Lifetime Care with William Bronston (UNLOCKED)
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Bea and Phil speak with lifelong activist Dr. William Bronston about his experiences trying to take down the infamous Willowbrook institution from within as a young doctor, his appeal to replace “long term care” with “lifetime care," and how his work towards deinstitutionalization informs his ongoing advocacy for single payer healthcare.
Dr. William Bronston 0:01
We are at war. We are at war with the money making, profit driven capitalist system. And we need to be thinking about how to humanize and generate the very best possible imaginative way of approaching caring. The issue here is we have to move from an I to a we, and from a them to an us.
Death Panel 0:51
[Intro music]
Beatrice Adler-Bolton 0:55
Welcome to the Death Panel. Patrons, thank you so much for supporting the show. We couldn't do any of this without you. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore, and preorder our co-host, Jules Gill Peterson's new book, A Short History of Trans Misogyny, coming January from Verso books, or request them both at your local library. And of course, you can also follow us @deathpanel_.
So I'm here today with my co-host, Phil Rocco.
Phil Rocco 1:27
Hey.
Beatrice Adler-Bolton 1:28
And the two of us are joined by a great guest. And we're going to be talking about single payer and how expansively and radically we should be thinking about the redistributive potential of ending health insurance as we know and hate it. Dr. William Bronston is a physician organizer who has spent a lifetime fighting for single payer and deinstitutionalization. He is the author of the book, Public Hostage, Public Ransom: Ending Institutional America, and is probably best known for a key role that he played in the fight to close the infamous Willowbrook State School in Staten Island, which if you don't know, is probably one of the most notorious American institutions in the history of the medicalized incarceration of children. We have him here today as one of the many authors of a California state single payer plan, that focuses on the idea of lifetime care and rejects the logics that helped to build and sustain the total institution system that still dominates today.
Dr. Bronston, welcome to the Death Panel. It's so great to have you here today.
Dr. William Bronston 2:32
Thank you so much. It's really a super honor to be with you. I mean, your work with Health Communism has been an inspiration and a huge ice pick in the block of this barbarousness that we suffer together.
Beatrice Adler-Bolton 2:45
Aww. Honestly, there's no higher compliment than calling Health Communism an icepick. So I really appreciate that. Thank you.
Phil Rocco 2:53
[laughing] That could be a blurb right there.
Beatrice Adler-Bolton 2:54
[laughing] But anyways, Bill, thank you so much for joining us today. Before we dive into the single payer model itself, and the framework of lifetime care, can we start by talking about your background, the lifetime of work that you've done. We definitely want to do an episode soon talking about the time that you spent at Willowbrook, at length. But I think, you know, if you're okay touching on that today, briefly, it's really important to sort of knowing where you're coming from, and how that informs some of the design for the single payer model that we're going to be talking about today. Because I mean, ultimately, we're having a conversation about how a lot of single payer plans, both current and past, are harmed by attempts to make them more palatable, and how single payer activists sometimes shy away from radical thinking or pushing proposals to be more radical at their own peril. And while I think, you know, that might come off to someone as glib or something, I assure you, it's not. That's definitely informed by experience. And I think the landscape specifically of the experience that you have, documenting and organizing against extractive abandonment, that's very well illustrated by your time at Willowbrook, particularly the resistance to your attempts to help kids on the inside, like in Ward 76. These are really crucial parts of the context of sort of where the idea of lifetime care comes from. So if you're up for talking about it, to just start us off, I think listeners would really appreciate just hearing from you about your time at Willowbrook, you know, can you talk through some of what happened when you tried to help people and how the institution itself responded to that. What were the politics that you came into Willowbrook with and how did that shape the fight to close Willowbrook? And how did that also eventually sort of influence your approach to single payer?
Dr. William Bronston 4:42
So let me start with a little bit of background. I went into medicine because I had this heartful sense of the need to serve and to care and to comfort, and that has been a prevailing theme and a prevailing emotion throughout my entire life. You know, I'm 84 now, and I've been doing this for a long time. When I was -- when I finally decided that I was going to go to medical school, and I figured out that I didn't have to study to be either a plumber or a businessman, early on in medicine, I was very involved in working to humanize my medical school and was able to seize control of the student government and organized first, a Los Angeles region wide, a coalition of progressive health science students, including nursing, dental, public health, med tech, and of course, medicine. And then nationwide, to put together a thing called the Student Health Organization, which was committed to ending the war in Vietnam. It was committed to supporting the struggle in the South, the Civil Rights struggle, and primarily aimed at challenging the inhumanity and the alienation, the brittleness, the dehumanization, in our medical school curriculum, in order to move us closer to caring -- comforting and caring and serving in a humble, subordinate role to the people that we were taking care of. And that led ultimately to my graduation. And then I did my internship at Children's Hospital of Los Angeles, which was really a profound experience. There was roughly 400 physicians, you know, and 80 beds. It was the most remarkable regional Children's Hospital, one of them, in the country.
Beatrice Adler-Bolton 6:38
And this was in the 60s, right?
Dr. William Bronston 6:40
In the 60s, yes. And then when I finished my internship, I proceeded to do my psychiatric residency at Menninger's School of Psychiatry in Topeka, Kansas. And the situation there was really -- what I walked into was horrendous. This was Kansas, bloody Kansas, with the workers mostly of color. And the work that they were doing was remarkable, and it was overwhelming. Everybody had to work two shifts, because of the inhumanity of the work in this whole network of mental hospitals. And we organized a hospital seizure as a job action in 1968, in order to demonstrate the shortcomings of striking, for health workers striking a health facility, and instead the union, which was a brand new union that we organized, an AFSCME union, American Federation of State, County, Municipal Employees, Council 50, essentially came in -- the afternoon shift and the night shift came in in the morning, and we notified the administration and all the hospitals -- mental hospitals in eastern Kansas, that we were going to take over administrative control, because of the bankruptcy of the administration and their dehumanizing relationship not only to the workers, but to the crowded patients, except, of course, the private hospital, the Menninger hospital, that had three workers per client, per patient --
Phil Rocco 8:09
Wow.
Dr. William Bronston 8:09
As opposed to the public hospitals, which were strewn across the VA and the state system and so forth. And that led ultimately to my having to leave Kansas after we won that action. [Bea and Phil laughing] There was a warrant out for my arrest. In order to plan our action, as we were going along, everybody had been arrested. So anyway, I came to New York and I spent a couple of years doing other work. I was involved very heavily with the Shakur family and working with the Black Panthers in the eastern seaboard, with 40 of my confreres in the Student Health Organization that showed up in New York at the same time, which was really incredible. I was two years older than everybody at the time. And that led to my needing to find a job where they wouldn't check my credentials [Bea and Phil laughing heartily]. And so, I had been trained in child development at Children's Hospital by the leader in the country at the time, that was a children's hospital, and so going to Willowbrook State School, even though I knew that the institution was potentially evil, was the likely place for me to go, given my crazy life. And when I walked into that place, I was thunderstruck. I was utterly thunderstruck.
I was the only physician for 200 people in the ward that I was assigned initially. And there was two nurses. And there were two to three ward workers initially assigned to each of the four wards in the building, which had, you know, 50 people incarcerated in each of the wards, 200 people in the building, mostly young people under 18 years of age. And there was no off service notes, there was no way of identifying anybody in there, the charts were sometimes a foot, or a foot and a half deep in terms of paper, but nothing about who the people were. There were accident reports and drug records and so forth. It was absolutely astounding to me. I just couldn't imagine it. And the time that I spent there, it took me a little time to really understand what was going on and why it was that way. Because, you know, when you walk into a job, you know, at some level, you're subordinate to the status quo. And I didn't get it. You know, I had come from one of the most opulent hospitals in the United States, both the Menninger's system and the Children's Hospital of Los Angeles. And so I was really, really thunderstruck.
And my mentor, Dr. Richard Koch, was really a locus for people coming from all over the world in order to look at his model. And what happened -- the way that system, his system worked in Children's Hospital, I'll get back to where I was in a minute, I just wanted to fill this piece in. He had a social worker, a public health nurse, a speech and hearing therapist, a psychologist, and the access to a limitless number of specialists in the most exotic world of medicine imaginable. And so a family would come suspecting that something was not working right with their kid in terms of their development. And he would work that family up, the kid and the family up in such a beautiful way that at the end of that evaluation, they would sit down with the family with the entire team, the service team in place, and they would work out an assessment with the family of what was going on. And 20% of the kids that were suspected of developmental delay were within normal range, and the others were deflected from institutionalization, which was the going coda for the medical community. Doctors were telling families that had a kid with an early diagnosis of mental retardation or developmental disability, put that kid away, have another one, you know? I mean, it was universal, it was uniform.
Beatrice Adler-Bolton 12:30
And how young, you know, on average, are kids getting diagnosed in that time period?
Dr. William Bronston 12:36
Sometime within the first two years, sometime in the first two years, you know, a decision is made. A kid may be born with Down syndrome, or a kid may be born with some kind of neurodegenerative condition, you know, that was obvious, or spinal bifida. I mean, there were some issues that would come up, differences that happen. But if the kid was "damaged" in some way, the medical community, the medical system, the medical community would say, put the kid away, start fresh, to the parent. I mean, this was the way it was. I mean, doctors were -- and because we were not trained in dealing with that kind of differentness. And to a doctor, mental retardation was a progressive, a degenerative condition, that led to non-participation in the world of work. So the doctor was engineered in our training to essentially reject that person from being integrated in society. And we had a society that essentially blocked participation of anybody that was really different in terms of hearing, seeing, walking, thinking, you know, communicating in any way. And that training at Children's Hospital was so profound, and so humanizing, and so loving, and so caring, and so thoughtful, and so competent, and so confident in their ability to keep that child in the family and to support that family in order to embrace and nurture that child. It was really something that I just took for granted, because I was trained in that context. I didn't know anything different from my training.
And I worked with Dr. Koch for four years while I was in medical school. And then of course, in the internship, you know, he and I were already profoundly close to each other. So when I got to Willowbrook, you know, now four years later, five years later, to walk in to that place was really astounding to me. And it took me a couple of years to kind of figure it out. But it became obvious that anything I did to try and bring modern, scientific developmental medicine into that relationship was seen as an attack on the administration and on the system. And what I learned from that system was that the state, which had only provided in the state of New York, massive institutions, no -- zero, no community based services for people, essentially, was taking Medicaid money in order to monetize those souls that were incarcerated. And they were put in there until they died, because as long as they were in the bed, in that institution, the state was drawing money every month, every year from Medicaid at an astounding degree. And it was clear that there was no intention whatsoever to matriculate anybody out of that institution, lest the state lost that Medicaid funding for that particular individual. Similar to, for example, the ADA, for school children, you know. If the kid is not in the seat, then the federal money doesn't flow into the school system.
Same thing with institutions, institutions require people to stay in those institutions. And they were not habilitated in any way in order to matriculate them, to put them back into open society. And so you can imagine the violence done to the families, who are told that they've made a terrible mistake having this child, putting the blame on the family. So that business of assigning a negative label to an individual that essentially puts them into a dehumanized role in society, less than human in society. And when you are dealing in a world where people are essentially commodified and monetized, regardless of where they are in the spectrum of society, and you say that this person is not a functional, valued human being in that society, it's a death sentence. And so the interesting thing is, and I just want to bring this up early in our conversation, that means that 100% of society, apart from that small coterie of extremely wealthy people, are assigned to incarcerated institutionalized terminus in their lives. We are all aimed at nursing home assisted living, which have been essentially created in this gigantic Medicaid financed culture. Medicaid has plowed $6 trillion since its inception into institutionalizing American culture. And people don't have the memory any longer after 50, 60 years of Medicaid establishment, of what it was like before institutions were the norm in our society, congregate institutions.
And so our strategy is, I mean, the obvious issue, going back to my experience with Children's Hospital, is to replace long-term care, which is the package, the Medicaid package that essentially defines the need for out of home placement, out of home funding to the institution wherever the person is placed, and the imposed requirements for impoverishment. People can't have more than a couple $3,000 of total assets, lest they lose portions of their so-called medical coverage, which is nothing more than incarceration and monetization of a devalued, extracted person, a surplus individual in society, as you write about in Health Communism, which is so brilliant. So when I got to Willowbrook, it took me a little time to understand because, you know, I didn't know. I mean, my education didn't include explaining to me anything about socialism, anything about pacifism, anything about feminism, anything about imperialism, anything about fascism. I didn't, I didn't -- you know, I didn't know, and I was beautifully educated. I gotta tell you, I went to UCLA. I went, I mean -- you know, I had high level education. And so, to learn this on the job, about the cruelty, the wanton violence, of institutional oppression, of crushing a person's identity and their physical reality, the lack of adequate food, the lack of adequate clothing, the lack of adequate medication, no planning for a return back into society.
And as the children that were put into Willowbrook get older, they wind up becoming, first of all, violently injured, all of them. No medical care of any meaningful kind, no meaningful diagnosis. One to two workers on a ward of 50 people, massively drugged, massively drugged in order to compensate for the lack of staff, so that they're essentially, you know, kind of knocked out, you know, unconscious, most of the day, doing nothing, nothing in a stone room with echoing chambers and smell and filth, you know, that is the norm. And so when a worker gets hired, a poor person gets hired into state service in order to work in an institution, they walk in, essentially, defined by the environment, they essentially buy into the notion that the people that they're caring for are below them, and essentially, not human. And so they don't hurt. They don't, they don't, they don't need, they don't feel, and they're essentially obstructed from interacting with their family, at every opportunity that the institution is able to engender, which has devastating, devastating social and psychological consequences on society in general. So the work at Willowbrook was an effort to shut that monstrosity down, and situations occurred in the institution where I decided, given my organizational skills at that time, that I was going to shut that mother down. Because it was -- it was a barbarity of maximum character. And it took time to kind of put the parents together. I mean, I had to find a constituency that had the clout in order to go against the status quo, which meant going against the governor and the state of New York, ultimately, and finally, we agreed that we needed to file a federal class action lawsuit for crimes against humanity, against the governor and the state. And that is the content, the story from beginning to end, of my book, Public Hostage, Public Ransom.
Beatrice Adler-Bolton 22:57
And in an oral history of yours, you called it "a self fulfilling economic nightmare," which I think is really a really important framing. And I just want to read a little bit from that oral history. You said,
"I came to find out the violence little by little as I went along. The doctor had to review -- had to daily review any problems that arose on the ward and every week renew all these massive tranquilizing drug orders. So I began to look at the charts. The charts were four to six inches deep, multiple charts. People had been there for years. They'd been brought there when they were 3, 4, 5. They were now 10, 12. The charts were filled with incident reports called pink slips. Week after week, they accumulated about a cut here, a bruise there, illnesses. The place was rampant with tropical diseases that had either been instilled purposefully for study purposes, like they were inoculating kids with hepatitis A in order to study how to develop a possible hepatitis vaccine, or German measles or rubella. They had every kind of intestinal parasite. We're constantly sending kids for bloodwork in order to make these diagnoses, in order to put them on these relentless amounts of rare antibiotics, in order to knock out all of these diseases that are strictly diseases of hygiene."
And you go on to describe the chaos, the horrific conditions, the smells, you know, the ways that folks are burned by radiators, the stickiness and Pine Sol goo build up on the floors. You know, this is a kind of -- I read a lot of horrible shit for the research I do, but like Willowbrook is one of those sites where when you do delve into the documents involved in the case or in the consent decree afterwards, for example, you get into the original materials, you know, it's hard stuff, and I can't even imagine how dehumanizing and difficult that must have been for folks inside but I think what you emphasize so well is the fact that while society saw the people inside Willowbrook as broken, you know, they're really broken by the conditions of the institution. It's not that they're broken people, it's that, you know, part of the way the institution was run, the ideology, the politics of it, the finance of it, that was productive of the brokenness that was being sort of ascribed as an intrinsic trait of that person themselves. It's a kind of horrific, as you said, a self fulfilling economic nightmare.
And it's just such a, it's such a difficult thing to sort of sometimes I think, for disabled folks who, like myself, who were born after Willowbrook closed and after the ADA, I think, often, it's really important to actually sit with what were conditions like in institutions, what was the kind of logic in institutions that perpetuated it. And so often, it focuses necessarily on some of these moments where we're talking about, like broad ableist prejudice or things like that, but what I think is also so important, as you focus on, and I just sort of want to underline, is the way that the funding mechanisms themselves, right, that's also a huge part of the driver here, the political economy of health, the political economy of the total institution, and the kind of problem that it was supposed to solve, right, is ultimately a larger sort of big picture issue about who deserves what in society, and sort of a rejection of interdependence, and a sort of focus on the only thing that makes you valuable is your ability to work, right? And I think it's so helpful, the way that you frame your experience of Willowbrook, not just in terms of like the direct interpersonal violence that's happening, but in terms of the broader economic violence that's mandated by the structure of reimbursement itself.
Dr. William Bronston 26:57
Understanding this, it has to be understood as a universal reality that is going to ultimately define our lives as we age, because as we age, we become dependent in more and more ways. And at the point where we no longer can be sustained in our families, because our families have to work, they can't be with us all day long, whatever, you know, or cope with the difference of behavior or thinking or whatever, we wind up being put into nursing homes, into incarcerated facilities, congregated facilities, and essentially, you know, kind of turned into Soylent Green. I mean, that's where society is going. And the fact of the matter is that 100% of the population, 99% of the population is going to experience institutionalization. So the people that got out of Willowbrook as a result of the federal class action lawsuit, they didn't go out to the street, the federal court mandated the state to individually place in a proper individualized site, every single member of those 6,000 incarcerated people at that time until they die, and there's still 1,500 of them that are still left alive. But the ultimate irony, the tragedy, the outrage, is that 100% of them are going to be returned back to smaller institutions, the metastasis of the Willowbrooks of America because of aging, not because of the disability, and that is just so incredible. We are threatened, 100% -- the population is under dire threat of being essentially put back into incarceration as we age. We're dying early, in institutional living. COVID pulled out 40% of the workers and the people in the institutions, in the nursing homes, as a result of its infectious hammer, you know, and it just -- it's something that people have to wake up to. That's why the solution, the antidote to this crime, is universal rightful health care that applies to 100% of the population, with no cost of out of pocket, at the point of service, comprehensive services, and a rethinking of caring, away from commodity based, profit driven service.
We do not have a healthcare system, we should not refer to what we have as a healthcare system. It is a medical wealth transfer system, where there is services there, medical services, but not health care. And the reason in large part for that is that the public health system in America has been massively defunded and depowerized over the last 40 or 50 years, as capitalism has taken a grip of the medical delivery system as one of the most profitable centers of wealth in the entire economy. The medical delivery system in America consumes 18 plus percent of the gross domestic product. And despite that, despite that massive expenditure, 30% of the general population of America does not have the capacity to get good services. They either don't have any coverage, or they can't afford to use the coverage they have, because of the imposed deductibles, copays, billing, and the insurance costs for their care. So that little by little, and we're seeing it escalating as the system capitalizes, there is a remoteness and an alienation of the medical personnel, the medical workforce in our system. So it's hard to get an appointment, it's hard to get a sense of connectedness between various different problems that you're having, because people are complicated and they have different systems that require treating, you know, as we as we go along. The situation is is abhorrent and the only solution is for the general public to understand what's in its own interest, and to demand a different experience of being cared about, cared for, you know, in our society. That's why we have to think in a very radical way about ending all profit in medical services. All profit has to be eliminated, and people have to be returned back to being an asset in society, regardless of where you are on the spectrum of differentness.
Phil Rocco 31:59
That's actually where I wanted to jump in. Because, you know, you have been now in your career, sort of at the forefront of this movement in California for a model of this kind of healthcare system or pushing for a model of this kind of healthcare system that you are talking about. And it occurs to me that, you know, we've seen, I think, now I count something like over 70 different pieces of legislation across the country to try to create sort of single payer at the state level in something like about two dozen states, with varying levels of kind of legislative traction. And it occurs to me that like your theory of the case, your theory of what needs to change is, in some ways, slightly different, or has some commonalities with those efforts, but is also different and distinctive in certain ways. And also that your theory of power, your theory of how it's going to happen, or how these inequalities that are generated by the current political economy of healthcare that we have in the United States, are going to be changed. And so I wonder if you could talk about kind of where you see this model of care that you're talking about, in relationship to those other single payer efforts, and then also kind of how you see it being different in terms of your like political theory of the case.
Dr. William Bronston 33:23
So that's a very, very profound challenge, Phillip, and I really appreciate you opening that door. Because the single payer movement has been going on for a long time. Back in the 60s, there was a piece of federal legislation to establish a national health service in America. And by the way, the Veterans Administration is a very interesting example of a totally integrated service delivery system that is being provided as a national health service. That is, every worker in that system gets a check from the federal government. It's a single payer source. The federal government pays every health worker in that field, and all the people connected to the military have potential eligibility for whatever they need in the way of health care services.
And there's a policy issue that is an issue, for example, people that were exposed to very toxic chemicals, you know, in warfare or whatever, essentially can go to the federal government in order to demand eligibility for coverage and care for the problems that were created from those experiences in wartime or in the military experience. So the other piece of that puzzle is that there are models around the world, where peopl, where governments, essentially driven by either socialist leaders or the general public marshaling their strength in order to demand proper care, have established universal, single payer, national systems of care. And secondly, you have the question of whether or not the people own the system, or whether the corporate world owns the system for profit. If the corporations own the system, if they hire and fire, if they define the costs, whatever, then you have essentially a totalitarian governance over the medical delivery system, where the people getting cared for don't have influence over the way in which they're cared for. So where in the world is there a system where the people own the medical delivery system, that is the people own and generate a health care system that comes from their consciousness and their clear understanding of ownership and control over that system? The answer, Cuba. Cuba is the only real country where the people own the system. So when you look around at the progressive countries, I mean, there are countries around the world where you had socialist revolutions that were essentially being driven, and with those revolutions came medical services and health care owned not by profit driven corporations, but potentially by nation states. So that is an enormous transitional historical reality that we are living through right now. Because the whole issue of moving away from profit driven goodness in society is still in progress. For example, we have a public -- in America, we have a public education system, we have a public transportation system, we have a public fire department, we have a public army.
If we had a universal, rightful system in America, and that would mean that everybody would be in a Cadillac quality, single tier of care, which would not be defined by class or race or gender or age or geography, we would have a universal education system that would be tuition covered for the workforce in the field that would transform the cultural competency of that workforce, which now is heavily dominated by racial animus. So the single payer system in America for the last 40 or 50 years has been rigidly confined to the transformation of the financing of the delivery system, not the construction and the organization of the delivery system. And so we have spent, I spent a year with 40 of my confreres from around the country, people like ex presidents of the American Public Health Association, major leaders of medical organizations in the country, major activists in terms of health rights, to craft a comprehensive, comprehensive world class model of health care, predicated upon my experience in looking at the Cuban system, and being in Vietnam, and being in China, being in India, being a lot of places in the world, looking to Scandinavian systems, and my tremendous experience in the individualized framework of developmental disability services in America, where individualized planning is a crucial component. And that's where life time care comes from, to replace long-term care. Long-term care is the Medicaid financing to put people away into an incarcerated state until they die. Life time care is planning to deflect people from exactly that terminus, is to move people back into and to keep them into the most integrated, inspiring, respectful, identity preserving reality of their lives until they die. And so what we need to be looking at is creating communities. And that's where the whole notion of the original name of the model that I created was the California Life Time Care Health Act. And it is a website. It's called CALTCHA. It's the acronym, CALTCHA.org, or as I've advanced in thinking about this going national, I now call the model OurHealth.pub, dot P U B, dot public. OurHealth.pub. So if you go on your computer to OurHealth.pub, or CALTCHA.org, it'll take you to the same website, that it breaks down in various components, an explanation of the comparison of what we have now with what we ought to have.
And it is a push to stimulate the current single payer movement in America, which is highly fragmented, in many, many states and in many, many communities inside any given state, to rethink caring, to understand the need for where public health fits, to understand the need for deinstitutionalization, and decentralization of the current empires, because even the nonprofit medical institutions in our society, like for example, here in California, the University of California has a whole set of medical schools and a whole set of major institutions around the state, but they are empires, they are in separate areas of the state. They are usually built and expanded without public accountability to areas where economic development is the objective, where you have the criss cross of covenants and redlining to block racial integration in housing historically in America. You have the absence of medical facilities for care. And wherever you put a medical facility, you build an economy, instantly, restaurants, stores, a whole variety of support entities that come around any quality clinic that's invested. So Kaiser, and University of California and the major hospital organizations use their billions of stored secret money in order to capitalize the construction of medical services in the perimeter, in the rural and the suburban areas where they want wealth to be developed, not in the rural farmland areas, but in the areas outside of the inner cities, where there is mostly a white dominant population, which is where this emphasis on racial discrimination is so prevalent in our society. And so in any meaningful single payer system of health care, meaningful health care, that has to be absolutely eradicated. And if not even an ulterior effort to reparations in order to compensate for the losses that have been experienced over the last two centuries in America as a result of slavery and anti-Latino, anti-Asian, anti-immigrant animus that essentially grips and is shattering American society.
Beatrice Adler-Bolton 43:03
One thing that might be great to take a second to talk about is sort of what the vision of community health or community level health actually is, in this kind of life time care model, because I think it can be really easy to sort of hear community health and sort of think, okay, well, so we're thinking sort of standard range of nonprofit community health organizations, or, you know, I think folks are so used to sort of hearing lines like Medicaid expansion is part of the path to single payer, or you know, that community health is really important, and sort of all these frameworks, you know, there are all these kind of ways that we talk about community health, but it's not -- it's different than what you're talking about, first of all, but it also, you know, never really necessarily gets at like what the actual sort of point of these things are. And one of the ways that you talk about like community level health and life time care, it's not just sort of about setting up cradle to grave care, and making sure that everyone has access to it, regardless. It's also about where that care is located, how close that care is to the people in your life, can people get there autonomously and independently, or do you need to travel two hours to get there. And the sort of community level health framework also is really intentional in your model that you all have developed where the idea is not just to necessarily put things in the community, but to also give communities some direct control in terms of governing, planning, provisioning, etc.
Dr. William Bronston 44:37
Exactly. Exactly. So first of all, when I was a kid and I got sick, my mother would call either my pediatrician or my general physician, they would come to my house. They would come to my house with their bag, and they would take care of me. I wouldn't go to the office. I wouldn't go to the office. They would come to my house. In Cuba, the physicians essentially work in their offices in the morning from eight to noon, and at noon, they shut the door, and they start walking through their neighborhood where they live, and service 700 to 800 families in the immediate area of their office. And so they have data where they know exactly where everybody is with regard to their age, their medical conditions, whatever it is, they know. And they are subordinate, they are owned by the people of their neighborhood. They make the same roughly amount of money as the people in their neighborhood, their peers in their neighborhood and they're caregivers that essentially belong to the people.
So what we're talking about, first of all, is neighborhood, every county in America has a bunch of legal entities called neighborhoods. Neighborhoods are legal entities. And if we were able to mobilize neighborhood assemblies, in partnership with the local public health system in each county in America, in order to monitor, assess, plan, prioritize what kinds of services needed to be there in order to make people feel well, to ensure that people had civic engagement, creativity, wellbeing, security. Now, all of us at the deepest level, bear fear that we may not be able to cope with something going wrong with us. And whatever the system is that we have to put in place, we have to eradicate that deep-seated universal fear and insecurity that comes from not knowing for sure, A, if something's going to happen, that can't be addressed, and B, if we have to pay for it, which we can't afford, or may not be able to afford. So in a health care -- in a health care system, we have to be looking at food, transportation, housing, jobs, wellbeing, engagement, and integration and celebration of life as a manifestation of health and well being. Look at all the people, for example, that are hanging on to shreds, fragments of medical coverage, doing mind numbing work, security work, I mean, it just goes on and on and on, people that are forced --
Beatrice Adler-Bolton 47:32
Medicaid estate recovery, yeah.
Dr. William Bronston 47:33
It's incredible. If we had a rightful system, the liberation of energy back into society would be breathtaking. And so the issue is not what's it going to cost for us to transform our system, which is going to take some time to do once the policy is in place. The policy has to be in place. We have to have a law that requires universal single payer health care for every single body. And then the question of transforming this god awful thing that we have now, this barbarity that we live with, this fear mongering situation, this monetized, dehumanizing, violent system called medical care in America, you know, has to then be transformed into its exact opposite. The public health system is a system that operates in terms of looking at the whole of society. They see health care as a social phenomenon, not an individual phenomenon. So the partnership between the neighborhood assemblies and the local public health departments and the proper financing of the public health system to make sure that there are diagnostic labs in every county, to make sure that there is a comprehensive public health capacity in every county at the local level, at the house level, at the neighborhood level, at the street level, is crucial.
In Cuba, the system is organized in tiers from the home to the national level, so that every 10 square blocks there is a polyclinic, and then a specialty clinic begins to get organized at the higher level towards the larger provincial area, and so forth. And so the specialty clinics are not necessarily at the local level. They are as they're needed, as the population numbers grow, and especially needs become, you know, appropriate. And it's the same thing in other countries where you have universal health care promised, not necessarily provided. In Canada, for example, there's an organization called Doctors for Medicare -- Canadian Doctors for Medicare in Canada, which is similar to my organization here called the Physicians for a National Health Program, which is 30,000 of us here in the United States committed to driving single payer health care for the last 30, 35 years. We just had our 35th anniversary. And we have to have clinical people, not necessarily medical people, but clinical people, social workers, anthropologists, psychologists, nurses, working in the interests of the general public, thinking about the general population, and figuring out how to get services down to the individual in their home, in their community, so that people do not have to travel more than walking distance to get to where they need to in terms of services. And as you are confronted with the need to individualize services on a single tier basis, in our delivery system, you begin to think creatively about what people need and realize that the only way we're going to figure this stuff out is to somehow debrief the people, the people themselves. The public has to begin thinking about what they need to be well and secure, and essentially healthy, you know, in the broadest sense of the word.
And so the model that we created, the CALTCHA.org model, the OurHealth.pub model, which is on the website, is an attempt to try and radically expand the conversation nationwide, in every state and nationwide in order to grow and humanize and detail what health care is all about in our single payer legislation. So in the model, first of all, we need to think about the differences of different kinds of health needs in the culture. For example, the education system requires a different kind of a team, working with kids in school, whether you're talking about preschool, or college. The mental health community and addiction community require a special kind of a team. The homeless, the houseless people require a certain kind of a team on the street. Team, not individuals. Team, working together in order to cope with the social determinants that essentially influence and affect all of that.
The people in the rural community, in the farm worker community require a different kind of professional team working in that environment to deal with the realities of work, production, creativity, society in that area. And we need to essentially, globally budget all post secondary health professional education in America, globally budget every college and university in America that's training health workers for an exchange year for a year, for every year that we essentially cover the tuition for medical students and nursing students and dental students and psychologists and social workers and public health workers, for service in what we would call a National Health Corps or a state Health Corps, that would assign those individuals year for year to rural and urban health deserts, medical deserts, where right now they're missing services, they're missing hospitals, they're missing clinics. We need to redistribute the workforce and the workforce needs to be culturally competent, they need to be multilingual, multiracial, whatever it takes in order to identify with, to respect, to love and care for the people in their constituency. And as we put people into barren medical service areas, people will essentially lock into those communities. They'll build relationships in those communities as they care for their people over a period of 2, 3, 4 years that they had their tuition paid for as health workers, and we take profit out of the system and we take cost out of the point of delivery. Not even one penny should be charged because we know from our data, that if you put a penny cost, you reduce utilization. There's no reason in the world to force people to have to jump through any kind of a barrier or hoop to feel secure and well and fear free.
Beatrice Adler-Bolton 54:34
Yeah, I mean, you know, regardless of sort of how we deliver care, right, there's a market and an economy and wealth created for the nation, or the state, or the private company, or the individuals involved when someone gets medical care in the US, you know, to end the long -term care system and to actually stand up what was sort of promised in the Olmstead decision by the Supreme Court, that home and community based care would be prioritized and institutions would be closed and, you know, that would be made available, if we were to stand those kinds of things up, like life time care, it would functionally end the nursing home industry, for example.
Dr. William Bronston 55:20
Exactly, and the charity industry.
Phil Rocco 55:23
So I mean, this is, I think, where the challenge comes in, which is that you've had the ability to observe some of the, I guess I would say, political roadblocks that have -- that other campaigns for single payer across the country have encountered, right? There's only one piece of legislation at the state level that -- and it was really watered down, for single payer in the past, in Vermont, and then it was basically abandoned. We've had, you know, in a way much more modest attempts at reform in states like New York, Massachusetts, I think, compared to what you're talking about. So I'm kind of curious, one, kind of what your diagnosis of those -- I guess I wouldn't -- you know, maybe not failures, yeah, but failures to pass at any rate, and how you see that playing into the kind of organizing that you're doing around this model now, because it occurs to me that you're actually -- by being more expansive, you're potentially building in more coalition partners. And I'm curious, I mean, you're taking on, you're certainly taking on more enemies, but at the same time, you're potentially building in more allies. So I wonder if you could talk more about that.
Dr. William Bronston 56:42
You know, there's a number of simultaneous problems here, which people have to be able to tolerate. I mean, you have to be able to tolerate a certain level of uncertainty and impossibility here and understand that if you've figured out something that's impossible, it's worth devoting your life to it.
Phil Rocco 56:59
Right, right, right. Of course.
Dr. William Bronston 57:01
That's what the adventure in life is, so.
Phil Rocco 57:02
Yes.
Dr. William Bronston 57:03
So first of all, when you look at all elected politicians, the way they get elected is by raising hundreds of thousands, millions of dollars to get elected. Where do they get that money from? They get that money from the corporate economy, in large part. So first of all, you have a political body where the overwhelming majority of state and federal legislators are bought off, or they're blocked from really understanding, really wanting to understand the need for a comprehensive, non-capital based health care to live -- a public utility, a major public utility, that health care should be an asset, a public good. So the reality of that is very, very disarming for most people. Most people can't imagine going against City Hall. I mean, they have to understand that the only way this is going to happen is when the general public rises up, in order to demand well being and security, the same way that the general public has to rise up in order to demand a correction to our carbon economy. And in order to have a true health care system in America, we have to transform the carbon economy foundation of the medical delivery system. Now, what that means is that ultimately, we're going to have to go to a direct vote of the people in order to work through referendums, and propositions in states and necessary at the federal level, in order to bring this about. And we have to somehow figure out how to defend against the disinformation, the misinformation, the lying, the incredible threats that are going to be leveled against the population, by the cartels, by the medical industrial cartels, and by the big banks and by Wall Street, in order to protect profit in medicine, which is the largest hunk, short of the military industrial complex, of the American economy.
Beatrice Adler-Bolton 59:18
Well, I think also, in a way, there's a lesson to be learned here from your experience with Willowbrook, right? In your oral history, you talk about sort of coming to the realization of where the money was going, where all those federal Medicaid dollars were going, you know, that they were getting all this money to manage the services, to manage the building. Clearly, it wasn't going into the care itself --
Dr. William Bronston 59:44
At all. None of it.
Beatrice Adler-Bolton 59:44
At all, right. And you say, you know, the interviewer asks you, you know, so where'd the money go, and sort of what happened to it, right? And you say, "That's interesting. That's the mystery. That's the shell game. You have to watch where the money is under the cover of the shells that you're pushing around. We never could really understand where the money disappeared to. I never really saw. All this stuff was new to me. You've got to understand, I'm a doctor. I'm in there, I'm holding people, I'm hugging people, taking care of people, writing prescriptions, sewing up lacerations. I didn't really think about and didn't understand radical economic research. What I did find out, little by little, was that there was a whole economic, financial, big money aspect to what the hell was going on. That the institution at Willowbrook, that institutions in general were major economic centers that hired thousands of people, purchased millions of dollars worth of stuff. That these were all professionals that had to be properly ideologized in order to be complicit with this anti-social scheme, and feel and believe that they were doing good, and operate in compliance with policies of deprivation, and reduction of resources on a continual basis." And so that part, and the part of your story where you've mentioned so far in the conversation of like having to sort of get parents involved and work against the paradigm that the institution was imposing on parents in order to achieve the recognition that what was going on in Willowbrook was not okay, because one of the things that was done is when kids were put into these institutions, there were ways of sort of socializing that familial separation, right? Like kids were not allowed to see their parents for certain periods. Oftentimes, you know, there's all these accounts of parents requesting visits for their children in institutions and it being denied. You know, that kind of separation is part of developing the consent, right and maintaining it.
And so what I found so fascinating about this one sort of passage, right, is like you're going into this really not paying attention, not explicitly looking for these kind of economic pathways to emerge, and they become so obvious and what you you do, and what you and your colleagues do with the community of Willowbrook is sort of gradually together, unlearn some of these frames that are required and require all of this maintenance in order for folks to continue to be complicit in systems of the status quo. Because, ultimately, you know, there is broad support for single payer, there is broad dislike of how austere Medicaid is, right? And even 25% of Republicans -- I think there was polling as recently as like last year, that said, you know, 25% of Republicans would support eliminating private insurance and standing up state single payer, you know, you're someone who has seen kind of the worst effects of "public insurance," right, through the Medicaid institutional relationship, and yet, you're still willing to sort of trust in these larger models, in a centralized, single payer system. And I think that's really important, right? Because I think oftentimes, one of the things that I'm often asked by people is like, well, how do we trust that they're going to do it right this time, right? And the only way to trust that is by getting involved, literally, in shaping the policy.
But I think, Phil, to your point, you know, this framework, and the push to expand single payer, rather than to sort of make single payer more palatable, more appealing to the people who are already profiting off of these systems of extraction and our "system of healthcare," you know, rather than appealing to those folks, right, like if we sort of brought in the framework of what single payer is trying to do, and actually what it's trying to stop, disrupt, or sort of redistribute these economic pathways, that actually opens up single payer in a way that reminds me of the constituency that you all were trying to create in order to both expose what was going on in Willowbrook, and also attempt to begin organizing a coalition to close it. And you know, New York had no options other than institutions. It became like one of the most famous cases of deinstitutionalization in the country. It's certainly the most well known. And I think it really speaks to kind of the constituencies that had to be put together in that fight specifically, just in terms of understanding, you know, there were thousands of jobs at stake in the fight to deinstitutionalize New York, and a big question was public sector unions and what they felt and what the guards and the workers and you know, and it's a similar kind of relationship of dealing with people in current jobs who have economic pressures and incentives to kind of maintain the status quo, dealing with having to replan, you know, this is building a similar constituency of having to overcome, you know, ending certain industries, whether that's the nursing home industry, the private insurance industry, and also building new things.
And I think part of what a lot of like the kind of frameworks for single payer are working towards is just a very different understanding of building power and building coalitions. And what I think is most interesting about this model is actually, you know, as Phil pointed out, the kind of theory of power that's embedded here, which is that rather than look towards a kind of moderate third way, you know, across the aisle, center politics, this is actually more, turning it back on the third way and saying, you know, let's build the kind of constituency, not through respectability, or through moderation, but through really pushing this and really asking ourselves, how can this be expansive? And how can this be explicitly redistributive in the face of, you know, as you call, like this not being a healthcare system that we have in the United States, but a medical wealth transfer system.
Dr. William Bronston 1:05:51
We need -- so my origin is very emotional, very subjective. My approach to what I do is heartful, is purely heartful. I'm not interested in making money. I'm not interested in being wealthy. I think, if you choose to be a healthcare worker, the joy, the pride, the fulfillment has to come from seeing the transformation in other human beings that are struggling and suffering, from the result of your relationship to them. And we need to be thinking about how to humanize and generate the very best possible imaginative way of approaching caring, and the linkage of everything and everybody in society. We are at war. We are at war with the money making, profit driven, capitalist system. And to the extent that we can become aware and understand that driving for a self interested healthcare system, is the universal, profound policy that is going to build unity and community among the people. It is something that all of us need, all of us fear the need for, and approaching this thing, in an imaginative and inspired way, creative way. Connecting the arts to this campaign, connecting education to this campaign, connecting child rearing to this campaign, connecting working with the aging population in this campaign. Dealing with every conceivable communication channel in our culture, in order to imagine and create a caring world, a caring society and speaking to people's hearts, because everybody, everybody is fearful of the current situation and some believe that the status quo, preserve self interest, is fallacious.
It's a fundamental error in people's understanding of the forces that are interested in squeezing every dollar and squeezing our life out of us, because our lives don't matter to the corporate cartel community. They don't matter whatsoever. The lives of the people at Willowbrook did not matter. They were kept alive at the most minimal, minimal level of indifference in order to suck money out of them, in order to build Rockefellers' Albany -- marble and gold palatial office building in Albany. There was a budget freeze in New York when I first came to work at Willowbrook that essentially resulted in 1/3 of the budget of Willowbrook being transferred to build that Albany mall. When the death making reality and the fraud that the state of New York was perpetrating against the use of Medicaid dollars, which it essentially up coded people's disability to maximize federal reimbursement occurred, and it was clear from Geraldo Rivera's exposé on ABC television at the time, about the atrocities and the intolerable crimes that were being passively committed and actively committed at Willowbrook. The governor never, never came to look at the problem, and had been preceded by the gunning down of the prisoners and the guards at Attica.
I mean, the state in its current iteration is engineered by extremely wealthy, extremely wealthy people tied to Wall Street, tied to capitalism, tied to profit, tied to self interest. And we are faced, if we are to have a healthcare system in America, we're going to have to confront on a daily basis, in everything we do, that inhumanity, that criminality, because essentially, they are using our lives as a way of enriching themselves. The whole concentration of the billions of dollars of capital, in the hands of the Facebook people and the Tesla people and so forth, is all stored labor. Every dollar that is extracted in profit from production is prohibited from being used as a source of work production in our culture. And that contradiction is so grave, so sobering, so shocking, so implacable, that we have to be ready to speak to, engage with each other, build a sense of community between each other, in order to challenge and address those crimes against humanity, and to redistribute wealth in a meaningful way that will uplift everybody in society into a new world. We're living in a world so, so overtly, clearly suffering from deprivation. And I see people, I just -- I'm just -- I have this knot in my chest, you know, what can be done? What can I as an individual do? And what I can do as an individual is to change health policy in America. That is the ice pick. And your book, Health Communism is the theoretical foundation and explanation and historical analysis of exactly what that's all about. America has to wake up to justice.
Beatrice Adler-Bolton 1:12:08
Well, thanks, Bill, I really appreciate that. It means a lot that the book has resonated with you so much. I know, Phil had a question. I want to leave room for him to hop in real quick.
Phil Rocco 1:12:17
Yeah. And I think that what you're talking about here, Bill, is that many of the most important sort of barriers to reconstructing this political economy of health care come from within the system itself, right? It's really illustrative that as the productivity has failed to generate profits for capital, they've plowed more and more money into a system that they can call themselves nonprofits, and essentially use public programs as a way of generating a constant revenue stream, to generate so-called non-profit revenues.
Dr. William Bronston 1:13:00
Exactly.
Phil Rocco 1:13:01
And I think the thing that you mentioned earlier about, you know, there is this kind of uncertainty and risk aversion that even highly mobilized actors in politics feel, the sense that if we confront this system, we might get a worse deal, who knows, than the one that we have. And I think this is, you know, can -- you know, some sense that I might not like what I have, but, you know, gosh, it could be worse, right? That I often -- I mean, I hear it in colloquial speech, but I also think that it operates at a macro level. And to some extent, right, that risk aversion isn't just false consciousness, like it might even be rational, because you don't know who's gonna be in control of things and who might screw you over. But I think that the challenge that you're confronting, is how to build solidarity, because that's really the only antidote, isn't it, to the kind of fragmentation of our interests, is to build a culture of solidarity where people can see, look, I might get what I want in year one, or I might avoid some some negative outcome perhaps in year one. But in reality, if we don't actually attack this system head on and confront the things that drive it, rather than the symptoms, we're going to be here again, and probably we're not going to be here, but we're going to be in a much worse place in 10 years, which is I think why even countries with fairly advanced -- "advanced" systems of care provision or redistribution, are dealing -- are confronting the long-term care challenge too. And that's like -- I think the fact that that's a keystone of what you're talking about, is really significant, because it's not just the States where that is -- where that horror show that you described is extant. I mean, it exists elsewhere. And I think it's something that if we're going to do anything about care provision, like we have to -- that has to be part of the struggle.
Dr. William Bronston 1:15:04
I mean, let me just say bluntly, the system cannot be worse than it is or that it's getting. We cannot afford to continue on the path that we're on, because it's a relentless, expanding cost and a declining consequence in terms of caregiving. So, the issue here is seeing everybody in society as you. We have to move from an I to a we, and from a them to an us. We have to understand that everybody will benefit if we're all in the same pot together. But we have to begin looking at each other as family.
Beatrice Adler-Bolton 1:15:50
I think that's the perfect place to leave it for today. But this has been really nice, Bill, I really appreciate you walking us through everything in such detail.
Dr. William Bronston 1:15:58
I'm so grateful for your interest and your understanding of this field. I mean, you're asking questions that nobody is asking, and tolerating answers that nobody wants to hear [laughing].
Beatrice Adler-Bolton 1:16:09
Well, that's what we do best here, you know. Exactly. And if you want to check out Bill's book, it is Public Hostage, Public Ransom: Ending Institutional America. And again, you can check out the entire model at CALTCHA.org, or at OurHealth.pub, which are also going to be linked in the episode description. Patrons, thank you so much for supporting the show. We couldn't do any of this without you. If you'd like to help support the show become a patron at patreon.com/deathpanelpod to get access to our weekly bonus episode and entire back catalogue. We'll catch you later in the week in the main feed. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore and preorder Jules’ new book, A Short History of Trans Misogyny, coming January from Verso Books, or request them both at your local library and follow us @deathpanel_.
Dr. William Bronston 1:16:57
Bea, I would suggest that they pick up five copies of Health Communism and give it to their best friend. Don't just, you know, horde one copy. You got to spread this word around.
Beatrice Adler-Bolton 1:17:07
You heard it here first, right? Pick up five copies of Health Communism [Bea and Bill laughing]. And as always, Medicare for all now, solidarity forever. Stay alive another week.
Death Panel 1:17:38
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