The State That Cannot Afford the Truth

Part Two: Necropolitics and the Cultivation of the Abscess

The Arithmetic of Postponement

When an institution denies a legitimate claim, it does not make the cost disappear. It relocates it.

The young man who cannot stand does not cease to exist because the UWV decided his condition was insufficiently disabling. His body continues to malfunction. His life continues to contract. The costs of his illness — medical, social, economic, psychological — continue to accumulate. They are simply redirected: onto his family, onto informal care networks, onto the frayed edges of municipal social support, onto the psychological reserves of a parent who now functions simultaneously as carer, advocate, legal researcher, and emotional shock absorber.

This is the hidden accounting of denial. The state does not save money. It performs a shell game with it — moving the liability off its own balance sheet and distributing it, without consent, across the people least equipped to absorb it.

And it does something else. It defers.

The bill does not disappear. It compounds.

A twenty-year-old denied disability recognition today is a forty-year-old with two decades of untreated chronic illness, zero pension accumulation, no career history, degraded social networks, and potentially severe secondary conditions that untreated primary illness tends to produce. That person will eventually re-enter the system — through emergency healthcare, through crisis social support, through a disability claim filed when the condition has become so undeniable that even the most convenient assessment cannot dismiss it.

By then, the cost will be substantially higher.

This is not an accident. It is how systems under financial pressure behave when they cannot afford honesty in the present tense.

They practice, in the precise academic language coined for exactly this phenomenon: necropolitics.

What Necropolitics Actually Means

The term was developed by Cameroonian philosopher Achille Mbembe, initially to describe how colonial states determined which populations were allowed to live and which were exposed to death — not always literally, but structurally. Who receives the resources of the state. Whose suffering is legible to the state’s instruments. Whose death — physical, social, economic — is permitted, managed, or quietly administered.

Mbembe was writing about extreme cases: war zones, colonial subjugation, the biopolitics of race and sovereignty. But the framework has since been applied, carefully and productively, to welfare states that manage populations by deciding whose conditions are recognized and whose are not.

Because recognition is not merely administrative. It is an act of political ontology — a declaration that this person’s suffering exists in the categories the state uses to respond to suffering. To withhold recognition is to place a person outside those categories. To render them, in the technical language, illegible.

Long Covid patients in the Netherlands are being rendered illegible.

Not shot. Not imprisoned. Not in any way that would trigger visible outrage or international condemnation. Simply placed outside the frame of official recognition — in a space where their suffering is documented, their diagnoses are medically established, their functional impairment is visible to anyone who spends an hour with them, and yet the state’s instruments look through them as though through glass.

This is necropolitics operating in a temperate, prosperous, self-congratulatorily humane democracy.

It is, in some ways, more instructive for being so mundane.

The Abscess

There is a biological metaphor that describes what happens to populations subjected to this kind of structured non-recognition, and it is not a gentle one.

An abscess forms when the body cannot clear an infection. Unable to eliminate the pathogen, unable to integrate it, the immune system walls it off — encapsulates the damage, seals it from the surrounding tissue, and maintains a condition of contained, chronic suppuration. The abscess does not heal. It does not resolve. It persists, walled off from the body’s resources, a pocket of accumulated damage that the body has decided it cannot afford to treat.

Long Covid patients, and more broadly the populations of people living with post-viral syndromes, ME/CFS, POTS, and related conditions that welfare states have refused to formally recognize — these populations are being managed as abscesses.

Contained. Isolated from the redistributive resources of the state. Walled off behind evidentiary thresholds they cannot meet because the thresholds were calibrated to ensure they cannot meet them. Left to accumulate damage in a sealed pocket of non-recognition, invisible on the official ledger, present and festering in social reality.

The state knows this, in the way that institutions know things — not as explicit policy, not as a memo signed by a secretary of state, but as an ambient institutional understanding distributed across thousands of individual actors who each make small, locally reasonable decisions that aggregate into systemic cruelty.

The Headsmen

And this is where the experience of these families becomes not just painful but philosophically clarifying.

Because the apparatus of denial is not staffed by monsters.

The UWV physician who writes the dismissive assessment is, probably, a moderately overworked medical professional operating under institutional guidelines, aware at some level that the guidelines are inadequate, but aware also that deviating from them carries professional risk and delivering the expected outcome does not. They may be personally quite sympathetic. They may use a slightly gentler tone on days they feel generous.

But what families encounter — and this is documented, repeated, consistent across accounts — is something recognizable as the behavioral signature of institutional bad faith: bitterness, condescension, passive aggression, a sarcastic edge to official communications, a barely concealed hostility that breaks through the bureaucratic register like heat through asphalt.

This is not random. It is a tell.

When an institution’s executors know, at some functional level, that what they are doing is wrong — when the gap between official position and observable reality is wide enough that the people enforcing the official position cannot entirely suppress their awareness of it — the psychological discharge often comes out sideways. Not as explicit acknowledgment of the injustice, which would be professionally catastrophic. But as contempt. As petty cruelty. As the particular hostility that people direct at those who make their own complicity visible simply by existing and persisting.

The family filing the appeal is not just a case number. They are an accusation — wordless, structural, impossible to directly answer. The system responds to that accusation the way all cornered systems do: not by capitulating, but by making the cost of persistence as high as possible.

The condescension is load-bearing. It is doing institutional work.

The Transferred Ledger

So what does this actually cost?

Not the cost to the state — the cost the state is so carefully managing through non-recognition.

The cost to society. The real, total, unshifted cost that denial merely relocates rather than eliminates.

A young person removed from the productive economy at eighteen, denied support, unsupported through the formation years of adulthood, will accumulate a lifetime of foregone earnings, foregone tax contributions, degraded health requiring increasingly expensive interventions, and family-level economic damage that ripples outward — parents who reduce work hours to provide care, siblings whose family resources are redirected, relationships that fracture under the weight of uncompensated caregiving.

Modeled across tens of thousands of people in this situation, the total social cost of denial likely exceeds the cost of recognition and treatment. It is simply distributed differently — spread thin across informal networks, diffuse enough to escape line-item visibility, paid in currencies the state’s accounting systems were not designed to measure.

Chronic unrecognized illness is expensive. It is just expensive for the wrong people.

The Question the State Will Not Answer

There is a question that sits underneath all of this, that every piece of evidence in this landscape keeps forcing back to the surface:

If recognizing Long Covid disability would cost billions, how much of the current uncertainty is genuine medical ambiguity — and how much is the institutional management of a cost the state has decided it cannot bear?

That question cannot be answered by any single case. It is answered, or not, by the pattern. By the accumulation of rejections. By the calibration of thresholds. By the behavior of the lawyers, the assessors, the courts — all of whom make locally explicable decisions that arrive, with remarkable consistency, at the same destination.

The abscess holds.

The costs compound.

The headsmen continue their work, efficiently and with a certain ambient contempt for those whose continued suffering makes their work necessary.

And somewhere, an eighteen-year-old who cannot stand up waits for a letter that will not tell him the truth.