Dump Your Health Insurance


“Health is politics by other means” -Alondra Nelson



For all its failings (and there were many) Obamacare held promise of a radical expansion of healthcare to millions of uninsured people. Access to care in a Trump presidency looks far less certain, and people have been quick to mobilize accordingly: clinics have been swamped with requests for long-acting birth control and transgender activists are issuing a nationwide call for allies to stockpile hormones in anticipation of stringent new restrictions.

The wide repeal of Obamacare stands to leave upwards of 20 million Americans uninsured, a disastrous outcome in the midst of 45,000 preventable deaths each year stemming from lack of coverage. While it remains unclear to what degree the Republicans will push back on the Affordable Care Act (ACA), Paul Ryan’s healthcare proposal is telling: it centers on Health Savings Accounts and market-based reforms. Privatization of care means higher administrative costs and reduced leverage in negotiating prices — it also means outright denial of care. The profit imperative is irreparably at odds with quality health care.

Even so, the ACA did not fix the problem of access: as many as 29 million Americans remain uninsured. Millions more remain underinsured, with high-deductible plans that, coverage or otherwise, leave medical care out of reach. A 2009 study found that 3/4 of medically-caused bankruptcies occurred to people who were insured at the time of illness — for millions, coverage is merely symbolic.

Where can we go from here? How do we build an alternative while people are suffering now? Though single payer healthcare is touted as the obvious fix, the world can’t wait until it’s politically feasible (it will never be politically feasible in a capitalist economy), much less as the incoming Trump administration ramps up its assault on state-funded care. The time has come for a radically different approach: let’s abandon health insurance altogether.

The insurance system serves as a middleman, redirecting funds while imposing high overhead (up to 24% of total healthcare spending goes to administrative, non-treatment related costs). Why not channel those funds directly to health care providers in the way of health care cooperatives? Rather than paying into a costly, under-serving insurance plan, consumers could reroute this monthly flat fee to local medical centers. Once exempt from market pressures, medical clinics could provide their services for free or at-cost. The cooperatives could work in tandem, subsidizing costs where necessary so that clinic quality was disconnected from the socio-economic status of the neighborhood it served.

It’s not a novel concept: the Black Panther Party employed this tactic to great effect. Organizing against systemic medical neglect in black communities, the Panthers deployed free medical clinics that provided not only comprehensive medical care, but patient advocacy, social welfare programs, and political education courses. Beyond the courses, the very existence of these clinics was political: for if they were able to achieve so much while sustained only through community donations and volunteers, how could the State, with a monumental array of resources at its disposal, not achieve more? For the Panthers, discourses around health fundamentally required a look at broader social ills that rendered care inaccessible or deadly to vulnerable communities.

The overwhelming success of Cooperative Home Care Associates (CHCA) speaks to the viability of such an approach even in today’s tough economic times: at America’s largest worker-owned cooperative, wages for healthcare workers are nearly double the market rate, with full benefits and guaranteed hours. The CEO to entry-level worker pay ratio is 11:1 (the statewide ratio is 405:1) and the cooperative is primarily owned by women of color. Spurred by the model’s accomplishments, Bill de Blasio allocated 1.2 million dollars to the development of further NYC cooperatives.

These cooperatives present a coherent vision of what a radically new medical system could look like: one that centers accessibility and cost effectiveness, and exists fundamentally to serve the people. Such a program is within grasp — a coordinated pooling of resources could upend the insurance system and provide quality care to those in need, now.

Natascha Uhlmann is an activist from Sonora, Mexico with the Nos Faltan 43 movement. Follow her on Twitter: @nataschaelena

Showing 6 comments

  • Brent Heverly
    commented 2017-01-07 01:40:44 -0500
    Please add this to your post if you’d like to spread the word:
    An existing model of this is “Patient/Physician Cooperatives” (first link below – check out the videos to learn more). Founded in Houston, residents in Portland decided to start their own. The original founder has made a wealth of resources available. On his other site (2nd link a non profit which sponsors the co-op), he has posted his book (third link) on how to start a healthcare co-op for free in a blog post (second link below). Let’s launch these everywhere! The strategy was been defined and already implemented in 2 cities. We just need to scale up the infrastructure elsewhere now.



  • Matt Costa
    commented 2017-01-04 16:57:11 -0500
    Blaming Obama administration for the the mess that has become the ACA is entirely ignorant. The Republican (and lobbyist) controlled congress let the insurance companies put thousands of addendums and stipulations on the ACA bill and then they were given the right to opt out any area that would not be profitable. Insurance companies are using high paid analysts and stat technicians to find the profits in the system, decline care by many means and leave the citizens hanging with the bill. They have many tools at the disposal. Like making many treatments unattainable through dozens of back handed schemes and cherry pick what clients they did not want to insure. Obamacare has proven in a 100 different ways, that the problem is 1st the insurance companies and 2nd the lack of any real representation by our elected officials. Or more concisely the point, there is no way to provide decent care for all AND to strive for MAX corporate profits. They are completely and utterly at odds with maximizing our healthcare resources as a nation.
  • Dan Va
    commented 2017-01-04 07:33:20 -0500
    It’s been a while since I read The Pig In The Python by some stock broker type. The reckoning called for in that book along with China’s and Russia’s rapid growth and/or awakening to the steak that capitalism can supply, is upon us now. There is going to be a call for a global currency. Either that , or the dollars saved by those “in the gut of the python” will evaporate. What a happy accident that would be for those owing on the debt represented by the dollars! It will highlight the fact that “there aint no free lunch” even for corpuses of money. The corporate imperative to make profits at all costs has finally realized the cost of profits at the expense of fair worker compensation.
    We should begin thinking of how our children must be able to cope at two economic extremes. One extreme of very limited technology and another that is currently reaching for Mars and driver-less cars. Cars used by the wealthy to be able to better ignore the poverty all around them as they go to some “party”.
    Store clerks are going the way of the Gas station attendant.
    Truck drivers will be soon to follow.
    Co-ops to do what?
  • Dan Va
    commented 2017-01-03 07:05:41 -0500
    Wow Lee Roberts; Now I understand why the second Dr. in Dec. has refused to see me after over 20 years loyalty. All we could afford was the “Bronze” policy on our insurance renewal. Now I have no doctor; and I take 10 meds to stay alive! and it only costs about 20K/yr. One of Norman V. Peal’s books described how the largest employment union was the AMA. Now I understand better. The Insurance companies have a large anti-trust problem on their hands.
  • Joe Barnwell
    commented 2017-01-01 13:08:14 -0500
    I wouldn’t use PayPal at all. Not only are you subjected to countless forms of surveillance, but PayPal’s co-founder is a major contributor to extreme rightwing causes and PayPal cut off WikiLeaks.
    Checks may be mailed to address supplied: Democracy at Work, PO Box 1516, New York, NY, 10276.
  • Dan Va
    commented 2016-12-27 17:36:44 -0500
    Tried to make a donation with PayPal and it wouldn’t accept. What gives?
    ..-.-.- This medical issue is extremely important and especially with our declining educated population and specialized professionals. Adam Smith said having a repetitive job was the most assured way to make a population as stupid as it could become. I submit that we need to look at future workers as police/carpenter/plumber/doctor to be a new singular utility personnel. Just as Nurse/cook/counselor/mechanic might be another one; and, Banker/bookkeeper/farmer/doctor, yet another. C.F. Adam Smith as discussed by R. Hielbroner The Worldly Philosophers.

Donate to Become a

[email protected]

Monthly Supporter

Customized by

Longleaf Digital