A recent legislative attempt at Medicare and Healthcare expansion has fallen to the monopolistic death-grip of corporate lobbyists.
What does the history of radical alternatives to healthcare have to teach us?
Before looking at examples of solutions, it is worth taking a moment to understand some of the potential changes lost by the complete abandonment of the Build Back Better legislation. One was the negotiation of lower prescription drug prices, in the same manner as is already done for the Department of Veterans’ Affairs. Another was the closing of the Medicaid gap which exists in many states, where a person earns too little to afford the Healthcare Marketplace coverage but too much to qualify for Medicaid, a state based program. A final proposed change was the expansion of Medicare to dental, vision, and hearing services.
Currently, the only way for Medicare beneficiaries (65 plus & disability) to access dental, vision, and hearing services is through a restrictive for-profit structure called Medicare Advantage (think HMOs & PPOs.) Enrollment in an Advantage plan threatens to forfeit one’s supplemental insurance Medigap, available to join almost exclusively for a 6-month period when a beneficiary enrolls in Medicare. Without a supplemental, a beneficiary is suddenly on the hook *for life* for the remaining 20% of costs Medicare doesn’t cover. Your insurance policy shouldn’t be a trap.
There are six distinct strategies for accessing healthcare, for which I will provide historical examples. One is the creation of alternative institutions. Another is expropriation and repurposing of needed equipment. A third is demanding more of existing institutions via occupation. A fourth is the free or at cost production and/or distribution of needed medicines, supplies, and equipment without regard to copyright. A fifth is a form of mutual aid involving exchange of services and resources. A sixth is the use of mutual aid involving the lending of zero interest loans to obtain capital, first described by Proudhon as the Bank of the People.
New Land, Same Problems
One radical approach to providing healthcare took place in Philadelphia among the Jewish community. As recent immigrants to the US, often refugees from pogroms in tsarist Russia in the late 1800’s and early 1900’s, many Jewish people could not afford the same healthcare as other Americans. Jewish doctors and professionals saw a need to establish free health clinics and pharmacies, paying for the costs themselves. The most famous example of these opened in 1899 and became Mt. Sinai Hospital, which remained open until 1997. The harsh capitalist reality facing many Jewish immigrant anarchists was the motivation to create the world they believed in, one where they cared for each other. They wouldn’t be the only immigrants on the east coast to grapple with these issues.
In the 1960’s, Puerto Rican immigrants in the Bronx organized to address health disparities between wealthy white areas and poor black and brown ones. The Young Lords began as a gang and developed into a political force of marxists seeking to establish universal healthcare in order to redress the dangerously low quality available to poor residents. There were specific targets- a tuberculosis x-ray van which never went to the working class neighborhood when people were around to get much needed screenings; and Lincoln Hospital, known as “the butchershop.”
On June 17, 1970, the Young Lords stopped the TB x-ray van and asked the medical professionals to help them in their mission, to which they agreed. The Lords directed the van and its team to a part of town with a large crowd of sick people already waiting for its arrival. When the newspapers reported the number of people who came to the van and received needed scans that day, the city continued to service the area. A single symbolic and material victory became a permanent improvement, and it wouldn’t be their last.
Their larger target was on the horizon. Lincoln Hospital was the focal point of many activist groups at the time. Besides the Young Lords, white recovering addicts and greaser activists White Lightning also saw the heroin epidemic as linked to the economic and health injustice poor whites faced alongside other oppressed people. There was also the Health Revolutionary Unity Movement, made up of hospital workers who had already done a 3-day sit-in demanding better conditions in 1968. On July 14, 1970, the occupation began.
The plan was a hopefully peaceful takeover of Lincoln Hospital to demand a Community-Worker Board with decision-making authority, as well as many other things. An HRUM organizer had recruited sympathetic progressive staff for a period of months before the occupation. When one hundred and fifty people entered to take over the hospital, they were greeted by more supporters than they had expected.
And what was the result, besides the Lords making an Ocean’s Eleven style escape right under the noses of police? A number of immediate material gains and the establishment of the first Patient’s Bill of Rights. The fight hasn’t ended, but the impact of those 12 hours is still felt decades later by millions in healthcare facilities across the United States.
In addition to working with Lincoln Hospital’s coalition of activist groups, White Lightning also had their own drug recovery programs. Formed from some of the ex-members of Logos, a therapeutic community model recovery organization, they were influenced by Black Panther Michael Tabor. Tabor applied a socio-economic analysis to recovery and rejected the personal pathology model of drug addiction, which in his view rendered the therapeutic community model impotent. White Lightning incorporated these insights into their programs with great success. They accused the government sponsored heroin epidemic of being nothing less than “chemical fascism.” Another brave group of radicals would arise later on the east coast, also influenced by the Black Panthers, but before looking at them, we must visit Chicago.
While the failure of healthcare legislation during a pandemic is discouraging, this isn’t the first time economic woes have piled on top of inadequate healthcare, public services, and rampant police brutality. In the late 1960’s, Chicago was experiencing a corrupt and tyrannical city government. “The Urban Renewal Program would displace thousands of poor residents, and the Model Cities War on Poverty was losing the war, because Mayor Daley controlled all aspects of the program, and he was not known for compassion for the poor. The poor could not sit on the Urban Renewal committees, because they were not land owners, nor did the Model Cities Advisory Committee have any power in the decision-making process.” (Thurman, 76)
It was in these conditions of being boxed into a corner that people carved their own way out. It is useful at a time like now to remember that the examples here were not born out of excess and convenience; Everything was going wrong. Still, people came together to change their everyday lives. When the authorities denied people their dignity and agency, they implemented it in ways outside the system.
The Black Panthers successfully established clinics in many cities based on the idea of Revolutionary service. This model was followed by others as well, like the Young Patriots, a white organization of displaced Appalachian working poor who joined the Panthers and Lords in the Rainbow Coalition.
Some of the Patriots’ longest lasting campaigns centered on community health care and urgent care access at city hospitals. In the tradition of the Panthers’ survival programs, the Patriots opened their own health center staffed by dissident doctors. For most residents, it was the first time they really understood what dignity and self-determination could mean for their daily lives. In their clinic, poor people were ‘treated with all the courtesy and dignity of a society matron going to the highest priced doctor you could find anywhere’… (Sonnie, 81-2)
The clinic was totally administered by poor white migrants, mostly Southerners, and led by Bobby Joe McGinnis. The Panthers shared with us their contacts in the medical field, so our clinic had medical doctors and students from some of the most prestigious medical schools and hospitals in the country. The recruitment of medical personnel was conducted by the Medical Core of Northwestern University Medical Union for Professional Services (MCPS), an affiliate of the Medical Committee for Human Rights, which was founded in 1964 in Mississippi to provide free health services to local residents. The recruits came from Northwestern University Medical School, University of Illinois Medical School, Presbyterian St. Luke’s Hospital, and Billings Hospital, in addition to a well-known psychiatrist, Aaron Hilkovich. At its peak, the clinic boasted a staff of 10 volunteer doctors, 10 nurses, and 50 community volunteers. The medical volunteer staff covered all expenses. (Thurman, 104-5)
In addition to providing pro-bono surgeries and treating over 600 patients every month, patients could also get help with transportation to and from visits, whether being personally driven or having reimbursement for public transportation. To contrast this with the current state of electoral politics in the US, this is something Medicare still doesn’t do today, and it wasn’t even proposed in negotiations for the recently abandoned legislation. It’s been nearly 6 decades that the federal government has failed to do on its massive budget what volunteers did shortly after their group’s formation. That’s the power of the people, and don’t ever let anyone tell you they don’t think poor people alone can do as much as the government can. They can do more with less than the gov’t, and could do *more* with more if not for government and corporate collusion against what they consider “competition.” They consider it competition to help the people they don’t and won’t.
Another group organizing in Chicago beginning in 1969 was Rising Up Angry, a working class community based group. Angry went beyond the displaced Southern Appalachian whites, recruiting from a broader white working class base, and benefitted from a growing feminist movement. (Sonnie, 122)
Sharing a practical commitment to women’s health concerns, women in Rising Up Angry developed a close collaboration with the abortion counseling service of the Chicago Women’s Liberation Union- known as “Jane”, the code name women would ask for when calling the hotline. Prior to the 1973 Roe v. Wade decision, women seeking abortions relied on a clandestine network of illegal and sometimes mafia-connected clinics… It is impossible to know exactly how many abortions Jane’s volunteer doctors performed as an underground service. Anecdotal evidence suggests that hundreds of women made the call.
While establishing new alternative institutions is clearly an effective solution, other circumstances can require making demands of currently existing ones, as with Lincoln Hospital and the Young Lords. Rising Up Angry was able to help their community do this as well. (Sonnie, 124-5)
One hospital, Augustana, announced that it would no longer accept any patients who were on public aid or who were otherwise unable to pay the full fees. In response, a group of neighborhood residents staged an impromptu demonstration and Angry members rushed down to support the action. Sitting down in the front lobby, they demanded that all free services be continued. The campaign proved successful; the hospital agreed to fund a community clinic in the basement of a local church. The Fritzi Englestein Free Health Clinic became an integral part of neighborhood life as volunteer doctors and nurses trained community volunteers to perform medical intakes, take pulses and serve as nurses’ assistants. The clinic offered three main services: pediatrics, venereal disease testing and gynecology. The clinic also provided clients with emotional support, documentation needed to get time off work and urgent care. The Fritzi Englestein clinic expanded from two nights a week to a full-time program that took the model of the Black Panthers’ ‘survival programs’ a step further.
How were the Panthers so effective at instructing others in organizing free clinics? Among other factors were their reputation in the community, the experience of doing it themselves, and a uniquely empowering perspective able to attract others and build alliances.
Formed as a mutual self-defense organization for African-Americans in Oakland amidst constant police brutality, the Black Panthers believed that medical discrimination was another way colonialism committed genocide. According to Prof. Alondra Nelson, this made their free clinics “medical self-defense.” The view was that the police don’t have to kill you if an untreated sickness, injury, or condition could do it instead. Of 44 BPP chapters nationwide, 14 had clinics, one continuing today in Seattle. A chapter in North Carolina had emergency ambulance service; others even had dental, eye services, and obstetrics for a time. Many of the clinics screened for numerous conditions. The Chicago chapter started a Sickle Cell anemia campaign, both sending members out to test people in their homes, as well as promoting awareness. This developed into a national campaign, saving thousands of lives which would have otherwise been ignored by a racist healthcare system because the patients were black. The Panthers also offered day-care centers to assist working people with getting to visits. It’s worth mentioning all of this work was done in tandem with strategies to mobilize city gangs together into volunteer groups to do the work, meaning entire organizations contributing to violence locally instead contributed to positive community projects that helped serve others. This strategy worked to build communities that had previously been attacking each other. They didn’t just set out to treat physical ills, but social ills as well. They understood the relationship between oppression and violence in their own community, and they did not settle for only treating one or the other.
In another stunning example of radically demanding more of existing institutions, rather than address an existing health issue, one was prevented by taking action against a negligent property owner. When sanitation is ignored as is often the case in poor and working class neighborhoods, capitalists exploit bureaucratic lack of accountability. This time, it would be a different group in Philadelphia, the October 4th Organization, or O4O. “In another incident, city inspectors failed to hold anyone accountable for a massive sewage backup in the home of a young Kensington family… O4O planned a sit-down to demand the city repair the broken pipe and locate the owner. The day before the action a plumber appeared at the home to clean up the waste and fix the sewer line.” (Sonnie, 147)
O4O didn’t limit itself to merely demanding more of existing institutions. They also recognized opportunities to contribute materially to causes in urgent need of support. The mutual aid of freely giving and distributing medical supplies like blood was one accomplishment of Philadelphia’s October 4th Organization during the Vietnam War.
During a pair of carpet bombings just before Christmas 1972, B-52 bombers unleashed thirty bombs over heavily populated sections of Haiphong and Hanoi in North Vietnam, and leveled the 900 bed Bach Mai Hospital, killing twenty-five doctors. In New York, the cast members of seventeen Broadway plays gave up their pay on Richard Nixon’s Inauguration Day and contributed the money to the hospital’s reconstruction. O4O came up with their own way to help. They launched a blood drive, walking door-to-door in Kensington and Fishtown to recruit donors. (Sonnie, 145)
Even with the serious problems O4O faced in their own community, they recognized the opportunity to help people around the world suffering in different ways under the same American regime. It was precisely this recognition of mutual struggle that led them to impoverished Kensington for supporters.
Turning now to the more recent past, the monopolistic hold over medical patents is something else that can be subverted for the benefit of all people. Certain medicines can be produced freely or at-cost and distributed. Access to healthcare is something corporate copyright law tries to put a paywall between, and those who can’t pay are denied their right to life and healthcare. One group has an answer.
“WHEREAS EpiPens save lives every day, but only for those who can afford them, and
SINCE The Four Thieves Vinegar Collective is dedicated to providing access to everyone
WE HAVE developed the EpiPencil, an epinephrine autoinjector which can be built entirely using off-the-shelf parts, for just over $30 US.” (The Four Thieves Vinegar Collective)
Offering more than the brief summary available on the Four Thieves website, Dr. Laufer had this to add in an interview:
“The EpiPencil was meant to address a single, life-and-death challenge at a time when the price of the auto-injector had soared past $600 for a two-pack. Now Laufer has turned his attention to publishing plans for the “Apothecary MicroLab,” — a general purpose chemical reactor built from materials purchased online for about $100. He also plans to publish free recipes for using the desktop lab to manufacture certain medicines.” (Scientific American)
No one should be forced to live for another or die so another may profit. Laufer’s work, at least for some, puts their life back into their own hands. If one has a right to life, they must also have the right to the means of supporting it- at the very least, access to the knowledge of how to acquire the means. Laufer has reduced the cost down to those needed for component parts and needed equipment. More importantly, this example of re-engineering regularly needed medical supplies and meds could be investigated further to discover more items it could be used to suitably provide to patients.
The fifth method of mutual aid to exchange services can be something similar to the model of Vietnam and Cuba. While exchanging food for medical supplies and doctors hasn’t solved the problem for either nation, it certainly has done something to help. The Vietnamese government has given hundreds of tons of rice to Cuba, and the Cuban government has sent a team of doctors and vaccines to Vietnam to help fight the Covid-19 pandemic. The Cuban manufacturer has a contract to supply Vietnam with 5 million doses.
Another example of similar mutual aid would be the centuries-long relationship between the Irish and the Choctaw. Having only themselves just walked the Trail of Tears, in 1847 the Choctaw nation donated $170, or about $5000 in today’s money, to help the Irish suffering from the Potato famine. Nearly 200 years later, the Irish continue donating hundreds of thousands of dollars to indigenous peoples like the Navajo and Hopi reservations for Covid relief. Using this template, groups of individuals, neighbors, or workers can determine what they need and what they may have to contribute to others in solidarity.
The sixth method of mutual aid is Proudhon’s Bank of the People. Proudhon may not have had the exact machinations laid out, but he did understand the moral need for the interest rate to be zero or for loans to be at cost of administration (so a nominal fee at most). I have written about that theory in much greater detail here on C4SS. While a real world zero-interest rate Bank of the People may not necessarily already exist, the internet has attempted similar things. A website called Kiva.org facilitates crowdfunded zero-interest loans. Until there is a true “Bank of the People” that doesn’t sound so bad. Not to mention the different crowdfunding sites which don’t require repayment. Also worth mentioning in this regard is a unique financial arrangement available legally only in two countries, Bolivia & Iran, but useful as a model for radicals anywhere. Anticreticos, or “against a credit”, is a system where someone gives a zero interest loan in exchange for use of some unused property like an unoccupied room in a house or a small business space, for a predetermined period of time. Default on the loan can have a predetermined, agreed upon result. It certainly sounds like something designed to subvert rent-seeking, as one person avoids paying rent while another avoids paying interest.
These six radical approaches are tools and examples of answers which can be used in combination with one another. The first and biggest is the creation of alternative institutions. The second, for if that isn’t possible or sufficient, is expropriation and repurposing of needed equipment. The third is demanding more of existing institutions via occupation. The fourth alternative is the free or at cost production and/or distribution of needed medicines, supplies, and equipment without regard to copyright. The fifth is a form of mutual aid involving exchange of services and resources. The sixth is the use of mutual aid involving the lending of zero interest loans to obtain capital, first described by Proudhon as the Bank of the People.
More approaches means a greater likelihood of addressing any one problem, and a greater number of possible problems solved. In many of these it is necessary to credit and further examine the ideas of the Black Panthers, who made a template other groups followed; “they addressed pressing concerns that needed to be resolved before the hoped-for revolution.” (Williams, 4) In doing so, they were revolutionary.
Following the model of Revolutionary service, these groups often pursued similar goals and therefore had similar projects into health care. Their experience of capitalism as a class conflict is shown to be true by this universal recognition of being dispossessed of healthcare access, among many other things. Even the Jewish anarchists before the Black Panthers experienced this. They faced similar issues to those we face now, and their experiences should inform us. Clinics and patients suffered harassment from law enforcement, as did activists. But what is new?
Inspired by these examples and their own contemporary needs, many different groups continue clinics around the world every day with similar and even more services, from Greece to Mexico. I’ve had the pleasure of visiting an anarcha-feminist clinic helping indigenous migrants with an herberiya, or herbal medicine pharmacy, doula and first-aid classes, & doctors and nurses with activists fundraising to get patients to local dentists.
In just this short review of answers we’ve seen places with doctors, nurses, and surgeons; pharmacies, abortion clinics, drug recovery programs, screenings, pediatrics, sti testing, gynecology, obstetrics, dental, vision; emergency and non-emergency transportation. One clinic became an official city hospital for most of a century, while another clinic still exists to this day. These were major cities — New York City, Philadelphia, and Chicago.
These were places staffed by the people of the community for each other- while boldly idealistic, there was nothing utopian about it. It was all about survival, and the cooperation that makes it possible against all odds.
From the Bullet to the Ballot: The Illinois Chapter of the Black Panther Party and Racial Coalition Politics in Chicago; Williams, Jakobi; The University of North Carolina Press, 2013.
Hillbilly Nationalists, Urban Race Rebels, and Black Power: Community Organizing in Radical Times; Sonnie, Amy and James Tracy; Melville House Publishing, 2011.
Revolutionary Hillbilly: Notes from the Struggle on the Edge of the Rainbow; Thurman, Hy; Regent Press, 2020.