Direct Action Casework and Health Care

After the conquest of Iraq, George Bush held a press conference where he said he would relieve the urgent medical situation in Iraq caused-he had to emphasize-by ‘a regime that built palaces when its people needed medicine’.

After the conquest of Iraq, George Bush held a press conference where he said he would relieve the urgent medical situation in Iraq caused-he had to emphasize-by ‘a regime that built palaces when its people needed medicine’.

Forget for a minute that the real cause of Iraq’s health crisis was that the US devastated the country in 1991 and imposed sanctions that never let it rebuild, and just concentrate on one simple point: that the US is supposed to bring medical relief to Iraq. The Iraqi population is around 22 million. Twice that number lack health insurance in the United States. So, who is going to bring medical relief to the US?

Cuba has a good, universal, public health system that they have managed to operate in a very poor country, responding to emergencies and even US-sponsored terror attacks. But, it is unlikely that the US will accept the Cuban model.

Canada’s health system is inferior to Cuba’s. In Canada, health insurance is public. But hospitals are private (though nonprofit), and doctors are private (for profit). Public services in general are inadequately controlled by the public, and this has enabled unscrupulous governments to de-fund the health system and try to introduce privatized health care. The drug industry is private, and exerts far too much control over research, development, and even medical practice.

For all its faults, however, Canada’s system is still far more efficient than the US system. Instead of trying to learn from it US health management companies are instead trying to destroy it and replace it with the US model of health care.

Some have remarked that if you tried to design a system more inefficient than the US health system, it would be difficult. Consider that for Canada in 1992, health spending is 10.3% of GDP, with public health as 72.2% of total health expenditure, resulting in universal health coverage. For the US in the same year, health spending was 13.2% of GDP, with public health as 43.9% of total expenditure, resulting in more than 40 million with no coverage at all.

This suggests that perhaps another export is in order: this time, from the Ontario Coalition Against Poverty (OCAP,

OCAP’s analysis of the current situation in North America was summed up by John Clarke*, an OCAP organizer:

‘In the years after the Second World War, corporations and governments adopted a policy of making limited concessions to the working class population. Unions were recognized and bargained with, social programs were incrementally strengthened, and living standards were allowed to rise. In return, union leaderships accepted having their organizations incorporated in an edifice of state regulated “labour relations.”

Strikes were permitted, but only on a limited basis and not within the life of collective agreements. A whole network of public and private agencies emerged to settle issues of social entitlement through “public discourse.” Protest still occurred but the earlier, explosive movements were replaced by much more limited forms.

Over the last couple of decades, we have now seen a new agenda develop that is dedicated to taking back the earlier gains. The bureaucratic structures of the unions, and the pervasive idea of limiting extra-parliamentary mobilization to the application of moral pressure, now act as a disastrous brake on social resistance. OCAP argues, then, for an end to the notion that we must still respect a social compromise that the other side has walked away from. We advocate a return to disruptive and generalized resistance so as to create a counter power to the neoliberal agenda and create the conditions for its defeat.’ (

Universal health care in Canada was one of the benefits of the ‘post WWII settlement’ that never got to the United States. Instead, the reverse is occurring, with the Canadian system under attack by private health care companies from the US, seeking to destroy the efficient system and replace it with one in which they can make profits.

OCAP’s day-to-day work is ‘direct action casework’. This is best explained by example. One recent example frequently referred to in OCAP’s public speeches is that of a man who got a job with a gas station. The gas station fired him after a week. He accepted this, but wanted the week’s pay. The company told him that they wouldn’t pay him for the week, because they were ‘training’ him during the week. He went to OCAP, who set up a picket at the entrances to the gas station.

The picket helped open the company’s eyes to labour rights, and the company paid the man for the week. OCAP does similar actions around welfare, immigrant, refugee, and housing rights. They are inspired both by the working class and unemployed worker’s movements all over North America in the 1930s, and by the Welfare Rights movement in the US in the 1970s (see Frances Fox Piven’s ‘Poor People’s Movements’);.

Direct action casework has many benefits. It offers a political solution to immediate and severe problems, helping people immediately. It offers small victories that build morale and hence, build movements. It builds solidarity between people.

All of these would be the case for a direct action casework movement around health care rights in the United States. Occupations and pickets of HMO offices, insurance offices, and public institutions where people are routinely refused health care aimed at winning health care in individual cases could help build a movement and organize a constituency that could eventually become strong enough to win universal health care in the US. In the meantime it could help many, many poor families avert disaster. If such a movement attracted sympathetic doctors, nurses, medics, and alternative medicine practitioners, it could simultaneously offer yet another emergency alternative for these families as they sought redress by direct action.

There are many reasons to think such a campaign could be successful. The presence of a constituency of over 40 million people who would have much to gain from supporting such a movement is one such benefit. Such a movement could be quite sympathetic to a still larger public, making it politically difficult to repress. If a national-scale movement could generate a crisis in the private health system that affected profitability severely enough, it might make replacing it with a public system an attractive option (unprofitable industries are usually ones elites are willing to allow to be public). The presence of working, viable examples of sensible health systems that are economically more efficient could offer a powerful argument.

Last, as OCAP has argued, the population has been facing a sustained assault for decades, and when it has fought back, it has been to try to defend gains made long ago. The health system in the United States could well be a political weak point. Isn’t it time to go on the offensive?

*John Clarke, Stefan Pilipa, and Gaetan Heroux are facing political trials in an attempt to destroy OCAP. Please find out more, and support this important organization (

Author: Justin Podur

Author of Siegebreakers. Ecology. Environmental Science. Political Science. Anti-imperialism. Political fiction.