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HEALTH PAC No. 63 March/April 1975 Health Policy Advisory M^mmmCenter

1 NCHR:

AN ORGANIZATION IN SEARCH OF AN IDENTITY. What happened io the most im- portant health organization on the Left. 30 Vital Signs 31 Peer Review

NCHR AN ORGANIZA- Ml TION IN " he Medical Committee for Human Rights SEARCH Or AN (MCHR) was on the Selma Bridge and at the IDENTITY Meredith March during the height of the 1960's civil rights movement. It attended to the injured during the Washington, D.C. urban riots and at the 1968 Democratic Na- tional Convention. It served the Black Pan- thers, Young Lords and other Third World organizations of the early 1970's. It was with women in support of abortion repeal, with welfare rightists fighting for supplemental food programs, with prisoners rebelling at Attica, with the National Liberation Front fighting to end the War in Vietnam, with hip- pies running free clinics and with workers struggling for occupational health and safety. In short, MCHR was anywhere and every- where there was movement in the decade from 1964 to 1974. There were, to be sure, other health organizations that for shorter pe- riods during that decade also played im- portant roles. It is conceivable that in the MCHR suffered from many of the long run some of them may prove to have same unresolved theoretical and been of greater historical importance. But as a reflection of the turmoil, conflict and con- political limitations as did the rest tradictions of political movement in the past of the American left. decade as it pertained to the health Left, only MCHR provides an adeguate canvas on which to depict that period in the richness, color and tone reguired for accurate inter- can make no claim to a detached impartial- pretation. ity. Clearly during our five years of activity What follows represents an attempt we took and fought for positions within the at an analytic history of MCHR. It is organization, and many of those perspectives our hope that this account will catalyze se- are reflected here. With time elapsed, how- rious reflection, discussion and debate con- ever, we believe that we have been able to cerning the many issues confronted by the look critically at the limitations of our own movement of the last decade, issues that prom- as well as others' roles. ise to recur, albeit perhaps in different forms, It will be obvious that MCHR suffered from in the movement of the coming decades. With many of the same unresolved theoretical and this end in mind, we encourage readers to of- practical limitations as did the rest of the fer their responses—positive and negative- American Left. Further, its wane was coin- to the article. For its part, Health/PAC com- cident with that of the larger movement. This mits itself to publishing and distributing such fact, however, provides scant solace or ex- comments in order to encourage continued cuse for those concerned with building a vi- and deepened debate and dialogue. able radical movement. It is our con- A word about our methodology: During the tention that unless the shortcomings of the course of the last six months, the authors past are presented, understood, meditated spoke with some 25 former and present upon and ultimately overcome, we can ex- MCHR activists. We make no claim that we pect nothing but a repetition under new touched all bases—a possibility precluded by guises of the same errors that plagued us exigencies of time and expense. We did, how- in the past and that still plague us. We real- ever, assiduously try to reach pivotal figures ize that this runs contrary to a strong tend- throughout the country who represented ency pervading the American Left and hav- many differing shades of opinion and per- ing its roots in the character of American spective about MCHR. The first draft of the pragmatism: to forget or ignore the past and article was submitted for comment to most to turn optimistically to the future, vowing to of the people interviewed, as well as to se- "try harder next time." Nonetheless, it is our lected MCHR members who had not been in- hope that such resistance can be surmounted terviewed. We wish to thank such people for and that at least the beginnings of such a their helpful comments, many of which have process will be stimulated by what follows. been incorporated into what follows. In addi- tion to these personal contacts, we perused The Catalyst and the Context organizational and personal files of MCHR One night in June, 1964 three civil rights members, with particular attention paid to workers were arrested for speeding in Ne- the organization's early years. Readers will shoba County, Mississippi while investigat- note that the article essentially concerns it- ing the burning of a Black church. The sher- self with the years 1964 to 1973, with only a iff claimed to have released them shortly superficial sweep given to the past two after their arrest. A month later their sav- years. This orientation was motivated by our agely beaten and mutilated bodies were desire to have sufficient distance from the found buried 18 feet under a clay dam. The press of immediacy to enable us to be more names James Chaney, Michael Schwerner reflective about the MCHR experience. and Andrew Goodman flashed across televi- Finally, we note that the authors were both sion sets all over the country. Millions of active in MCHR between the years 1969 and Americans were shocked, angered and more 1973. Given that personal involvement, we determined than ever to complete the cru- sade for which the young men had given their lives. Mississippi was to be liberated by exorcizing racism and hatred from its bowels. Health/PAC has initiated a policy in The year was that of the Mississippi Sum- which each of its two offices takes mer Project or, as it became known. Freedom Summer. Though supported by a coalition of responsibility for the contents of an civil rights organizations including the Con- entire issue of the BULLETIN. gress of Racial Equality (CORE), its phos- This issue of the BULLETIN was phorescent guiding light, moral impetus and prepared by Health/Pac's New catalytic energy was provided by the Student Non-Violent Coordinating Committee (SNCC). York office; May/June issue will be The silent '50's were over as thousands of prepared by the San Francisco office. Americans, mostly students, trudged off to the front lines of Mississippi to be greeted by bombings, beatings, arrests, state troopers, ferocious dogs and sometimes death. Up to this time the medical community had justice. With the killing of Chaney, Schwerner been mostly quiescent. There were, however, and Goodman, they, as well as similar progressive medical organizations still func- groups in other cities, were galvanized into tioning as holdovers from the Old Left of action. earlier eras. Despite their low energy levels, Toward the mid-1960's organizations they represented latent forces for social com- sprung up within the medical community mitment within the medical community and with a more explicit civil rights focus. In set the stage for MCHR's emergence. 1963, for example, a group of doctors, mostly In New York City, the Physicians' Forum from New York City, organized the Medical held educational meetings, issued pro- Committee for Civil Rights (MCCR) in re- nouncements on current issues and wrote sponse to the growing militance of the civil legislative proposals that were almost invari- rights movement. Its first officers included ably ignored by a Congress that with all de- John Holloman and Walter Lear, both des- liberate speed was going nowhere. Not that tined to play central roles in MCHR. Other members of Physicians' Forum and similar MCCR members later to join MCHR included organizations had never known struggle. Tom Levin, Aaron Wells, Charles Goodrich Many had a history of political activity dat- and Paul Comely. ing back to the Communist Party of the MCCR saw its role as challenging segre- 1930's; some had been on the front lines of gated medical facilities in the South and the founding of the CIO; a few had been on segregated local medical societies. In early the even tougher front lines of the Spanish June, 1963, MCCR wrote to the President of Civil War fighting on the side of the Loyal- the American Medical Association (AMA) ists. They may in practice have accepted the appealing for the ". . . termination of] the 1950's ideology of the end of ideology but, racial exclusion policies of State and County unlike their medical colleagues, they had Medical societies . . . direct membership in been bitten and sensitized by the political the AMA [for] Negro physicians who are de- bug. Their concern was heightened now by nied membership in their State and County the fact that many had children who had medical societies . . . opposition to] the gone South to join the fight for freedom and 'separate but equal' clause of the Hill-Burton

Published by the Health Policy Advisory Center, 17 Murray Street, New York, N.Y. 10007. Telephone (212) 267-8890. The Health/ PAC BULLETIN is published 6 times per year: Jan./Feb., Mar./Apr., May/June, July/Aug., Sept./Oct. and Nov./Dec. Special reports are issued during the year. Yearly subscriptions: $5 students, $7 other individuals, $15 institutions. Second-class postage paid at New York, N.Y. Subscriptions, changes of address and other correspondence should be mailed to the above address. New York staff: Barbara Caress, Oliver Fein, David Kotelchuck. Ronda Kotelchuck, Louise Lander and Howard Levy. San Francisco staff: Elinor Blake, Thomas Bodenheimer, Dan Feshbach, David Landau, Carol Mermey. San Francisco office: 558 Capp Street, San Francisco, Cal. 94110. Telephone (415) 282-3896. Associates: Robb Burlage, Morgantown, W. Va.; Constance Bloomfield, Desmond Callan, Nancy Jervis, Kenneth Kimmerling, Marsha Love, New York City; Vicki Cooper, Chicago; Barbara Ehrenreich, John Ehrenreich, Long Island; Judy Carnoy, San Francisco; Susan Reverby, Boston, Mass. BULLETIN illustrated by Bill Plympton. © Health Policy Advisory Center, Inc. Act." On June 20, following AMA inaction, sissippi. By July 4, 1964, with a vague sense 20 MCCR doctors, all wearing suits and ties, of action and little sense of strategy, the first shocked the medical community by picket- team of doctors flew to the Magnolia State ing the annual convention of the AMA in on what was called a fact-finding mission. Atlantic City, New Jersey, in what MCCR The team included Tom Levin, Elliott Hurwitz, described as a "dignified public protest." Chief of Surgery at Montefiore Hospital, Les Later that summer MCCR published its first Falk, a deputy director of the United Mine newsletter, announcing its support for the up- Workers' health program, the national office coming March on Washington for Jobs and of which was located in Pittsburgh, and Freedom, which had been promoted by all Richard Hausknecht, a private-practicing the leading civil rights organizations. MCCR New York City gynecologist. that year also testified before Congress in Once on Mississippi soil the team scattered support of pending civil rights legislation. in different directions. Those more or less Another group, albeit a nascent one, sharing a public health perspective, such as played a role in the genesis of MCHR. In the Falk, spent their time investigating segrega- early 1960's Tom Levin, a clinical psychol- tion in local health facilities and exploring ogist in New York City, gathered together a the local health establishment, particularly mailing list of psychologists and social the Black medical establishment, in search of workers who had given money and support people willing to meet the needs of civil to the civil rights movement. The group, rights workers. They concluded that what called the Committee of Conscience, became needed to be done was to directly fight segre- the first medically oriented group to make gation in Southern health institutions. They contact with the Southern-based civil rights suggested that the separate-but-egual clause movement when Levin went to Mississippi to of the Hill-Burton Act was a potential "action obtain first-hand information about brutality wedge" for such a program. against civil rights workers. The contacts Tom Levin, on the other hand, spent Levin made, in particular with SNCC and most of his time "on the front lines" with Bob CORE, later proved to be the direct link to Moses, SNCC leader of the Summer Project. MCHR. After touring the battlefield. Levin concluded In Los Angeles the Charles Drew Society that what was needed was "medical pres- had an ongoing concern with discrimination ence" to directly aid the beleaguered civil against Black doctors. In Chicago the Com- rights workers and to employ the prominence mittee to End Discrimination in Medical and wealth of Northern doctors in support of Institutions (CED) was MCHR's direct pred- the civil rights movement (the idea, in fact, ecessor. Indeed, two of its members, Quen- behind Levin's Committee of Conscience). tin Young and Irene Turner, were to assume When the team returned to New York City preeminent leadership positions (nationally everyone agreed about one thing—that an and locally, respectively) in MCHR. organization was needed. At the suggestion of Falk, it was named the Medical Committee Mississippi Bound for Human Rights. As to exactly what, how- The killings of Chaney, Schwerner and ever, the organization was to be and do, there Goodman resulted in a panicked telephone was disagreement—in a form that was to be- call to Tom Levin from James Forman, head come prototypical of future debates within of the Council of Federated Organizations and about MCHR. At stake was the guestion: (COFO). Although neither Forman nor Levin What is MCHR? had a clear idea of what should be done, a The seemingly more militant camp identi- series of hurried phone calls resulted in a fied with CORE and SNCC, the most militant meeting two days later of 25 to 30 largely civil rights organizations and pushed the no- older white and Black professionals held in tion that MCHR should be a support organiza- the office of Dr. John Holloman. tion for the civil rights movement, providing One of the doctors present was Edward medical care on the front lines, that is, med- Barsky, a surgeon who had served as the ical presence. Those less enamored of civil chief medical officer of the Lincoln Brigade rights militance argued for a direct assault during the Spanish Civil War. Perhaps out upon Mississippi's two-class health-care sys- of his experience it was proposed that a "sort tem. Paradoxically this apparently less mili- of Abraham Lincoln Brigade" be sent to Mis- tant approach would have given the infant »

organization an independent and self-defined role. The seemingly more militant approach of medical presence won out, however, and defined MCHR as an adjunct of the civil rights movement. In this decision lay the kernel from which MCHR's legacy would grow. Later the civil rights movement would be replaced at differ- ent times by the anti-war movement, the Black Panthers and the Young Lords, the American Indian movement, the prison re- form movement, poor Appalachians and workers on the job. But MCHR would never escape the legacy (some might say the curse) of being a service-and-support organization attached to whatever movement was most current or fashionable at the time. And at every step of the way, those within MCHR pushing for the closest association and iden- tity with other movements would be regarded as the militants and radicals. In MCHR's earliest days the position of the less militant faction was not helped by their nagging, mostly behind-the-scenes opposition to Aaron Wells, a Black New York City doc- tor, as the first chairman of MCHR. Several Black doctors who had been present alluded in retrospect to the opposition to Wells as the first sign of latent racism within the or- ganization, a charge that was to be reechoed before MCHR completed the civil rights phase of its history.

Freedom Summer Every two weeks like clockwork through the summer of 1964 MCHR sent 20 to 40 doc- tors, nurses and students into Mississippi. The nerve center of the operation was the Congregational Church (United Church of Christ) in midtown Manhattan which, at the request of Dr. Connie Friese, a member of the church and of MCHR, made space avail- able free of charge. At first Tom Levin di- rected the project; later the job was assumed by Des Callan, a young New York City doc- tor working at the Columbia Neurological Institute. During this period John Parham, originally with the Urban League, had re- sponsibility for the day-to-day operation of the national office. In the South MCHR found a dependable ally in Bob Smith, a Black doc- tor, who had been providing most of the med- ical care to the civil rights workers. MCHR decided to set up a full-time office and hire staff. By 1965 Dr. Alvin Pouissant headed the Jackson office. Early leaders of MCHR stated their goals in the trenches. But, according to Des Callan, in amorphous terms, but most members once MCHR doctors got to Mississippi they shared at least some of the following pur- discovered that despite isolated physical at- poses: tacks on civil rights workers, their gory ex- • provision of direct medical aid to civil pectations had been greatly exaggerated. rights workers; This fact, together with the growing demands • provision of a medical presence at dem- of SNCC militants and the perceptions of onstrations and marches, designed to fore- MCHR's nurses, threw the emphasis upon stall brutality against participants; medical presence and its public relations • appeal to the conscience of health pro- foundations into serious question. As Cun- fessionals and the general public to gain sup- ningham later commented regarding the port for the movement; and visiting-fireman approach, "Pompous liberal • raising money for the civil rights move- doctors could think highly of themselves by ment. daring a two-week voyeuristic trip to the With the exception of providing medical wilds of Mississippi but then go back home aid for civil rights workers, the remainder of and without batting an eye continue their the program was necessarily geared toward lucrative, and often racist, private practices." public relations and placed strong emphasis Most galling of all to the nurses was that upon professionals, especially doctors. This posture was reflected by the operation of the national office of MCHR in New York City. An early advertisement in the New York Times, for example, raised an astounding $80,000. There was something incongruous Nor did it help matters when the about the high-stepping fund-raising parties doctors, according to Cunningham, and dinners at some of New York's poshier hotels, the Columbia University Faculty Club referred to the "grand work and the Caprice Restaurant ("entertainment being done by our little maids in by Bobby Short!"), all ostensibly for the bene- Mississippi." fit of Black sharecroppers in the Deep South. In the bewitching spotlight of publicity in which MCHR doctors basked, the organiza- tion lost sight of the fact that much of the day-to-day nitty-gritty work down South was being done not by doctors but by nurses, who while MCHR was paying them "peanut butter barely had access to the wings of the stage, and jelly" wages for unstinting service, it, at let alone the footlights. least during the first year, was usually pay- Nurses such as Phyllis Cunningham, who ing its doctors their plane fare and expenses had formerly worked with SNCC, along with for their brief appearances. Nor did it help a few doctors such as June Finer, worked matters when the doctors, according to Cun- full time, night and day, traveling sometimes ningham, referred patemalistically to the dangerous back roads of Mississippi to pro- "grand work being done by our little maids vide first aid for civil rights workers and in Mississippi." community people and to hold educational The tensions felt, particularly by non-doc- classes on childhood diseases and nutrition tors and women, were barely articulated in for Black mothers. They also observed first the '60's but were to erupt with devastating hand the effects of segregated hospitals, fury by 1971. In the meantime, on the surface clinics and doctors' offices and became less at least, MCHR appeared the picture of and less enamored of simple medical health. Participation increased and financial presence. stability seemed at hand. In September, 1964 MCHR decided to form an ongoing national Rhetoric and Reality: organization with locally based chapters. An Uneasy Truce Chapters rapidly sprang up in New York MCHR members originally thought of Mis- City, Washington, Boston, Chicago, Detroit, sissippi as a battlefield and romantically en- Philadelphia, Los Angeles and San Fran- visioned themselves going to give first aid cisco. By April, 1965, at its first annual meet- ing in Washington, at-large membership was extended to people in cities where no local chapter existed. Local chapters, as spelled out in the Execu- "We should not restrict ourselves to tive Committee minutes, were "to have max- imum local autonomy consistent with a medical personnel; the majority will functioning national body. . ." Ostensibly always be physicians. Let us act in membership would not be limited to doctors magnanimity and not limit or professionals, although those same min- ourselves." utes reveal MCHR's ambivalence on the guestion: "Anybody interested and who can Executive Committee Minutes, 1965 function [italics ours] is welcome." On the guestion of voting rights MCHR's profession- alism and paternalism were undisguised: "We should not restrict ourselves to medical personnel; the majority will always be phy- sicians. Let us act in magnanimity and not limit ourselves." Whatever the interpretation of the rhetoric, in the years 1964 to 1966 MCHR's style was lish community health centers to serve the dominated by doctors, though by 1965 there Black community in the Deep South. Even- was a large influx of nurses and medical tually Jack Geiger, one of the members of students into the organization. An indication this group, succeeded in opening the much- of the leaders' real resistance, however, to heralded Mound Bayou Health Center in consumer involvement was their reaction Mississippi. But the very decision to seek an when a group of Mississippi Black people alternative represented both the failure and asked to address the 1966 annual convention the abandonment of the earlier struggle, and in Chicago. After much haggling, each con- those sharing the alternative vision soon left sumer was allowed one minute to address the fold of MCHR—and the movement. the dignified assembly. To compound the Still through 1966 there was no sense of irony, the convention's keynote speaker was crisis. MCHR tried to "keep on keepin' on" Dr. Martin Luther King. with the civil rights movement, providing medical presence as it marched that year Drifting and Shifting through Mississippi on a mammoth voter reg- As early as 1965 MCHR began to lose istration drive. It was on this march that ground and support, at least of its original James Meredith, the first Black student ad- base, through guiet attrition. Early leaders mitted to Ole Miss, was shot. It was also dur- such as Tom Levin began to drift away, in ing this march that Stokely Carmichael, a part because of the doctor-dominated atmos- SNCC militant, first shouted "Black Power!" phere of MCHR. The Black doctors who had The contagion of these two words threw provided so much of the early leadership were the civil rights movement into disarray, as also early departers. Some merely wished the more militant leaders and soon SNCC to devote more time to the pursuit of their itself began to guestion whether white partici- growing private practices. Others moved on pation was more a hindrance than a help. to organizations more appropriate to their so- Having been rejected by the very cause for cial concerns than MCHR. Several turned for which they felt they had sacrificed, whites toward the National Medical Association abandoned the civil rights movement. White (NMA), and in 1966 John Holloman was participation plummeted and with it white elected to the NMA presidency. support and financial contributions from the At about the same time MCHR lost many North. of the public-health-oriented doctors who had MCHR, no less than other organizations, made up its early roster. For some, who sur- was thrown into a tailspin. As one MCHR mised that a movement could not be created communigue put it, "The financial situation to confront the Southern two-class, racist has not improved during the summer and it health system, the alternative was to push seems that there is little interest by MCHR for foundation and federal money to estab- members since the Meredith March." Indeed, only 25 percent of MCHR members responded to urgent fund-raising appeals. For the first time there was discussion of whether MCHR should continue and, if so, what its role should be. By this time many of the prominent and busy doctors who had founded and shaped the early MCHR had left it. They had been happy to step into a heroic role when history called on them, but most had no ongoing rad- ical commitment and certainly no ongoing commitment to MCHR. It had become clear that early MCHR had been dominated by too many generals and had too few soldiers. The generals had no patience to stick around at a time of great confusion to chart out a new course for the organization. To the extent that a few may have wondered about sticking it out, they were soon enough dissuaded from doing so by the shift to the left that MCHR was about to take. A harbinger of this shift had taken place at the 1965 annual MCHR convention when younger members, mostly doctors and med- ical students, proposed that MCHR adopt a resolution denouncing the War in Vietnam. Although the resolution was defeated that year by a narrow margin, it was passed at the next convention. The old guard within MCHR was not ready to take a stand on the War and could see lit- tle relevance of the War to MCHR's civil rights concerns. Their qualms were greatly magnified by the fact that those who pushed the anti-War position were also beginning to vocalize, largely in response to demands of Black-power militants, the need to do some- thing about medical care back home in the North. This meant attacks upon the medical system in which many of the older members had vested interests. This was the last straw; nearly all of the remaining older members bid MCHR adieu.

The Interim Years By 1967 MCHR was a dead letter in New York City. But there was still vitality in Chi- cago and it was logical to move the national office to the Midwest. From that time on no name stands out more clearly in connection with MCHR than that of Quentin Young, who came to be regarded by many as "Mr. MCHR." In 1967 Young was a youthful-looking 44- year-old internist with a private practice catering to the mixed university commu- nity of Hyde Park and assorted movement in fact, may well have hidden, was the need people. He had been active in MCHR since for an ongoing political program, that could its founding in 1964. Earlier Young had been guide the organization when the dramatic involved with the Committee to End Dis- reguests faded and that could meaningfully crimination in Medical Institutions in Chicago engage the old members as well as integrate and before that with various political activ- the new ones. When it came to articulating ities of the Old Left. Even with this extensive such a program MCHR fell back on grand- political experience under his belt. Young iloguent pronouncements, such as "We argue clearly had his work cut out for him with maintenance men in American hospitals. The MCHR. greatest concentration of hospital workers is With the eclipse of the civil rights move- in nursing services. They run the gamut from ment Young inherited in MCHR an organiza- that health care is a human right . . . that tion in danger of losing its raison d'etre. Nor our economy should . .. make available to all was there any new issue current on the Left the people." Hard to disagree with, but that could provide the holistic, even if trans- hardly a prescription for a program. itory, sense of direction that the civil rights That MCHR could articulate no meaning- movement had so readily furnished. ful national program during this period For a while it looked as if MCHR might be should come as no surprise, for the years 1967 successful in turning the corner. In lune, 1967 to 1971 were not in general good years for it was applauded with front-page headlines national organizations. Rather this was the when, in conjunction with the Poor People's era of suspicion of leadership, structure and Campaign, an MCHR member disrupted the central direction, of extreme local autonomy AMA convention in San Francisco by seizing and of "doing your own thing." While the the microphone to denounce MCHR's arch national organization shrank to a mere ves- foe, while other activists picketed outside the tige, local chapters attained varying de- auditorium. Aside from keeping the name of grees of apparent vitality. MCHR alive and helping recruit new blood to the organization, the event also served as a New Faces model for similar demonstrations at subse- The year 1967 introduces an almost en- guent AMA conventions in other cities. tirely new cast of characters into MCHR. As In 1968 MCHR again hit the front pages, the older doctors left, they were replaced by this time for its role in ministering to the vic- younger doctors, nurses and, more impor- tims of the police riots at the Democratic Na- tantly, by nursing and medical students. tional Convention in Chicago. Shortly after- Many of the medical students, in particular, ward MCHR again gained prominence when had been activists within the Student Health Quentin Young was subpoenaed to testify Organization (SHO), which had burst onto before the House Un-American Activities the radical health scene in 1966 (see BULLE- Committee (HUAC) concerning MCHR's role TIN, September, 1970). at the Democratic Convention. Again in 1969 This is not the place to discuss the politics MCHR was in the public eye as it provided of SHO, except insofar as they impinge on aid and medical care to the 2,400 poor resi- MCHR. Perhaps because its summer project dents of Resurrection City in Washington orientation so successfully capitalized on D.C. student energy (even as Freedom Summer MCHR's success in the newspapers, added had) or perhaps because of its early success to its earlier civil rights reputation, gave it in gaining funds and support, SHO during an important asset. MCHR acguired a na- this period was viewed by all as the more tional prominence and recognition among the vibrant and vital of the two organizations. medical community that would bring it new Many identified with both, and the more com- recruits for years to come. More than that, mitted SHO members graduated into MCHR these spurts of activity offered the hope of in the late '60's as they graduated from their carrying the organization through a period of medical schools. confusion and dissipation. For at no time was It is important to recall that many SHO MCHR more in its prime than when it was members had been recruited into political ac- responding to the dramatic medical needs tivity as undergraduates and were influenced of one or another movement group. A need by the Students for a Democratic Society which these spurts of activity did not fill, and (SDS) and the model it presented for com- munity organizing, the Economic Research the middle '60's. While the War may have and Action Project (ERAP). For SHO as well been driven home to many participants by as many MCHR members, this influence, in the threat of the draft, the tone of the anti- addition to the influence of Black power, was War movement was one of support and serv- all important. SHO members tried to respond ice to the Vietnamese people. It was for many to the insistence of their former Black civil the direct descendant of the civil rights move- rights compatriots: They went back to their ment transported by American militarism communities in the North to fight against and imperialism some 10,000 miles away. white racism. This often resulted in projects Like others in the anti-war movement, seeking better services for Third World and MCHR members organized opposition to the poor white communities. When applied to War in their own institutions. Leaflet and lit- health, these projects occasionally confronted erature tables blossomed at medical schools, institutions such as local health departments and contingents carrying bold banners in- that denied adeguate care to the poor or med- scribing the names of local MCHR chapters, ical schools that refused to admit significant schools and hospitals appeared at anti-War numbers of Third World students. By and demonstrations. So overwhelming was this large, however, early SHO and later MCHR political thrust that for an entire year the projects had a distinctly service-and-support- New York City chapter of MCHR was liter- oriented flavor. This was the genesis of proj- ally submerged into the Medical Committee ects like lead screening, sickle cell testing, to End the War, which in the spring of 1967 childhood immunization and rat control. turned out over 2,000 health personnel for But despite the new faces and the emphat- an anti-War rally in Central Park. ic orientation toward local as opposed to na- MCHR went beyond general anti-War ac- tional projects and organizations, much of tivities to play a more specific support role, what MCHR was during 1967 to 1971 was a serving as the medical arm of the anti-War movement. Hence almost all MCHR chapters set up a system of draft counseling and re- ferrals for physical examinations to serve By and large, early SHO and later young men seeking medical exemption from the draft. One exceptional draft panel in Los MCHR projects had a distinctly Angeles proved an embarrassment to MCHR service-and-support-oriented flavor. when it turned out that participating doctors were pocketing thousands of dollars in pri- vate fees for performing draft physicals. An even more direct transfer of earlier tac- continuation of what MCHR had always tics was the medical presence MCHR mem- been—a medical support group for move- bers provided at anti-War demonstrations ments outside the health system itself. All and marches. In San Francisco, for example, that had transpired between 1964 and 1967 the local MCHR chapter was largely ab- was that the unitary civil rights movement sorbed by the pressing need for medical pres- had fragmented into half a dozen move- ence in the Bay Area. Hardly a day went by ments, with MCHR now trying to serve them without the police attacking a group of dem- all. This is not to say that medical support onstrators, often anti-War, but also Black work was bad. It was not, and often MCHR's students (as in the San Francisco State strike) services were urgently needed. It is only to and years later white community-control ad- say that MCHR never developed a concep- vocates (as in People's Park). Necessary and tion of itself that went beyond support, a fact commendable as such support work was, that was to prove severely debilitating, if not still the episodic nature of this sort of activity devastating, as the political movement of the forestalled coming to grips with considera- '60's moved into the disillusionment, frag- tion of the development of a more organic mentation and demise of the '70's. program for MCHR members.

Vietnam As the New Mississippi Counterculture and Free Clinics No movement shows MCHR's orientation As the New Authenticity more clearly than that against the War in Although a bit more complicated than the 10 Vietnam, which mushroomed beginning in anti-War movement, the role played by MCHR in the second great activity of the late and sellout of the needs of the most oppressed '60's—the counterculture movement—was fun- members of American society. damentally similar. The year 1967 marked the Free clinics, however, were not long to re- birth of the Haight-Ashbury Free Clinic, the main the preserve of the counterculture. flower child and the long-haired hippie. The Minus some of their countercultural accoutre- counterculture proved to have a magnetic at- ments, free clinics fit perfectly into the com- traction to young health workers and stu- munity-organizing strategies of the Black dents (see BULLETINS, October, 1971 and Panthers, I Wor Kuen (a revolutionary group February, 1972). Indeed the counterculture suggested a way out to health-science students, interns, resi- dents, nurses and technical personnel who The simple transfer of medical felt oppressed by years of grueling study, expertise to the service of the regimentation, pleasure denial and hierarch- ically ordered health institutions. These movement resulted paradoxically young professionals had come to under- in not politicizing health care. stand that health-science education involved more than learning about disease diagnosis, treatment and (least of all) prevention, but rather involved a total socializing process. in New York City's Chinatown) and various Doctors and nurses were being taught to ac- revolutionary Chicano, Puerto Rican and im- cept their class and professional roles, along migrant white Appalachian groups in the with the attendant alienation. Midwest and on the West Coast. If medical and nursing school and hospital The dilemma in which MCHR activists medical practice seemed to embody the ob- working at free clinics found themselves il- jectivization of young professionals, then the lustrates a bind inherent in MCHR's service recovery of subjectivity that free clinics and orientation. MCHR activists began by simply the counterculture seemed to offer came as a asking how their medical skills could be godsend to many. They represented a strong used to best advantage on behalf of move- antidote to the treatment of students as com- ments for social change. They thereby unwit- puter punch cards. (The "do not bend, fold or tingly imported a medical model of social mutilate" mentality of college deans pertained change. Given the free clinics' severely no less to health-science school officials and limited resources, their choice was to serve a hospital administrators.) In free clinics young miniscule number of people in a model of professionals saw the promise of rebellion, a humanized care, in which case the clinic was new lifestyle, immediate fulfullment and an medically irrelevant, or to accommodate a overcoming of the personal alienation, ego greater load of patients in traditional assem- disintegration and humiliation that had been bly-line fashion, in which case the clinic had their daily bread for all of their lives. Free abandoned its original ideal of providing an clinics seemed to offer not merely a vision alternative to mystified, alienated and hier- of the future but a Utopia in the here and archical forms of medical practice. In many now. Moreover, so it was claimed, by the cases, clinics tried to do a little of both, sheer weight of their example they would un- which resulted in no one being satisfied. The dermine the values of the health system. simple transfer of medical expertise to the While few local MCHR chapters actually service of the movement resulted paradox- set up their own free clinics, almost all chap- ically in not politicizing health care—an ob- ters had members whose major energies jective that should be the very quintessence were expended working in them. Some were of a health movement. attracted to this work by the "good vibes" of The attachment to the counterculture and the counterculture, but many more politically to political free clinics were both misdirected sophisticated MCHR members rejected as approaches in that both obscured the so- fatuous the political claims made in support cially determining role played by estab- of free clinics. Indeed, for many MCHR mem- lished health institutions in distorting health bers the attention paid to the middle-class, care toward dehumanized services for pa- white hippie clientele of the earliest free tients and an alienated work environment for clinics represented a self-indulgent waste health personnel. 11 The Pitfalls of Guilt western University Medical School in Chi- During the civil rights era, MCHR militants cago, on behalf of a coalition of political free were those who, through medical presence, clinics, challenged MCHR's doctors' com- allied themselves most closely with the most mitment: ". . . why hasn't MCHR contacted militant civil rights organizations. Likewise, these bullshit physicians and demanded during the late '60's a similar identification their participation?" The students went on took place, except that now MCHR militants self-righteously to demand that if the doc- were those who worked for the most polit- tors refused to donate their time, "... they are ically "radical" free clinics. The analogy to be removed from the organization." Fi- can be carried further: In both instances nally, if this was not done, the Northwestern MCHR militants sought their identities Health Collective threatened to "expose through transference to groups that pur- [MCHR] as a liberal front for health profes- ported to represent a class, and often a race sionals. . . ." This psychological blackmail and culture as well, that were different from extended beyond MCHR doctors in Chicago. their own. In December, 1969, for example, an MCHR This search for identity through identifica- statement extended the indictment to the rest tion with society's most oppressed groups of the nation: "To the people of America, we was not limited to MCHR members but was say that if the [Black] Panthers are de- endemic to large parts of the movement. It stroyed, we are all guilty. . ." stemmed from an unresolved and unmediated Aside from the personal debility engen- sense of guilt deriving from the activists' own dered by the politics of guilt, there were privileged class and professional status. other, no less serious, conseguences. The Without, however, coming to terms with this point came when local MCHR chapter activ- dilemma, MCHR members could not accept ity, like much activity of the New Left, degen- themselves as legitimate agents of change, erated largely into a set of political slogans much less consider the legitimacy of their and mindless rhetoric. It was apparent to own needs. The alternative for health rad- many, for example, that the political free icals was to submerge their own needs (and clinics could not meet the health needs of the hope they would not reassert themselves in poor and that—what was worse—their exist- too distorted a way) and to look to ostensibly ence had taken people's attention far away more revolutionary groups for leadership. This is not to say that there is an easy resolu- tion to the conflicting needs of these two groups—the poor, driven by their deprivation Slogans—meant, after all, to to seek material gain and inclusion in so- ciety's benefits, versus the more privileged, crystallize people's comprehension driven from materialism by alienation and a of reality—instead made this reality sense of their own impotence. At the very more opague than ever. least a viable radical movement in America will have to recognize and deal with the needs of both groups. Unfortunately, the tendency of the more from the institutions that were ultimately re- politically aware MCHR members to define sponsible for the denial and distortion of their identities through the eyes of a class health services to the poor in the first place. other than their own led to what can only be Indeed, no amount of serve-the-people rhet- called a compulsive need to constantly raise oric could disguise the fact that the commu- the ante: If political commitment was defined nity people allegedly being served were, as service to radical groups, then one's self- with few exceptions, disinterested in and assurance as a radical reguired constantly aloof from the work being done at the most seeking out and attaching oneself to what political free clinics. appeared to be the most radical group on the The truth is that the orgy of guilt that per- scene. Anything less was a copout. meated both MCHR and the Left in general in This dynamic meant that MCHR was at the the late '60's had led to the divorce of political beck and call of whatever group could most language from reality. Slogans—meant, after skillfully manipulate its guilt. In 1970, for ex- all, to crystallize people's comprehension of 12 ample, a group of medical students at North- reality—instead made this reality more opaque than ever. Middle-class radicals suf- ity of personhood that alone defined his or fering conflicts over their identity were more her humanity. concerned with their own radicalism and The economic antidote for this dissolution militance than they were with the task of of the personality has been the systematic convincing others of the correctness of their effort of capital, with no small assist from position. An observation of Norman Fruchter its advertising, product design and packag- on other parts of the movement applies with ing subsidiaries, to personalize the consumer equal force to MHCR: "Radicals . . . were products of advanced capitalist industrial rarely about to cut through their rhetoric to society. As depicted by Marcuse, even the argue their position so that it connected with most intimate of human activities, such as people outside the small, increasingly iso- sexuality, is grist for the mill of commodity lated circle of the radical left." (Norman production and sale. Nor has medicine es- Fruchter, "Movement Propaganda and the caped this fate, as a glance at the ads in Culture of the Spectacle," Liberation, May, any medical journal will demonstrate. 1971.) This analysis accounts for much of the common dissatisfaction with a medical care The Dissolution of Self system that the health movement, in particu- Russell lacoby's writings about the same lar the women's health movement, correctly years draw an even sharper conclusion, perceives as being insensitive to need, bu- namely that the distortion of political thought reaucratically administered and technolog- and action that characterized the movement ically determined. Such a system necessarily of the '60's was not ä mere accident or mis- drives the human element out of the patient take but was the movement's rhyme and and at the same time necessarily deprives reason. According to this perspective, its health workers of what should be the gratifi- rhetoric concealed the movement's driving cation of work based on serving people in force, which was an effort to recoup what ad- need. Both health workers and patients be- vanced capitalistic society had taken away come interchangeable parts of technologic —the individual's very identity and personal machinery and as such mere tools for those experience, one's ability to act as the subject who control and administer the health sys- of one's historical destiny. (Russell Jacoby, tem for profit and aggrandizement. Social Amnesia, Boston, Beacon Press, 1975.) In response to this loss of genuine sub- According to this analysis, the creation of jectivity, MCHR, like the health movement a mass of socially impotent men and women and the rest of the movement in general, en- in American society ultimately stems from gaged in what Jacoby calls the politics of the expropriation by capital of the free labor subjectivity. If monopoly capital had de- of individuals, by which bourgeois society prived men and women of their very selves originally defined the free individual. The and egos, the corrective, so the logic went, next stage in the historical process was the was to create a movement solely concerned conversion by capital of these amputated with feeling, friendship, brother/sisterhood, individuals into a mass of supposedly free good vibes, communality and the like. But commodity buyers. But whether seen as a "if the intensification of subjectivity is a di- source of labor or as a potential customer, rect response to its actual decline, it actually the individual had been robbed of the total- works to accelerate the decline." As the cult of subjectivity spread to every movement group, individuals became less and less able to combat the brutal objective imperative of American society to "eclipse the individual." Both health workers and patients Paradoxically, the end result was that the become interchangeable parts of two seemingly divergent movements—the technological machinery and mere countercultural and the revolutionary polit- tools for those who control and ical—merged imperceptibly into one another. The counterculture drew its strength from its administer the health system for recognition, long denied by traditional Marx- profit and aggrandizement. ist/Leninists, that individuals and their alien- ation matter and are of political concern; it erred, however, in believing that alienation 13 could be righted with larger doses of sub- MCHR's service-and-support role illumi- jectivity or, put another way, "with just a lit- nates one last curious feature of its activity. tle help from our friends." Or to follow lacoby, While everyone acknowledged the impor- "To the damaged loss of human relations it tance of the organization, it had a strangely proposed more of the same." The revolution- peripheral relationship to many, if not most, ary political movement, on the other hand, of its activities. Most such activities would insisted that "offing the pig" and "armed have gone on and most MCHR members struggle" were the answer, refusing to un- would have participated with or without the derstand that sloganeering unmediated by existence of MCHR—which may be only to thought and analysis does "not serve to say that service and support, while they popularize thought but replace it." may facilitate or heighten the success of a Both thrusts were reverse sides of the same project, cannot be the essence of either coin and both ultimately made the same mis- MCHR or of the outside project being sup- takes—ahistoricism, contempt for theory and ported. analysis and the flight from reality into wish- fulness. Both parts of the movement finally Speck of Light opted to counter American society's drift At long last in October, 1970 a group of toward the obliteration of the individual by health workers and MCHR members living seeking to create the experience of the indi- together in Brooklyn who called themselves vidual here and now. Invariably, however, Hampton's Family, after Fred Hampton, the since the individual cannot now exist in so- slain Chicago Black Panther leader, tackled ciety, this approach must lead to psycholo- many of the guestions MCHR had stubbornly gizing reality, when in fact what is needed refused to recognize or had been unable to is an objective appraisal of reality. The ini- come to grips with during its first six years. tial need is for the development of an objec- After suggesting that MCHR had failed tive theory of subjectivity. From here one both locally and nationally, the Hampton's would hope for a political movement aimed Family Paper went on to say that "this failure at realizing the objective development of the at both levels can be traced to the fact that subject. MCHR as a whole lacked a sense of its own Of course no one, either in the movement proper role in these struggles, a clear under- generally or in MCHR particularly, was standing of who its constituency was, how eguipped in the late 1960s to deal with these, to reach them, and in general, a strategy for and many other, underlying points of theo- challenging the health empires and their retical confusion. Still, unless they were dealt subsidiaries." with, it was just a matter of time until its The paper went on to argue strongly for foundations of sand guaranteed the collapse the development of a "progressive organiza- of the entire movement. These weaknesses tion" that could organize "large numbers of may have been invisible to MCHR as long middle level health workers" who would re- as its members could believe that they were late to community and worker (presumably in the thick of "where it was at." But as the lower-echelon) struggles. It suggested that movements of the'60's began to wane, MCHR MCHR be that organization and that its pri- was once again left high and dry. Further, ority be a "commitment on the local level to the nature of the support role by which the build political activity in local institutions organization defined its existence had ob- and health science schools." Hampton's Fam- scured (and possibly even created) inherent ily thought an MCHR national office should structural weaknesses in many MCHR chap- exist "to provide and support a full time staff ters. These chapters had always drawn mem- as well as regional coordinators," presum- bers in one's, two's and three's from widely ably to foster the local priority aims. diverse institutions, situations and interests. In summary the Hampton's Family Paper The very nature of chapter membership thus called for a membership drive designed to at- constituted an obstacle to developing an in- tract upper-level and middle-level health dependent role for MCHR. Beyond service workers, concrete struggles around institu- and support, the guestion of what MCHR tional organizing and a strengthened national should be doing seldom had an answer be- office of MCHR to assist these efforts. Al- cause it was asked of the wrong people in though the clearest exposition up to that time the wrong situation. of MCHR's problems, the Hampton's Family Paper was not without its own ambiguities. To begin with, its suggested role for the na- tional office was left only implicit, a fact that was soon to have dire consequences for MCHR's development. Further, when it came to concretizing its suggested theoretical program, the paper re- peated many of the same errors that MCHR had already made. For example, it called for more and better (meaning "more political") service projects, medical presence, draft exams and support for sundry movement or- ganizations and, finally, opposition to chem- ical and biological warfare. But it was pre- cisely these diverse and multifaceted ap- proaches that had up until then prevented MCHR from doing what in the main the Hampton's Family Paper argued it must do- define its identity around organizing in health institutions, with a constituency of upper- level and middle-level health workers and health-science students. To be sure, as the Hampton's Family Paper argued, "Our perspective must be broader than our local hospital or medical school. We are part of a national and international movement and must link up in our struggles to other issues." Unfortunately, the national leadership of MCHR that was elected in the next year readily seized upon the "larger perspective" without ever bothering about the local building blocks that could have made such a perspective concrete.

The 1971 Convention: The Beginning of the End Although the Hampton's Family Paper had grasped, albeit tenuously, the critical issues facing MCHR and had generated discussion within the organization, by the time of the 1971 annual convention, held in April at the University of Pennsylvania, it was an idea whose time had already passed. The paper was hardly mentioned at the convention and, insofar as it had any impact, it helped to push MCHR in directions diametrically op- posed to the intentions of Hampton's Family. Even more ironically, despite profound differ- ences bubbling just beneath the surface, an atmosphere of unanimity and good feeling prevailed at the convention in which there was little if any disagreement or debate. These anomalies stemmed from at least two sources. First, there was little political sophistica- tion or leadership in MCHR as of 1971. New recruits swelled MCHR's ranks, but even old ganizational directions, involving decisions timers lacked the theoretical and practical on constituency, program and structure and political knowledge and experience to recog- elected a leadership that foreclosed in the nize the essential issues, think through their immediate future the possibility of the organ- organizational implications, take an unwav- ization coming to terms with the critical issues ering stance and engage the organization in facing it. In many ways the subsequent years meaningful debate. By shortly after the con- are but a playing out of those decisions, and vention it became clear, in fact, that few it could be argued that our story could stop enough of the members of Hampton's Family here. Yet what happened during and after themselves really understood the implica- the 1971 convention is worth examining in tions of the position put forth in their paper, some detail, because the issues then faced as several went over to articulating precisely by MCHR continue to be serious and unre- the opposite perspective. solved ones, admitting of no easy solution. Second, the more politically experienced Moreover, while the fallacies of the course members, who might have been expected to adopted by MCHR in 1971 are readily evi- take leadership, were intimidated from doing dent in retrospect, the approach, perhaps be- so by a sense of guilt for being largely white cause it offers a simple formula, continues male doctors and professionals, although to have currency for many organizations and these had been among MCHR's chief constit- activists today. uencies in the past. This pervading sense of guilt was exacerbated by the theme and at- Constituency: Y'all Come tendance of the convention but had its roots The April, 1971 convention decided that it in developments taking place in the larger was paramount to open MCHR's doors to movement. women, Third World people, nonprofession- Organized around the theme "The Con- als and consumers—a decision implemented sumer and Health Care," the convention for in the context of a growing militant national the first time drew substantial numbers of women's movement, the influence of which articulate and organized women. Third World was enhanced by the large number of mil- people, nonprofessional health workers and itant women at the convention. To their consumers. The growth of independent Third strong voice was added that of the smaller World groups, such as the Black Panthers, but still significant number of Third World and the emergence of the women's liberation delegates. movement engendered in MCHR as in many While there was no disagreement on this other groups, a consciousness and concern decision, there were radically different inter- about its internal racism, sexism, elitism, pro- pretations of what it meant—differences that fessionalism and organizational style. went undiscussed and unresolved. To some This consciousness and concern were at this decision meant addressing manifesta- once MCHR's critical strength and its critical tions of racism, sexism and elitism within weakness. They constituted the basis upon MCHR and opening up the organization to a which the organization could broaden its broader though still limited constituency of membership. Yet at the same time, the guilt middle-level health workers. To others, in- borne of the charges of racism, sexism and cluding what came to be the national leader- elitism led MCHR to throw out the baby with ship, it meant transforming MCHR into a the bath water, repudiating a major part of mass organization incorporating all strata of its historical constituency (and those with whom it could work most effectively). Indeed, MCHR carried over a disdain for organizing doctors or medical students who, it was rea- soned, if organized could only act ultimately in their own, already privileged self-interest, which would of course be counterrevolution- In short, there was no one who ary. Instead, MCHR tried to transform itself was not part of MCHR's newly into precisely what it was not—an organ- defined constituency. ization of women and Third World non- professionals and consumers. 16 In this atmosphere MCHR charted new or- health workers and of consumers as well. exist to serve, support and coordinate local MCHR was to be the radical health vehicle activities, building the organization from the of both the doctor and the dishwasher, the bottom up (the Hampton's Family position)? medical student and the ward clerk, the ad- Debate eluded the issue, however, and once ministrator and the consumer, the privileged more everyone took home his or her own in- and the poor, the Third World and the white, terpretation of the subseguent decision. the man and the woman. The second proposal, drawn up by the East In short, there was no one who was not Coast Women's Caucus, also endorsed a part of MCHR's newly defined constituency. strengthened national structure but empha- MCHR would no longer simply serve the van- guard—MCHR would be the vanguard by shedding its skin and wishing itself a new one. The impact of this shift was devastating. One minimal advantage of the previous serve-the-vanguard approach had been that MCHR rendered itself superbly at least it allowed MCHR professionals, es- manipulable by whomever within pecially doctors, to embrace their own iden- its ranks was most adept at social- tities. They could still be who they were and use their skills and positions, as privileged as psychological blackmail. they might be, toward the support of groups judged to be more revolutionary. With its new decision on constituency, MCHR lost even this. Now MCHR was no longer simply at the sized expanding the leadership to include beck and call of whatever outside group women. Third World people and non-profes- could lay the greatest claim to militance, op- sionals as a means of broadening MCHR's pression or other hallmarks of legitimacy. membership. This broadening, they con- At least in that circumstance the organiza- tended, could evolve only if MCHR adopted tion had the theoretical right to decide where a collective style of leadership, a concept to give its support. Internalizing this process, clearer in its criticism of the past than its MCHR now rendered itself superbly manip- prescription for the future. The women's cau- ulable by whomever within its ranks was cus at the convention demanded a guarantee most adept at social-psychological black- that half of those comprising MCHR's leader- mail. And because MCHR had indeed been ship structure be women, and the Third guilty of racism, sexism and elitism, it now World Caucus followed suit, demanding one- lost its right to guestion or judge the validity guarter. The result was an elaborate struc- of their claims or how they fit into MCHR's ture that was to prove as unwieldy and dys- agenda. Those who tried could be discredited functional as it was superficially democratic. as racist, sexist and elitist. The convention agreed, virtually unani- mously, to set up a strong national structure Structure: Form Without Content that would function in a collective manner. Two major proposals, both written and cir- The National Executive Committee (NEC), the culated before the convention, dominated the interim governing body, was to consist of discussions of structure and spoke to the four national officers and four representa- issue of broadening MCHR's constituency. tives from each of four regions. Each set of The first, written by the Chicago Chapter, four regional representatives was to include argued for a strong national office. It met at least one Third World person and two with hearty response, since many MCHR ac- women, assuring that the whole body would tivists had seen the loose-knit, locally based, be at least 50 percent female and 25 percent almost anarchistic structure of MCHR's mid- Third World. Travel funds were assured so dle years dissipate energy in frenetic activ- that no NEC member would be excluded from ity. What was not agreed on, incredibly participation because of financial need or enough, was the key guestion: Should a geographical isolation. Permanent caucuses strong national structure exist to give central of women and Third World people were to direction, create a national image and build be established, which would be given the op- MCHR from the top down, or should it rather portunity to meet at every MCHR gathering 17 and which would assure that women's and spectively, and Ann Garland, a Philadelphia Third World representation and participation nurse and leader of the Third World Caucus, in the organization met with their satisfaction. was reelected treasurer. The convention also Thus in 1971 MCHR painstakingly created resolved to hire three full-time staff members, the forms of democracy and egalitarianism and shortly thereafter Frank Goldsmith, a in its national structure. In so doing it pio- former staff member of the United Auto neered an approach to addressing issues by Workers and a friend of Hampton's Family, implementing changes in form rather than was hired as national organizer and Pat changes in substance—an approach that was Murchie, a member of MCHR's Chicago to become the hallmark of the later organiza- chapter, was hired as executive secretary. tion. No one asked what MCHR had to offer Later Tanganika Hill, a Black activist from women or Third World people, or how it Houston, was hired by the Third World Cau- cus to be the Third World organizer. (Her tenure was short and she was never replaced by the Caucus.) The three staff members People were frequently elected shared one striking trait—all were virtually brand new to MCHR. to leadership positions because they fit a quota. Program: Jumping on the Bandwagon While the 1971 convention sported the usual panoply of workshops and passed the would have to change to meet their needs usual multitude of resolutions, it focussed pri- sufficiently to give them a reason to make mary programmatic attention on national the investment that leadership reguires. health insurance. In fact, an air of excitement Rather it was assumed that having estab- pervaded the convention, for everyone felt lished the guotas and caucuses and having that the country was on the threshold of this elected the right number of people of the momentous change in health care. Just six right race and sex to the leadership, these months before Sen. Edward Kennedy had in- problems would somehow resolve them- troduced his sweeping bill (the Health Secu- selves. rity Act) into Congress, and the political The result was predictable. People were climate of that time was such that it ap- freguently elected to leadership positions be- peared to be a viable if not leading candidate cause they fit a guota, not because they had in that arena. Everyone felt that national necessarily demonstrated interest, commit- health insurance would be the major cam- ment or leadership ability in MCHR. These paign issue of the 1972 election if it had not representatives in many cases fell away as been passed before then. Indeed, it seemed soon as they were elected, often, one suspects, that issues of health policy were reaching a because they had not resolved the guestions historic moment in which MCHR might, just whether MCHR was the most appropriate might, be asked to play a vital role. vehicle for their concerns and whether Prior to the convention, Tom Bodenheimer they were prepared to deal with its of the San Francisco chapter drafted and cir- residual racism, sexism and professionalism. culated a national health care proposal em- The end result was that the newly elected bodying MCHR's principles, which might representatives exercised little leadership serve as its alternative to existing national and the old timers, intimidated by their own health insurance bills. The 1971 convention, sex, race and status, withdrew from leader- again with seeming unanimity, adopted the ship—leaving a vacuum too inviting to go national health care plan with minor altera- long unfilled. tions as the basis of a campaign of educa- Quentin Young was elected to head a tion and agitation; again there was little un- strong, centralized national office, which was derstanding of what this action would mean. moved from Philadelphia back to Chicago. This campaign offered several immediate Felicia Hance and Barbara Maggani, both advantages to MCHR. It addressed an issue members of the Eastern Women's Caucus seemingly capable of uniting many diverse and both part of Hampton's Family, were constituencies; it capitalized on the national 18 elected vice chairperson and secretary, re- interest and momentum around the national health insurance issue; and it seemed tailor- the five points of MCHR's alternative plan made for the new national role that MCHR and invited those interested to join MCHR. had adopted. Indeed, it offered the hope of Local chapters were urged to distribute these being to the later MCHR what the civil rights leaflets at shopping centers and department movement had been to the earlier organiza- stores, in addition to medical schools and tion—with one critical difference. There was hospitals, and to conduct press conferences, no popular movement afoot for national polls and petition-signing campaigns. health insurance. Most chapters ignored or laughed off the Thus the 1971 convention did not come NHC; some were incensed at its public-rela- to grips with the critical issues facing MCHR; tions style. At least one chapter—the one in it turned the organization in opposite direc- New York City —actually attempted to follow tions. Whereas the Hampton's Family Paper the NHC's directives, but came to an impasse called for a broader but still focussed constit- when it could not figure out what was news- uency, a more focussed program and a local worthy enough to warrant a press confer- orientation, the convention gave license for ence. Many agreed with the NHC's educa- the national leadership to move ahead with a tional potential but, assuming success in united-front approach to constituency and educating and mobilizing people, no one program and a centralist, as well as cen- could answer the question that followed: tralized, national structure. "What can I do?" MCHR did not wish to thrust people into the legislative arena to support existing bills (although later there was to be disagreement on this); it could not pass off its proposal as legislatively viable; Most chapters ignored or laughed and it could not point convincingly to local programs that would make it viable. off the National Health Crusade; As criticisms of the programmatic poverty some were incensed at its public- of the National Health Crusade grew over the relations style. summer of 1971, the national leadership be- came more and more defensive, until it even- tually was arguing that implementation of the NHC could include virtually all forms of MCHR activity. Free clinics, occupational Uniting AH Fronts health initiatives, lead poisoning and sickle At the urging primarily of Frank Goldsmith cell screening, institutional struggles, anti- and Quentin Young, MCHR's new program War activity, military organizing, student or- was dubbed the National Health Crusade ganizing, prison health—any and all could be and was designed to promote five principles, seen as implementing some aspect of the Na- or perhaps more accurately five slogans, tional Health Crusade. When by late summer boiled down from Bodenheimer's alternative some of the underlying questions about the health plan. These included an end to profit- viability of the National Health Crusade were making in health; financing by progressive raised at an NEC meeting, the doubters were taxation; provision of complete and pre- resoundingly put down by the national lead- ventive health care; local administration of ership for being disruptive. health centers through patients and health By the fall of 1971 the National Health workers; and nationalization of the drug and Crusade had begun to quietly collapse under medical supply industries. the weight of its own contradictions. But even At the national level, the National Health as it fell apart, it highlighted important ele- Crusade (NHC) was to consist of a series of ments emerging in the style and politics of nationally coordinated local press confer- the national office. First the NHC had the ences and the mass distribution of polls, pe- form of a political program, but little consid- titions and a series of leaflets and brochures eration had been given to its content—the on MCHR's alternative national health plan. essence of political bureaucratism. But more The first leaflet came out in May, headlined than this, its lack of programmatic content "If you needed it [health care] right now ... pointed to the disturbing signs of political Could you find it? Could you pay for it?" It opportunism. Sometime between spring and briefly critiqued present health care, set forth fall it became clear that MCHR did not take the goals of the NHC seriously in their own Other task forces were encouraged to fol- right and perhaps never had. Instead of ask- low the pattern of raising money, hiring na- ing what MCHR could do for a national tional staff, producing newsletters and litera- health care plan MCHR instead asked what ture and organizing conferences. Soon a national health care plan could do for it. MCHR's list of task forces burgeoned to in- The answer was that it could project MCHR's clude prison health, national health plans, name and image to facilitate its mass organ- institutional organizing, community/con- izing and membership recruitment strategy. sumer organizing, women's health, commu- Thus its genius was closely akin to its vacu- nity health programs (including lead poison- ousness: It could encompass all constituen- ing and sickle cell programs and free clinics), cies and mean all things to all people. Fur- anti-War activities, mental health, rural ther, through the NHC it became evident that health, patients' rights, nutrition, nursing, the idea of centralization of MCHR also em- house staff, health-science students and bodied the idea of centralism. Dissent from health care for the aged. within the ranks was not welcome. However sensible it may have appeared, The National Health Crusade was MCHR's the task force approach had serious draw- last attempt to adopt a single programmatic backs for MCHR. First, it codified in a sophis- focus and the last juncture at which that was ticated form the more primitive do-your-own- possible. Shortly after its demise MCHR thingism that had plagued MCHR's past. adopted the model of task forces as the an- More disturbingly, it could be and was used swer to its programmatic problems. Task to deflect or absorb those who argued that forces were designed to coordinate similar MCHR needed a programmatic focus. Now activities going on around the country and such dissenters could simply be told to set up their own task force. For the only pro- grammatic approach acceptable to the na- tional leadership was one which, like the un- successful National Health Crusade, could The vast majority of task forces embrace all constituencies, a formula in represented nothing more than a which ultimately everything equalled noth- handful of people scattered around ing. Moreover, the task force model could be and also was used to abet MCHR's publicity the country. and recruitment drive by magnifying embry- onic and often virtually nonexistent projects. The vast majority of task forces represented nothing more than a handful of people scat- were modeled after the strongest and most tered around the country who shared a par- successful programmatic undertaking of lat- ticular interest and who saw each other at ter-day MCHR—the occupational health task MCHR gatherings. Yet when asked what it force. was doing, MCHR could point with pride to The occupational health task force was or- its vast array of task forces. ganized by a small group, including Phyllis Cullen from Denver, Don Whorton from Bureaucratism Run Amuck Washington and later Dan Berman. They be- During the summer of 1971 the MCHR na- gan by organizing a training session that tional office began to function as it never had could draw together interested workers (both before: Membership and mailing lists were union leaders and rank-and-file) and health organized; literature began to be massively activists. The task force spent much of the produced; two internal communications, "The winter traveling from place to place gener- Office News" and "The Organizational News- ating interest and activity in occupational letter," were initiated and sent to key con- health. The task force raised (and personally tacts on a regular basis; liaison with other contributed) money to hire a full-time staff groups was systematically established; and member in the person of Dan Berman, who Health Rights News, MCHR's house organ, had previously worked with the Teamsters began to appear on a regular basis. During in St. Louis. Soon it was publishing a news- that summer MCHR raised $60,000 in founda- letter, pouring forth literature and holding tion grants and received $20,000 more in 20 conferences. membership dues. There was widespread ap- preciation throughout the organization that the organization including one, for example, there now existed an organized and respon- in which it was claimed that MCHR sup- sible national office. ported the Kennedy-Labor national health But with the appreciation there coexisted a insurance bill. And in addition to promotional growing apprehension about the style of that reprints, brochures and buttons, MCHR bal- national office. The upbeat tone of office com- loons ascended for the first time at the Oc- munications, while possibly appropriate for tober, 1971 American Public Health Associ- potential recruits, struck MCHR old-timers as ation convention in Minneapolis. overblown and condescending. "You re- The bureaucratic style and public-relations ceived a sample of the national petition [for tone of the national office combined with its the National Health Crusade] which should stance on programs make it clear that, all be reproduced locally. Please do this as soon protestations to the contrary, the only signif- as possible so your friends and neighbors icant concern of the national office during can Sign Up for guality health care," read an this period was membership recruitment, early office communication. Another en- publicity and image-building and that all its thused: "Now is the time to fill your local com- activities were in one way or another tailored mittees with active new enthusiasts. The last to that end. It appears, in fact, that the na- three months has proven that people are tional leadership espoused a critical mass ready to move if they are just informed of the theory of social change, in which what mem- opportunities awaiting them with MCHR." bers did was essentially irrelevant, so long MCHR accomplishments as reported in the as they indicated allegiance to the "right MCHR media were often magnified beyond side," which would presumably grow and recognition. When four MCHR members at- grow until by sheer force of numbers it would tended a two-day occupational health meet- assume power. ing, another internal communigue charac- The chinks in the armor of the national terized that fact as "This excellent attend- leadership were not hard to find. New re- ance, spurred by MCHR's new emphasis in cruits might for a short time buy MCHR's this health area "And whenever an MCHR salesmanship. But for its older members- member participated in a project or a strug- many of whom had been attracted to the New gle, MCHR rushed to add that project to its Left precisely because of their alienation burgeoning list of accomplishments. from the Madison Avenue aspects of corn- Numbers became the standard of MCHR's modified American life and from the rigid success—numbers of chapters, numbers of bureaucracy, hierarchy and hypocrisy of their members, numbers of names on mailing lists, institutions—the style and tone of the new numbers of leaflets and newsletters dis- MCHR national office were thoroughly re- tributed, numbers of meetings, numbers of pugnant. Finally, no amount of glib sales- projects, numbers of letters and telephone manship, hyperbole or Sears-Roebuck cata- calls made and received, numbers of resolu- loguing of task forces and projects could dis- tions, numbers of alliances. There was little guise MCHR's lack of a focussed and action- concern for what the numbers meant and able program. there was hostility toward those who asked. While heralding the formation of the fifty- Tactions: The Dissidents third MCHR chapter, for example, the na- Some within the organization perceived tional organizer, when pressed, admitted that the limitations of the national office's top- it consisted of three people, none of whom down bureaucratism. These members, large- had ever met one another. Their names had ly from the older big city chapters, including simply been lifted from letters of inguiry re- New York City, Boston, San Francisco and ceived by the national office and, ipso facto, Los Angeles, were unimpressed with the another MCHR chapter had materialized. large numbers of new recruits flocking to Health Rights News became, at times, little MCHR. They saw the numbers as reflections more than a cheerleading sheet, recounting not of the success of present leadership and victories and editing out problems. The na- policy but rather of the ferment created by tional office began reprinting any and the civil rights and anti-War movements, as every article laudatory of MCHR from the well as the past reputation and visibility that national media, some in spite of the fact that MCHR had established for itself. What did they contained serious misinformation about impress them, however, was the fact that 21 both nationally and locally MCHR had be- come a gigantic revolving door. Interested people came to it, looked around for mean- ingful involvement, more often than not could What the group needed but lacked not find it and then left in droves almost as was both a theoretical and a large as those in which they had come. For practical sense of what it might do. this syndrome MCHR's array of task forces offered no remedy. This faction shared an acute sense of MCHR's being in trouble—not for lack of projects, but for lack of a unifying program, a direction that would inform not only national organizing but local struggles as well. three links could create the conditions that Correct as their criticisms may have been, would make possible the desired result—en- this group found itself in an untenable posi- abling individuals to experientially under- tion. Its members were united by little more stand that it is both their responsibility and than opposition to the style and politics of potentially within their power to become the the national office and in answer to it, by a agents of the construction of their own future. vague sense of the need to limit constituency In some ways the existence of groups such and to focus on institutional organizing as those at Lincoln Hospital and San Fran- which itself went hardly beyond the level of cisco General Hospital may even have ob- slogans. What the group needed but lacked scured the possibilities of institutionally was both a theoretical and a practical sense based organizing with middle-level and up- of what it might do to actually act upon these per-level health workers. The embarrassing vague parameters. Necessarily this short- truth was that at a very early stage of the coming allowed the national office to charge, organizing at such institutions, it was clear with partial plausibility, that the effect of the that the organizers had themselves very lit- dissidents was merely destructive and ob- tle sense of strategy and direction (see BUL- structionist. LETINS, April, May and September, 1969, The true weakness of the dissidents can September and October, 1970). Worse yet, be seen in their inability to implement their the romanticization of these early institution- own strategic orientation in a situation where al struggles, while intending to move health they exercised complete control—at the level workers elsewhere to join the struggle, ul- of their local chapters. Even in New York City timately had the opposite effect—the block- and San Francisco, cities that had already ing of a process of thought that might lend experienced collectives doing institutional or- clarity, direction, vision and strength to stra- ganizing, the MCHR dissidents were both tegic options and implications of institutional peripheral to these efforts and were unable organizing. to emulate or go beyond them. In this regard we would be remiss in not The weakness of the dissidents' position placing some of the onus for this state of af- stemmed from their inability to develop three fairs on Health/PAC, whose BULLETIN more elements critical to the launching of a suc- than any other intellectual journal fostered cessful strategy: a concrete, human and un- the idealization of these struggles. This pos- rhetorical explanation of how and why the ture sprung from the felt need, conveyed in existing health-care system devalues human dozens of ways by movement groups during experience; an analysis of the contradictions these uncritical years, of presenting a posi- inherent in the system that could inform or- tive image of the possibilities of social ganizing perspectives by providing the change so as to encourage the growth of the bridge between theory and concrete reality; movement. The end result of such unreflective and finally, the incorporation within an or- and unwarranted positivity was epidemic ganizing strategy of a means of realizing in- disillusionment, divorce from reality and termediate stages of an ultimate vision of a fostering of false premises, all of which were health-care system in which the needs of pa- without doubt self-defeating. Finally, this in- tients were the central focus and in which tellectual euphoria depleted groups such as control was vested in an egalitarian work- Health/PAC of their ability to delve deeper 22 force. Nothing less than the forging of these into an analysis of the health system and its oppressiveness to workers and consumers, road to factionalism and demise. The national which analysis alone can ultimately form the office honed a set of tools with which it at- foundation of a movement for social change. tempted to discredit, silence and eventually expel dissenters. Questions probing the con- Factions: The National Office tent or meaning of the numbers, the claims or The national office faction consisted of the style of the national office were taken as Quentin Young, Frank Goldsmith and Pat hostile attacks. From a disturbingly early Murchie, the editors of Health Rights News stage in the new regime, people were seen and the leaders of both the Third World as either friends or enemies and there was caucus and the Occupational Health Task little in between. New activities were warmly Force. Although later events would reveal embraced and solicited by officers and staff the fragility of this coalition, to the dissidents until the first time they expressed doubts or this group at the time seemed monolithic, if criticism, whereupon they became pariahs. not conspiratorial as well. Old friends who dissented were at first ig- Fueling the dissidents' readiness to see a nored or dismissed out of hand and later conspiracy were the facts that several people branded as negative, destructive, localist and in the national office faction were open or re- ultra-Leftist. puted members of the Communist Party and that the national office faction could depend Structuring Out Dissent on support from groups and/or individuals in The most subtle of these tools for repressing New York and the South that had long been dissent was the structuring of MCHR gather- associated with the Party. Whether or not ings so that it was difficult if not impossible particular individuals were actual Party for dissidents to meet or talk. This tactic in- members and whether or not the Party made volved rigidly tight scheduling and the use of a conscious policy of putting forth its line in constant fragmentation into small groups, all the organization, there is no question that for the purpose of precluding any occasion many aspects of the national office leader- for a broad discussion of overall politics. At ship were reminiscent of the Old Left, includ- the 1972 convention in Chicago, for example. ing its united-front approach to constituency, its mass-line, least-common-denominator ap- proach to the program, its bureaucratic style, its opportunistic use of issues and its central- ist orientation, with its intolerance of dif- From a disturbingly early stage ferences or criticisms from within the organ- in the new regime, people were ization. seen as either friends or enemies The national office felt that the success of and there was little in between. its political leadership was confirmed by the large numbers of new people turning out to MCHR functions. Because it was better or- ganized and shared more political unity than anyone else, it felt no need to discuss polit- the leadership scheduled some 40 workshops ical directions or develop a program for the and 15 constituency caucuses. As a result, organization. Instead, it felt threatened when the four-day convention provided only a others wished to do so, because this felt need short Sunday morning plenary session as a in itself represented criticism, and because forum for organizational business. Older such discussion could not but weaken its po- members were both frustrated by this ma- sition. Indeed, before long the energy ex- neuver and resentful of the fact that every pended by the national office at thwarting MCHR gathering was geared to the recruit- criticism and fending off dissent almost came ment and needs of new people, who were to define its entire operation. invariably neither interested in nor experi- enced with MCHR internal affairs, rather Keeping Dissent at Bay than to the needs of those for whom those It was in the end the unwillingness of internal affairs were of paramount concern. either faction to back off and the repressive When older members began to organize tactics stemming from the centralist stance occasions compatible with their needs, they of the national office that led MCHR down the were slashingly criticized by the national of- 23 fice. One such occasion came when leaders but a small fraction of the MCHR member- of the Northeast Region, out of dissatisfaction ship. with the organization of the Chicago conven- The selection of delegates for an MCHR tion, organized a largely unstructured re- trip to China taking place during the summer treat to soberly analyze the organization's of 1972 provided a classic illustration of the directions and viability. The national organ- manipulative use of the charge of racism. izer, when informed of the meeting, threw a A handful of national office partisans in New virtual tantrum, branding the members in- York, none of whom had ever participated volved as elitist, exclusionary and racist, and in the New York chapter, suddenly consti- castigating them for having "No Workshops! tuted themselves as a chapter at Columbia- ... No Caucuses! ... No Women's Caucuses! Presbyterian Medical Center and nominated ... Task Force and Constituency Organizing a candidate for the trip. He was Calvin Sin- Completely By-Passed!" nett, a doctor who had never been active in MCHR, was not even a member and who Dirty Names avowed that he would not have the time to The national office wrapped itself in the speak to groups on behalf of MCHR when he cloak of a united-front constituency and bu- returned. Although the establishment of the reaucratic structural solutions to MCHR's chapter violated the MCHR constitution and problems of racism, sexism and elitism in an Sinnett's selection violated every prean- attempt to immunize itself from criticism. It nounced rule of the selection committee, the then used these concerns as epithets to be national office suddenly took leave of its hurled at its critics. Those who wanted a concern for such legalisms and chose Sinnett focussed constituency were dubbed exclu- as the New York delegate. sionary and elitist, anticonsumer and anti- When the New York chapter objected and worker. Those who felt frustrated by the con- asked for justification, it was informed by the stant fragmentation into special-interest cau- Selection Committee that none was neces- cuses were dubbed sexist and racist. sary since Sinnett (who is Black) by then had Using this kind of ammunition, Goldsmith been endorsed by the Third World Caucus, opened a frontal assault on the big city chap- a factor that apparently overrode the previ- ters by the fall of 1972. (It was no accident ously announced guidelines. When the New that MCHR had meanwhile discovered the York City chapter protested further, it was virtues of rural organizing.) Goldsmith drew scathingly denounced as racist by Ann Gar- land, former national treasurer and leader of the Third World Caucus. It was clear that in this instance the issue of race came only as an afterthought and as a means of attempt- Those who felt frustrated by the ing to intimidate anyone critical of the na- constant fragmentation into special- tional office. interest caucuses were dubbed Dirty Tricks sexist and racist. By this time MCHR was well down the road to factional demise, but one weapon, the most extreme, remained—outright expulsion of the critics. The national office first at- tempted to pave the way for this tactic up an organizational report purporting to through a seemingly innocuous and legalistic evaluate chapters by a list of criteria includ- maneuver to revise the MCHR constitution, ing racism, professional dominance and sex- which was generated in Chicago and pre- ism, which found the big city chapters guilty sented at the 1972 Chicago national conven- on every count. To sustain his charge of tion. A close look, however, showed that vir- racism, for example. Goldsmith maintained tually every change proposed was designed that the anticonsumer bias of the older, to create a greater centralization of power larger chapters was nothing but a ruse to ex- and a consequent weakening of the opposi- clude Third World people from participation. tion. Specifically, the revisions would have What he did not mention was the fact that increased the chairperson's power by insti- 24 Third World people everywhere constituted tuting a longer term and by allowing the chairperson to act independently on a num- ber of issues (such as hiring staff) rather than having to consult with representatives of the NEC. More importantly, they would have al- lowed the NEC to remove its own members and would have diluted the impact of big city city chapters. The proposed constitutional revisions were resoundingly defeated and their actual im- pact was to expose the intentions of the na- tional office faction and to increase polariza- tion. Yet the national office was undaunted. At the following meeting of the NEC, Gold- smith presented a proposal for permitting the NEC, after an investigation, to expel chap- ters. (Grounds for expulsion were unspeci- fied.) In special cases, which presumably could not await investigation, the proposal provided for immediate "temporary disaffili- ation." These attempts to set the stage for ex- pelling critics, the final and most extreme at- tempt to tighten the centralization of the na- tional organization, were doomed to failure. They were premature, to say the least, and it is doubtful they could ever have worked. For the national office had to rely for sup- port on the ranks of new recruits, most of whom were only in the process of walking through MCHR's revolving door. Those who stayed around were either repulsed by such tactics or simply felt themselves too new to take a stand on such a controversial and seemingly internecine issue. Meanwhile, mounting criticism eroded the unity of the national office. Shortly after his reelection at the April, 1972 convention, Quentin Young— to the sharp displeasure of others in the na- tional office—accepted the position of Chief of Medicine at Cook County Hospital, a job too consuming to allow him to continue to play a strong role in MCHR. At that point the polarization was so great that both sides felt too frustrated, even para- lyzed, to have the stomach for the investment of energy that fund-raising and other vital leadership functions reguired. Conseguently by the summer of 1972 MCHR's financial state became critical. The organization had spent over $160,000 since the April, 1971 con- vention. Quentin Young had been the only person to do substantial fund-raising and that activity had ceased by the end of his first term. The clash of the two factions reached a head when, in spite of MCHR's financial condition, Pat Murchie and Frank 25 Goldsmith at the fall NEC meeting asked for a cost-of-living salary increase from $10,000 to $11,000. The NEC, having just severely challenged Goldsmith for his attack on big Those factors that have led MCHR city chapters, denied salary increases and proceeded to pack the real wallop to Gold- to the brink of total demise have smith as it voted on financial priorities. When as yet barely been articulated, the inevitable crunch came, the NEC voted let alone addressed. that funds for the executive secretary would have first priority, travel funds for the NEC second and funds for the national organizer third. With that, both Goldsmith and Murchie quit.

The Aftermath isolation that now characterized the inde- With the national staff gone, the chairman pendent Left. Political parlance came to be consumed in his new job, the treasury bank- studded with talk of the Progressive Labor rupt and the organization exhausted from Party, the Communist Party, the October factionalism, MCHR sank to an all-time low. League, the Revolutionary Union and the Na- True, national MCHR still holds annual con- tional Caucus of Labor Committees, to men- ventions, its NEC still meets from time to time tion only the most prominent. and it still maintains a national office in Pitts- MCHR had never anticipated the demise of burgh. Publication of Health Rights News has the many groups that had lent it its raison recently been suspended for lack of re- d'etre. More than that, its residual reputation sources and participation. MCHR's most vis- and appeal to new recruits, its breadth of ible national activities of late have been its politics and its lack of self-definition made it presence at the annual conventions of the a perfect breeding ground for sectarian American Public Health Association and the groups. Once entrenched, such groups added formulation of the old MCHR national health still another obstacle to MCHR's addressing plan into a bill to be introduced into Congress the critical issues, since it is then put in the by Rep. Ronald Dellums of California. reactive position of having constantly to re- In the aftermath of the fall 1972 NEC spond to the initiatives of better organized out- meeting the national office once more shrank side forces. The New York and Boston chapters to a vestige and in the next year was moved withstood the onslaughts of the Progressive to Pittsburgh. Unlike the immediate post- Labor Party only to have the Revolutionary civil-rights period, this time there were few Union rise to take its place there and in other local chapters for the organization to fall Eastern cities. At the national level, the Com- back on. Many had barely existed to begin munist Party began to function more overtly, with except in the body count of the national and in the following years MCHR members office; some, such as Chicago, had under- closely associated with the Party were gone political splits that spelled their demise; elected as officers and served as staff. but most simply reaped the harvest of bitter In spite of these setbacks and obstacles, seeds planted in other movements. there still exist in many cities small numbers With the anti-War years over, the larger of long-standing independent MCHR activists movement was in disarray. SDS and the who are guardedly confident that MCHR can Black Panthers had split, been repressed and be rebuilt. They point to the ability of MCHR's faded from the national scene; many local name and reputation to draw new people community struggles had faded as well. With into its orbit through low-keyed conferences, the fall of the larger movement rose the star forums, projects and the like. And given the of the Left sectarian groups, whose attraction absence of any other organization to fill the to activists was their simple, complete and bill, many activists see little alternative. prepackaged sets of answers to the thorny Whatever the good faith and good intentions issues facing the American Left and—prob- of such individuals, however, there remains ably more importantly—their apparent sense a fundamental obstacle to the realization of of purpose and community, a welcome con- their hopes: Those factors that have led trast to the confusion, fragmentation and MCHR to the brink of total demise—its latter- day contempt of democratic dissent, its dis- dain for theoretical perspective, its unwilling- ness to concretely analyze its activities and its impatience with the slow task of building bases—have as yet barely been articulated, let alone addressed.

Epilogue For the decade between 1964 and 1974 MCHR was the standard bearer for the health left. Though often standing in guicksand, it still has claims to success. MCHR was an important, freguently effec- tive ally of the civil rights movement. More than any other organization it alerted the health community to the truth about the War in Southeast Asia. It acguitted itself well throughout by allying itself with the weakest, most oppressed and despised members of American society. More often than not its heart and muscle were on the right side at the right time. Internally, for all its faults, MCHR can boast of accomplishments that no other health organization can claim. Even in its days of greatest doctor domination, it opened itself to other health workers and to those out- side the health system altogether. It issued an early challenge to a racist health system both in terms of its delivery of health care and in terms of the treatment afforded minorities within it. Almost alone of all health organiza- tions, MCHR saw the sexism within the health community and strove to banish it from with- in the organization. Finally, MCHR was hardly alone among organizations, either in the health movement or in the movement generally, in its inability to come to terms with the two critical gues- tions: who was to be its constituency and what was to be its strategic thrust? The long MCHR experience, in both its positive and negative aspects, has brought many MCHR activists to understand the importance of focussing their energies on a limited constit- uency of middle level and upper level health workers in the setting of those growing bas- tions of power and resources—America's health institutions. What the MCHR experience has not done is to point the way past this most elemental step in understanding toward a strategic path which might lead to the objective of a health system humane to both its workers and its patients. To do this, we believe, will reguire at least two tasks, both analytical and to some extent abstract in their nature increased technology, specialization and cor- and both, we fear, going against the grain of poratization affected the role definitions, the the impatient, action-oriented movement of self perceptions, and the felt needs of health the '60s and '70's. workers? Is their course, and with it the course The first task is that of concretely analyz- of increased fragmentation and alienation of ing and understanding the health system, in- the workforce, unalterable? What forms of re- cluding both an overview of its political sistance and rebellion have different workers economy, and an analysis of how it more im- groups taken and what are the implications mediately shapes the values, perceptions and for the workforce as a whole and for pa- relationships of the workers and patients tients? Can trade unions deal with such wide- upon whom it impinges. At the level of an ranging issues? Are they necessarily limited overview, it is hard for us to imagine a suc- vehicles for worker defense? Or contrariwise, cessful movement which has not addressed do they serve to regulate the workforce and such questions as: By what forces or combi- integrate it into the designs of management? nations of forces is the health system con- To what extent can worker concerns mesh trolled? Is it by doctors? ... by administra- with those of patients and to what extent do tors? ... by banks? ... by insurance com- they conflict with them? panies? For what purposes is it controlled? Finally, the success of the health move- ... profit? ... social control? .. . empire build- ment as well as of the movement at large ing? What is the relationship of the health rests on one last and possibly more difficult system to other controlling interests in Amer- analytical task. We believe that the move- ican society, for example, to multinational ment must apply equal intellectual and ana- corporations? ... to finance capital? ... to lytical rigor to itself—its own forms, styles and labor unions? What roles does the govern- modes of organizing. For it is only in doing ment play? Is it simply a handmaiden of the this that the movement can effectively focus controlling interests? ... a mediator of them? and conserve its precious energies and re- ... an independent force? Clearly these ques- sources, and not squander them in impulsive tions are only suggestive. reaction, outmoded models and acting out Likewise, at a more immediate level, it is unconscious needs. hard for us to imagine a health movement But at least three serious obstacles stand serious about health workers and institution- in the way of accomplishing these tasks, al change which does not have a firm under- particularly the latter. The first is that, need- standing of such questions as: How has less to say, activists obviously have large personal stakes in the struggles and organ- tions. Indeed, not to accept the very existence izations of the '60's and '70's which, much of these activities as signifying success, to rhetoric notwithstanding, inhibits candid crit- even press the need for sober evaluation, is icism of political practice. Indeed, not unlike likely to cast the critic as a defeatist when, the establishment, movement organizations in fact, he is like the proverbial messenger structure themselves to ward off criticism. who must suffer the conseguences of the But an even more serious obstacle, we message he brings. think, is an anti-intellectualism woven into The final obstacle is the absence of an in- the very fabric of the movement, stemming tellectual tradition in the American Left from a paradoxical and often unconscious which, when activists finally recognize the amalgam of American pragmatism and need for theory and analysis, makes them Marxist historical determinism. From Amer- susceptible to the formalistic and outdated ican pragmatism comes an ethos of "nothing answers lifted from the Marxist classics and succeeds like success" and "what works, mechanically applied out of time and context works." Moreover, this philosophy dictates to 20th Century America. that what "works" will be found in action, Not to address and overcome the anti- not words, although in practice the action intellectual and unreflective undercurrents more nearly resembles trial-and-error. From described above guarantees a future resem- Marxist historical determinism comes the as- bling the past, where the movement responds sumption that socialism will emerge inexor- to rather than directs the course of history. ably from the contradictions of capitalism Indeed, it is as if activists have stood attempt- and that individuals can only hasten or ing to discern the first swell of a wave, have hinder the course of history, not alter it. Thus leapt on and ridden it as long as possible, they are also relieved from the responsibility and then have been cast on the shore to have of determining it. Together these two traditions the process repeat itself. And at any point undergird the tendency for the movement to in time, success has been measured by the mindlessly laud any and every activity, proj- height, splash and roar of the waves. Rather, ect and organization as signifying success by we would suggest, it is the responsibility of their very existence and hence bringing the activists to take account of the waves, but to movement that much nearer to final victory. turn their attention to navigating the tide on Likewise, they underlie the tendency of the the way to their chosen goal. movement to recoil from sober evaluation of —Ronda Kotelchuck its activities in the context of larger direc- Howard Levy vard, and the new units have reduced the time reguired to Vital Signs get medical assistance from 10 minutes to a minute and a FINDING MASSES half. EN MASSE "Do it our way or not at all," the New York Cancer Society PATIENT'S RIGHTS ON VIDEO has ordered the Concerned Citizens of Canarsie, a Brook- The Berkeley Community lyn group sponsoring a five- Health Project has produced a day breast cancer screening half-hour videotape entitled program. The source of the dis- "Patients' Rights, or How to pute is the community demand Talk Back to Your Doctor." that women be pre-registered Through scenes of doctor-pa- and appointments be made to tient encounters accompanied avoid "herding them like cat- by commentary, the videotape tle." "If we can serve only 140 deals with the right to know, women a day, there's no rea- the right to dignity, the right son to have 100,000 people in to confidentiality and the poli- line. We'd rather do it with de- tics of the health system. The corum and make the women Project hopes that community feel like people, not cattle," health groups will find it use- stated the chairman of the ful as a focal point for discus- Canarsie group. sion of and organization around patients' rights issues. To the Cancer Society this Those who would like informa- was an "excessive demand." tion on buying or renting the "We have the expertise, we videotape should contact the know the logistics. It's national Project at 2339 Durant Avenue, policy to screen as many peo- Berkeley, California 94704, ple as possible and have the (415) 548-2570. program open to the public," said the Brooklyn Field Repre- sentative. "As far as I'm con- HAMBURGER HAZARDS cerned, Canarsie has already A dermatologist in Beech- been cancelled." wood, Ohio has tentatively identified a new skin condition he calls McDonald's acne. It 50-YARD LINE: NEW freguently appears during the FRONTIERS OF MEDICINE summer months (when acne The latest breakthrough in ordinarily improves) among health care delivery has been teen-agers working at fast-food pioneered by Harvard Medical restaurants, where their job School, where no one can say brings them into freguent con- that medical care is inacces- tact with hot cooking oils and sible or unresponsive to at greases. When the patient least some human needs. Har- leaves the job (typically in vard now stations two emer- the fall, to return to school), gency coronary care units, the acne dramatically disap- manned by a four-person pears, freguently without the health team, including one aid of medication. As the der- doctor, on the 40-yard line matologist notes (in a letter to during every Harvard Univer- the editor of Archives of Der- sity home game. A fatal heart matology), the condition should attack strikes a spectator once be compensable under work- every 2.5 home games at Har- men's compensation laws. sire, whim, or need of the sur- geon rather than that of the Peer Review patient. I am concerned that STERILIZATION: the other extreme is to deny THE RIGHT TO DECIDE the individual woman the right Dear Health/PAC: to decide whether she wants It was, of course, with great the procedure or not. Ade- interest that I read your article quate counselling—yes. Deci- "Fit To Be Tied" in the current sion making—no. The proper [January/February] BULLE- role of the surgeon is to give TIN, which did present a good the patient the benefit of the review of the current status of art when the patient requests sterilization. I was pleased to it. The doctor should give a participate in the background fair, honest, and complete ac- gathering and would like to re- count of the pros and cons of inforce the thrust of the piece. any operative procedure. The That is the role of using selec- ultimate decision must be that tive patients as so called of the patient. That is what is "teaching cases" for resident missing—the giving up of the training, a practice which is control in which the surgeon the mainstay of teaching hos- has such great investment. Or pitals. Under our present sys- better expressed—the deglorifi- tem, it seems to me that a cation, the demystification, and wiser distribution of house the deprofessionalization of staff can be made so that ade- the medical profession. quate teaching is provided on There's the ambivalence. On indicated pathology rather one side is not placing the so- than "create" quasi-indica- cial-economic deprivation of tions for the sole benefit of the patient and thus the pa- education. No such risk to a tient in a position of being de- human can ever be justified nied so as not to persecute. for that purpose. The other is leaving it up to As director of the section of them as individuals. It all boils psychosomatics of the Depart- down to the same basic ques- ment of Obstetrics & Gynecol- tion that always is at the "bot- ogy at the New York Medical tom line"—that being poor College-Metropolitan Hospital, means being second class. I have certainly seen this Poverty is our only disease change downward in requests state. for tubal ligations. There are Again, thank you to Ms. those who are active in having Caress. Her survey was excel- these prospective patients seen lent and well-appreciated. and counselled before the fi- -Don Sloan, M.D. nal decision is made. However, there is one point BOOKS RECEIVED I would like to make that is Alford, Robert R. Health Care from the other side of the coin. Politics (Chicago: University It makes this problem of tubal of Chicago Press, 1975). $12.50. ligation somewhat ambivalent Annas, George J., The Rights in my thinking (in contrast to of Hospital Patients: The Basic hysterilization, for which there ACLU Guide to a Hospital Pa- is no place). I refer to the basis tient's Rights (New York: Dis- for much of the thinking be- cus Books, 1975). $1.50. hind the placing of women Bell, David, A Time to Be Born either in or out of the operat- (New York: William Morrow, ing room depending on the de- 1975). $5.95. Bergwall, David F., Reeves, $10.95. Community Hospital: A Sys- Philip N., and Woodside, Nina Franks, Violet and Burtle, Va- tems Analysis (Lexington, B., Introduction to Health Plan- santi (eds.). Women in Ther- Mass.: Lexington Books, 1973). ning (Washington, D.C.: Infor- apy (New York: Brummer/ $16.00. mation Resources Press, 1974). Mazel, 1974). $15.00. Seham, Max, Blacks and $15.00. Freudenberg, Herbert J. (issue American Medical Care (Min- Brenner, M. Harvey, Mental ed.). The Free Clinic Hand- neapolis: University of Minne- Illness and the Economy book, The Journal of Social Is- sota Press, 1973). (Cambridge: Harvard Univer- sues, Vol. 30, No. 1 (1974). Scott, Rachel, Muscle and sity Press, 1973). $15.00. Hartogs, Nelly, Boards of Di- Blood (New York: E. P. Dutton, Burlage, Henry M. and Bur- rectors (Dobbs Ferry: Oceana 1974). $8.95. lage, Robb K., The Four Walls Publications, 1974). $15.00. Shannon, Gary W. and Dever, of Pharmacy (New York: Van- Hejinian, John, Extreme Rem- G. E. Alan, Health Care Deliv- tage Press, 1974). $5.00. edies (New York: St. Martin's ery: Spatial Perspectives (New Cravioto, Joaguin, Hambraeus, Press, 1974). $7.95. York: McGraw-Hill, 1974). Leif, and Vahlguist, Bo (eds.). Hyman, Herbert Harvey (ed.), $2.95. Early Malnutrition and Mental The Politics of Health Care Silver, George, Family Med- Development (Atlantic High- (New York: Praeger, 1973). ical Care. (Cambridge: Bollin- lands, New Jersey: Humanities Mechanic, David, Politics, Med- ger. 1974). Press, 1974). $20.25. icine and Social Science (New Spiegel, Allen D. and Podair, Demone, Harold W., Jr. and York; John Wiley, 1974). $12.95. Simon (eds.), Medicaid: Les- Harsburger, Dwight, A Hand- Mendelson, Mary Adelaide, sons for National Health Insur- book of Human Service Organ- Tender Loving Greed (New ance. (Rockville, Maryland: izations (New York: Behavioral York: Vintage, 1974). $2.45. Aspen Systems Corporation, Publications, 1974). Miles, Rufus E., Jr., The Depart- 1975). $24.00. Dorsey, John M. Psychology of ment of H.E.W. (New York: Timiras, P. S., Developmental Ethics (Detroit: Center for Praeger, 1974). $10.00. Physiology and Aging (New Health Education, 1974). $8.00. Perlman, Mark, (ed.). The Eco- York: Macmillan, 1972). Durbin, Richard L. and Spring- nomics of Health and Medical Verrett, Jacgueline, and all, W. Herbert, Organization Care (New York: Halstead Carper, Jean, Eating May Be and Administration of Health Press, 1974). $7.95. Hazardous to Your Health Care (St. Louis: C. V. Mosby, Quinn, Joseph R. (ed.) Med- (New York: Simon and 1974). $11.75. icine and Public Health in the Schuster, 1974). $8.95. Editors of Consumer Reports, People's Republic of China Wise, Harold, Beckhard, Rich- The Medicine Show (New York: (U.S. Department of Health, ard, Rubin, Irwin and Kyte, Pantheon Books, 1974). $3.50. Education and Welfare, DHEW Aileen L., Making Health Etzioni, Amitai, Genetic Fix Publication No. (NIH) 73-67, Teams Work. (Cambridge: (New York: Macmillan, 1973). 1973). Ballinger, 1974). $7.95. Ramsey, Paul, The Patient as Wren, George R., Modern Forssmann, Werner, Experi- Person (New Haven: Yale Uni- Health Administration (Athens: ments on Myself (New York: versity Press, 1974). $2.95. University of Georgia Press, St. Martin's Press, 1974). Rhenman, Eric, Managing the 1974). $8.00.

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