Radical Medicine

In the last edition of Random Lengths News, we highlighted the work of San Pedro’s Harbor Community Health Centers in the wake of the state’s expansion of MediCal. In that story we got a small sense of the cradle-to-grave care single payer advocates are demanding. 

For this issue, Random Lengths News interviewed Dr. William Bronston, the face of the Physicians for a National Health Program and author of the book, Public Hostage Public Ransom in which he offers his account of his experiences as a staff physician at the infamous Willowbrook State School in Staten Island, NY. 

Bronston was a key figure in the federal class action lawsuit against the state that ultimately closed the institution in 1987. Having been closed to admission by public scandal and impossible overcrowding, families were blackmailed to have their developmentally challenged, dependent member submit to secret viral research whose impact was completely unknown, where rampant disease, gruesome sanitation, lack of adequate food, clothing, carloads of tranquilizing medicine and the most minimal care and supervision is the brutal norm.

Nearly half the book is Bronston’s memoir whose early professional training in top Los Angeles Universities in the 1960s steeled him with a deep moral, professional, and cultural bond to Willowbrook’s 6,000-person incarcerated body, a population filled with the developmentally challenged. Bronston helped provide an inside look into Willowbrook to local investigative journalists and was a key interview in the Geraldo Rivera televised documentary of the institution in 1972.

After completing his undergraduate degree in contemporary history with a minor in contemporary art history, he attained a degree from USC’s School of Medicine. Bronston completed an internship at Children’s Hospital of Los Angeles where he had been a fellow for all four years at USC, working for Dr. Richard Kock, who headed the child development department of Children’s Hospital.

“He [Koch] was really a leader and had established the Regional Center system with Assemblymember Frank Lanterman back in those days based on his model work,” Bronston explained. “And so my whole experience, while I was in training, had to do with deflecting people from institutionalization based on my work with this particular department in Children’s Hospital, which was aimed at supporting families to keep their kids at home with enormous multi-professional support from psychologists, Public Health nurses, speech and hearing therapist, etc.”

Bronston had received a draft notice during the Vietnam War but wound up a conscientious objector. So as an alternative to military service, he did his psychology residency at the Menninger School of Psychiatry in Topeka, Kansas.

After Kansas, Bronston went to New York where he became the medical officer for that branch of the Black Panther Party. He had recruited 40 of his peers whom he had formed into a national organization arriving in New York to do their internships and further their training. 

“We had doctors in every hospital in New York City. And so we can handle anything surreptitiously if somebody got shot,” Bronston explained.  “Whatever it was, we could handle it medically and we had access to an endless amount of medical tools that we “liberated” from the hospitals in order to do iron deficiency screenings and a whole variety of other activities that the Panthers were involved in.” 

But after two years with the Black Panther Party, he needed a job. 

From Radical Medicine to Willowbrook
When Bronston was a senior, he helped organize the USC Medical Student Forum with sophomore Michael McGarvey and advice from former members of the Association of Internes and Medical Students (AIMS). The USC Medical Student Forum was a series of lecture forums featuring many influential figures covering a variety of topics in medicine. These included a forum on the legalization of abortion featuring Planned Parenthood president Alan Guttmacher, and a forum on the health effects of Jim Crow laws featuring civil rights activist H. Jack Geiger and others including Michael Harrington, Thomas Szasz, and Benjamin Spock.

Inspired by the success of the forum, organizers also began the student newspaper, Borborygmi (meaning “stomach rumbles”) in 1964, which featured essays and editorials centering on medical students. In January 1965, Bronston and McGarvey transformed the lecture forums into the Student Medical Action Conference (SMAC), which integrated the forums with praxis by organizing various social and political public health projects ― hence the health clinics under the Black Panther Party in New York. 

It was this pedigree that coalesced around Bronston while he was at USC that got him the job at Willowbrook State School.

“I knew they wouldn’t check my credentials and they didn’t and so there I was absolutely stunned at the horror of the place given what I was used to in terms of the opulence of services to that community from Children’s Hospital in Los Angeles,” he said. 

“We need to have a revolution in health care provision,” the octogenarian said, filled with the same level of passion and vigor for medicine and helping the disadvantaged as he must have had when he was in his thirties. We need to establish universal… rightful public… single-payer healthcare as the strategic solution to most of the major problems in our culture.” 

The Future of Healthcare
Bronston reasoned that if we had publicly supported comprehensive healthcare services instead of what he describes as a “medical market system,” it would fundamentally change everything in society and our relationship with one another. 

Part of the problem, as he sees it, is this enormous alienation of a large part of the community most in need of care from the general population and devaluing of “unwanted” people ― people such as the developmentally disabled, people living with mental health conditions and seniors who often can check off all of the above boxes if they live long enough. 

Bronston identified the book, Health Communism, by Beatrice Bolton out of Pittsburgh, Pennsylvania. In it, she talks about how the “surplus population” is monetized and exploited.

He argues that the offenses perpetrated by the medical delivery system are just beginning to infuriate people.

The 84-year-old doctor noted that every single one of us has a relative who has, one way or another, been abused by the system or is having trouble getting medical appointments or seeing a doctor or having any coordination between anything that needs to be coordinated between various systems in our bodies. Whether pulmonary, circulatory, or oncological. 

His advancing age accompanied by growing health needs seems to have caused Bronston’s passion to be infused with the utmost urgency. 

Bronston said he has about 10 different specialists who address his various medical issues, including his prostate, hypertension, non-Hodgkins lymphoma, but those doctors don’t talk to each other. 

To get care, I have [to] in large part go to an empire… a concentrated hospital facility that… is not where the services are most needed,” he said.  

Bronston explained that the Americans with Disabilities Act has a requirement every three years for every single nonprofit hospital to produce a comprehensive assessment of the health circumstances in their catchment area with specific instructions to identify the negative health outcomes and exactly how they’re going to address those negative health outcomes. 

Bronston cites Cuba as having the most ideal service delivery system on the planet. 

“Cuba is owned by the people, the men at the medical system. They’re owned by the people. All health education is provided by the state,” Bronston said. “They have 22 medical schools and the 22nd medical school in Cuba has 20,000 students. None of them are Cubans. All are from poor countries all over the world that the Cuban people support and train and return to their societies to work in poor underserved areas from where they came.” 

To get there, he points to the website, caltcha.org (California Life Time Care Act). He renamed the website OurHealth.pub to simplify it and to generalize it so that people understand what “our” means and what “health” means simply in the most direct way.  He said the original title was the California Lifetime Care Health Act because he wanted to introduce the concept and the language of “lifetime care” as opposed to long-term care as a shift away from Medicaid to remodel the model over the past three or four years. He admits he hasn’t quite been successful at it just yet. 

Bronston said the website is a draft policy model for an ideal healthcare delivery system that invites expansion and that invites improvement by people interested in and concerned about an ideal healthcare delivery system. Still, the movement is not willing to take on the responsibility of crafting the ideal delivery system. 

Bronston said that those who are interested in seeing the fruition of a true single-payer health system have locked onto Pramila Jayapal’s House single-payer bill and Bernie Sanders Senate single-payer bill, and the California Nurses Association Cal care bill and the New York State organizations group of New York Healthcare.

“In 17 or 18 states around the country there are already models of single-payer legislation, but they are gravely incomplete,” Bronston explained. “They don’t deal with the need for a revolution in the workforce. They don’t deal with the 41 million caregivers who are not paid to care for dependent members of their families, even at the expense of going to work. 

They don’t deal with the need to deinstitutionalize and return services to the home and the neighborhood. They don’t think creatively about normative healthcare. Somehow or another, those 17 or 18 other state models have locked onto a very limited 20 or 30-year-old paradigm of single-payer healthcare that hasn’t changed or been expanded other than the many loopholes that have been inserted to preserve Kaiser’s insurance system. 

“So Pramila Jayapal’s bill was a clean bill and most of that has come from the work that my organization the Physicians for a National Health Program have engineered and led nationwide,” Bronston explained. 

Bronston doesn’t have much hope for the self-entitled advocates of single-payer health care, people he calls “corrupt, chickenshit guys.”

They have the lobby money to go forward, Bronston railed. “Like Richard Pan, who’s running for mayor here in Sacramento who is responsible for driving home the progressive legislation around vaccination.” 

Bronston said the legislation was corrupted by the pharmaceutical industry from which he takes an enormous amount of money… “and he’s opposed to single-payer… a doctor opposed to single-payer.” 

“Our Congressman Ami Bera who was the public health fucking director for Sacramento… he’s opposed to single-payer. These are chickenshit, corrupted guys that apart from the fact that they’re doctors, are essentially taking big lobby money to keep their trap shut and to not talk about this.

Bronston highlighted a recently released report about how equity finance firms are taking over medical delivery systems and the negative impacts it’s having on patient care. 

“Despite this clear target and articulation [00:39:13] of the problem, they deflect saying that we need a single-payer system to solve the problem systemically,” Bronston said. “We need a piece of legislation to establish a single trust fund with 100% of every health dollar in that trust fund that essentially would be billed by vendors who are providing services to people, whatever they need, whenever they need it, wherever they need it from whomever.” 

Bronston noted that his medication for his lymphoma is $15,000 a month for a single bottle of 60 capsules. 

“The barbarity of it! The greed of it, the corruption of it, and then you have every major corporation, all the major insurance companies, all the major pharmaceutical industries all the major hospital cartels spending millions and millions of dollars in punishment costs for corruption that are being pursued by governmental monitoring agencies for missed billing for essentially not doing what they say.” 

Bronston said medical schools are now training students to upcode to maximize reimbursement. 

“It’s all about money, all about money. We have to get the money out of health services in order to save ourselves,” Bronston said.

Public Hostage Public Ransom: Ending Institutional America” available at amazon.com, ebay, Barnes and Noble.com