Adler-Bolton

 ''Biocertification is assumed to be a necessary gatekeeping mechanism or checkpoint to prevent the “wasting” of resources on fakers, cheats, imposters, and malingerers: “invoking both a model of scarcity, in which resources must be reserved for those who truly deserve them, and a distrust of self-identification, in which statements of identity are automatically suspect unless and until validated by an outside authority.”

The generosity of these currencies-in-kind is often extraordinarily overstated in the social-reproductive imaginary. Cultural perceptions dictate a picture of disability, illness, and marginalization which is not reflective of the material “gains” that come as a result of being biocertified for social welfare supports like the United States’ Social Security Disability Insurance (SSDI) or Medicare/Medicaid. This is what Samuels describes as a tendency to commonly perceive “these [eligible] identities as lucrative commodities.” The boundaries and borders of qualification are guarded by a combined medical-legal authority and rest on the understanding that identities are readily measurable, verifiable, and fixed, ascribing meaning to biological observation and institutions of authority which seek to standardize the line between social citizenship and exclusion.

This constructed preference for standardization and biocertification arises out of the imbrication of health and capital. If the economy of health is to be bled for excess profit, then the fundamentally inefficient process of facilitating our mutual survival must be made to be efficient. The modern welfare state measures and quantifies metrics of individual health against a picture of the individual’s economic resources and labor power in order to restrict the administration of aid. To determine eligibility for SSDI in the United States, for example, the Social Security Administration (SSA) “uses formulas and charts to transform bodily conditions into percentages of ability.” Physical conditions of the body and its organs are clinically evaluated to determine their relative distance or deviance from an abstract ideal normal body (worker). To the SSA, all impairments, symptoms, circumstances, and conditions are of equal value and attention; all health is equally neutral. This is because the severity of illness, impairment, or disability is not actually the metric the SSA uses to determine eligibility. The crucial axis is instead the individual’s relationship to work. What emerges from these phenomena is a shadow biocertification regime that hides in plain sight as a means test to ward off would-be “waste, fraud, and abuse.” Labor power is equated to bodily state, and health is measured through this contradictory lens.

To the SSA, illness is only relevant in relation to whether and to what degree it impacts a person’s capacity to work. As Rosemarie Garland Thompson argues, this presumes that ill-health, disability, and impairment are located only in the body and not also in the broader social, political, and geographical context that comprises the individual’s social determinants of health. Impairments and disabilities are reduced to numbers on a page: “On one scale, for example, limb amputation translates as a 70% reduction in ability to work, while amputation of the little finger at the distal joint reduces the capacity for labor by a single percentage point.” Garland Thompson’s critique of the disability eligibility schema in the US questions the ability of the state to meaningfully measure such complex and dynamic situations as a person’s health and worth using a precise “mathematical relation.” Labor power, social and material conditions, and bodily states are collapsed into a single metric, measuring all health along a continuum of relative currency.

The ideological framing of wage work as a mitigating factor in an individual’s eligibility for health and welfare benefits attempts to map economic valuations of life onto regimes of biocertification, as is readily evident in SSDI determinations. Social Security disability eligibility is a legal process of decertifying a body for work, not the certification of a body for any type of qualifying disability or impairment demonstrating need for care and additional social supports. These notions have become replicated in social security and social insurance programs internationally. Countless states limit or adjust their benefits dependent on the amount of productive labor the individual has already participated in during their life. This has become particularly prevalent alongside the spread of social insurance privatization schemes by international financial firms, as discussed at length in BORDER.

The authority of medical opinion is widely used as a means to measure the truth of a body’s impairment and certify to the state’s satisfaction that the benefit applicant is truly biologically incapable for work, through “no fault of their own.” This arguably subjective perspective of medical authority is treated as if it is a visible and clearly quantifiable fact. The state relies upon the signifier of medical authority as a means of depersonalizing and depoliticizing the biocertification process writ large. Relying on claimed scientific or medical frameworks, biocertification schemes seek to identify and sort bodies, placing each within the context of their correct category, which is reflective of the intersections of their race, gender, citizenship, wealth, or ability, as a means of validating the social truth of a person’s identity. This framework assumes that a person’s biological identity can in fact be scientifically measured, rendering their ultimate categorization or eligibility as if depoliticized—a procedural, objective, binary decision. An individual’s material conditions or identity cannot be understood as in any way fluid or abstract under this biocertification preference. Existing outside of certification means categoric exclusion.

Biocertification regimes assume that validating characteristics are readily obvious or apparent, falling squarely in the category of “common sense” generalizations, meaningful or not, about various observed metrics. Despite little scientific basis, strategies of biocertification are treated as fact and reinscribed through law and policy, leveraging medical authority to consolidate the power of the state to determine life chances—who lives and who dies. Importantly, none of this is to say that states of being, “conditions,” ailments, and so on do not exist. Far from it. Instead, it is to say that the intersection of those conditions of health—or simply of being, of states of existence—have become of significant use to capital in its demarcation of ontological boundaries within society and the resulting distribution of resources. Resisting biocertification does not mean resisting “diagnosis” or identification. It means resisting the leveraging of these certifications by capital and the state''

Adler-Bolton and Vierkant