Conclusion

Kotelchuk, Rhonda, and Levy, Howard (1986). The Medical Committee for Human Rights: A Case Study in the Self-Liquidation of the New Left. In Race, Politics, and Culture: Critical Essays on the Radicalism of the 1960s. Reed, Adolph, ed. New York, Greenwood Press.

Conclusion

For the decade between 1964 and 1974 the MCHR was the standard bearer for the health left. Though often standing in quicksand, it still has claims to success.

The MCHR was an important, frequently effective ally of the civil rights movement. More than any other organization it alerted the health community to the truth about the war in Southeast Asia. It acquitted itself well throughout by allying itself with the weakest, most oppressed and despised members of American society. More often than not its heart and muscle were on the right side at the right time.

Internally, for all its faults, the MCHR could boast of accomplishments that no other health organization could claim. Even in its days of greatest doctor domination, it opened itself to other health workers and to those outside the health-care system altogether. It issued an early challenge to a racist health-care system both in terms of its delivery of care and in terms of the treatment afforded minorities within it. Almost alone of all health organizations, the MCHR saw the sexism within the health community and strove to banish it from within the organization.

Finally, the MCHR was hardly alone among organizations, either in the health movement or in the movement generally, in its inability to come to terms with the two critical questions: who was to be its constituency and what was to be its strategic thrust? The long MCHR experience, in both its positive and negative aspects, brought some MCHR activists to understand the importance of focusing their energies on a limited constituency of middle-level and upper-level health workers in the setting of those growing bastions of power and resources---America's health institutions.

The MCHR experience did not, however, point the way past this most elemental step in understanding toward a strategic path which might lead to the objective of a health-care system humane to both its workers and its patients. To do this, we believe, will require at least two tasks, both analytical and to some extent abstract in their nature and both, we fear, going against the grain of the impatient, action-oriented movement of the 1960s and 1970s.

The first task is that of concretely analyzing and understanding the health-care system, including both an overview of its political economy, and an analysis of how it more immediately shapes the values, perceptions, and relationships of the workers and patients upon whom it impinges. At the level of an overview, it is hard for us to imagine a successful movement which has not addressed such questions as: By what forces or combinations of forces is the health system controlled? Is it by doctors? by administrators? by banks? by insurance companies? For what purposes is it controlled? profit? social control? empire building? What is the relationship of the health system to other controlling interests in American society, for example, to multinational corporations? to finance capital? to labor unions? What role does the government play? Is it simply a handmaiden of the controlling interests? a mediator of them? an independent force? Clearly these questions are only suggestive.

Likewise, at a more immediate level, it is hard for us to imagine a health movement serious about health workers and institutional change which does not have a firm understanding of such questions as: How has increased technology, specialization and corporatization affected the role definitions, the self perceptions, and the felt needs of health workers? Is their course, and with it the course of increased fragmentation and alienation of the workforce, unalterable? What forms of resistance and rebellion have different workers' groups taken and what are the implications for the workforce as a whole and for patients? Can trade unions deal with such wide-ranging issues? Are they necessarily limited vehicles for worker defense? Or contrariwise, do they serve to regulate the workforce and integrate it into the designs of management? To what extent can worker concerns mesh with those of patients and to what extent do they conflict with them?

Finally, the success of the health movement as well as of the movement at large rests on one last and possibly more difficult analytical task. We believe that the movement must apply equal intellectual and analytical rigor to itself---its own forms, styles and modes of organizing. For it is only in doing this that the movement can effectively focus and conserve its precious energies and resources, and not squander them in impulsive reaction, outmoded models and acting out unconscious needs.

At least three serious obstacles stand in the way of accomplishing these tasks, particularly the latter. The first is that, needless to say, activists obviously have large personal stakes in the struggles and organizations of the 1960s and 1970s which, much rhetoric notwithstanding, inhibit candid criticism of political practice. Indeed, not unlike the establishment, movement organizations structure themselves to ward off criticism.

An even more serious obstacle, we think, is an anti-intellectualism woven into the very fabric of the movement, stemming from a paradoxical and often unconscious amalgam of American pragmatism and Marxist historical determinism. From American pragmatism comes an ethos of "nothing succeeds like success" and "what works, works." Moreover, this philosophy dictates that what "works" will be found in action, not words, although in practice the action more nearly resembles trial and error. From Marxist historical determinism comes the assumption that socialism will emerge inexorably from the contradictions of capitalism and that individuals can only hasten or hinder the course of history, not alter it. Thus they are also relieved from the responsibility of determining it. Together these two traditions undergird the tendency for the movement to mindlessly laud any and every activity, project, and organization as signifying success by their very existence and hence bringing the movement that much nearer to final victory. Likewise, they underlie the tendency of the movement to recoil from sober evaluation of its activities in the context of larger directions. Indeed, not to accept the very existence of these activities as signifying success, to even press the need for sober evaluation, is likely to cast the critic as a defeatist when, in fact, he is like the proverbial messenger who must suffer the conseguences of the message he brings.

The final obstacle is the absence of an intellectual tradition in the American Left which, when activists finally recognize the need for theory and analysis, makes them susceptible to the formalistic and outdated answers lifted from the Marxist classics and mechanically applied out of time and context to twentieth century America.

Not to address and overcome the antiintellectual and unreflective undercurrents described above guarantees a future resembling the past, where the movement responds to rather than directs the course of history. Indeed, it is as if activists have stood attempting to discern the first swell of a wave, have leapt on and ridden it as long as possible, and then have been cast on the shore to have the process repeat itself; and at any point in time, success has been measured by the height, splash, and roar of the waves. Rather, we would suggest, it is the responsibility of activists to take account of the waves, but to turn their attention to navigating the tide on the way to their chosen goal.