities. Faced with competing demands, these positions should not be regarded as equally valid. Migrants are
thus not under the same obligation to recognize the demands of the settled populations of receiving countries to maintain their cultural or
social status quo, as this population would be under the obligation to recognize migrants’ needs for protection and humane living conditions.

The notion of solidarity as closely akin to recognition in the way Honneth formulates it is also unsuitable for a second reason. Honneth’s
discussion implies that there exists, necessarily, a positive center of particularity we will have to recognize in the other. The relationship
between self and other grounds on the mutual recognition of the positive attributes the other has to offer. It
is argued that every
other person has something that makes her unique and thus establishes her value. While this might be the
case, the idea that we need to recognize another person because she has something positive to offer is

not the best way to approach debates about migration . As I have tried to show above, an ethics of hospitality
hinges on the insight that who the other is cannot be of importance . Conducting debates about
migration in terms of the positive contributions migrants could make to the ‘host’ society risks derailing the
conversation. The question cannot be whether a migrant has something to offer to enrich a receiving
country’s culture or labor market. Instead, solidarity with migrants is based on migrants’ need and/or on the
insight that a right to free movement cannot be limited to the citizens of rich Western countries.

CONCLUSION

This paper sought to establish non-sovereignty as a term that allows to think relationality and difference together. Starting from the notion of
the non-sovereign self, I argued that engagement with the other not only establishes the human relationship to its external environment as
such, it is also a necessary condition of embodied existence. We do not only need others, however, we can also understand the relationship to
others as one of ethical and political obligation. If we believe that no one has more right to ‘the enjoyment of the world’ than any other person,
a normative argument for unconditional welcoming and freedom of migration can be made.

My argument complicates the possibility to draw a comparison between singular existences, the relationship between an ‘I’ and a ‘you’ or a
‘host’ and a ‘guest’ on the one hand, and broader societal processes on the other hand. While extrapolating from notions of the individual or
person to the level of the state or society is a well-worn strategy of argumentation in political theory, it is not unproblematic. One goal of this
paper is to reorientate how the relationships between singular human beings and communities are imagined. I argue against an understanding
of society as a clearly circumscribed, singular organism or body that mirrors the body of a human being as a singular, clearly bounded entity in
space. If we concentrate on the conditions of vulnerability, non-sovereignty and precariousness, which are universally shared but still affect
every being in unique ways, the interconnections between bodies and thus between various social, political and economic networks come to
the fore.

Establishing a sense of communities as interrelated networks then challenges the notion that any political community could be bound in a
similar way as the living bodies of human or non-human animals. States are artificial formations, whose external borders
and internal rules are malleable in ways that cannot translate into metaphors of living bodies. If we
understand the state as a negotiable entity, however, there is no firm ground on which we could deny
entry and membership to some people while granting it to others.

It is from this position that a case for solidarity with migrants is made. Solidarity marks the movement beyond
organic concepts of established commonality. To develop solidarity with others we thus have to challenge the

boundaries of our communities , and our positions within them. Solidarity implies that we might put the interests of the other, the
stranger or non-member, above the (assumed) interests of our own, pre-established, community. The appeal to do so is based on the insight of
otherness as constitutive of subjectivity and creates a bond between diverse people. If
we accept that we carry otherness
within ourselves, that we are not self-identical, we might be in a better position to accept the otherness of
another person and refrain from the need to captivate what she is within preconceived ideas of
identity based on origin, religion, race or legal status. Such an understanding of solidarity also allows us to rethink
political practices. Instead of stressing the need to create a strong and lasting set of common goals,
agendas or identity traits, political action in concert can be redefined as needs-based, a notion that
allows for the creation of more fluid and flexible forms of political association . These continuing efforts to
restructure the public sphere are not unique to movements of solidarity with migrants, but are part of many struggles for emancipatory
political change.

The response to structural injustice should foreground policy changes in areas where
we are particularly responsible for past harm and where changes to law and policy can
have particularly beneficial effects. These criteria demand that the ballot prioritize the
extension of health care to non-citizens, while not foreclosing the value of addressing
other injustices
Patricia Illingworth 17, professor in the Department of Philosophy and Religion and in the D’Amore-
McKim School of Business, lecturer in law at the Northeastern University School of Law; and Wendy E.
Parmet, Matthews Distinguished University Professor of Law and Director of the Center for Health Policy
and Law, Professor of Public Policy and Urban Affairs, Northeastern University School of Public Policy
and Urban Affairs, 2017, The Health of Newcomers: Immigration, Health Policy, and the Case For Global
Solidarity, p. 182-189

But does such solidarity go further and create a moral obligation to carry the health costs of newcomers? The
presence of fellow
feeling underlying solidarity is not enough in and of itself to assert that solidarity is morally required . Fellow
feeling cannot be enough to trigger a moral duty to carry costs for the simple reason that sometimes fellow feeling can be in the service of
immoral ends—such as the fellow feeling among ISIS members or the Ku Klux Klan. Iris Young
provides a framework for
distinguishing occasions when solidarity-based duties are triggered. Briefly, her answer is that generally duties of
solidarity are triggered by the presence of structural injustice . We discussed this important concept in chapter 7.
Recall that, according to Young, injustice
exists when some people experience material disadvantage, such as
poverty, through no choice of their own, and other people benefit, as a result of circumstances . Young
argues that injustice is fostered not only through the acts of individuals but also through social

structures .49

Young believes that responsibilityfor carrying costs can arise when there is structural injustice . People who
participate by their actions in the ongoing schemes of cooperation that constitute structural injustice
are responsible for them, in the sense that they are part of the process that causes them.50 As with a violation of negative duties not
to harm others, complicity in a structural injustice can give rise to a duty to help. Today, structural injustice
is both local and transnational .
With her focus on structural injustice, Young gives some normative and prescriptive content to solidarity. Some of the examples discussed in
chapter 7 are illustrative of structural injustice. For example, medical tourism contributes to the creation of structural injustice. Medical tourists
benefit from inexpensive health care, enhancing their own opportunities, and at the same time compromising, although unintentionally, the
health of people in poor countries by diverting skilled medical help away from them. The medical brain drain also exhibits characteristics of
structural injustice. As people in wealthy countries recruit and hire skilled medical personnel to care for their loved ones, they deprive people in
poor countries of the medical workers they need, often leaving them without an adequate health care workforce. People who hire health care
workers from other countries or support workers to care for their elderly parents do not intentionally or directly harm people in poor countries.
Yet they are complicit in a global structure that results in harms to others, including to some of the most vulnerable people in the world. In
some cases, they recruit health care workers; in others, they hire them; and in still others, they are nursed to health by them. If we follow
Youngs reasoning, solidarity responsibilities are triggered by the role that people play in structural injustice. Put simply, the fact that people
engage in practices that shift medical resources away from the global poor to wealthy countries can give rise to solidarity duties to poor
countries and to the victims of structural injustice.

As we saw in chapter 7, affluent societies contribute to the creation and persistence of global poverty and
attending health problems. The multiple mechanisms that impact global health contribute to structural injustice. Newcomers
are often victims of structural injustice. To the extent that the activities of rich countries and their communities exacerbate
global poverty and contribute to structural injustice, solidarity responsibilities are triggered. Those responsibilities can be met
internationally, for example by funding clean water projects in the sending countries, or locally , for example by supporting the

health of newcomers. Structural injustice is not only transnational. Sometimes the victims of
structural injustice live next door.

Young grounds the obligation to carry costs for others, and to act in solidarity, on the presence of "social
connection": "Our responsibility derives from belonging together with others in a system of interdependent
processes of cooperation and competition through which we seek benefits and aim to realize projects . . . Responsibility
in relation to injustice thus derives not from living under a common constitution, but rather from
participating in the diverse institutional processes that produce structural injustices ."51

For Young what matters are the connections among people and the responsibilities that are generated by
those connections. People are connected to others in countless ways, both directly and indirectly, strongly and weakly. Young identifies
some parameters to determine when people ought to carry costs for others.52

There are four parameters that trigger solidarity responsibilities for structural injustice. These are power ,
privilege , interest , and collective ability .53 The first, power, advises that efforts toward achieving structural injustice
should target injustices in which the actors are able to successfully effect change . Second, when people
have enjoyed privilege within a structure, they ought to carry costs. In terms of health care, people in affluent
nations who have benefitted from migrant health care workers would have responsibility to the victims of structural injustice, such as HIV
patients in sub-Saharan Africa who are in want of nurses and physicians. Third, having a
vested interest in structural injustice
triggers responsibilities to address the injustice. Thus, even the victims of structural injustice may have solidarity
responsibilities with respect to the injustice because they have a strong vested interest in the injustice. Arguably, because health has public-
good qualities, it would seem that all
people have a vested interest in health and, in turn, an interest in ensuring the health of
all. Fourth, the ability to act as a collective, and in solidarity, is a triggering consideration. Universities, for
example, enjoy collective ability to address structural injustice in a way that a small business owner might not.54 If we recognize duties to carry
costs when there is (1) power to effect change, (2) privilege connected to the structure, (3) a vested interest, and (4) collective ability, a strong
case can be made that there are solidarity-based responsibilities to carry the health care costs of
newcomers. We share close ties with newcomers in a way that we do not with people across the
globe. By invoking Young's parameters, we can identify which instances of structural injustice
have priority . This is not to say that we are only responsible when the four parameters are satisfied.
But they provide a place to start .

Most people are involved one way or another in a large number of structural injustices. They buy clothes
made in sweatshops, eat fruit farmed by immigrants who die from pesticides, receive medical care from physicians who
have left developing countries, and enjoy the leisure that is made possible through international caretakers. When it is necessary to

prioritize help because of time and resources constraints, Young’s parameters can be informative. When they are
applied to newcomers, a strong argument can be made that there is a responsibility to carry health costs for
them .
Many newcomers work in low-skill occupations: farming, domestic work, and house painting, to name a few. These
occupations are especially burdensome on their health. Paint fumes, cleaning products, and nursing the sick carry health
risks for those who undertake this kind of work. Exposing newcomers disproportionately to these risky jobs arguably
creates an injustice.55 Poverty is a risk factor for health, and many immigrants live in conditions of poverty. The role that social
structure plays in sustaining global poverty gives rise to the push factors that drive immigrants to new
countries, offering hope of relief from poverty. We also share other kinds of connections with newcomers: we eat the food
they harvest, drive the cars for which they pump the gas, and are the patients for whom they care. We employ them and we fire them. We see
them on a daily basis. We flood their habitats with greenhouse gas emissions. The
connections people from wealthy
countries have to newcomers both internationally and domestically are substantial, close, and often
intimate.

Young's second criterion for triggering solidarity responsibilities is also satisfied in the case of newcomers. Providing for the health of
newcomers is one sphere in which receiving countries can have an enormous impact . Of all the
structural injustice to which people bear a connection, a duty to carry costs is triggered when there
is a probability of effective impact . The health of newcomers is one place where clear steps can be
taken that will result in good health outcomes for newcomers. Health care is available and it is possible to
modify some of the social determinants of health . Laws that discriminate against newcomers can be
changed , and often for little to no additional cost. Moreover, the health systems in affluent countries have the
collective wherewithal to support the health needs of newcomers in a way that those in sending countries
cannot. Health is often compromised in the poor countries from which newcomers originate, and good health care is more difficult to come
by, because of weak infrastructure and corruption in those countries. The health care that can be given to newcomers may be more effective in
receiving countries than in sending countries.

Third, being a privileged beneficiary can trigger a duty to carry costs. People
who have benefitted from structural injustice
may enjoy greater privileges.56 This too would seem to require receiving countries to carry costs for
newcomers . Those who hire newcomers, and often pay them under the table, benefit financially from such arrangements. They hold a
privileged position with respect to others. Many newcomers also pay into Social Security, or similar national pension systems, without ever
receiving benefits. Citizens who collect Social Security benefit from the contributions of newcomers who have contributed, but who will never
receive Social Security. Many citizens in receiving countries are able to remain healthy because newcomers perform unhealthy work. Were it
not for newcomers, many unhealthy jobs would need to be performed by natives. Public health benefits from the work that newcomers
perform both because newcomers toil in many unhealthy occupations, and because they very often care for sick citizens, putting their own
health at risk. Thus, citizens are privileged with respect to them. Fourth, if we consider only the responsibilities to carry health care costs, and
set aside the other policies for the present, health
systems in developed countries have the capacity for collective
action, and are easily able to extend what exists to noncitizens. Indeed, as we suggested in chapter 2, it can be more
expensive to exclude newcomers than to include them. The ability to act collectively is likely to be stronger in nations with more efficient health
systems.

Wealthy nations that receive newcomers benefit enormously from them, and it would be foolhardy not to ensure that those with whom they
interact and depend on a daily basis are healthy. Not only would failure to do so put the health of natives at risk, but it would also threaten the
ways in which natives can cooperate with newcomers. We have argued that among those affected by structural injustice,
newcomers have priority with respect to our solidarity-based duties to carry health costs. We are both
connected to their health harms and to them personally. We have benefited from these connections. In addition, the
role of affluent societies in structural injustice violates negative duties. Finally, because health is a global public good, it behooves receiving
nations to ensure the health of all people.

The health-related responsibilities to newcomers do not seem to change when newcomers are present in large numbers, as they have been
with the global migrant crisis that began in 2011. Some countries in the European Union found themselves overwhelmed by the sheer number
of newcomers during the crisis. Many, but not all, newcomers are entitled, by international law, to refugee status. But not all migrants qualify
as refugees; some migrate to escape poverty and find a better life.57

Economic migrants, those seeking a better life and escape from poverty, also constitute part of the current crisis, but they are not legal
refugees and do not have a valid claim to asylum. In the absence of a legal obligation, some EU countries, such as Macedonia, Serbia, and
Croatia, have turned them away.58 It is beyond the scope of this book to provide a close review of the crisis. Nor do we address the question of
what a nations obligations are to admit migrants. From a moral point of view, however, and given the arguments of this book, the fact that
there are many newcomers to help does not change our health obligation to help them. If anything, large numbers of newcomers may make
the global public-good argument especially compelling. We have argued that all newcomers should be treated equally with
citizens with respect to health. Because health is a public good, and nonexcludable, potential health harms of many newcomers
may be greater than they would be if there were fewer.59 When refugees (some who may have been more appropriately termed asylum
seekers) arrived in Germany, for example, they were immediately checked for health problems and serious injuries. They were then moved to
camps where they received free care from Refudocs. Refudocs founder Mathias Wendeborn reported that the health problems encountered in
the refugee population most often resulted from the trip the refugees had taken – skin infections, foot injuries, and symptoms of poverty and
compromised hygiene.60 He also noted that the refugee population is overall healthy. Others have observed mental health problems that
require alleviation.61 Lawrence O. Gostin and Anna E. Roberts note that forced migrants face “profound health hazards” at each stage of the
journey, beginning before departure. They have high mortality rates, many die at sea, and they face health risks caused by “people smugglers,”
poverty, and lack of food, water, and shelter. Women and girls are subject to sexual abuse, and refugee and internally displaced person (IDP)
camps are subject to epidemics of infectious diseases: typhoid, tuberculosis, measles, cholera, and infections that accompany overcrowding.62
Given the public-good dimension of health, and the arguments of this book, there is no moral reason to treat forced migrants differently than
any other newcomers. In view of our argument, the burden of proof shifts to others to demonstrate that newcomers who are a part of the
migration crisis should be treated differently.

The international response to the refugee crisis also speaks to the willingness of different nations to help strangers: nations vary over time in
their willingness to show solidarity with refugees. Canada is projected to accept as many as 50,000 government- and privately-sponsored
refugees by the end of 2016, while in 2015, Donald Trump, then the Republican frontrunner for the party’s presidential nomination, wanted to
ban Muslims from entering the United States.63 The Obama administration aspires to welcome 10,000. The United Kingdom intended to bring
20,000 refugees by 2020. France planned on 30,000 over two years. Germany had shown the greatest generosity, having taken one million
refugees in one year. Sweden took in 150,000 refugees in roughly a year.64 At the time of writing, Canada had not experienced the kind of
backlash against refugees that other countries report. It has a unique program that combines private and public sponsorship of refugees.65
Justin Trudeau welcomed refugees at the airport with the words, “You are home now.” In turn, he was thanked by a Syrian man for the warm
welcome. In Trudeau’s words, “This is something that we are able to do in this country because we define a Canadian not by a skin color or a
language or a religion or a background, but by a shared set of values, aspirations, hopes and dreams that not just Canadians but people around
the world share.”66

Far more common, however, are stories demonstrating ethnocentrism. Many people show hostility toward strangers rather than a desire to
bring them into the fold. Ethnocentrism, a disposition to divide the world into in-groups and out-groups, is a
fact of life. Donald Kinder and Cindy Kam found that ethnocentrism is pervasive in modern society, affects public opinion about
immigration, and influences policy toward immigrants.67
Ethnocentrism, like racism and sexism, is a form of bias and in-group favoritism.68 It may be a form of
unconscious or implicit bias , an example of social identity theory, or an outcome of natural selection. In any case, as an
expression of discrimination, it is unethical, inconsistent with principles of universality, the very heart
of ethics. And, as we have argued, it makes for ineffective health policy . It is beyond the scope of this book to review the
social and psychological causes of ethnocentrism. Nonetheless, it is safe to say that because ethnocentrism is unethical, it
does not constitute a good foundation for health policy for newcomers. If anything, recognizing the
pervasiveness of ethnocentrism and the impact it has on policy should signal a warning to create
policy that is unburdened by in-group bias and discrimination against "strangers ." The point of
policy, law, and ethics is in large part to monitor behavior that does not come easily to human beings,
and to ensure that their better selves guide their conduct .

The call for non-citizen health care must be articulated within a call for universal
access that’s truly universal---the 1AC rejects the idea of simply bringing excluded
groups into an already-fundamentally-unequal system just to compete in a zero-sum
contest for care. Rather the 1AC positions the overall transformation of the health
care system through the specific narrative of non-citizens’ exclusion, and both aspects
are necessary to put forward radical alternatives to the status quo
Brietta R. Clark 8, Professor of Law, Loyola Law School, Los Angeles, Summer 2008, “The Immigrant
Health Care Narrative and What It Tells Us about the U.S. Health Care System,” Annals of Health Law, 17
Ann. Health L. 229

The discourse surrounding immigrant health care has been primarily about the proper role of immigration
status and its link to health policy decisions. It has centered around two critical questions: to what extent is health policy a
legitimate or effective mechanism of immigration control, and to what extent do immigration status and immigration-related concerns serve or
undermine important public policy concerns in allocating healthcare resources? This
article has gone one step further to ask whether
the immigrant health care narrative can or does influence health policy decisions .

Pro-access advocates' have attempted to construct a narrative that engenders empathy and minimizes
the blaming and bias that encourages fear and mistrust of immigrants, which in turn fuels harsh immigration-related policies. They
have also challenged the justification for benefit restrictions by describing health care as a public good
for which benefit exclusions and heightened enforcement of eligibility hurts citizens and noncitizens alike. Nonetheless, immigration-
related concerns continue to pervade health policy discourse and decision-making.

This begs the question - to what extent can the health policy concerns of pro-access advocates be
meaningfully addressed by reconstructing the immigrant health care narrative?
Ironically, despite the preoccupation on both sides of the debate with this narrative, the answer is probably that changing this narrative will
have very little effect on health care policies and on the lives of immigrants in our healthcare system. First, it
is not clear that
changing the immigrant health [*272] narrative will result in the removal of immigration-based
eligibility criteria or would necessarily bring about fairer or sounder health policy decisions . In fact, the
rhetoric used to justify or challenge restrictions for immigrants is not that different from the rhetoric
used to allocate resources among different groups of citizens. Indeed the nature of the restrictions and
exceptions for immigrant health care largely mirror the same kind of barriers and linedrawing of citizens
based on "moral dessert," a utilitarian, cost-benefit analysis, or some combination of both. Health
care is not considered a human right to which everyone should have access . In fact, the federal government will
only provide funding for certain categories of people, such as those who have contributed to the Social Security system long enough to be
viewed as having a legitimate claim to benefits (Medicare coverage for the aged), those who have become particularly vulnerable and unable to
care for themselves for reasons beyond their control (Medicare / Medicaid coverage for poor children and the disabled), the very poor parents
of children and pregnant women because it is a cost-effective way to ensure healthy children (Medicaid/SCHIP), and people in need of care to
deal with serious bodily harm and life-threatening illness or injury (such as laws requiring emergency care or funding dialysis treatment for
those with end-stage renal disease). n217

Even if immigration-status was removed as an eligibility criterion, it would only potentially help
immigrants who qualify under one of the designated eligibility categories, and even then, qualified
immigrants still might not feel they can access care. We know this in part from data showing that immigrants forego care
for themselves and their children, even when they are legally entitled to it. n218 Fears of becoming labeled a "public charge" or being deported
have had a serious chilling effect that will not simply disappear with the elimination of immigration-based eligibility criteria. For example, even
after the INS issued a policy stating that receipt of public benefits would not be used to label immigrants "public charges" subject to
deportation, the fears and chilling effects persist. n219

Moreover, the elimination of status-based criteria would not guarantee access to care; it only removes one barrier among many affecting
immigrants. Immigrants are vulnerable along a number of axes: delays in care and poor quality care are due to the intersection of immigration
status, economics, ethnicity and race, as well as gender for women and transgender individuals. Immigration is certainly an added impediment
to care, but it is not the only one. n220 In fact, the racialization of certain types of immigrants, [*273] and the creation of a permanent class of
"alien citizens" divorced from immigration status, reveals the entrenchment of discrimination that will not be easily eliminated by simply
challenging the health policy-immigration link. Challenging
the narrative offers only limited success because of the
inherent limitations and structural defects of our existing healthcare system. By engaging
restrictionists' on their terms and under the existing health care paradigm, pro-access advocates can
unwittingly reinforce the "Us-Them" dichotomy that pervades health policy decision-making. Linedrawing
within this paradigm will always pit immigrants against citizens, just as it pits different groups of
citizens against each other . One could argue that while linedrawing based on immigration status is unfair and
unsound for many reasons, it is not atypical or unusually cruel in light of a healthcare system that routinely draws
lines based on flawed or irrational assumptions about who is "most deserving," while excluding
millions of others in need through no fault of their own. n221
This is not to suggest that the dominant immigrant narrative does not influence health policy discourse in ways that harm immigrants. Nor
should we trivialize the unique and compounded effects of these benefit restrictions on immigrants, especially those impacted in multiple ways,
such as immigrants with disabilities. What this article argues, however, is that the immigrant health care narrative is only one factor influencing
policy decisions and discrimination at access points. Reconstructing the
immigrant narrative or story to argue for
greater access for immigrants will offer only limited success and, in some ways, could actually backfire and undermine
the goals of immigrants' rights groups and public health advocates.

This reconstruction of the "immigrant health care narrative" and the discourse surrounding benefit restrictions is
very useful, however, for refining our understanding of the problem and suggesting more creative
approaches to reforming health policy :

Like the miner's canary that uses a call of distress to the miner of warn the hazardous atmosphere in the mine, the
critiques people of
color offer [*274] our institutions are warning signals to alert us to the presence of more systemic
problems . Instead of relegating the voices of minorities to the complaint category and relegating it as race-specific, we must look at those
critiques as a reflection of what is not working in our institutions. n222

Lani Guinier and Gerald Torres use this metaphor of the canary in the mine to suggest one important benefit of critiquing our institutions from
an "outsider's" perspective:
The canary is a source of information for all who care about the atmosphere in the mines - and a source of motivation for changing the mines to
make them safer. The canary serves both a diagnostic and an innovative function. It offers us more than a critique of the way social goods are
distributed. What the canary lets us see are the hierarchical arrangements of power and privilege that have naturalized this unequal
distribution. n223

To this end, the

immigrant healthcare narrative provides a particularly compelling example of how our
healthcare system is structured in ways that are inconsistent with notions of equality and fairness. The
problem at its root is not unique to immigrants. Immigrant-specific discourse or advocacy thus will
not solve the fundamental problems of immigrant access to care and can serve to reinforce, rather than challenge,
the fundamental defects of our health care system. Rather than simply fighting for more rights for immigrants within

an inherently flawed and inequitable healthcare system, we should use the immigrant experience
to fuel fundamental reform of the existing system to ensure better access for everyone.

Viewing the problems of our healthcare system through the immigrant lens also presents opportunities for crafting more creative solutions. In
particular, it should encourage partnerships between citizens and noncitizens in building coalitions to advocate for comprehensive health
reform. Immigrant communities have demonstrated a robust and powerful commitment to grassroots organizing and mobilization to protest
actions considered anti-immigrant, despite the fact that these communities are typically politically, economically and socially vulnerable. Recall
the massive protests and community mobilization seen all over the United States by immigrant communities in response to the Sensenbrenner
bill in [*275] March 2006. n224 In her recent book, Suburban Sweatshops, Professor Jennifer Gordon also describes examples of successful
mobilization by unauthorized immigrants, particularly vulnerable to discrimination and labor violations, to fight for labor reforms. n225

Citizens and noncitizens should also view each other as coalition partners in the fight for health reform because they suffer many of the same
burdens and effects under the current healthcare system. Given the multiple axes along which immigrants suffer
discrimination: age, gender, disability status, race - this leads to multiple opportunities for coalition building and

lines of advocacy for reforming the healthcare system in ways that may or may not be immigrant-
specific, but that will ultimately benefit immigrants as well. n226 While immigrant-specific exclusions affecting children
and people with disabilities have led to partnerships between these respective groups, gaps in the existing healthcare system that exclude
immigrants and citizens should encourage partnerships and advocacy aimed at more fundamental reforms. Involving
immigrant
communities and advocacy groups in this broader health reform movement could generate the kind
of momentum and political will needed to change the system . n227
Professors Kevin Johnson and Jennifer Gordon gives examples of these kinds of partnerships in other contexts: women's and immigrants'
groups fighting for relaxation in the requirements of immigration marriage fraud laws; n228 these same groups partnering to achieve greater
recognition of gender-based persecution for purposes of asylum; n229 immigrants working with lesbian and gay organizations to repeal legal
provisions interpreted to [*276] allow the exclusion of immigrants based on sexual orientation; n230 and labor unions reaching out to include
immigrants. n231 At first glance, this kind of partnering may not appear as likely in the fight for greater access to public benefits. n232 The
examples provided by Professors Johnson and Gordon do not involve fighting for limited resources. They were fighting to reform the
immigration process to ensure fair administration for groups marginalized in ways that violated our internal shifting norms about equality and
fairness, to enhance labor protections, and to ensure that existing protections were being enforced for everyone. Any movement to increase
economic entitlements or access to limited resources is going to be much more controversial and presents a greater challenge for immigrant
communities.

Despite these challenges, there

is a meaningful chance that such partnerships can be used to successfully
advocate for healthcare reform. First, the fact that patients do not get money directly, but rather receive coverage for health care,
is important because health care providers and benefit administrators provide a gate keeping function. n233 They help to ensure that resources
are only used for a legitimate medical need, which minimizes, even if it does not completely eliminate, mistrust arising out of fears about fraud
and waste in the distribution of resources. n234 Second, because
health care access has obvious public health
implications, people's interests are interconnected in ways that should encourage collaboration rather
than competition, and does not require singling out any particular group . Third, health care providers are
potentially powerful coalition partners in heath reform efforts. Although examples of discrimination by healthcare providers were cited
throughout this article, many providers believe they have a moral and ethical duty to treat all regardless of ability to pay or immigration status.
They not only oppose immigrant-specific barriers, but have mobilized to fight for universal health care that would eliminate much, if not all of
the problematic linedrawing currently used to distribute benefits. Moreover, they are also hurt economically by benefit exclusions that
jeopardize federal and state funding for the services they feel a moral duty to provide.

[*277] Finally, while the current discourse focuses primarily on immigrants as patients in need of benefits, the medical system has viewed
physicians and healthcare providers from other countries as an important part of the solution to dwindling resources and a growing need for
culturally-appropriate care in underserved communities. For example, in California a bill was proposed to relax the requirements for physicians
from Mexico willing to come here and work in underserved communities. n235 In fact, one of the motivations underlying the bill was to
increase healthcare access for California's Latino population. n236 Such initiatives reveal a more complex and positive relationship between
immigrants and the health care system than generally portrayed in the health care discourse.

VII. Conclusion

Our existing healthcare policies are influenced by the dominant narrative of immigrants and thus reinforce
that dominant narrative in unfortunate ways. Immigrants, unauthorized and legal, immigrant children, and even communities labeled as "alien
citizens" fall victim to policies designed to discourage immigrant health care access. In
trying to challenge these policies,
however, pro-access advocates are put in the regrettable position of unintentionally reinforcing some of the fear,
mistrust, and assumptions about immigrants as a threat to the public fisc that help fuel these policies
in the first place. While scholars and public health advocates try hard to structure their discourse in a careful and respectful manner,
these effects are unavoidable as long as they engage restrictionists on their own terms and
accept the current healthcare paradigm for allocating resources .

The immigrant health narrative is the canary in the mine that is warning us of danger if vulnerable groups
continue to compete against each other for a greater piece of the pie rather than working together
to challenge the status quo and eliminate inequities inherent in our current system . Fortunately,
policymakers, advocates, and providers participating in this Symposium and the dominance of immigration goals over public
health goals are important factors in illuminating the weaknesses of the commonly asserted justifications
of restrictionists' claims. However, the immigrant's narrative in health care is particularly powerful in
illuminating the fundamental problem in our healthcare system that must be addressed before any
meaningful reform of immigrant access can take place. It [*278] creates a discourse that will facilitate coalition building
and advocacy to fight for meaningful and comprehensive healthcare reform that will benefit everyone. They are heeding the warning.
2AC Case
 Single Payer Inevitable
Mass movement for single payer now because of the utter failure of Trumpcare---it’s
guaranteed – only a question of expanding access to all people
Greg Camp 17, “Thanks to right-wingers, single payer now looks inevitable.,” 7/28/17,
https://politicsmeanspolitics.com/thanks-to-right-wingers-single-payer-now-looks-inevitable-
521abefa59e9

The continuing disaster that is the Republican attempt to repeal and perhaps replace Obamacare has provided
delicious months of schadenfreude, while defying the efforts of writers to describe it adequately. A train wreck, for example, happens and then
is done. Twitter users came up with the hashtag, #FailureFriday, which is typical for that social media platform in capturing the moment. But
the failure of Trump and congressional Republicans has plagued them daily since the beginning of 2017, and observers are left to come up with
cases when a political party had so much opportunity and fell so solidly face forward in the dirt.

There is more good news here beyond the pleasure to be had in watching fools fail. What Republicans have done is guarantee that
America will have a single-payer healthcare system .

This is the result of the structural flaws in the right wing of American politics. A handful of the Republican
senators recognized that taking away the current protections for healthcare would harm their constituents, a rare
conflation of personal and public interests, while others objected that the repeal bills weren’t draconian enough . A
party that tries to care for their voters at the same time as pushing a libertarian agenda is doomed to fail.

One irony is that if the Republicans had been a little more organized, they could have given their donors a gift in Obamacare. The Swiss system
is exactly what the Affordable Care Act was trying to be. Every citizen is required to have private insurance, and those who cannot afford the
cost, which is the same for everyone, is given income-based subsidies. This means that the private market has guaranteed customers who are
able to afford the product. That’s exactly what shareholders in the private healthcare market in this country would love. And in fact, when
healthcare executives are asked, that’s exactly the answer that they give. Because the Republican Party has run on stirring up hatred against
Obama, however, they’ve put themselves into a position of not being able to perform their usual job of benefitting the donor classes, thus
letting their voters keep them from serving their real masters.

As a result, support for a single-payer system is rising, especially among Democrats. If the Democratic Party can get
their act together, the 2018 election offers them worlds of possibility. Of course, that party is uniquely capable of screwing up once again if they
haven’t learned anything from the 2016 experience. But if the American people maintain the pressure, we can finally
have a rational healthcare system, and we can thank the right wing for ruining their own attempt to take essential
medical services away.
 Rationing
Single payer solves better health distribution – doesn’t cause physician shortages,
budget shortfalls , or cost-sharing
Adam Gaffney 17, MD from New York University, Medicare for All Should Be a Litmus Test, Jacobin,
8/10/17, https://www.jacobinmag.com/2017/08/medicare-for-all-health-care-obamacare-single-payer
But would they? Again: all major single-payer proposals go beyond Medicare, eliminating cost-sharing and covering a more comprehensive
array of health care benefits.¶ What differentiates the small-bore approaches that Holland and Krugman support from the
deeper reform that single-payer advocates propose is that the latter is designed to improve health
care for everybody, not just to make sure the uninsured get some form of coverage. After all, despite the talk
about people wanting to keep their good employer-sponsored plans, in 2016 29 percent of covered workers had a high-
deductible health plan (up from 4 percent in 2006), while the dollar value of workers’ deductibles has
shot up by 300 percent since 2006.¶ Workers also often face copayments and coinsurance (a percent of
the cost of the health care service paid out of pocket) for doctors’ visits, hospitalizations, tests, and
drugs. And such payments are generally much higher under the non-group private plans purchased on or off the Obamacare exchanges.
Many also have to deal with shifting — and often narrow — networks of doctors and hospitals, to the great detriment of doctor-patient
relationships and continuity of care, not to mention choice and equal access.¶ In short, Holland’s point about “loss aversion” misses the mark
by a mile: who would resent exchanging a limited network, high-deductible private insurance plan for a public plan that provided first-dollar
comprehensive coverage without networks, and which could never be taken away?¶ Holland doubles down on this point, however, and brings
up a related concern. He suggests that because some doctors might not take part in the national health program, “we couldn’t even promise
that if you like your physician you can keep seeing him or her.” Yet a
single-payer system would be the only game in
town: while a tiny percentage of physicians might cater to the rich with boutique concierge practices,
we can safely predict that the vast majority of physicians would participate in the national health
program.¶ Why? Well, consider that even today (when there are alternative forms of insurance), some 93
percent of primary care doctors who see adults accept Medicare — essentially the same percent as
those who accept private insurance. This rate would presumably be even higher under Medicare for All.
Canadian physicians, after all, do quite well under the country’s single-payer system. And to ensure the
same held true in the US, we could subsidize the educational costs of health care workers who
participate in the national health program, as the latest proposal from Physicians for a National Health Program
recommends.¶ Holland is on firmer ground when he moves to the issue of overall health care spending. While single payer would
produce administrative savings, he’s right to note that we can’t reverse history: implementing Medicare for All
wouldn’t suddenly bring US health care expenditures in line with those of single-payer countries. But
so what? It doesn’t need to.¶ International examples strongly indicate that, at the very least, single payer should be
no more expensive (in terms of overall national health spending) than what we have today. And what
single-payer advocates are really arguing is not that we will soon be spending the same percentage of
GDP on health care as Canada, but rather that by eliminating the enormous waste of the extractive and
useless private health insurance apparatus and slashing drug prices (among other efficiencies), we will
generate the savings we need to create the system we want: one in which everybody has first dollar
coverage and equitable health care access .¶ But might there be a third, less disruptive, alternative to the
status quo and single payer?¶ On the one hand, many other systems don’t actually do the sorts of things that single-payer advocates
are calling for in the US (this is Holland’s point); on the other, single payer is not the only international example worth considering (a point that
both Holland and Krugman stress).¶ Holland, for instance, notes that US single-payer proposals go beyond Canadian
Medicare, which doesn’t cover prescription drugs or dental and eye care, causing many to buy supplementary insurance plans. This is true,
yet it only reinforces the argument for a better single-payer system here. Canadian Medicare should cover those things; the
fact that it doesn’t is one flaw of that overall superior system. One study, for instance, found that among eleven high-
income nations, Canada was surpassed only by the US in the proportion of residents aged fifty-five and over who didn’t take medications
because of cost. Not surprisingly, progressives in Canada are pushing for universal drug coverage.¶ Pointing
out other single-payer
systems’ shortcomings, then, is hardly a knock against a proposal for a more comprehensive single-
payer system here.¶ In other respects, however, it’s not clear that single-payer advocates are asking for much more. Holland asserts, for
instance, that “no other health care system offers such expansive benefits” as Conyers’s Medicare-for-All bill, which eliminates out-of-pocket
costs for all health care services. While it is
true that most systems have some form of (rather limited) cost-
sharing, this is both unnecessary, and not universally the case, as Holland seems to suggest. There are no co-
payments (much less deductibles) for doctor visits or hospitalizations in Canada or the United
Kingdom. And in Northern Ireland, Scotland, and Wales, prescription drugs are free for all.¶ The second and
larger point that Krugman and Holland stress is that some European nations have more of a mixed private-public model, and thus that single
payer is not the only option. “There are lots of ways to skin this cat,” Holland writes. But while it is true that every health system is something of
a snowflake, the best European examples share some key similarities. What we call single payer is basically national health insurance, which
despite some (mostly unnecessary) organizational heterogeneity and complexities is what basically exists in countries like Australia, Canada,
and (for the most part) France. The United Kingdom also has a single-payer system, albeit coupled with a more socialized delivery system:
nationalized hospitals.¶ Other nations admittedly have more complex systems. Making sense of the basic nature of Germany’s system, for
instance, has been called something of a “puzzle,” yet its not-for-profit system of highly regulated statutory sickness funds — jointly run by
labor and employers — barely resembles the Obamacare system, and might better be seen as a decentralized form of national health
insurance.¶ FOLLOW US ON FACEBOOK¶ Then there is the Dutch example, often cited by those who find the incremental road appealing.
However, though it is true that in 2006 the Dutch transitioned toward a somewhat more market-oriented, Switzerland-like, “managed
competition” model, its system remains tightly regulated well beyond the Obamacare system; more importantly, evidence suggests that the
managed competition makeover wasn’t particularly helpful, and indeed may have had a dubious impact in terms of equity and efficiency. As
Kieke Okma, Theodore Marmor, and Jonathan Oberlander concluded in the New England Journal of Medicine in 2011:¶ The Dutch experience
provides a cautionary tale about the place of private insurance competition . . . The idea that the Dutch reforms provide a successful model for
US Medicare to emulate is bizarre. The Dutch case in fact underscores the pitfalls of the casual use (and misuse) of international experience in
US health care reform debates.¶ Two final, key points: first, it is not clear that transitioning to a more complicated public-private model that
turns insurers into nonprofit, highly regulated funds will be more politically feasible in the US than going all the way to national health
insurance. The industry will fight both to the death. And second, hybrid models — like those in the Netherlands and Switzerland — are less
efficient than fully public ones. If first-dollar comprehensive universal health care under single-payer produces some new costs (and it will),
achieving such a system would only be that much more expensive, and perhaps truly unaffordable, when implemented within the framework
— and subordinated to the interests of — the bloated private insurance industry.¶ In reality, neither Holland nor Krugman are recommending
we adopt the Dutch model. What is it, then, that the Medicare-for-All naysayers are actually promoting in place of single payer?¶ Krugman
mentions that the public option should be strongly considered, but that otherwise progressives should basically abandon health care reform
and move on to other things. Holland, for his part, more explicitly discusses an ambitious public-option-like program drawn from political
scientist Jacob Hacker, which he calls “Medicare-for-All-Who-Need-It.” But here’s the thing about both: they would not, if achieved, deliver the
benefits that Medicare-for-All proponents are fighting for.¶ This is not simply about different ways to skin a given cat, as Holland writes, but
about which particular cat we intend to skin (with due apologies to cat lovers). Single-payer
advocates’ aims are admittedly
ambitious, yet also quite clear: we want to eliminate uninsurance and underinsurance, and create a right
to equitable, comprehensive, first-dollar health care for everyone in the country, as soon as possible. And
our proposals (e.g., the Conyers bill) would achieve those goals if implemented.
2AC K
 Perm
This series of oppositional networks accelerates the fragmenting power of anti-
hegemonic networks
Hardt 2 – Prof. of Literature @ Duke & The European Graduate School
New Left Review, New Left Review 14, March-April 2002,

http://newleftreview.org/II/14/michael-hardt-porto-alegre-today-s-bandung
Anti-capitalism and national sovereignty The Porto Alegre Forum was in this sense perhaps to happy, to celebratory and not conflictual enough.
The most important political difference cutting across the entire Forum concerned the role of national sovereignty. There are indeed two
primary positons in the response to today’s dominant forces of globalization: either one can work to reinforce the sovereignty of nation-states
as a defensive barrier against the control of foreign and global capital, or onecan strive towards a non-national alternative
to the present form of globalization that is equally global. The first poses neoliberalism as the primary analytical
category, viewing the enemy as unrestricted global capitalist activity with weak state controls; the second is more clearly posed
against capital itself, whether state-regulated or not. The first might rightly be called an antiglobalization posit on, in so
far as national sovereignties, even if linked by international solidarity, serve to limit and regulate the forces of capitalist globalization. National
liberation thus remains for this posit on the ultimate goal, as it was for the old anticolonial and anti-imperialist struggles. The second, in
contrast, opposes any national solutions and seeks instead a democratic globalization. The first position occupied the most visible and
dominant spaces of the Porto Alegre Forum; it was represented in the large plenary sessions, repeated by the official spokespeople, and
reported in the press. A key proponent of this position was the leadership of the Brazilian PT (Workers' Party)—in effect the host of the Forum,
since it runs the city and regional government. It was obvious and inevitable that the PT would occupy a central space in the Forum and use the
international prestige of the event as part of its campaign strategy for the upcoming elections. The second dominant voice of national
sovereignty was the French leadership of ATTAC, which laid the groundwork for the Forum in the pages of Le Monde Diplomatique. The
leadership of ATTAC is, in this regard, very close to many of the French politicians— most notably Jean-Pierre Chevenement—who advocate
strengthening national sovereignty as a solution to the ills of contemporary globalization. These, in any case, are the figures who dominated the
representation of the Forum both internally and in the press. The non-sovereign, alternative globalization position, in contrast, was
minoritarian at the Forum—not in quantitative terms but in terms of representation; in fact, the majority of the participants in the Forum may
well have occupied this minoritarian position. First, the various movements that have conducted the protests from Seattle to Genoa are
generally oriented towards non-national solutions. Indeed, the centralized structure of state sovereignty itself runs counter to the horizontal
network-form that the movements have developed. Second, the Argentinian movements that have sprung up in response to the present
financial crisis, organized in neighbourhood and city-wide delegate assemblies, are similarly antagonistic to proposals of national sovereignty.
Their slogans call for getting rid, not just of one politician, but all of them—que se vayan todos: the entire political class. And finally, at the base
of the various parties and organizations present at the Forum the sentiment is much more hostile to proposals of national sovereignty than at
the top. This may be particularly true of ATTAC, a hybrid organization whose head, especially in France, mingles with traditional politicians,
whereas its feet are firmly grounded in the movements. The
division between the sovereignty, anti-globalization
position and the non-sovereign, alternative globalization position is therefore not best understood in
geographical terms. It does not map the divisions between North and South or First World and Third.
The conflict corresponds rather to two different forms of political organization. The traditional parties
and centralized campaigns generally occupy the national sovereignty pole, whereas the new movements
organized in horizontal networks tend to cluster at the non-sovereign pole. And furthermore, within traditional, centralized
organizations, the top tends toward sovereignty and the base away. It is no surprise, perhaps, that those in positions of power would be most
interested in state sovereignty and those excluded least. This may help to explain, in any case, how the national sovereignty, antiglobalization
position could dominate the representations of the Forum even though the majority of the participants tend rather toward the perspective of a
non-national alternative globalization. As a concrete illustration of this political and ideological difference, one can imagine the responses to the
current economic crisis in Argentina that logically follow from each of these positions. Indeed that crisis loomed over the entire Forum, like a
threatening premonition of a chain of economic disasters to come. The first position would point to the fact that the Argentinian debacle was
caused by the forces of global capital and the policies of the IMF, along with the other supranational institutions that undermine national
sovereignty. The logical oppositional response should thus be to reinforce the national sovereignty of Argentina (and other nation-states)
against these destabilizing external forces. The second position would identify the same causes of the crisis, but insist that a national solution is
neither possible nor desirable. The alternative to the rule of global capital and its institutions will only be found at an equally global level, by a
global democratic movement. The practical experiments in democracy taking place today at neighbourhood and city levels in Argentina, for
example, pose a necessary continuity between the democratization of Argentina and the democratization of the global system. Of course,
neither of these perspectives provides an adequate recipe for an immediate solution to the crisis that
would circumvent IMF prescriptions—and I am not convinced that such a solution exists. They rather present different political
strategies for action today which seek, in the course of time, to develop real alternatives to the current
form of global rule. Parties vs networks In a previous period we could have staged an old-style ideological confrontation
between the two positions. The first could accuse the second of playing into the hands of neoliberalism, undermining state
sovereignty and paving the way for further globalization. Politics, the one could continue, can only be effectively
conducted on the national terrain and within the nation-state. And the second could reply that national
regimes and other forms of sovereignty, corrupt and oppressive as they are, are merely obstacles to the global democracy that we seek.
This kind of confrontation, however, could not take place at Porto Alegre—in part because of the dispersive nature of the event, which tended
to displace conflicts, and in part because the sovereignty position so successfully occupied the central representations that no contest was
possible. But the more important reason for a lack of confrontation may have had to do with the organizational forms that correspond to the
two positions. The traditional parties and centralized organizations have spokespeople who represent them and conduct their battles, but
no
one speaks for a network. How do you argue with a network? The movements organized within them
do exert their power, but they do not proceed through oppositions. One of the basic characteristics of the
network form is that no two nodes face each other in contradiction; rather, they are always triangulated
by a third , and then a fourth, and then by an indefinite number of others in the web . This is one of the
characteristics of the Seattle events that we have had the most trouble understanding: groups which
we thought in objective contradiction to one another—environmentalists and trade unions, church groups and
anarchists—were suddenly able to work together, in the context of the network of the multitude. The
movements, to take a slightly different perspective, function something like a public sphere, in the sense that they
can allow full expression of differences within the common context of open exchange. But that does
not mean that networks are passive . They displace contradictions and operate instead a kind of alchemy, or
rather a sea change, the flow of the movements transforming the traditional fixed positions; networks
imposing their force through a kind of irresistible undertow. Like the Forum itself, the multitude in the movements is
always overflowing, excessive and unknowable. It is certainly important then, on the one hand, to recognize the differences that divide the
activists and politicians gathered at Porto Alegre. It
would be a mistake, on the other hand, to try to read the division
according to the traditional model of ideological conflict between opposing sides . Political struggle in the age
of network movements no longer works that way. Despite the apparent strength of those who occupied centre stage and
dominated the representations of the Forum, they may ultimately prove to have lost the struggle. Perhaps the representatives of the traditional
parties and centralized organizations at Porto Alegre are too much like the old national leaders gathered at Bandung—imagine Lula of the PT in
the position of Ahmed Sukarno as host, and Bernard Cassen of ATTAC France as Jawaharlal Nehru, the most honoured guest. The leaders can
certainly craft resolutions affirming national sovereignty around a conference table, but they can never grasp the democratic power of the
movements. Eventually they too will
be swept up in the multitude, which is capable of transforming all fixed
and centralized elements into so many more nodes in its indefinitely expansive network.

Racism is a network of practices, not a conceptual structure---framing racism as belief

that produces behavior is circular & misses the networked structure of racism
Bonilla-Silva ‘1 – Professor of Sociology @ Duke, White Supremacy and Racism in the Post-civil Rights
Era, Eduardo Bonilla-Silva, 2001,

7. Racism is analyzed in a circular manner 'If racism is defined as the behavior that results from the belief, its discovery
becomes ensnared in a circularity—racism is a belief that produces behavior, which is itself racism'
(Webster, 1992, p. 84). Racism is established by racist behavior, which itself is proved by the existence of

racism. This circularity results from an insufficient grounding of racism in social relations among the races. If
racism, viewed as an ideology, were seen as possessing a structural 5 foundation, its examination could be
associated with racial practices rather than with mere ideas and the problem of circularity would be
avoided.
FOOTNOTE 5 BEGINS…

5. By structure I mean, following Whitmeyer (1994), 'the networks of (interactional) relationships among actors as well
as the distributions of socially meaningful characteristics of actors and aggregates of actors' (p. 154). For similar
but more complex conceptions of the term, which are relational and which incorporate the agency of actors, see Bourdieu (1984) and Sewell (1992). I reserve

the term material to refer to the economic, social, political, or ideological rewards or penalties
received by social actors for their participation (whether willing, unwilling, or indifferent) in social
structural arrangements .

FOOTNOTE 5 ENDS.
 Lytle
The 1AC’s challenge to the notion of sovereign community and political belonging
functions as a criticism of the very logic of white supremacy---precariousness and
precarity are a grammar for understanding antiBlackness and colonial violence
Cynthia Lytle 17, independent scholar, 2017, “Violence, borderlands and belonging: The matter of
Black lives and Others,” Coolabah, Vol. 21

To belong , as defined by the OED, is to “have an affinity for a specified place or situation” or to “have the right
personal or social qualities to be a member of a particular group.” A particular group can be demarcated
through cultural, geographic and national borders. In instances where a group is threatened, violence can be used to
protect members and keep others out or contained. Belonging to a group can mean acceptance, but it can also be claimed as a method of
protection. Yet
who dictates the social qualities needed to belong? How are these powers to separate the
belonging from the un-belonging obtained? In Dispossession: The Performative in the Political, Judith Butler points out that
belonging is sometimes supported by the perception of the autochthonous, through belonging by rights of land and
earth, and this nationalist logic , for example, emboldens people to tell African-Americans to go back to
Africa or to claim immigrants from Africa and the Middle East do not belong in Europe (Butler and Athanasiou 2013: 23).
Butler argues that through colonial violence, populations can become simultaneously dispossessed in
processes and ideologies that disown and abject through powers of normalization (Butler and Athanasiou
2013: 2), such as one’s removal from lands, detention or immobilization in designated areas such as in refugee camps, and
through the refusal of entry into European cities with the result that “the targeted population belongs, finally, to no land” (2013: 23-
24). Moreover, violent ways of subordinating a group in which people are dehumanized, made precarious,

and ultimately deemed disposable , what Achille Mbembé terms as necropower and necropolitics, are not only used as
methods of un-belonging but become methods of destroying a population (Mbembé 2003: 40). Through the
concepts of dispossession and necropolitics, this paper will explore the Black Lives Matter i movement and refugees
of the so-called refugee crisis to argue that systemic violence, through intersectionalities of race, gender, and
nationality, has continued to reinforce the black/white binary and push these groups to the
borderlands, which, according to Gloria Anzaldúa are “physically present wherever two or more cultures edge each other, where people of
different races occupy the same territory, where under, lower, middle and upper classes touch, where the space between two individuals
shrinks with intimacy” (Anzaldúa 1999: 19). While these
groups are seemingly different, both groups have been
displaced through forced migration and dispossession, and marginalized through continual violence.
This paper will also contend that to combat this perpetual construction of the Other and maintenance of the

status quo, in addition to multiple narratives, a greater context of history and the power structures
created during colonization must be considered.
The Matter of Black Lives

Black Lives Matter. Sparked by the despair and outrage over the death of 17-year-old African-American Trayvon Martin, these three seemingly
simple words became a social movement that swept across the U.S. and crossed the Atlantic into Europe.ii On February 26, 2012, Martin was
killed while walking home from a convenience store by neighborhood watchman George Zimmerman, who followed Martin because he was
“suspicious” (Botelho 2012: “What happened”). Zimmerman was acquitted using the defense of Florida’s “Stand your ground” law, which
enables the use of deadly force if a person “reasonably believes that using or threatening to use such force is necessary to prevent imminent
death or great bodily harm to himself or herself or another or to prevent the imminent commission of a forcible felony” (Florida Statute
776.012). His acquittal moved the nation, and with the simple hashtag #BlackLivesMatter, a national conversation soon became a social
movement (Chokshi 2016: How #BlackLivesMatter Came”; Stephen 2015: “Social media helps”; Safdar 2016: “Black Lives Matter”) and later an
official policy agenda (“The Movement for Black Lives”).
Amid the increasing reports of police violence and unfortunate deaths of Black girls, boys, women, and men, Black Lives Matter (BLM) has
fought to reify the humanity of the lives of all Black Lives. In their “Herstory,” co-founder Alicia Garza writes,

Black Lives Matter is a unique contribution that goes beyond extrajudicial killings of Black people by police and
vigilantes. It goes beyond the narrow nationalism that can be prevalent within some Black communities … Black Lives Matter affirms
the lives of Black queer and trans folks, disabled folks, Black-undocumented folks, folks with records,
women and all Black lives along the gender spectrum. It centers those that have been marginalized within Black liberation
movements. It is a tactic to (re)build the Black liberation movement.

When we say Black Lives Matter, we are talking about the ways in which Black people are deprived of our basic human rights and dignity. It is
an acknowledgement [that] Black poverty and genocide is state violence (Garza 2014: “A Herstory”).

By calling
attention to the underlying structural racism that makes laws, controls court systems, and
ultimately governs the daily lives of Black people, Garza raises awareness to the profundity of the power
and violence that have commanded Black lives both externally and intra-communally through gender, racial, social and class
hierarchies throughout American history.

As in the death of Trayvon Martin, media has contributed to violence through the inclusion of irrelevant background information about the
victim, the violence is seemingly justified, as exemplified on CNN.com:

Martin didn't live in Sanford, a central Florida city of about 53,000 people. Yet by that winter night, he'd been there for seven days, after being
suspended for the third time from Dr. Michael M. Krop High School in Miami, in this instance, for 10 days after drug residue was found in his
backpack, according to records obtained by the Miami Herald (Botelho 2012: “What happened”).

By describing Martin as being outside of his hometown, alluding to multiple school suspensions, and implying Martin is linked to drugs through
the drug residue discovered in his backpack, the young victim becomes a wrongdoer and criminality is inferred. Moreover, he is made a
trespasser who does not belong in Sanford, while his background and suspicious activity put Trayvon Martin on the path to his death.
Furthermore, this suspicion enables the rationalization of Zimmerman’s deadly actions as “self defense.” In an interview, Judith Butler argues
Every time a grand jury or a police review board accepts this form of reasoning (that police act in self-defense when there is no gun present),
they ratify the idea that blacks are a population against which society must be defended, and that the police defend themselves and (white)
society, when they preemptively shoot unarmed black men in public space (Yancy and Butler 2015: “What’s Wrong”).

In the interview Butler argues the

phrase “Black lives matter” states that what should be obvious—that a life
matters—is apparently not and has not been historically realized (Yancey and Butler 2015: “What’s Wrong”). She
reminds readers that under slavery, Black lives were deemed barely a fraction of a human life, and with this
in mind, today, what justifies violence against Black lives is that these lives are perceived of as a
threat (Yancey and Butler 2015: “What’s Wrong”).
Police violence has been justified through self-defense and the fear of danger, resulting in the rash killings of Black men, women, boys and girls.
MappingPoliceViolence.org, based on an effort to record police violence throughout the U.S., has found that Blacks are three times more likely
to be killed by police than whites. Moreover, in 2015 police killed 102 Black people. This number is five times more the rate than killings of
unarmed whites and likely to be higher due to underreporting. Of the Black people killed, less than 30 percent were armed and suspected of a
violent crime. In police violence on Black lives, police hold the power to “define who matters and who does not, who is disposable and who is
not” (Mbembé 2003: 27, original emphasis; Butler and Athanasiou 2013: 20), what Mbembé describes as sovereignty. In his example, Mbembé
refers to Frantz Fanon’s spatial reading of the colonized world that is divided and made exclusive. Fanon argues this space is separated in two
with the border marked by barracks and police stations, and Mbembé brings this argument into a contemporary space where what he calls
necropower operates, controlling death over life (Mbembé 2003: 27; Fanon 2004: 3). Thus, with both Fanon and Mbembé in mind, to avoid the
terror and possibly deadly consequences of leaving one’s space designated through sovereignty, Black lives must have an inherent knowledge
of which spaces are and are not allowed to be entered. Simply by
being in the “wrong place,” Black lives, considered
trespassers, can be lost, and at times, as in the case of Trayvon Martin, among countless others, there is neither
consequence nor remorse for the death (Almukhtar 2016: “Driver Aquitted”; Baker and Mueller 2015: “Beyond the Chokehold”;
Chiquillo 2016: “Teen Slammed”; Hackman 2015: “She Was Only a Baby”). Fanon argues, “The agent does not alleviate oppression or mask
domination. He displays and demonstrates them with the clear conscience of the law enforcers, and brings violence into the homes and minds
of the colonized subject” (Fanon 2004: 4). Moreover, as
agents of sovereignty do not hide their authority but use
violent rationale that continually seeks to demonstrate power over the dispossessed, they continue
to assign precariousness and maintain vulnerable states of life in their “proper place” under
constant control (Butler and Athanasiou 2013: 20).

The politics of
disposability comes from histories of liminality that take place along “racial, gendered,
economic, colonial, and postcolonial lines” (Butler and Athanasiou 2013: 146-147). As previously mentioned in the Black Lives
Matter herstory, Garza takes these intersections into consideration and calls for the rights and dignity of “all Black lives along the gender
spectrum” as a way to strengthen and rebuild the Black liberation movement both from within and externally. This herstory points to the need
for a movement that is more inclusive by opening dialog on the intersectionalities of gender, social class, and ability as Black liberation has been
criticized in its cis-androcentricity (Hall 2000: 151; Hill Collins 1998: 67; Wicomb 1990: 63-70) while women’s liberation has largely ignored
people of color (Anzaldúa 1999: 230-231; Carby 2000: 389-403; hooks 2000: 372-388). Thus, BLM not only acknowledges but also insists on
placing importance of the intersectionality of identities within the movement, and in this way, she recognizes the borderlands of the movement
and pushes back the borders to make an all-encompassing space. Gloria Anzaldúa describes her experience with white feminism and explains,
“gender is not the only oppression. There is race, class, religious orientation; there are generational and age kinds of things, all the physical
stuff, et cetera … They wanted to apply their notion of feminism across all cultures … I was asked to leave my race at the door” (Anzaldúa 1999:
230-31).

Kimberlé Crenshaw points out, when considering violence against women, race and class are important dimensions (1991: 1242). She contends,
“Although racism and sexism readily intersect in the lives of real people, they seldom do in feminist and antiracist practices. And so, when the
practices expound identity as woman or person of color as an either/or proposition, they relegate the identity of women of color to a location
that resists telling” (1991: 1242.) Violence on Black women in importantly different ways includes lesser media coverage and even the exclusion
of their stories. In February 2015, the African American Policy Forum, a think tank of academics, activists, and policy makers created initiatives
including the hashtags #BlackGirlsMatter, which focuses on excessive disciplinary actions against young Black girls, and #SayHerName, which
highlights issues around brutality and racial violence against Black women. In a report for the SayHerName campaign, Crenshaw and Andrea J
Ritchie write, “Black women who are profiled, beaten, sexually assaulted, and killed by law enforcement officials are conspicuously absent ...
When their experiences with police violence are distinct—uniquely informed by race, gender, gender identity, and sexual orientation—Black
women remain invisible” (Crenshaw and Ritchie 2015: 1). The report includes individual cases categorized by “catalysts” to the violence such as
“driving while Black,” being poor, and being casualties of the war on drugs and, it lays bare the violence women face while they are suffering
from mental illnesses, are imprisoned, or are just “collateral damage.”

Black Lives Matter and SayHerName quickly became a great presence in social media and in physical demonstrations, heightening the
vocalization against police violence on Black bodies. The BLM movement has also become a hot topic in politics, as exemplified by New Jersey
Republican governor Chris Christie. In an interview with CBS, he argues, “[Obama] does not support the police, he doesn't back up the police,
he justifies Black Lives Matter” (Flores 2015: “Chris Christie”). In this way, Christie constructs the Black Lives Matter Movement as an antithesis
to police or “lawfulness.” Moreover, he attempts to simplify police violence to the narrative of a “bad cop,” or an anomaly, removing
accountability. He argues,

When there are bad cops, they need to be prosecuted, like there are bad lawyers and bad doctors and bad engineers, they all need to be
prosecuted when they see something wrong … but our police officers are putting their lives on the line every day, let's back them up so we can
end the real violence in this country that's happening in the streets of our cities all across this country.

(Flores 2015: “Chris Christie,” emphasis added)

Christie not only removes the fault of police but he proclaims the violence against Black lives is not real, and in effect, he denies the systemic
violence that embedded within law enforcement culture (Anderson 2016: 1-2; Jones-Brown and Maule 2010: 140-173; Bruce-Jones 2017: 25-
35). Furthermore, by suggesting that the violence against Black lives is unreal, Christie alienates Black lives by denying them the right to feel
safe, the right to be conscious of the violence they experience, and the right to feel protected by the police as other citizens of the nation are,
all of which are forms of dispossession similar to Marx’s concept of alienation, as Athanasiou points out, in the “[deprivation] of the ability to
have control over life” and the denial of the “consciousness of their subjugation as they are interpellated as subjects of inalienable freedom”
(Butler and Athanasiou 2013: 6).

As a way to combat the ever-present threat of violence, parents instruct their Black children on what to do when approached by police known
as “The Talk,” exemplified by author and journalist Ta-Nehisi Coates on the moment his son finds out the killer of Michael Brown, the 18-year-
old who was stopped for “fitting a description” and later shot by the police officer from inside his car. Brown fled and was later killed; however,
Wilson was not charged, resulting in protests that turned into riots in Ferguson, MO (Buchanan 2014: “What happened?”). In “Between the
World and Me,” which was written as a letter to his son, Coates explains,

I heard you crying...I didn’t hug you, and I didn’t comfort you, because I thought it would be wrong to comfort you. I did not tell you that it
would be okay, because I have never believed it would be okay. What I told you is what your grandparents tried to tell me: that this is your
country, that this is your world, that this is your body, and you must find some way to live within the all of it. (2015: 11-12)
Coates’s decision to not console his son attests to the conditions of necropolitics and threat in which Black lives must live as, what is described
as “non-being” in the logic of dispossession (Butler and Athanasiou 2013: 19-20), or in Mbembé’s terms, a “social death” by way of removing
one from humanity (2003: 21). Coates acknowledges the forces, or the necropower, that work to take ownership of Black lives and uses history
to explain the constructs that continue to subjugate the Black body, showing the capacity of un-belonging. He warns and empowers his son
through knowledge to resist comforting narratives that suggest irrepressible justice, and he also reminds his son, “The enslaved were not bricks
in your road, and their lives were not chapters in your redemptive history. They were people turned to fuel for the American machine” (Coates
2015: 70). By stressing the humanity of the enslaved people to highlight the importance of remembering the humans that were terrorized to
create America, Coates emphasizes the repercussions of this systematic subjugation that still echoes today.

The Matter of Other(ed) Lives

Imperialism and colonial occupation led to new technologies and declared new spatial and social
relations that helped instill the systematic frameworks of oppression that is modernly practiced today
(Mbembé 2003: 25-26). Such practices have included the categorization of people and the segregation of

geographical spaces enabling the sovereignty or occupation and marginalization of a population, in what
Mbembé describes as “a third zone between subjecthood and objecthood” (2003: 26). In such spaces, necropolitics, as argued in the previous
section, sees that the sovereign exercises power over who lives and who dies, who matters, and thus asserts who belongs (2003: 26-27). Thus,
as people are deemed disposable by sovereignty, their humanity is put into question. They are
dispossessed and made precarious , and in instances where the battle is no longer between two nations but between a nation
and various groups, as in the case of violence, conflict and war, the civilian population is often made disposable. Mbembé writes, “Increasingly,
war is … waged by armed groups acting behind the mask of the state against armed groups that have no state but control very distinct
territories; both sides having as their main targets civilian populations that are unarmed or organized into militias” (2003: 34-35).

Conflicts in the Middle East and Africa have created spaces that are no longer safely habitable for stark circumstances such as, in many cases,
threats of violence, torture and life endangerment. Such precarious conditions have led people to leave their homes for an arduous journey to
the unknown. Although a final destination might be an EU country such as Germany, death is a very real possibility. This influx of refugees,
migrants, and displaced persons came to be the so-called refugee crisis (European Commission/ECHO 2016 “Refugee Crisis”; Lehne 2015: “The
Roots”). As individuals no longer have their safety, living in violent conditions such as the Syrian civil war is a form of dispossession, and leaving
one’s homeland leads to another form of dispossession; by leaving one’s homeland, a person allows him or herself to become dispossessed
(Butler and Athanasiou 2013: 2). However, while refugees, migrants, and displaced persons risk their lives—and sometimes the lives of their
children, large amounts of money and the possibility of being exploited—their act of leaving is a call for the recognition of their own humanity
and the humanity of their families in a search for a better life. Those who embark on this journey perceive the possibility of death is better than
staying in their own homes, neighborhoods, lands, and nation. In Mbembé’s analysis of necropolitics, death and freedom are hand-in-hand for
those enslaved or living under occupation (2003: 38). He argues, “In such circumstances, the discipline of life and the necessities of hardship
(trial by death) are marked by excess. What connects terror, death, and freedom is an ecstatic notion of temporality and politics…the present
itself is but a moment of vision—vision of the freedom not yet to come” (2003: 39, original emphasis), and in such extreme cases, death is the
only site where an individual has power over his or her life. Thus, through their act of walking for months through several countries and
crossing deadly seas, these displaced persons see that only by leaving, regardless of danger that could also be a freedom, can an end to
precariousness be reached.

In 2014, roughly 170,000 refugees and migrants landed in Italy, with the highest numbers from Eritrea, Somalia and Nigeria. In 2015, this
shifted and refugees mostly travelled from Syria and Afghanistan to Greece; 90 percent were asylum seekers (UNHCR 2015: 11). From January
to March, 479 refugees and migrants died at sea or went missing and this number soared to 1,308 in April alone (UNHCR 2015: 8-9) with one
capsized boat taking roughly 800 lives from various nationalities. This was finally the catalyst to get some aid from the EU, and numbers
significantly dropped. The boat was found in June 2016 with about 400-600 bodies still inside (Kingsley 2016: “Italian navy recovers”). The plight
of these people was occasionally highlighted in a special report or on the front page of daily newspapers, but many European countries turned
the other cheek, and in this way, these lives were disposable. Athanasiou argues, “As long as bodies are deemed disposable, found discarded,
and remain uncounted, the notion of disposability will be associated with the concepts and practices of dehumanization and necropower”
(Butler and Athanasiou 2013: 147). Butler brings up the important point that “to count” in English means both to matter and to be a calculated
number; however, numbers and ordering can prove to be polemic in situations such as in the war in Gaza, where every person in the
population is an enemy (2013: 100). Butler questions, “Under what conditions do numbers count, and under what conditions are numbers
uncountable?” (2013: 100). In terms of necropolitics, if bodies are deemed disposable, what do these numbers signify? The refusal to aid Italy
and share in the acceptance of refugees and migrants into other EU countries led Italian Prime Minister Matteo Renzi to threaten to issue
temporary Schengen Visas. At this time, about 40,000 refugees and migrants on their way to other countries like Germany and Sweden were
stuck in Greece and Italy (Kingsley 2015: “This isn’t human”). Renzi’s strategic threat of legalizing bodies and allowing them to freely enter the
EU, a Foucauldian performance of biopower, became a way of dealing with the so-called refugee crisis, and fellow EU states responded
(Foucault 2007: 16-17; Butler and Athanasiou 2013: 168).
Rendering these refugees and migrants immobile is a form of detention, and by creating spaces that
confine, these groups are dispossessed and forced to remain in physical borderlands. In Calais, thousands of refugees and
migrants were stuck at the borders between France and England in makeshift camps. In what came to be known as “the Jungle,” the population
waited to enter England through the port or Eurotunnel by hiding in trains, trucks, ferries, and cars. British Prime Minister David Cameron
described the group as, “a swarm of people coming across the Mediterranean” (Elgot and Taylor 2015: “David Cameron Condemned”), and
after international condemnation for his degrading words, Cameron contended that he did not think the use of “swarm” was dehumanizing
(Walton and Ross 2015: “David Cameron Insists”). Such
Othering language is reminiscent of colonial thought on the
native Other as an animal and from a completely different world and species, in what Mbembé calls part of the
“credo of power in the colony,” where the native belongs to a set of objects that could and would be used
according to sovereign will and where the only relationship was one of violence (Mbembé 2001: 26). In this
relationship, the colonized’s death did not matter but was nothing more than an “inert object” (2001: 26).
Thus through such Othering language, especially by a high state official, the lives of those in “the Jungle” were deemed of no more importance
than a threat to British society.

More than 137,000 refugees and migrants crossed the Mediterranean in the first half of 2015 (UHCR 2015: 2-3)
and continued on through Serbia and Hungary, the latter of which enforced a billboard campaign against immigration (Thorpe 2015: “Hungary’s
poster war”). The situation and numbers escalated, and Hungary put up four-meter high, razor-wire fences along the borders of Serbia and
Croatia, and threatened to do the same in Romania. Using Othering language and fear tactics, the campaign presented refugees and migrants
as a threat to Hungarian jobs and livelihood. Moreover, on September 15, 2015 the Hungarian government passed a law that treated anyone
illegally entering its borders as a criminal. The following day 367 people were taken into custody: 51 are being prosecuted for illegally entering
and 316 for damaging the fence (Squires 2016: “Hungary says migrant influx”). The new law did not distinguish juveniles as in normal
procedures and put defendants under house arrest in a refugee camp. Once a refugee was arrested, he or she could not apply for asylum and
did not receive the charges or judgment in his or her mother tongue, and in some cases, he or she might not even receive the documents as
they might be delivered to the defense lawyer (Budapest Sentinal Staff 2015: “Lawyers rule of law”). Thus, not only was the erecting of the
fence and criminalization of refugees received as a way of protecting Hungarian society but also a very direct way of denying life. Yet people
crossed the razor-wire-lined border, and in doing so, the refugees and migrants performed acts of resistance in what Butler and Athanasiou
describe as becoming present (2013: 14). Athanasiou explains,

In becoming present to one another, as an occasion of being both bound up with subjugation and
responsive and receptive to others, we may be positioned within and against the authoritative order
of presence that produces and constrains the intelligibility of human or non-human presence … if we
reinstate presence in a different or catachrestic way, we might put our social existence at risk …but we
might also start to performatively displace and reconfigure the contours of what
matters, appears, and can be assumed as one’s own intelligible presence .
(2013: 15)

Refugees and migrants finally entering Austria and Germany were met with big signs welcoming refugees in a stark contrast to Hungary.
Volunteers, organizations, and companies worked together to bring hot food and cold water to train stations. Big tents, community centers,
and school gyms were set up with cots and blankets, giving refugees and migrants temporary places to sleep while they waited to be registered.
In the meantime, disagreements within the EU over a quota system continued. Slowly the influx of refugees became too large for Germany and
Sweden to bear, and borders were temporarily closed and the excitement and acceptance of refugees began to die down.

In January 2016, after a string of thefts, violence and sexual assaults reportedly by men mostly of Arab and North African descent (Smale 2015:
“18 Asylum Seekers”) on the night of New Year’s Eve in Cologne, 1,700 from anti-Islam group PEGIDA (Patriotic Europeans Against the
Islamization of the West) and AfD (Alternative für Deutschland) demonstrated against Islam and refugees. Holding signs stating “RAPEfugees
not welcome” and “Integrate barbarity?” the groups protested against immigration and Merkel’s “open-door” policy claiming that refugees and
Islam would ruin Germany and that protecting women was their right and duty. As Anne McClintock argues, family is an important motif of
nation, with women symbolizing the land, markers of national borders, producers and bearers of tradition, among other representations, that
must be preserved for the sake of the nation (McClintock 2010: 89-92). By using the woman as a marker of the nation and some “thing” that
must be protected, women’s bodies are transformed into tools of the nation, with patriarchy in control. In this way, women belong, as objects,
to the discourse of national race, which in effect, must be protected from the Others. However, it was not only rightwing groups such as
PEGIDA and AfD that promoted such Othering and scare tactics. Reporting on these assaults in Cologne for The New York Times, Alison Smale
writes
It was not clear exactly when the migrants who may have been involved arrived in Germany. But the disclosure added to worries over
acculturating hundreds of thousands of people from conservative Muslim societies—many of them young men—who have little experience
with open European mores, particularly regarding women (Smale 2015: “18 Asylum Seekers”).

Smale’s patronizing narrative of the event displaces the assaults and a culture of violence against women as part of Muslim culture, and she
continues by mentioning the “challenge of assimilation.” In this way Smale presents Muslim culture as misogynistic while reinforcing anti-
immigration notions through fear for European safety. Reporting such as Smale’s helps shape public discourse on refugees and migrants and an
entire religion, and it reiterates the repeated fear of threat to the sanctity of white womanhood (Crenshaw 1991: 1266). The events on the
night of New Year’s Eve in Cologne also motivated Alice Schwarzer, a prominent German feminist, to comment that those involved in the
attacks were “Young men of Arab or North African descent [that were] playing war in the middle of Cologne” and described their night as a
“gang-bang party,” attributing sexual violence in Germany as a problem that originated outside and arrived with immigration” (Spiegel Staff
2016: “How New Year’s Eve”). Her comments were not only racist and xenophobic but, in the name of “protecting women,” she employed
patriarchal narratives using women’s bodies to fuel anti-immigrant sentiment. Schwarz has also suggested people from “Islamic cultural
groups,” including existing immigrants and incoming refugees, migrants, and displaced persons, ought to be taught gender equality (Hoffman
and Pfister 2016: “A Feminist View”), and in this way, Schwarz presents a monolithic threat, feeding the justification of xenophobic sentiment
perpetuating racist ideologies and calls for a protection of national culture and white space.iii In this way the
intersections of
patriarchy, racism, misogyny, and colonialism work together and dispossess not only the refugees and
migrants but also the very European women that are claimed to be protected.

In an understanding of national identities where whites are the most valuable and have the most
power such as in the U.S., England, and Germany, non-white groups attempting to enter pose a threat to the
nation in degradation of racial and blood purity . Patricia Hill Collins connects the notion of blood ties and race in the U.S.
with the view of race as family, which was based on scientific and lawful classifications (Hill Collins 1998: 70). Using the logic of race as an
indicator of common bloodline, Hill Collins ties this logic to an understanding of ethnic nationalism where the group shares common cultural
expressions (1998: 70). Therefore when media outlets illustrate refugees as a great Muslim danger, the threat is not only on white women, as
they represent the protectors of blood purity, white family, and a white nation but Muslims—and non-white Others—are also a threat to white
spaces and, in effect, whiteness. Therefore all groups that do not have family blood ties, meaning they are not from white countries, are
considered less-worthy to immigrate and become naturalized citizens (1998: 70), resulting in a diminished acceptability of people of color to
belong in such countries.

The notion of blood ties and race sometimes can prove to play a stronger role than citizenship. In France, Prime Minister Manuel Valls has
promoted the consequence of stripping citizens with dual nationality of their French citizenship if convicted of terrorism, despite the fact that
the Paris November attackersiv were mostly French citizens without dual nationality (Nossiter 2015: “French proposal”). Such alarming notions
not only further stimulate feelings of fear and being under threat, but they also send the message to non-white Europeans and those with dual
nationality that they are still “the Others,” and their belonging is, paradoxically, circumstantial. Furthermore, while the proposal was eventually
abandoned, it helped create the false notion that that French nationals, or nationals of any “Western” country could be terrorists.

This circumstantial belonging can also be exemplified by the comments of Angela Merkel, who in 2010 claimed that the notion of living in a
multicultural society “had absolutely failed” (Evans 2010: “Merkel Says”). To a group of CDU Party youth, she said,

We are a country, which at the beginning of the 1960s actually brought guest workers to Germany. Now they live with us, and we kidded
ourselves for a while saying that they won’t stay and they’ll disappear again one day. That’s not the reality. This multicultural approach, saying
that we simply live side-by-side, and are happy about each other, this approach has utterly failed.

(Evans 2010: “Merkel Says”)

Merkel’s rejection of the possibility of living happily together with guest workers is in complete contrast with the portrayal of “Mama Merkel”
for the welcoming of Syrian refugees, who are patronizingly likened to poor children by mainstream media. While Merkel opened the borders,
she has admitted to a lack of “order” and “control,” and was worried about losing German’s “societal center” that “makes Germany so strong”
(Spiegel Staff 2015: “The Lonely Chancellor”). Furthermore, to combat the criticism and the poor election results that resulted in AfD wins in
Berlin in September 2016, Merkel has worked toward integration policies that require German language acquisition and entry into the labor
market. Included in these policies are courses that would include topics to reinforce social values such as gender equality (Delcker 2016:
“Angela Merkel to Refugees”). When considering those who live in precarious circumstances and are categorized based on race, gender,
sexuality and these representations, Athanasiou questions the act of judging and sanctioning through migration policies (Butler and Athanasiou
2013: 165). She gives the example of the misuse of power when Dutch immigration required immigrants and asylum seekers to view videos of
topless women swimming and gay men kissing as a way to evaluate the capacity to integrate (2013: 166). Such events not only use naked
women and gay men as tools of European openness but they also dispossess these people and movements from their continuing struggles
(2013: 166). Moreover, if an integration policy includes courses on gender equality, or other values of Germany society that make it so strong, is
it inferred that there is gender equality in Germany? If so, what ruler is used to mark gender equality? Returning to the events on the night of
New Year’s Eve in Cologne, Schwarzer’s comments also sparked a feminist debate. Schwarzer was criticized for suggesting gender violence did
not exist before immigration but was imported (Hoffman and Pfister 2016: “A Feminist View”). In an interview with Schwarzer for Der Spiegel,
Anne Wizoreck contends Schwarzer’s view of Muslims wrongly displaces the focus of the issue of sexualized violence regardless of the
perpetrator and calls for a debate on integration rather than exclusion (Hoffman and Pfister 2016: “A Feminist View”). The construction of
refugees and migrants as sexual predators and integration policies that aim to “correct” behavior, as previously argued, reiterates a fear of the
Other that threatens European values, and it is this message that is repeated by governments and instilled in the minds of many European
citizens.

Conclusion

My aim has been to analyze ways in which oppressive

colonial systems are foundations of dispossession and how,
through violence, dehumanization, and disposability, they affect belonging. I have attempted to show that
through nationalisms, necropower and necropolitics, sovereignty continues to construct, impose, and
enforce systems that maintain the subordination of the marginalized and destroy populations. I have
chosen seemingly distinct populations: Black lives on the one hand and refugees, migrants,
and displaced peoples from the Middle East and Africa, part of the so-called “refugee crisis,” on the other to show how
both these populations are dispossessed through intersectionalities of race, gender, and nationality.
While the violence of forced migrations has caused these populations to become dispossessed, these populations have

performed acts of resistance, calling for their humanity and dignity and for the end of their
precariousness . Moreover, as media can act as tools of the sovereign, we must look for the lesser-told stories of the
borderlands, of the precarious, and all stories, as most of us have been taught only the single
story , which was to be accepted without question. And what is wrong with this single story? Nigerian author Chimamanda Adichie summed
it up beautifully in her 2009 TED Talk “The danger of a single story:”

The single story creates stereotypes, and the problem with stereotypes is not that they are untrue, but that they are incomplete. They make
one story become the only story.

Stories matter. Many stories matter. Stories have been used to dispossess and to malign, but stories can also be used to empower and to
humanize. Stories can break the dignity of a people, but stories can also repair that broken dignity.
 Gaffney
Single payer can reduce racial health inequalities even if forms of discrimination
persist – our burden is not to prove the plan solves antiblackness but that it improves
health care access
Adam Gaffney 16, MD from New York University, 3/7/2016, Is the Path to Racial Health Equity Paved
with “Reparations”? The Politics of Health, Part II, https://lareviewofbooks.org/article/is-the-path-to-
racial-health-equity-paved-with-reparations-the-politics-of-health-part-ii/#!

At the same time, the

government’s persistent failure to create a public health care system played a
foundational role in structuring American health care inequalities, both by class and race. Despite high hopes
that the New Deal might realize such a system, Franklin Roosevelt failed to make health reform a priority (among other issues, he wasn’t enthusiastic about the
prospects of confronting the rather reactionary doctors’ lobby).[5] At the end of World War II, a major campaign for national health insurance did emerge, backed
by both Harry S. Truman and — critically — organized labor.[6] “Our new economic bill of rights,” Truman proclaimed to Congress in 1945, “should mean health
security for all, regardless of residence, station, or race – everywhere in the United States.”[7] Yet this bold vision was soon smothered, the victim of a toxic
redbaiting campaign pursued by the American Medical Association (AMA).[8] All that survived of it, at least in the short term, was the Hill-Burton Act, a law that
funded a massive campaign of hospital-building throughout the nation. But Hill-Burton was permeated with racism from its birth. While in theory it forbid
discrimination by race, the law nonetheless made an allowance for “separate but equal” facilities.[9] The implications were clear: explicit medical segregation had
received the imprimatur of the law, together with generous public subsidization. ¶ Only through the combined force of the civil rights movement, the Civil Rights Act
of 1964, a number of key legal challenges, and the passage of Medicare in 1965 could the rollback of American apartheid medicine begin, as will be discussed in
more detail below. For now, it’s worth noting that the
impact of the civil rights movement on black health was not
insignificant, as demonstrated in a revealing 2013 study by epidemiologist Nancy Krieger and
colleagues. In the early 1960s, these investigators found that black infant death rates were
significantly higher in “Jim Crow” states (the 21 states, plus the District of Columbia, with racial
discrimination on the law books) than in non-Jim Crow states. This is hardly surprising. Yet, during the late
1960s, the death rate of the former group did improve, and by the 1970s the difference had
evaporated. This can be touted as evidence that political change can yield real improvements in
health over time. But two additional facts complicate this interpretation. First, after 2000, the gap again
opened up, albeit to a lesser extent. And, second, regardless of the impact of the Civil Rights
movement on disparities among blacks, throughout this period black infant death rates were still
twice that of whites.[10]¶ Meanwhile, in terms of life expectancy, recent years have seen the
reduction — but not the elimination — of black-white inequalities. As the Centers for Disease Control reported last
November, the difference in life expectancy between the two groups fell from 5.9 years (in 1999) to 3.6

years (in 2013). However, even this may not be entirely goods news. A widely covered study published last fall found a unique and disturbing rise in
mortality among middle-aged whites (of lower socioeconomic status) between 1999 and 2013, leading the investigators to conclude that falling white-black
mortality disparities in this age group “was largely driven by increased white mortality.”[11] ¶ Moreover, during this same period and on into the present, a

series of events have functioned as starkly visible and undeniable examples of ongoing structural
health racism. Following the death last year of Freddie Gray while in policy custody, many made note
of the enormous chasm in health and mortality between black neighborhoods like his and adjacent
wealthier and whiter ones. Other commentators have highlighted “environmental racism,” or
inequities in exposure to environmental hazards by race, emblematic of embedded structural
inequality. Revealing reporting by the Washington Post, for instance, described Gray’s history of
childhood lead poisoning, an exposure that is in part racially patterned. More recently, mass poisoning by lead in Flint,
Michigan — the disastrous consequence of dimwitted austerity and structural marginalization — has provided yet more evidence of the downstream health
consequences of political exclusion.¶ Inequalities
in criminal justice itself — specifically mass incarceration and
police violence — are now being explicitly contextualized within a framework of health.[12] In protest
of such inequalities (made starkly visible by the killings of men like Eric Garner and the ensuing “Black
Lives Matter” protests), medical students throughout the country have begun to advocate for change
— for instance, with
a solidarity “die-in” action on December 10, 2014, which in turn led to the formation of
a new racial health justice organization (“White Coats for Black Lives”) on Martin Luther King Day in 2015.[13]¶ Finally,
two new books are tackling head-on the problem of racial health inequality, albeit from very different “expert” perspectives — one from within medicine and the
other from a legal perspective. Damon Tweedy’s Black Man in a White Coat, released last year, is a thoughtful memoir that explores the nexus of race and medicine
through the eyes of a black physician. Law professor Dayna Bowen Matthew’s Just Medicine: A Cure for Racial Inequality in American Health Care, on the other
hand, is an integration of legal analysis and social science that culminates in an overarching policy recommendation. ¶ In what follows, I’ll first examine the issue of
racism within the medical profession, turning to Tweedy’s experiences and reflections as described in his book. Next, I’ll focus on Matthew’s book, and examine the
problem of explicit and implicit medical discrimination historically and in the present — and how civil rights law might be used to combat it. From there, I’ll discuss
the place of the health system in the perpetuation of inequalities, and the largely neglected role that health care universalism plays in “health equality.”¶ Lastly —
but most importantly — I’ll explore how health inequities by race and by class intersect. To phrase the question plainly: Does confronting the problem of racial
health inequality mean that we must embrace the cause of economic redistribution, as discussed in the first part of this essay? If so, should this economic
redistribution proceed within the context of social democracy (or democratic socialism?), or should it — must it — proceed along explicitly racial lines? Is the path
to racial health equity paved with “reparations”?¶ ¶ 2. Black doctors: Discrimination within the profession ¶ The plotline of Steven Soderbergh’s unnerving and
beautifully shot series The Knick tackles racism within the medical profession by making it viscerally visible in another era. Set in a downtown Manhattan hospital at
the turn of the 19th century, the black, eminently qualified physician, Algernon Edwards (Andrew Holland), is treated with derision and disdain by many of the
hospital’s white staff and administrators. At the same time, the hospital turns away black patients from its outpatient clinic; Edwards surreptitiously begins treating
them — under rather suboptimal operative conditions — in the hospital’s basement.[14]¶ But what about after the time period depicted in this series? Into the
mid-20th century, blacks were excluded from many medical schools, and those who graduated faced intense discrimination in the course of practice. For instance,
even decades after the events depicted in the Knick, black physicians were unable to provide care for their hospitalized patients in the South. This was because
physicians needed to gain entry into county medical societies as a prerequisite to hospital-admitting privileges; and, in the South, these societies entirely or almost
entirely denied blacks membership. The AMA virtuously professed that it opposed discrimination, and yet excused itself from doing anything, claiming it was
impotent to compel integration. It took decades of political pressure to force change. In
1968, the Medical Committee for Human
Rights, a health-oriented civil rights group, took matters into its own hands, invading the AMA’s
convention at the extravagant Fairmont Hotel in San Francisco. Such actions — in conjunction with the
Civil Rights Act and the passage of Medicare — ultimately contributed to the AMA’s vote later that
year to expel county societies that excluded black members, at long last forcing their disgracefully
delayed integration.[15]¶ This is, of course, not to say that blacks subsequently gained equal footing
within the medical profession. Black representation in US medical schools has remained
proportionally low over the decades, especially for men. Indeed, a report from the Association of American Medical Colleges last
year showed that the number of black male matriculants in medical school is lower now — in absolute terms — than it was in the late 1970s. Tweedy, now an
assistant professor of psychiatry at Duke University Medical Center, was one of these matriculants. In his book, he describes some of the challenges he faced.¶ In
addition to being one of only “a handful of black students” in his class at Duke Medical School, Tweedy came from a working class family, in stark contrast to the
majority of his classmates. On the one hand, Tweedy highlights the importance of affirmative action: “So there it was: Not only was I admitted to Duke, when in a
color-blind world I might not have been, but I had arrived with a full-tuition scholarship in hand.” On the other hand, his first exchange as a first year student with a
medical school professor was markedly inauspicious: the professor approached him to ask if he was there to fix the lights. While he was a medical student, patients
routinely queried him about his presumed basketball skills. Far worse was his interaction as a resident with a racist patient and his confederate-flag adorned family
(“I don’t want no nigger doctor,” the patient told a nurse). Tweedy’s diligence and persistence ultimately, however, won them over. On another occasion, a black
patient rejected him, presuming his medical skills to be inferior and seeing the assignment as evidence of racist mistreatment of him as a patient. Given the
insecurities that afflict medical students and trainees in general, we can only imagine the additional strain created by such presumptions and prejudices.¶ Tweedy’s
book is also very much about the experience of black patients. He bears witness to the second-class care they too frequently experience when, for instance, as a
medical student he spends time in a makeshift rural clinic, “nestled within a group of dingy trailers and makeshift houses.” The clinic serves poor black patients who
cannot afford prescribed treatments. They are likely to see a different doctor at every visit and receive grossly insufficient preventive care. In another chapter, he
describes how one black patient, who quite reasonably declines one of his team’s medical recommendations, is dispatched with a punitive psychiatric diagnosis.¶
Toward the conclusion of his book, Tweedy briefly explores the larger and looming question: what
is the cause of racial health
inequalities? Early in his medical career, he had assumed — like many others — that genetic
differences were the primary factor. And indeed, for years, a huge amount of resources have gone
into uncovering the genetic sources of health disparities. However, as Jason Silverstein explains in a revealing article in The
Atlantic (“Genes Don’t Cause Racial-Health Disparities, Society Does”), this money may have been better spent elsewhere. He describes a 2015 paper that
systematically reviewed the collective evidence thus far for the proposition that genetic factors explain racial cardiovascular disparities. It’s worth quoting from the
study’s conclusion:¶ The results reveal a striking absence of evidence to support the assertion that any important component of observed disparities in these
diseases arises from main-effect genetic mechanisms as we currently understand them … Despite the enormous social investment in genomic studies, this research
program has not yet provided valuable population-relevant insights into disparities in the most common cause of morbidity and mortality.[16] ¶ Why then,
Silverstein asks the study’s lead author, do genomics still get so much attention? The author responds with a sentiment I’ve long suspected: if inequalities are built
into the very base pairs of our genetic code, what can we really do to alleviate them? More research? In effect, as the investigator tells Silverstein, the fact is that
racism and inequities are let off the hook if our genes are the culprits. Tweedy notes that he came to reject this genetic explanation: even if genetic factors play

some role with respect to specific diseases, they explain little of the overall differences in health between races. ¶ In contrast, there are reams of
evidence that point to social and economic inequalities as drivers of racial inequalities. In the first part of this
a large body of literature has demonstrated that poverty, for
essay, I focused on the impact of economic injustices on health:

instance, is associated with a panoply of poor health outcomes, and some researchers argue that
inequality itself causes worse health for everyone in society (perhaps via increased psychosocial strain
as well as other factors).[17] No doubt such socioeconomic factors are a major factor in racial health inequalities,
given the tight association between economic status and race.[18] Similarly, differences in health care access associated with
race (like being uninsured) are no doubt factors as well. ¶ But what might be said about the role of racially discriminatory treatment itself? This issue has received
increased attention since the 2002 publication of an Institute of Medicine evidence report, Unequal Treatment: Confronting Racial Disparities in Health Care.
Tweedy quotes from the report’s conclusion: “Although myriad sources contribute to [health] disparities, some evidence suggests that bias, prejudice, and
stereotyping on the part of the healthcare providers may contribute to differences in care.” Or, as he puts it, the “doctor-patient relationship itself serves as a
catalyst for differing outcomes,” which is in part the result of the fact that “some doctors are prone to hold negative views about the ability of black patients to
manage their health and therefore might recommend different, and possibly substandard, treatments to them.” ¶ This issue — namely, the problem of racially
disparate treatment — is the central focus of Dayna Bowen Matthew’s book. She explores how “implicit bias,” as she terms it, deforms physician behavior; in her
view, it constitutes the most neglected determinant of inferior health among blacks. ¶ ¶ 3. Jim Crow medicine: Past and present¶ Matthew is a law professor with
appointments at both the University of Colorado Law School and the Colorado School of Public Health. Matthew is also one of the founders of the Colorado Health
Equity Project, a multidisciplinary organization that works to “remove legal barriers to equal health access and health outcomes for Colorado’s vulnerable
populations,” as its website puts it. Her ambitious book lays out a case for a legal remedy for racial health inequality. ¶ Key to her argument is the historical context
of civil rights law, which she sees as a swinging pendulum. Hill-Burton, as we’ve seen, legally enshrined the “separate-but-equal” standard — established in the
Supreme Court case Plessy v. Ferguson — within the health care system. Legal challenges to this standard were unsuccessful, until Simkins v. Moses H. Cone
Memorial Hospital, the “watershed case,” as Matthew puts it, initiated its unraveling. As she recounts it, the case was brought by black practitioners and patients
against a discriminatory hospital in North Carolina that received Hill-Burton funds. The Fourth Circuit Court of Appeals decided in favor of the plaintiffs, declaring, as
quoted by Matthew, that “Racial discrimination by hospitals visits severe consequences upon Negro physicians and their patients.”¶ She describes two
consequences that flowed from this decision. First, the case helped catalyze subsequent successful health-care related civil rights litigation throughout the country.
Second, the decision — which the Supreme Court importantly declined to reconsider — helped lead the way to Title VI of the Civil Rights Act of 1964. According to
Matthew, Congress took the Supreme Court’s decision not to accept the case as a signal that it saw hospital segregation as unconstitutional (and, indeed, several
legislators explicitly cited the Simkins decision during debate over the bill). Much good came from this: “From 1963 through the early 1990s,” Matthew writes, “Title
VI proved an effective weapon against the segregation and discrimination that minority patients and physicians had experienced in American health care since the
colonial era.” For instance, the Johnson administration required hospitals to comply with Title VI in order to be eligible for Medicare payment. Few could afford not
to, and so the age of explicit hospital segregation finally came to a close. ¶ Yet Matthew asserts that, to an extent, this more auspicious era ended abruptly in 2001,
when a more conservative Supreme Court ruled in Alexander v. Sandoval, in a decision written by Justice Antonin Scalia, that Title VI was applicable only in cases of
deliberate discrimination; disparate impact was not enough.[19] This new standard precluded a great deal of civil rights litigation because it required that plaintiffs
produce tangible evidence that racist health care was intentional, which is made difficult when, as she notes, “few Americans are careless enough to create an
evidentiary record of outright bigotry.” Thus,
according to Matthew, with respect to health care discrimination, this
decision effectively rendered Title VI “a dead letter.” This decision, she argues, must be undone if
progress against racial health inequalities is to proceed. In short, unconscious racism in health care
must, according to her, be made illegal through an act of Congress and an expansion of Title VI. ¶ This may
sound Orwellian to some. Is it meaningful, after all, to talk about outlawing sentiments or attitudes that lie deep

within the dark depths of our unconscious? Can we root out biases if we are, by definition, unaware of
their very existence? Matthew marshals a body of literature from various disciplines to answer in the affirmative. Conscious racism, she argues, is
slowly being replaced by the unconscious variety: “But while overt racism is subject to nearly universal derision, unconscious racism due to implicit bias is hidden, is
tolerated, and even excused despite its destructiveness.” She persuasively explores various literatures demonstrating that physicians harbor unconscious negative
perceptions of blacks. She cites studies that show that patient race affects which treatments doctors recommend, how much time they spend with patients, “the
level of verbal exchange and shared decision-making in which they engage” with patients, and even the manner of their nonverbal engagement. She concludes that
there is a sufficient base of evidence to conclude that these implicit biases contribute to disparities, that there is reason to believe that such biases, even though
they are implicit, are remediable, and that health care providers — both on the individual and institutional level — can therefore be held legally responsible for the

results of their implicit biases.¶ The “evidence of malleability” is strong, according to Matthew. In
other words, she thinks specific
interventions can mitigate implicit biases and, as a result, disparate outcomes. The sorts of interventions she
envisions, however, seem of mixed applicability and utility. Nonetheless, overall, she makes a strong case that clinicians make racially biased decisions, whether or
not they intend to, and that this issue must be directly addressed. People like me — that is to say, white physicians who believe they are immune from racially
biased thought and action — have a great deal to gain from reading this book. ¶ That
said, it is also important to examine the larger
picture. There is no question that more needs to be done to address physician bias. Yet we also have
to keep in mind that, in the pre-Alexander v. Sandoval era (when Title VI was, according to Matthew,
more robust), there were still large racial inequalities. Litigation may be a useful tool, but it’s a limited, post-facto modality.¶ More
broadly, the recommendations of both Tweedy and Matthew ultimately seem inadequate. Neither gives much credence to the notion
that further increasing the universalism of the health system might play an important role in reducing inequalities. Moreover, Tweedy says nothing, and Matthew
only a little,[20] about the notion of economic redistribution as a tool against racial health inequalities. In fairness, these concerns are not the focus of
their books. However, to my mind, they are crucial considerations in the larger discussion of racial health care

justice.¶ ¶ 4. Health equity and health system universalism¶ Martin Luther Kings Jr.’s statement on the evils of health inequality is frequently quoted, but not
usually in its full form. In his 1966 speech at the annual meeting of the aforementioned Medical Committee for Human Rights, he said, “Of all the forms

of inequality, injustice in health is the most shocking and the most inhuman because it often results in
physical death.”[21] Indeed, studies have shown a statistical association between lack of insurance
and mortality. Removing the boundaries between individuals and the health care system is a critical
step in the movement toward health care equality.¶ Tweedy, for instance, sees firsthand the harm inflicted on the uninsured when
he works at the rural health clinic described earlier. But, even so, like Matthew, he gives insufficient attention in his book to the fact that, even with the

reforms of the Affordable Care Act, we will continue to lack universal health care.[22] For instance,
under current reforms, 27 million are expected to remain uninsured 10 years from now, according to
an approximation of the Congressional Budget Office. We know that Hispanics and blacks are
disproportionately represented among the uninsured.[23] Covering these excluded millions seems
critical. Moreover, neither author discusses the fact that the US health care system imposes substantial financial burdens
at the “point of use,” in the form of copayments, deductibles, and co-insurance for medical care,
which may deter care for those who need it. Some have legitimately suggested that these forms of
cost-sharing disproportionately harm minorities, who have lower median income and net wealth.[24]
In other words, the potential harm of, say, a $2,000 medical deductible is dependent on your income and assets: those with fewer resources may lose out on
important health care. And finally, though Tweedy refers to the shortcomings of Medicaid, neither he nor Matthew emphasizes that a health care
system with a separate tier of access for the poor may be inherently unequal.¶ But would “true”
universal health care do much to combat racial health inequalities, if it were, say, a single-payer
system that eliminated out-of-pocket expenses and was equally accessible by all, without tiers or
walls?[25] Or would it replicate current biases and inequalities? To some extent, the answer is yes to both questions. But even so, a body of
research has suggested that, even if these biases persist, a fully universal system might nonetheless be a
powerful tool in reducing racial health care inequalities. That evidence comes from what is arguably a quasi-single-payer system
located in the US: the Veterans’ Administration (VA). Notwithstanding recent scandals that are indeed of great concern, the modern-era VA has

justifiably earned praise for delivering a high — indeed, comparatively superior — quality of health
care.[26] There is also evidence that it may indeed effectively reduce, even potentially eliminate,
some racial health inequalities.¶ Last fall, a study published in Circulation, the premier journal of the American Heart Association, received wide
coverage in the media for some provocative findings. “The US Veterans Health Administration (VHA),” as the study notes in its introductory section, “is a healthcare
system that does not impose the typical access barriers of the US healthcare system that may disproportionately impede enrollment of blacks.” The investigators
therefore hypothesized that racial inequalities in cardiovascular outcomes and mortality found in the general population might be reduced in the VA, a “healthcare
system that allows enrollment independent of race or socioeconomic status.”[27] Consistent
with previous studies, in their analysis of
data from the general (non-VA) population, they found racial inequalities much as they expected to
find them: blacks had a much higher mortality (after adjusting for various other factors) as compared
to whites (indeed, approximately 40 percent to 50 percent higher).[28]¶ In striking contrast, in the VA population, even
though the risk of stroke was either higher or similar among blacks as compared to whites depending on which statistical adjustments were used, the risk of
coronary heart disease as well as overall death was actually lower among blacks. This is, of course, only a single study, albeit a rather large one with more than three
million subjects. An accompanying editorial concedes that a number of factors may be at play. Nonetheless, the fact is that, as described by the investigators, these

findings build on an existing literature consisting of multiple studies that together point to a
reduction of racial health inequalities within the VA for critically important outcomes like
mortality.[29]¶ No doubt, there are still discriminatory practices in some or all of these facilities, and
we can assume that there are conscious or unconscious biases at work in the minds of some of its
clinicians, as there are elsewhere. Indeed, other studies clearly show that, even after the significant reorganization and reform of the VA in the late 1990s,
there are still racial disparities in the VA.[30] If we moved to a single-payer system on a national level, such biases would still need to be addressed along the lines

Matthew argues. But the point is that a more egalitarian structure of the health care system itself might go
even further in reducing them . Indeed, in light of this research, it seems fair to say that health care
universalism could be a very powerful tool in combatting ubiquitous racial health inequities. Attaining health
care equality, in other words, requires true equality of access. And yet this simple notion is all too often ignored entirely in any discussion of health “disparities.”
 Stephens
Theorizing racism as ontological is counterproductive---mystifies the reality of racism
and forecloses liberation
R.L Stephens 17, A. Philip Randolph Fellow at Jacobin, 5-31-2017, "Between the Black Body and Me,"
Jacobin, https://jacobinmag.com/2017/05/ta-nehisi-coates-racism-afro-pessimism-reparations-class-
struggle
Liza Bramlett was a slave. She lived on a cotton plantation in the Mississippi Delta during the nineteenth century. White men raped her
repeatedly throughout her life. They traded her body amongst themselves in exchange for calves and piglets. In the end, Liza gave birth to
twenty-three children, twenty of whom were conceived by rape.

One of Liza’s daughters, Ella Townsend, was born after emancipation, but remained in the bondage of sharecropping in
rural Mississippi. As an adult, she carried a pistol with her in the fields, determined to protect herself and the surrounding children. One day, a
white man on horseback rode into the fields. He had come to abduct a young black girl.

Ella, carrying her pistol in a lunch pail, intervened. “You don’t have no black children and you’re not going to beat no black children,” she told
the intruder. “If you step down off that horse, I’ll go to Hell and back with you before Hell can scorch a
feather.”

“Ido not believe that we can stop them … because they must ultimately stop themselves,” Ta-Nehisi
Coates says of white racists in the final paragraph of his bestseller Between the World and Me, written as an open letter to his son.
Coates describes racism as galactic, a physical law of the universe, “a tenacious gravity” and a “cosmic
injustice.”

When a cop kills a black man, the police officer is “a force of nature, the helpless agent of our world’s
physical laws.” Society is equally helpless against the natural order. “The earthquake cannot be subpoenaed,” says
Coates.

In a widely replicated gesture, Coates locates the experience of racism in the body, in a racism that “dislodges brains, blocks airways, rips
muscle, extracts organs, cracks bones, breaks teeth.” In the slim volume, fewer than two hundred pages, the word “body” or “bodies” appears
more than three hundred times. “In America,”
he writes, “it is traditional to destroy the black body.” Another
brooding passage dwells on the inevitability of this violence.
It had to be blood. It had to be nails driven through a tongue and ears pruned away. It had to be the thrashing of a kitchen maid for the crime of
churning the butter at a leisurely clip. It could only be the employment of carriage whips, tongs, iron pokers, handsaws, stones, paperweights or
whatever might be handy to break the black body.

Yet Coates’sdescriptive language and haunting narrative are not mere metaphors. They act as a kind of
ontological pivot, mystifying racism even as it is anchored in its physical effects.
Metaphor has long been used to capture racism’s almost unimaginable brutality. Lynching became “strange fruit” in Abel Meerpool’s song,
made famous by Billie Holiday. In a wry, tragic innuendo, rape was referred to in Black communities as “nighttime integration.” The use of
metaphor is not in itself an obfuscation. But Coates wields metaphor to obscure rather than illuminate the reality
of racism.

What we find all too often in Coates’s narrative universe are bodies without life and a racism without people. To
give race an ontological meaning, to make it a reality all its own, is to drain it of its place in history
and its roots in discrete human action. To deny the role of life and people — of politics — as Coates
does is to also foreclose the possibility of liberation .
No Helpless Agent
Ella knew her mother Liza’s unimaginable suffering, but her memory was not a yoke on her shoulders. It provoked something in Ella.

As an adult, she did not see the white predator stalking the fields as some helpless agent. She
took matters into her own hands.
There was no gravity strong enough to break her will or loosen her grip on her pistol. Her efforts rippled beyond those
cotton fields.

Ella taught her own daughter, Fannie Lou Hamer, not only to struggle, but to resist.

Fannie Lou was born into a sharecropping family in rural Mississippi but would go on to become a beacon of the Civil Rights movement. She
is best known for her work registering black voters in Mississippi, most famously during 1964’s Freedom Summer, at
great personal risk.

Police arrested and beat her. White racists shot at her. Lyndon Johnson dismissed her as an illiterate. In 1973, an interviewer asked her, “Do
you have faith that the system will ever work properly?” By then, Fannie Lou had seen a decade of setbacks and false
dawns since first walking off her plantation in 1962 to fight for Civil Rights. She responded,

We have to make it work . Ain’t nothing going to be handed to you on a silver platter. That’s not just black people, that’s people in
general, masses. See, I’m with the masses… You’ve got to fight. Every step of the way you’ve got to fight.

She marched. She sang freedom songs. She testified. She co-founded the Mississippi Freedom Democratic Party. For her,
the logical solution was political: uniting a powerless many against a powerful few. White racists could be
stopped. Black people could resist, and Fannie Lou and so many others did just that.

Fannie Lou knew that the wages of racism were measured on the body. “A black woman’s body was never hers alone,” she once remarked.
White doctors sterilized her without her consent during a minor surgery, a barbaric intrusion so common she called it a “Mississippi
appendectomy.” However, though she knew racism’s physical toll, she drew inspiration from stories of black resistance
passed down orally across the generations. Hamer recalled her grandmother’s will to survive and her mother’s weapon of
protection.

These intergenerational
resistance narratives, according to Charles Cobb in his book This Nonviolent Stuff’ll Get You Killed,
“underlay a deep and powerful collective memory that was invisible to whites but greatly
affected the shape and course of
the modern Freedom Movement.” As a result, Fannie Lou and so many others possessed an intimate knowledge not only of their
own human dignity, despite the racist brutality they endured, but also of the human frailty of their racial oppressors.

In the years before Fannie Lou’s political struggle began, whole communities, black women and men, rose up against the violence that was
forced on black women’s bodies. Feminist historian Danielle McGuire argues this anti-rape
community organizing in Alabama
laid the foundation for what eventually became the Montgomery Bus Boycott. She observes, “The majority of
leaders active in the Montgomery Improvement Association in 1955 cut their political teeth demanding justice for black women who were
raped in the 1940s and early 1950s.”

Despite being a poor, black sharecropper drowning in the poverty and racial terror endemic to rural Mississippi, Fannie Lou held fast to her
forbearers’ stories of resistance. She did not resign herself to fatalism, as Coates does.
The "Birthmark of Damnation"

Coates too takes a multigenerational view. Between the World and Me is framed as a letter to his son. However, rather than seeing a legacy of
resistance, he finds a lineage of blackness defined by fear and dysfunction.

“When I was your age the only people I knew were black, and all of them were powerfully, adamantly, dangerously afraid,” he writes. “I felt the
fear in the visits to my Nana’s home in Philadelphia,” Coates continues. “And I saw it in my own father.”

My father was so very afraid. I felt it in the sting of his black leather belt, which he applied with more anxiety than anger, my father who beat
me as if someone might steal me away, because that is exactly what was happening all around us.
Coates describes his condition, and that of all black people, as a “birthmark of damnation.” The
resistance stories passed down to Fannie Lou and so many others spurred them to march. Coates’s
narrative, riddled with fear and futility, begs us to retreat.
Though Coates has never explicitly cited it as his theoretical framework, the dour outlook of his work evokes the themes of Afro-Pessimism.
The pivot to the ontological that is apparent in Coates’s rhetoric is a hallmark of Afro-Pessimism.
“Ontology by definition is the study of being, and to speak of Blackness as an ontological condition means analyzing the state of Black bodies
through the lens of slavery,” Afro-Pessimist scholar Michael Barlow, Jr., writes in the academic journal Inquiries. However, for Barlow, the
relation of slavery that ontologically defines blackness is not a matter of political economy, but rather
a “libidinal economy.”

In this telling, labor

and ownership — that is, political economy — are merely incidental to racial slavery.
Instead, it’s the white imagination and its depraved “metaphysical desires for Black flesh” that both
predated and catalyzed racialized chattel slavery.

Racism is reduced to the spiritual, more a matter of a sinful nature than a political struggle. Coates has echoed this retreat to
interiority, to the spiritual, to consciousness.

It’s the ontological pivot that leads Frank Wilderson, perhaps the world’s foremost Afro-Pessimist, to declare in his
foundational text “Gramsci’s Black Marx: Whither the Slave in Civil Society?” that black people are no more than cows in a
slaughterhouse. Wilderson posits that “death of the black body is foundational to the life of American civil society,” just as a cow’s death
is essential to the slaughterhouse.

Flippantly, Wilderson asks, “how would the cows fare under a dictatorship of the proletariat?” Coates adopts a similar sense of
impotence. He characterizes struggle as aimless toil — an apolitical end in itself.
“The struggle is really all I have for you,” he tells his son, “because it is the only portion of this world under your control.” Yet how are we to
struggle against earthquakes and physical laws? How can we fight gravity?

Both Coates and Wilderson speak of power in terms of dreams. Coates writes of monolithic white “Dreamers,” those whose investment in the
American Dream requires a faith in their own whiteness.

Similarly, Wilderson sees America as enacting two distinct dreams . For Wilderson, “the dream of black accumulation and
death” is separate from “the dream of worker exploitation.” Ultimately, in both Coates’s and Wilderson’s respective frameworks, solidarity is
unimaginable and class struggle is rendered futile.

Though Coates does not go to the lengths Wilderson does to position himself in opposition to materialist politics, the
result is effectively
equivalent: a
separation of race and class combined with a deep skepticism of class-based solidarity,
reforms, or even revolution.

This is a turn away from the Freedom Tradition embodied by Fannie Lou Hamer. For her [Hamer], the
problem of racism wasn’t cosmology or ontology — it was an expression of politics implicated in class
antagonism. Fannie Lou Hamer stood “with the masses,” both white and black. Solidarity through struggle from
below, including class struggle, formed her path to victory.

Coates’s ontological pivot is more muddled than Wilderson’s. Fleetingly peppered throughout his work are allusions to material reality,
betraying the imposition of metaphysical abstraction that ultimately drives his perspective. “We did not choose our fences,” he writes. “They
were imposed on us by Virginia planters obsessed with enslaving as many Americans as possible.” Coates knows that Virginia
planters
did not invent gravity or earthquakes. Yet this historicizing impulse does not prevent him from
essentializing racism when he confronts it head on.
In string of tweets from December 2016, Coates conceded that racism is not transcendental, noting that “at its very root it was always
economic.” But acknowledging racism’s economic impact has not led him to embrace class struggle. Even Frank Wilderson can acknowledge
that racism has an economic impact, but he still believes that class struggle and racism exist on distinct planes.

Coates holds a similar belief; that racism is wholly different in kind from class. In the same series of tweets, he concluded that “in America,
‘class’ isn’t the only kind of class.”

Just as he mystifies racism, even while locating its impact in the bodies of black people, here he again pivots. Coates cannot address
material politics on its own terms, preferring instead to retreat to a contrived mystification. He
replaces action with interiority.
As he recently told an auditorium of eager Northwestern students, “The process should not be… people looking out at the world and saying, ‘I
would like for there to be change in the world, how do I do that?’” Instead, he implored the crowd to engage from the “inside-out, not outside-
in… because if you are in the business of justice, and making this society more democratic, you might get a lot of disappointment.”

Consciousness matters, of course. “Baby you just got to love ’em,” Fannie Lou Hamer would say of the white segregationists who routinely
threatened her life. “Hating just makes you sick and weak.” This was Hamer in a reflexive moment, but it was no retreat. In the very next
breath, she warned, “I keep a shotgun in every corner of my bedroom and the first cracker even look like he wants to throw some dynamite on
my porch won’t write his mama again.”

Fannie Lou truly was her mother’s daughter. Reflection, whether through intergenerational story or her own thoughts, enhanced her
resistance.

The same cannot be said of Coates. Instead

of finding relief in political action, Coates finds it in a cookout at
Howard University’s homecoming, surrounded by black people. He fantasizes that he is “disappearing into all of their bodies,” as
the music and dancing, the black cultural zeitgeist of the moment, cure him of the “birthmark of damnation.”

The curse is lifted. Blackness is transfigured, becoming a space “beyond the Dream.” It’s another
ontological pivot, this time allowing Coates to conclude that The Mecca’s” — his term for Howard — cookout has a “power more
gorgeous than any voting rights bill.”

It’s a fantasy of retreat, as if black culture were beyond the machinations of capitalism, as though
black cultural expression existed in the world but was not of it and were enough to take us to a new
one.
Between the World and Me concludes with Coates considering climate change. He sees climate change as a manifestation of a polluted white
consciousness, rather than the unfettered excess of industrial capitalism. It is a “noose around the neck of the earth,” allegedly resulting in
large part from white flight, the mid-century exodus of negrophobic white families to the suburbs and the pollution caused by the cars that
took them there.

Coates’s words here are poetic but grossly inaccurate. They mimic Afro-Pessimism’s
emphasis on the white libido,
relegating his rhetoric to the realm of interior life, the souls of white folks, and stopping well short of
the political domain.
For Coates, the Civil Rights movement was not a struggle to alter a material world; rather the “hope of the movement” was merely to “awaken
the Dreamers.” Black politics is only relevant as far as it can arouse white consciousness, which he sees as a largely futile
exercise, due to “the small chance of the Dreamers coming into consciousness.”
Coates sees common interest between the black elite and the black poor, as he marvels at “the entire diaspora,” from lawyers to street
hustlers, present at Howard’s homecoming. Yet he cannot conceive of anti-capitalist class solidarity across racial identity. He has a darker
vision, of a kind that Corey Robin has described as “apocalypticism.” Coates’s
ultimate hope is not in collective human
action, but rather the total annihilation of the world and all those living in it— another feature that
unites him with Afro-Pessimism, which calls explicitly for the “end of the world.”
As he says of the Dreamers, “the field for their Dream, the stage where they have painted themselves white, is the deathbed of us all.”
Paradoxically, though he can see a collective fate in apocalypse, he rejects shared struggle for liberation.
“The Dreamers will have to learn to struggle themselves,” he declares.

The problem is, the whole of capitalist enterprise, both past and present, cannot be reduced to race as Original
Sin. Left out of Coates’s mythology is the fact that colonial enterprise, in what would become the United States, relied first on European
indentured servants, most of whom died within a handful of years after arriving on the continent.

It’s Coates’s reading of race as sin that pushes him to imagine a perverted form of salvation in the
fantasy of apocalypse . In this racial fatalism, reparations for slavery emerges as the anticipation of the inevitable Judgement Day. It is
therefore no surprise that Coates has taken up racial reparations as his cross to bear — not to change the world, but to condemn it.

A Moral Debt

For the better part of two years, Ta-Nehisi Coates has been the most visible and combative supporter of reparations in politics. Coates calls
reparations “the indispensable tool against white supremacy.”

In 2016’s “My President Was Black” and “Better Is Good,” Coates refers to the “moral logic” of reparations. They are a measure that could
atone for what he called in 2014’s “The Case for Reparations,” the “sin of national plunder.”

There he claimed that the nation owes a “moral debt” that must be remedied by the “spiritual renewal” that reparations would facilitate.
Reparations for slavery is Coates’s ontological pivot fully realized.

These days, we find Coates touring prestigious universities and making his case for reparations in keynote addresses to packed auditoriums.

“I think every single one of these universities needs to make reparations,” Coates said to thunderous applause at a March 3 conference at
Harvard University. The day-long conference, “Universities and Slavery: Bound By History,” began with Harvard’s president admitting that the
university “was directly complicit in slavery from the college’s earliest days in the 17th century.”

Coates pushed the university to “use the language of reparation” as a measure that would “acknowledge that something was done.” Though
Harvard acknowledged its history, no race-specific remedy was forthcoming.

Last fall, Georgetown did Harvard one better. They not only used the language of reparations; the school also put forward a program of
financial and symbolic atonement. The university admitted to selling slaves in 1838, “a transaction that helped save Georgetown from financial
ruin.”

In 2015 Georgetown convened a commission to “reflect upon our University’s history and involvement in the institution of slavery.” The
commission recommended granting preferential admission for descendants of the 272 slaves the university sold two centuries ago, in addition
to gestures like changing the names of campus buildings from those of slavemasters to those of slaves and free people of color.

Georgetown’s example is the closest actualization of reparations policy that has taken place during Coates’s three years of evangelizing. Coates
said of the plan, “folks may not like the word ‘reparations,’ but it’s what Georgetown did. Scope is debatable. But it’s reparations.”

Coates wants “special acknowledgment” from above, in the service of spiritual renewal — which explains his penchant for means-tested trickle-
down anti-racism. But if he had faith in “the masses,” as Fannie Lou Hamer did, he’d see that the renewal and acknowledgement he seeks
comes from below, from class solidarity in the struggle for universal emancipation.

Harvard has a $37 billion endowment. Mere months before Coates’s appearance, dining workers at the school were locked in a protracted
battle for a living wage. Many of these workers are themselves descendants of slaves, but the university was unmoved by their struggle. The
dining workers spent the better part of a month on strike, before finally forcing Harvard to concede to their demands.

The university was quicker to take the less expensive measure of admitting that the school was complicit in seventeenth century slavery than it
was to pay its workers fairly today.

I’m a former staffer for UNITE HERE, a hospitality union. Last year, I worked on a campaign in a multiethnic, multiracial university cafeteria in
Chicago. The campaign’s primary demands were for wage increases and healthcare, using the slogan “Dignity and a Doctor.” Negotiations with
the subcontractor had stalled, and strike preparations were under way. Pressures ran high. Workers were afraid. However, just as stories
catalyzed resistance for Civil Rights leaders, stories anchored the worker organizing in our campaign.

Though workers’ struggles with poverty wages and a lack of health coverage were crucial, one story stood out above the others. Workers
continually shared stories that their Chinese colleagues were being abused for speaking Chinese on the shop floor. Managers would walk past,
and upon hearing Chinese, they’d smack the speaker on the back of the head commanding the worker to “speak English!”
Most of the workers were people of color, but the majority were not Chinese. The largest plurality in the workplace was made up of African-
Americans, virtually all of whom only spoke English. But everyone could identify with the indignity of the story, the asymmetrical relations that
empowered the bosses to abuse any one of them for any reason.

Workers from a whole range of identities fought in solidarity with the Chinese workers. Discrimination on the basis of language became a
central demand in the broader campaign. The campaign attached the specificity of the Chinese workers’ situation to all the workers’ common
struggle against the boss.

This form of class struggle was not enough to overcome racism the world over. But it did give a brief glimpse of solidarity across backgrounds
and experiences through acknowledging the shared indignity of class exploitation.

In the end, the workers won. As the campaign victories were listed, the excitement in the room was overwhelming, a type of energy that I’d
only ever felt at a particularly intense church service or while attending a high-stakes game in a packed stadium. The organizer announced that
healthcare had been won. We clapped. We celebrated as the wage increases were added up.

But when the organizer revealed that the contract guaranteed the right to speak non-English languages in the workplace, the room erupted.
The black workers were palpably just as invested as the Chinese workers, and everyone was ecstatic.

Because he fails to deeply consider what real, material resistance of the masses might look like, the
kind that guided Fannie Lou Hamer, Coates ends up idealizing racism. He evokes metaphors of
earthquakes and physical laws to describe its magnitude.

But for the workers in that university cafeteria, racism was a smack from a boss. For
millions of poor black people, racism is
the corrosive water pipes poisoning their bodies. School closures, crumbling and unstable housing,
and all the intimately practical things necessary for everyday life are the measure of racism.
These racist realities are not separable from questions of class. In fact, they are expressions of class politics. The racialized tragedies faced daily
by people of color require us to embrace class struggle, not Coates’s demobilizing metaphysical maxims about how white people “must
ultimately stop themselves.”

Solidarity from below, between cafeteria workers, truck drivers, secretaries, and any number of everyday people is worth
magnitudes more than the kind of special acknowledgement from elites that Coates is after. This
solidarity through shared struggle, as Fannie Lou Hamer recognized, is the foundation for social transformation .

Where Coates would have us retreat, she called on us to march. She knew that the only way to defeat racism was to fight it,
every step of the way.