On Howard Waitzkin’s Rinky-Dink Revolution

When I was in college, I took a class in medical anthropology. One of our readings was an analysis of the U.S. health care system from a Marxist perspective by a physician sociologist, Howard Waitzkin. As a pre-med, I found this of more relevance than trying to wade through Marx’s polemics from, say, the Rheinische Zeitung. Also, I actually learned more about Marxism by seeing it applied to the here and now.

Later on, while I was in residency at Cook County Hospital in Chicago and as I met Black patients who were angry about the state of their lives, Waitzkin’s formulations about the micropolitics of the medical encounter helped me understand that my role as a physician made it difficult for me to recommend political engagement as therapy. As I try to integrate my own clinical and political work through the praxis of social medicine, I am guided by Waitzkin’s narrative of the founding of social medicine (by Engels, Virchow, Allende) in The Second Sickness.

Broadening our purview from human health to planetary health, it is becoming increasingly clear that the survival of our species and life on earth is threatened by the climate catastrophe, nuclear war, and grotesque economic inequalities. During 2020, we have watched the U.S. health care system (in particular) and U.S. political economy (in general) collapse in the face of COVID-19. The capitalist way of doing things has A close up of text on a white background

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But what exactly does revolution look like? Is it putting on a beret, slinging an AK-47 over your shoulder, and trying for that far-away look in your eyes? Well, no, that’s called suicide by cop (and nobody is going to put your face on a T-shirt). In the short pamphlet/e-book/PDF/audiobook Rinky-Dink Revolution (available on a donation basis from Daraja Press and at Monthly Review), Waitzkin suggests instead that we engage in postcapitalist forms of social organization. He gives us examples such as the Zapatistas in Chiapas, the Rojava in northern Syria, Jackson, Mississippi, and Rustbelt collectives such as the Horizontal Stateline Autonomous Zone in Northern Illinois. Of note, many of these formations take inspiration from anarchism. The Rojava, for example, base their revolution on feminist and ecological principles. [Its Women’s Protection Units (YPJ) and People’s Protection Units (YPG) had beaten back ISIS before Trump abandoned them in October 2019 to an invasion by Erdogan’s Turkish army.]

By “creative constructions” within postcapitalism, Waitzkin means affordable housing, sustainable, local agriculture, and non-exploitative work. He means opting out of the economic system that enriches the few and immiserates the many. As it has become evident that consumption based on burning fossil fuels is destroying the planet, postcapitalism will involve de-growth.

By “creative destructions” of capitalism, Waitzkin means opting out of participation in the finance, insurance, and real estate (FIRE) economy. He recommends that those with the means direct their disposable income instead to sustaining local communities. He outlines how to resist paying taxes to support the U.S. military budget. He points to how Standing Rock was a defining moment against the entirety of fossil fuel-based capitalism.

Waitzkin quotes Frederic Jameson: “Someone once said that it is easier to imagine the end of the world than to imagine the end of capitalism.” COVID-19 has shown us that some aspects of capitalism, such as the breakneck pace of global air travel, can actually change quickly. By April, daily global carbon emissions were down by 17%. We all need to determine what are the other aspects of capitalism in which we don’t want to participate any more.

Waitzkin calls it a Rinky-Dink Revolution because it’s everyday stuff that you can do while you scour the thriftshops in search of that beret. OK, OK, so I will concede that it’s easier to order it over Amazon – but then, aren’t you participating in the capitalist system? Can you and I give that up? Yes!


Seiji Yamada, a native of Hiroshima, is a family physician practicing and teaching in Hawaii.