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Health Care Politics: APHA Conference Report
by Allen Silverstone
From October 20-24, the American Public Health Association (APHA) held its 102nd annual meeting in New Orleans. The theme was a more progressive one than ever previously adopted as a convention topic: “The Health of Non-White and Poor Americans”. The more than 8,500 participants represented a cross-section of American health professionals, from doctors and nurses to social workers to community health organizers. There are enough interesting parallels with the AAAS to make lessons drawn from organizational experiences there relevant to the functioning of Science for the People at the AAAS Convention in January.
The APHA is a large, amorphous body with tendencies reflective of more progressive forces in health care than the AMA. Historically, the APHA was based in the military medical personnel, state health personnel, and federal personnel who weren’t military. Its conventions, in recent years, have been the gathering point for the progressive forces within the American health care establishment. It is a large body with no official lobbying mechanism. However, with a 1.2 million dollar annual budget (18% from the Agency for International Development), it has been able to mount conventions that are significant enough to attract presidential aspirants, secretaries of (not too much) Health, Education, and Welfare, and so forth. Its leadership carries weight within the various advisory mechanisms for health policy at the state and federal level. By contrast the AMA, a much smaller body, is much more influential. Firstly, the AMA represents a more homogenous class grouping, chiefly physicians in private practice. Because of this homogeneity it can represent the distinct economic interest of this very privileged minority. The APHA, on the other hand, represents all aspects of the health profession, from the lay practical nurse to the physician in public health, and even many private phsyicians. Secondly, the AMA has set up a “separate” body, AMPAC, which funnels huge sums of money into legislative lobbying, the election of candidates, and public propagandizing against “socialized medicine”. The huge sums of money that it raises by stiff dues assessment make AMPAC a powerful political force. Only the AFL-CIO (as a single entity) outspent AMPAC in the 1974 elections, and then, not by much. Even though most of their candidates lost, the amount of money and the coherent economic interest AMPAC represents will make it a powerful (a negative) force for defense of private fee for service medicine in the coming years,
A second grouping within the APHA organization is historically more recent, and actually reflects the political movements of the late sixties. There are Black, Latino, Puerto Rican, Asian, and women’s caucuses. These hold official meetings that are announced in the APHA program, elect officers, and establish communication networks for the year. They make sure that certain sorts of papers are presented in various sessions, and organize “soapbox” sessions on themes they feel are being neglected. In fact, the theme of this year’s convention was established by demonstrative action from the Black Caucus confronting the official APHA governing council. These forms are not present in the AAAS… probably because science is a much more racist institution in this country than the health profession (and if that isn’t an indictment). The caucuses had to demand and win their official position within the APHA structure (it was not a gift of an enlightened bureaucracy). SftP might consider winning such a role within the AAAS, if we can learn to use that position effectively, rather than being co-opted into being a sort of “loyal opposition”.
The major sessions of the APHA convention were the plenaries. The opening plenary was addressed by Dolores Huerta of the Farmworkers Union, Sargent Shriver (who called on the APHA to replace the AMA as the voice of American medicine), and Jesse Jackson (could you imagine AAAS opening with a similar gathering?) Almost 8,000 people were in attendance for this talk, in which Shriver struggled mightily to compete in militancy with the other two speakers. It was a strong note to open on, but without immediate sessions to follow up on the themes raised by the speakers, much of the impact was lost. Another major plenary was held on “women and health”, in which Dr. Helen Rodriguez-Trias gave a speech emphasizing the problems of Puerto-Rican women and therefore strongly linked the problems of racism, chauvinism, and male supremacy within the health profession. Again, immediate follow-up sessions would have strengthened the impact of such a talk (attended by more than 2,500 people), but it was not to be.
Another large scale session was held on the question of national health insurance. It is in examining this meeting that we can see a good model for linking plenary session turn-ons with concrete action and organization. The speakers were Malcolm Todd of the AMA, speaking in behalf of the AMA’s proposed Medicredit plan; Peter Fox from HEW speaking on behalf of the administration’s C.H.I.P. (comprehensive health insurance plan) program; Max Fine speaking on behalf of National Health Security (formerly known as the Kennedy-Griffith’s Health Insurance plan); and Ronald Dellums speaking on behalf of legislation he is proposing to introduce to Congress next year creating a national health service and abolishing fee for service medicine. The almost 2,000 participants responded in interesting fashion to the speakers. The AMA spokesperson attempted to say the right things in terms of what was needed, but then proposed the AMA remedies which, if not fascistic, are certainly irrelevant to meeting the health needs of the American people today. He was booed mildly. The administration spokesman was worse than the AMA man. He offered nothing, and in fact proposed cuts in already inadequate services. The response was gratifying. He was almost shouted down and many paper airplanes were seen flying through the room. Max Fine spoke for the general aims of the Health Security Bill (a bill which Kennedy merely sponsored… it was drafted by trade union people and progressive medical faculty people). As many people know, Kennedy withdrew his sponsorship from this bill to co-sponsor a bill with representative Wilbur (swim in the lagoon) Mills. This bill was merely a rationalizer of the administration’s bill which the major insurance companies would surely love (since they wrote it). However, the trade unions refused to support Kennedy (though academics such as Adam Yarmolinsky did), and many congressional people continued to keep the Health Security Bill on the fire. Fine’s presentation earned a mild applause, especially when he polemicized against the regressive features of the AMA and administration plans. Dellums, however, ignited the audience. He outlined what was necessary for a decent, people-controlled, totally inclusive, non-profit-making health care system. He contrasted his program against the weaknesses of all the other plans. He then declared he was going to introduce legislation that would cover the key points for creating a national health care system, and called on the APHA to help him win such a measure. He concluded by pointing out, in dramatic fashion, that every member of Congress already enjoys the total benefits of health care his “radical” bill would provide. The response was electric. More than ¾ of the room stood and cheered wildly (i.e., more than 1200 health professionals whose privileged position is, to some extent, threatened by such proposals… but whose ability to deliver health care for the people would be immeasureably enhanced).
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Immediately after Dellums’ talk, there was a work meeting, where those who had drawn up a draft legislative piece summarized their work briefly, and then solicited volunteers (more than 200 people volunteered at this meeting for work on one or more sections). Also, Dellums met with the representatives of all the caucuses, and, in a hard business like way emphasized how this legislative piece would change the whole character of the health care debate in the U.S. Congress, how it would raise issues untouched by all proposed legislation (occupational health, environmental health, special health needs of nationally oppressed peoples, financing of health care, and the possibility of nationalizing drug and hospital equipment companies), and therefore turn the debate from a constant right-wing gavotte from Health Security to Medicredit, to a debate in which Health Security is a moderate position. The caucuses were receptive, and have become active in the campaign around preparing the Dellums bill (those interested in working on the bill can contact Mike Duberstein in the office of Ronald Dellums, U.S. House of Representatives, Washington, D.C.). It is in directing a plenary toward creating a movement around a specific issue, that we can see how the format of such gatherings as APHA or AAAS might best be used.
Another significant activity at the APHA convention was the organization of a Cuba-Chile information project. This activity was organized by the U.S. Cuba-Health Exchange (U.S. CHE), based in New York. The organization paid for a booth ($400), and staffed it with members of the organization who were attending the convention. The booth had a large display, gave away thousands of pieces of literature, and generally outdrew most of the corporate and federal agency booths. Two sessions were organized by these people, one on Chile, at which two refuge Chilean doctors spoke, contrasting health care in Chile under Allende, with health care now. The second session was a report back from a medical delegation to Cuba. Both sessions were well-attended, and the presence of some hostile people plus many unfamiliar faces indicated that good new agitation was accomplished by the sessions.
Through much of the meeting, sessions of the Executive Council were going on. These voted on resolutions which had been previously drafted on a variety of topics. Like the AAAS, APHA is hide-bound by deadline rules on submitting resolutions. However, there was some sympathy to suspending the rules to introduce a resolution on, for example, behaviour modification. This sympathy stemmed from a strong threat from the Black Caucus, as well as many concerned individuals that action ought to be taken on this theme. (Unfortunately I do not know what transpired around the resolution once it reached the floor). Again, the most effective action for radicals to win through to such positions is to be tightly connected to an organized form, such as a caucus, and act, within the council, as a spokesperson for such a caucus.
Nevertheless, our caucusing within the AAAS may be said to have motivations similar to those involved in organizing a caucus within the APHA. That is, the conventions are exceptionally large gatherings at which one can, within the framework of opportunities unwittingly (or consciously) provided by pseudo-liberal leaderships, raise issues more pointedly and to a higher level, organize more communication and co-operation between progressive forces, and confront those who do wield actual advisory power to the government with the bankruptcy of their position, and push them a little further toward either some genuinely progressive position or a genuine break with the power structure. Furthermore, both the APHA, and the AAAS have adopted “progressive” themes in this year, and, for APHA, the next. Leaning to work within the framework of such themes would seem to be an important step for us.
There are several organizational features of APHA which are worth examining. Basically, APHA is officially organized into 24 “sections”. These range from community health planning, to environment, to health administration, to laboratory, to maternal and child health, to medical care (the largest section), to occupational health, to new professionals (a special caucus representing Black and Latino health workers), to school health, to statistics. The sections each set up a program of sessions for the convention, at which papers are given in the topic area. They also have one to three business meetings and some sort of social affair which raises the funds for the coming year. Some of the sections are very progressive, such as the new professionals or occupational health. These sections frequently have non-health people speaking to their working sessions (e.g., Tony Mazzochi of the Oil, Chemical and Atomic Workers Union was an invited speaker in an occupational health session on Environment, Politics, and Health). Some of the sections have elected people with whom Science for the People has a working relationship. The next convention, scheduled for Chicago in November, 1975, has, as its theme ‘Work and Health’. This topic will be heavily influenced, in all sessions, by the Occupational Health section, which is influenced strongly by people who have written for SftP in several issues. Already people are considering what sort of sessions could be suggested to other sections, and what can be organized within their own section to emphasize a pro-people approach within this theme. It should not be presumed that there is not some sort of struggle within each section, or between sections. I attended a session on “What Every Public Health Official Should Know About Nuclear Power,” sponsored by the radiological health, epidemology, and occupational health sections, which was mainly an apology and defense for using nuclear power plants (since other things are proven to be more dangerous). What is important is that progressive people can strongly influence the agenda of the working sessions by organizing to give good papers.
APHA in many ways is similar to AAAS. However, it has one great advance. It has significant, organized participation from third world people. The racism of the training structure of American science has thus far prevented such caucuses from appearing at AAAS. We should be interested in attacking such racism, and winning commitment from AAAS to do more than promote Equal Opportunity. As in all education today, the fight against racism is the central touchstone around which we will successfully advance — or fall into fascism. In addition to this fight, we must also struggle against sexism (again, a disease more serious in science than in the general level of health professionals represented by APHA), and elitism. We should consider bringing nonscientific people, especially trade unionists and third world people into the AAAS convention to set down their agendas of needs. The theme of the convention makes this legitimate. It is not up to a scientific elite to define what makes the quality of life… it is up to us, as radical scientists and people interested in science to bring together a coalition of masses of people to demand of science and scientist a true Science for the People.
In sum, I am not recommending legislative action, or any other single panacea for our role in AAAS or APHA. Legislation, especially legislation that radicals write and organize around is valuable, but only valuable in being part of creating a mass movement. Similarly, it would be important for us to strengthen the role of SftP as a caucus at APHA, but not with the aim of “taking over” the leadership of the organization (an illusion at best, but a misdirected aim that could prevent us from addressing how to build a radical science movement, at worse). Rather, a caucus would act to mobilize progressives, bring them together and give them direction toward concrete programs and activities. As a grouping an effective caucus can educate and agitate for a true Science for the People, and expose what is not at all Science for the People. Similarly, we can educate about imperialism, and how it uses and misdirects science, by relating it to people’s work. We might consider uniting people around progressive legislation of specific relevance to science. For instance, there is a debate about how scientists should “advise” the government, now that the Nixon negativism is being replaced by the Ford-Rockefeller co-option view. What should be our stance in this debate? Can we concretize our view from agitation to legislation? These are questions for collective exploration.