Examining "Meds and Eds" as City Savior

I’ve been doing some pre-grad school reading now that applications are done. Before getting to the awesome list of LA centric books sourced from parents and family friends, I set myself the task of reading Social Justice and the City, by David Harvey. I’m not finished yet, but I’m up to the second-to-last chapter of the original text (my edition has the 2008 right to the city essay at the back) on urbanism and the city.

On the T tonight, I came across this section: “In a capitalist economy, accumulated surplus value is in large part put to work to create even greater quantities of surplus value. This process does not occur with similar intensity in all sectors or territories of the capitalist economy. Its intensity depends, among other things, on the degree of market penetration in the sector or territory in question.” As the chapter is largely on the relationship between cities and surplus value, an idea popped into my head, and I’m hoping/guessing that it is not original, but I’m curious to know what’s out there on the topic, so here goes.

“Eds and meds” have been touted as the saviors of rust belt cities. Major hospitals and universities have led turnarounds in Pittsburgh and Cleveland, among others, and are looked to in any number of cities as the sectors that will at least stabilize, if not reverse the end-of-manufacturing decline. My idea/question is: Does the use of eds and meds as urban growth engines actually signal the penetration of health care and academia by the market, meaning that, potentially, much of the rising cost of healthcare and education is due to the institutions being put in place to ensure health care providers and universities are operated as a business/extract additional surplus value, rather than as a doctor’s office and a school? In healthcare, examples I can think of would be the biopharmaceutical industry, the patenting (or commodification) of genes and procedures, and the proliferation of shiny new hospital wings and research centers for things. In academia, in addition to the insanity that is textbooks, which economists keep trying to explain away as a incentives problem (the assigners of the books don’t pay for them, but that doesn’t explain why young economists need new editions every 2 years), there’s the idea that schools need to sell themselves with buildings, and study abroad, and all manner of bits of education that you consume rather than, I don’t know, grapple with in a good conversation with other smart people.

Second, if that is the case (and I think it is), how does thinking about it that way lead to better solutions? I think that among its key usefulness is that it shifts focus from the bits of the institutions that are still trying to operate like doctor’s offices and schools to the bits that are operating like businesses. In other words, if you’re looking to cut costs in healthcare, cut profits in biopharm and hospitals by making them less market-based rather than more. This means stop patenting plants and genes and allow the government, not “the market” to set prices for procedures, rather than blaming doctors or patients or emergency rooms. Stop the ballooning administrative positions, building construction, and degrees created to make money university tactics in favor of supporting faculty and student research, and stop trying to create performance measures and standard methods of evaluating the productivity of faculties and departments. None of those ideas are particularly novel, but I don’t know that I recognized their importance relative to other strategies that don’t specifically target the market penetration problem until I started thinking about surplus value.

That brings me to the last part of the thought, though. I like cities. I prefer cities that don’t have multiple sections that could be zombie movie sets (no offense meant, Cincinnati). If I’m against the collection of surplus value from the eds and meds sectors because it puts people I know and love into serious debt and makes others fear that they have outlived their funds and are a burden to their family, am I also then, without knowing it, calling for Pittsburgh and Cleveland and even Cambridge to be less vibrant and enticing places to live?

My current answer is I don’t think so. My two favorite quotes from Marx so far in this book are “All history is nothing but a continuous transformation of human nature” and “The productiveness of labor that serves as its [capital’s, I think] foundation and starting point, is a gift, not of Nature, but of a history embracing thousands of centuries.” We know more than we have ever known about the way the world works (and can/should work), and we can get to a point where the idea that people work to feel fulfilled and there is enough to meet everyone’s needs does not make the reader of this blog shake their head at my naivete. We have learned that we like cities, and that people think great big thoughts best in cities, and that while cities may have arisen because they were located at necessary transhipment points and were a place where capitalists could capture value as goods were transported (among other reasons), they are also awesome places to try to cure cancer and teach yoga and have science museums and aquariums and Japanese burritos and kosher gluten-free dim sum and stores devoted entirely to lox. Therefore, even in a world where workers were not as alienated from the surplus they produced, surplus would likely still be used by many to support the cities we have come to love.

I think.

What do you think?

This post was written by Rosalie and originally appeared at the blog It Depends.

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