October 27, 2009

CHART-ing the way

Campus health care activists should shift their focus toward the bigger picture.

This summer, University of Chicago students helped maintain and expand the most ambitious campus organization project to date: the Coalition for Healthcare Access Responsibility and Transparency (CHART). Born amidst the controversy over the U of C’s attempt to transition the University of Chicago Medical Center (UCMC) away from primary care, CHART has consistently advocated for making an expanded commitment to primary care for both students and residents of the South Side. Remarkably, CHART has formed a wide coalition that includes student and community groups, as well as labor organizations, and has organized rallies, protests, teach-ins, and speak-outs. Everything that could be done has been done, and yet the administration of the UCMC remains as intransigent as ever. How, if at all, can CHART succeed?

The question of strategy is fundamental to answering this question, insofar as it is clear that CHART—like most contemporary activism—is deeply lacking in it. This is not to say that they are not protesting an extreme problem. The South Side is statistically the unhealthiest population in the United States, as the UCMC readily admits. Moreover, the University has been shockingly unresponsive to its own students’ concerns over the rising costs of health care and long waits at the Student Care Center for general appointments.

But the real problem with health care, which is endemic to society as a whole, has not yet been addressed as a social problem, but as a University-specific problem. By confusing a general problem with a particular instance of it, CHART appears to act on the effect of the problem while loosing sight of its cause. Even CHART’s reductive analysis appears inconsistent with its own tactics, which have centered on protesting the UCMC’s Urban Health Initiative. In CHART’s populist reasoning, it seems, the University is simply a greedy rapscallion that wants to cut resources to the poor. Perhaps, but if the University is so bad, its leadership would have to be overthrown and replaced—a tall order that CHART has not set as its goal, let alone reached the capacity to achieve. Rather, CHART hopes it can pressure the University to make morally virtuous financial decisions by appealing to values such as equality and fairness. But the University is not organized to be fair, and is certainly not concerned with equal provision of health care to area residents. It exists to advance its own agenda in terms of biomedical research and higher learning; it was not meant to prop up a decaying national health care system, and now it is not pretending to do so anymore, it is simply laying its own priorities on the table.

Now, the very real social problem of health care reform remains. On this issue, CHART has remained publicly silent. However, the group would be remiss to ignore the national, if not global, dimensions of the health care problem, because a national solution to the problem would obviously be to CHART’s advantage. And it is not as if Congress or the President could possibly make substantive reforms without a progressive social movement demanding them. At present, there is no such movement: There are small groups, organized around specific issues like single-payer health care, that are weak and fragmented. This weakness and fragmentation in turn weakens the public’s understanding of social problems and the means by which they can be solved: The key flaw of the American health care system appears to be merely the preponderance of insurance companies and other private interests—like the University. It is not seen as a structural problem faced by society as a whole.

This problem could perhaps be surmounted by a nationwide student movement, in coordination with organized labor, to push for what we might now consider a utopian goal: the universal establishment of open-access clinics, salaried and provisioned by the federal government but responsive to the health needs of local constituencies. There is nothing technically impossible about this, but it would require political leadership that could counter the domination of capitalist interests in the health sector. It is on this point that Obama is floundering, because while he demagogically speaks of “big money” interests, he is nevertheless pursuing a line of least friction that has resulted in the deterioration of the idea of universal health care.

Right now, the key political obstacles seem to be capitalist interests in the health care sector and the moderate elements of the Democratic Party, which have gutted the idea of social provision of health care and have reduced the current reforms to dubious half-measures. Institutions like the University of Chicago, and even the disjointed Republican Party, seem to be derivative agents. Blaming these institutions misses the point that it is under the ostensibly “progressive” leadership of Obama and the Democrats that the attempt to achieve universal health care is being degraded. The situation is compounded by the complete absence of any political opposition to the left of Obama and the center-right Democrats.

Although there is still wiggle room to win community claims on health care access from the UCMC, a real solution to the health care problem on the South Side (and around the world) must come through demanding the idealistic goal of socialized health care. In order to win this, it is necessary to mount a political opposition to the left of the Democratic Party. Otherwise, any attempt to solve the health care crisis will be stymied by opposition by the Right. Without this, any victory that CHART wins will be highly limited. Moreover, it will have missed the opportunity to transcend its own particularity and contribute toward truly progressive social change. The pragmatic community organizer may retort that my suggestion is impractical and hopelessly utopian. But it is only in being utopian that students can prepare the ground for change that, though impossible today, can be realized tomorrow. Although, as students, we cannot solve these problems ourselves, we are in a unique position to use our critical faculties to think beyond the narrow confines of the present, and to propose real solutions to the big problems that affect us all.

Greg Gabrellas is pursuing a degree with the Master of Arts program in the Social Sciences and is a member of Graduate Students United. He graduated from the College in 2009 with a degree in anthropology.