movement, the Mississippi Summer Project, and desegregation. The younger participants often identified as part of the counterculture and the New Left.123 Levy allied with this cohort of young medical activists. Geiger, alternatively, represented the older incarnation of health reform activists who cut their teeth during the civil rights movement of the mid-1960s and were more amenable to building partnerships among the federal government, established medical institutions, and local grassroots organizers.
Despite their differences, Levy and Geiger both wrote from the perspective of wanting to transform what they viewed as a bloated and ineffective medical delivery system that did not serve poor patients very well. Levy believed, however, that Geiger’s OEO-funded NHCs only made the problem worse by accepting federal “establishment” dollars and imposing an outsider’s will on local health care providers by tying medical schools and medical elites to local projects. Indeed, over 50 percent of U.S. medical schools had been involved in NHC projects. Levy wrote, “It could have been predicted that the interests of the professionals, not those of the people, would be preserved when medical schools, chasing after the federal dollar, boldly stepped into poor communities, medicine bag in hand.”124 Levy argued that real experiments in community-driven health care delivery could be found in Black Power clinics provided by nationalist organizations like the Black Panthers. He also pointed to a critical letter that appeared in a local newspaper written by a Mound Bayou Black Power group opposed to the Tufts sponsorship of the health center in Mound Bayou as evidence that local blacks were not supportive of the project. Levy suggested that architects of the Tufts-Delta Health Center, Geiger in particular, never intended to alter medical delivery significantly. Rather, he believed that because the health center existed with federal financial support and medical professional guidance from mostly northern and white outsiders, it could not represent any real transformation of health care for the poor. It was, instead, an example of a kind of medical missionary project that maintained hierarchies between medical administrators/physicians and the recipients of care.125
Geiger countered that the Black Power group in question was never representative of the Mound Bayou community. They were an assertive group of activists who put themselves in the public eye, but that in no way gave them community authority. Instead, he noted, the Tufts-Delta Health Center had acquired “a staff and leadership that is 95 percent Black and 90 percent from Mississippi—and those percentages include the professionals: Black health center director, business administrator, clinical director, director of environmental health, social services director, director of training, and Black youth organization leaders, southern pharmacists, nurses, sanitarians, data processors, and three of the nine physicians.”126 He continued, asserting that locals “organized themselves first at the grassroots. . . . And in any given month 700 people come to a health association meeting.”127
Yet, in his critique, Levy raised important questions about the OEO-sponsored health centers and the extent to which they could provide real transformed medical care that not only expanded resources for the poor but also fundamentally changed the way health care was provided. Levy and Geiger fundamentally disagreed as to whether OEO-supported NHCs were the proper vehicles with which to meet their common goal of creating a health care system that no longer neglected the poor. Levy argued that storefront clinics provided by groups such as the Black Panthers were better examples of reformed medical institutions for the poor because they were funded and operated entirely by black activists (although they also employed white medical professionals from entities such as the Student Health Organization to staff the clinics and raised funds from white supporters). Geiger countered that these were patchwork measures and largely ineffective because their services were so limited. He believed that federal dollars linked to an established medical delivery system in the form of hospitals, medical schools, and local departments of public health could be effectively utilized by local health care activists to achieve successful health reform.128
Most examples of SHO and Black Panther attempts to provide clinics for the poor confirmed Geiger’s criticism. White volunteer medical students who provided medical support in SHO summer clinics (which did receive federal funding through OEO) in poor urban areas and in Black Panther clinics often found that they garnered important educational experience from the work but did little to change overall medical provision for the poor over the long term. A handful of clinics set up to serve the poor, most of which, like SHO summer projects, were also temporary, could do little to transform a medical system that failed to provide for the vast majority of the poor in both large cities and rural areas. SHO disbanded its summer clinics for this reason.129
Levy’s critique of and Geiger’s support for the NHCs hinged on what each meant by community control and, specifically, on whether they thought that involvement by the “establishment” negated community control. Did community control necessarily mean that white professionals and federal government support needed to be absent? Geiger insisted that the resources held by professionals, medical institutions, and the federal government were too important to reject. He wrote,
Those resources are now in the hands of the Establishment institutions—the medical schools, the hospitals, and all the rest—and the funds needed to operate significant health services must come from the Establishment, and overwhelmingly from government itself. These institutions are now, properly, damned for their racism, their elitism, their indifference and hostility to the community, their exploitation of the poor, and their refusal to surrender even a share of their control to community/worker groups. But what if they are dragged by the community, or the workers, or the students, or some of their own professional staff into primary care and community action and community service, or even into new institution-building under community control?130
If we accept Geiger’s assertion that the presence of the “established” medical and government institutions did not by itself hinder health care reform, did NHC programs foster a real partnership between traditional medical providers—public health administrators and medical professionals—and local poor residents and consumers of health care? From evidence gathered for this chapter, it appears that the NHCs were mostly successful in their effort to involve the community in health care provision and in broadening the meaning of health care to better serve the real needs of poor communities. Much of that success, however, depended on the quality of community representation at a particular NHC. Hatch explained that “OEO programs were often planned as if poor communities had no viable social organization or structure. They, therefore, sought to create or sanction new structures rather than to conduct a hard analysis of what existed.”131 Geiger agreed with Hatch that community boards at NHCs could be more or less effective depending on how representative board members were of the local community. He also asserted that community worker involvement in the clinics impacted medical delivery much more consistently than did community board involvement. Medical administrators reported that community outreach workers often improved contact with and design of programs within a particular neighborhood. Maximum utilization of community workers, however, also required adequate training programs, which were also unevenly operated at the NHCs. In some of the more successful cases community workers were hired for nonprofessional reasons such as their intimate knowledge of the community but then trained to develop new career tracks as professional employees.132
It is very unlikely that such an extensive program of health care reform could have been realized or even minimally successful without strong federal support and some help from established medical providers.133 The program required both money and medical expertise ideally guided by those who most needed and used the resources but provided in dialogue with professionals who delivered technical expertise and services at least until community workers could be trained to deliver services themselves. A less successful (and much smaller) health care reform effort that took place in 1970 at Lincoln Hospital in the South Bronx, a city-run hospital affiliated with Albert Einstein College of Medicine, lacked both federal funding and broad support from the medical administration. This program’s failure to establish lasting reform lends credence to Geiger’s contention that some federal money and established medical involvement combined with community input were essential for any real sustained change.134
The Young Lords, a Puerto Rican nationalist organization modeled
