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“Health is politics by other means” -Alondra Nelson

BY NATASCHA UHLMANN | DECEMBER 27, 2016

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.