There is much debate in the current political climate over what to do about our broken healthcare system. Should we universalize it under a state monopoly? Should we provide a public option? Should we form health insurance cooperatives? Should we turn it over to crony corporations to reap a profit from our misfortune? No matter what our current healthcare situation is as a nation, there are many ways for anarchists to decentralize and universalize access to the medical care we need.
Many social anarchists tend to side with some form of state-run universal healthcare system as a transitional measure while promoting a syndicalist-style takeover of the medical system by the workers. While this could possibly work, it doesn’t address the real issue of why healthcare costs so much. As Adam Conover of Adam Ruins Everything explains:
[A]fter the rise of insurance companies, hospital billing got complicated, in part because these gigantic corporations demanded gigantic discounts. So to please these powerful insurance companies, hospitals cooked up a plan.
That plan? Artificially inflate the standard prices and give the insurance companies a discount on the inflated prices. The insurance companies didn’t care as long as they could tell their customers that they are getting a discount.
[I]n less than a century, hospital prices went from reasonable to nonsensical. These crazily inflated prices are kept in the hospital’s Chargemaster… [H]ere’s the really evil part. If you don’t have insurance, you actually get charged these fake prices… And politicians have spent decades arguing over how to pay the bill instead of asking why the bill is so high.
Even most universal healthcare proposals would do nothing to stop these over-inflated prices. With this in mind, how can we strike this problem at the root and increase affordability and access for all?
In order to brainstorm ways to correct the problem we’ll follow the guideline laid out in Toward Just Healthcare by Don Stacy:
1.) Abolish licensing requirements for medical personnel and accreditation requirements for medical schools, hospitals, clinics, pharmaceutical manufacturers, medical device companies and all other healthcare-related businesses.
While this may sound scary, as anarchists we need to build non-state solutions to the useful functions of the state. This means using labor unions and other market-based solutions as an alternative form of accreditation, repealing laws which prohibit the publication of a doctor’s or hospital’s success rates, and repealing educational requirements for medical professionals so that practitioners can specialize even more (i.e. a practitioner who specializes only in setting broken bones and nothing else).
2.) Foster grassroots mutual aid healthcare networks.
Creating, supporting, or volunteering at free clinics, cooperative clinics, and grassroots union-run facilities are great ways to increase access to medical care for low-income individuals. Having these facilities also promote and focus on preventative care, rather than treatment, can also cut down cost and increase public health in the long term. The Ithaca Health Alliance was created by the same minds behind the labor time-based alternative currency known as, Ithica Hours. It is a wonderful example of a community-based healthcare cooperative that is right in line with anarchist values and tactics. Their network of over 150 local healthcare providers offer a 5-10% discount to all IHA members. The IHA also runs the Ithaca Free Clinic, a free community clinic staffed by volunteer physicians, herbalists, acupuncturists, and more. The Ithaca Health Fund, which offers emergency medical grants to low-income patients, also provides grants to other community-based health projects in the area, all funded through donations. They also host educational events, publish a regular medical newsletter with helpful tips, and donates medical books and resources to local libraries in an attempt to make medical knowledge more freely accessible. The most impressive part is IHA only has three paid employees, with the bulk of the work being done by community volunteers. IHA sees itself as a model for grassroots cooperative healthcare for all that could be replicated and spread.
While smaller clinics are important, there is still a place for larger hospitals, and, while mutual aid is typically preferred to charity, donating to local hospitals or participating in charity drives, runs, bike rides, motorcycle rides, gaming marathons, etc. can raise money to cover the costs for uninsured and low-income patients who can’t pay their bills, ensuring these facilities can still attend to low- and no-income patients in the absence of government funding. Supporting medical NGOs and charities such as Doctors Without Borders (which gets only 9% of its funding from governmental sources) and Planned Parenthood (which gets indirect funding through Medicaid) in the work that they do and encouraging people to donate and raise money for them can go a long way in helping them continue their work now, and long after we end the state’s tax system and any remaining government funding they receive. We cannot call for a cut in government funding to actually needed goods and services the state provides without having a plan for how to still provide those goods and services on a voluntary basis in a free society. As anarchists, we say that we have faith in the power of humanity to provide for their communities without the state, but we must remember that we are part of humanity and, therefore, must do our part to prove what we say to be true. As anarchists, we must therefore take responsibility in aiding these organizations and promoting their work.
In the realm of Do-it-Yourself medical care, groups like the Icarus Project offer a grassroots alternative to standardized mental healthcare. The gray market prescription trade, in the form of importing medicine from other countries, and black market prescription trade, both on the streets and on the darkweb, allow individuals access to necessary, and sometimes lifesaving, medication that they may otherwise have a hard time getting or affording through our broken white market healthcare system. Other non-prescription drugs on the black market also have medical properties such as marijuana, LSD, psilocybin mushrooms, kratom, heroin, MDMA, and more. The Multidisciplinary Association for Psychedelic Studies (MAPS) conducts legal studies involving the effects of psychedelic drugs on treating various mental health issues and has had some astounding successes.
A big part in the push to decentralize healthcare are efforts to decentralize medical knowledge. Ignoring copyright law entirely, groups like Four Thieves Vinegar and Chematica offer DIY ways to make everything from pills to EpiPencils cheaply at home or in a local community science lab. Websites like SciHub allow scientific papers to be pirated and shared freely instead of being stuck behind paywalls, and sites like WebMD allow people to research their symptoms and increase their access to medical knowledge. Community science labs, such as Counter Culture Labs in the Oakland, are another important aspect of decentralizing science, and ,therefore, medicine, alongside things like CRISPR kits, biohacking, mind-hacking, herbal and alternative medicine, 3D printing, open source medical research, open source medical devices, and medical skillshares.
CRISPR kits and similar biohacking tools allow individuals to engage in basic or advanced genetic modification, which is the basis for a lot of our modern medicines and all vaccines. This could allow people the ability to create new medicines or replicate existing medicines in their home or local lab. Other forms of biohacking such as personal nutrition, exercise, nootropics, and cybernetics can also help improve one’s health and performance. Groups like Grindhouse Wetware are working on a number of DIY cybernetics projects including an arm implant that measures your biomedical data and alerts you to any abnormalities.
Mind-hacking techniques such as yoga, meditation, nootropics, psychedelics, cognitive behavioral therapy, and hypnosis all offer treatments that can be complementary or used as an alternative to mainstream treatments. Skillshares such as CPR classes, guerrilla/protest medical training, combat medical training, herbal medicine, etc. are also useful for spreading useful knowledge and skills to the general public. “Alternative” treatments such as massage, acupuncture, chiropractic treatment, hypnosis, and herbal medicine sometimes get thrown in with blatant pseudoscience such as homeopathy but are still often pursued by patients seeking treatments and cures for various pains and ailments. Unlike mainstream medicine, some of these alternative treatments are not covered by health insurance. On the one hand, this tends to avoid the problem of inflated pricing, but it can also limit access to those with the financial resources to afford these treatments. Incorporating some of these alternatives that have proven benefits into community free clinics or mutual aid services and repealing state licensing could expand this access.
3.) Eliminate state regulation of the health insurance industry.
While abolishing insurance should be the goal, in the meantime there are certain measures which can help along the way such as repealing “laws defining who can be an insurance provider so that healthcare cooperatives, fraternal societies, and physician themselves can provide plans (i.e. physician who wants to offer her patients care on a flat-fee-per-year basis),” unionizing to push for employers to provide healthcare, pressuring labor unions to provide healthcare for their members that is not tied to employment, forming secular versions of health care sharing ministries to get around insurance requirements, and legalizing the purchasing of insurance over state lines to increase competition and drive down prices. These, however, only do so much to correct the problem.
However, in addition to increasing access to insurance, this also opens the door for alternatives to insurance to compete and hopefully flourish. Ideas such as sick benefit societies, lodge practice,or paying doctors directly may come back into practice as prices get driven down. As alternative medical institutions spring up, new ways of providing access will also be created.
4.) Exhort the malpractice insurance industry to convert to restitution-based practices from retribution-based practices.
Health insurance isn’t the only thing driving up medical costs. Malpractice insurance and punitive damage awards also increase the cost of operations for medical professionals and promote the practice of “defensive medicine” where doctors are fearful of sharing too much medical advice for fear of making the wrong educated guess or are fearful of suggesting risky medical procedures even if the patient knows and accepts the risks. Medical professionals are not all-knowing and are only making their best guesses given the evidence available to them. Suing them every time they make a wrong guess only makes their jobs more difficult. Now of course there are instances where a doctor’s negligence or less-than-professional practice can cause serious harm for which they should indeed be held accountable but instead of feeding the corporatist scheme that is malpractice insurance, we should switch to a simple restitution system for which the patient is compensated by the practitioner. Restitution for malpractice claims should be limited to the cost of damages, recovery, and court costs to keep things fair. This, along with customer reviews, union certifications, and public success rate records, gives more direct incentive for medical workers to conduct themselves professionally in their field.
5.) Spur the relevant workers of state-privileged healthcare organizations to homestead the unjustly acquired scarce resources from their employers.
Following the ideas of of the social anarchists (as well as Rothbard during his leftist period), we should promote syndicalizing and/or mutualizing all state-run and/or state-funded medical facilities and organizations, at the very least. This means promoting unionism in the medical industry while stripping away the corporate subsidies and state privileges these organizations receive.
6.) Nullify intellectual property, especially pharmaceutical medical technology patents.
Repealing intellectual property laws allows for the creation of generic medicines and medical devices. Promoting open source ethics in pharmaceuticals, medical research, and technology allows for individuals to build on the creations of others and make new advances and discoveries in the field. Even with copyright laws still in place, groups like Chematica and Four Thieves Vinegar ignore the law to continue to promote these ethics and increase accessibility. Sites like Thingiverse have countless open source .cad files for prosthetic limbs and other useful medical tools, and, combined with the open source machines created by Precious Plastic, one could print these devices from their own recycled plastic waste. The open source movement also offers other potential game changers such as the idea of keeping your medical records encrypted on the blockchain for easier doctor and patient access.
7.) Foster nutritious ecological agriculture by negating state agribusiness subsidies.
The overuse of ingredients such as corn syrup, sugar, and other unhealthy products is a direct result of agricultural subsidies. Repealing these subsidies would decrease the over-usage of these food products thus decreasing related health problem. Focusing on good environmental practices can increase health too. Examples such as the Flint water disaster, the numerous oil pipeline spills, air pollution from factories, water pollution from overuse of toxic herbicides and pesticides, fracking, etc. show the health risks of bad environmental practices. Cleaning up our land, air, and water helps reduce these risks. Opposing the creation of new pipelines, promoting the usage of alternative energy sources, and more can all go a long way towards increasing health and decreasing medical costs.
8.) Revoke taxes, especially sumptuary (sin), sales and income taxes.
As libertarians constantly remind us, a good way to end government involvement is to stop funding the government. Starve the beast and stop paying taxes. As long as we are forced to pay them however, rerouting funding from war, police, etc. into healthcare is a reform that will actively save lives. Whether it goes towards funding a public option, the creation of healthcare co-ops, creating a state single payer system such as Green Mountain Care, or just funding local hospitals, these options are vastly preferable to funding wars at home and abroad despite the obvious faults of reformism.
9.) Spark healthcare unions by annulling anti- and pro-union state regulations.
Like many modern state- and corporate-backed business unions, the American Medical Association is a corrupt institution which often lobbies against the interests of medical patients. Despite this, as anarchists we should still stand in solidarity with the actions taken by the rank and file workers within the AMA while working to repeal the laws which promote union corruption. Repealing such laws as the National Labor Relations Act, the Wagner Act, Taft-Hartley, and countless others, while promoting the grassroots unionism of groups like the IWW can pave the way for the overhaul or replacement of the AMA with a truly worker-led union movement in the medical industry. This, in turn, would pave the way towards syndicalization.
Once we abolish the insurance industry, syndicalize the hospitals under worker control, and decentralize access to tools and medicines, we will have achieved the vision of a truly anarchistic medical system built on the ideas of universal access and worker control. That is a healthcare system worth fighting for.