NetNews Usenet Archive 1992 #18/NN_1992_18.iso/spool/misc/activism/progress/5786

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From: [e-mail] (Rich Winkel)
Subject: Mutual AIDS: the Radical Potential of Buyers Clubs
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From: [e-mail] (New Liberation News Service)

Included below is an article from the New Liberation News Service
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NLNS  Packet 2.11  -  July/August, 1992
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Mutual AIDS: the Radical Potential of Buyers Clubs
Bart Bingenheimer, The Bug

(NLNS)--The institutions of this nation have failed to respond
adequately to the AIDS crisis, and a number of explanations for this
massive failure have become conventional among scholars. One
such explanation is that the organizations involved were structurally
unprepared, that "AIDS fell upon a 'system' that could tolerate only
small-scale disturbances." Another claims that the failure occurred
due to a lack of funding, thanks in part to "the Reagan
administration's aversion to any increase in spending for human
services." A third conventional explanation is that these institutions
have failed to respond because "AIDS victims are highly stigmatized,"
either as AIDS victims or as members of other marginalized groups,
such as gay men, intravenous drug users, poor people, people of
color, women, and so on. While each of these points contains a
certain amount of truth, I would go further to contend that the AIDS
crisis exposes this nation's institutions and, in particular, the free
market economy as inherently flawed. A more rational and humane
alternative, buyers clubs present a serious challenge, along anarchist
lines, to capitalism and capitalist structures.

What is anarchism?
    In 1917, in order to combat the distorted representation of
anarchism that the general public was receiving through the press,
Emma Goldman wrote and published the essay "Anarchism: What It
Really Stands For." Apparently she failed to get her point across,
however, for today anarchism is still associated, in people's minds,
with violence, destruction, chaos, and mayhem. But anarchism is not
anarchy. Such characterizations obscure the rich, diverse body of
anarchist thought in political theory. Because of its bad reputation,
and because of the vast diversity of ideas which are encompassed
under the single word "anarchism," it is necessary for me to define
what I mean by the term.
    The first characteristic of anarchism is that is emerges from a
critique of the economic system. Often this critique is based upon
the social and political consequences of the economy, and thus can
closely resemble a Marxist critique. Recently, however, critiques have
been appearing which focus on the environmental consequences;
the most notable of these is Murray Bookchin's "social ecology," also
known as "eco-anarchism." The anarchism to which this article refers
is explicitly anti-capitalist. The alternative economy proposed
involves organizations that would be "(1) decentralized, (2)
egalitarian, (3) self-managed and empowering, (4) based on local
needs, and (5) supported by other autonomous units in a non-
hierarchical fashion."
    Whatever the critique may have in common with Marx,
however, it does not suggest the same solution. Anarchism is also
explicitly anti-state, which in the definition I am using does not
mean anti-politics or anti-organization.  The political institution
opposed is the centralized state; local, human-scale democratic
political bodies would replace centralized authority. Anarchists have
two main objections to the state. First, the state supports and
enforces the existing capitalist economic system, which anarchists
oppose. And second, the state is seen as a self-perpetuating, self-
interested entity which controls a massive amount of power, and
power corrupts. Thus, even if the state allows the economic system
to be altered, it is still to be opposed because it is a dangerous
institution in and of itself.
    Finally, there is the question of how to proceed. Some
anarchists have chosen to lash out violently at the state, but this kind
of strategy has proven counterproductive by providimg the state with
an excuse to consolidate its authority even further. The definition of
anarchism used in this article, consequently, fits the following
assessmnent: "The state is not something that can be destroyed by a
revolution, but is a condition, a certain relationship between human
beings, a mode of human behavior; we destroy it by contracting
other relationships, by behaving differently." The best way to
institute an anarchist political economy is to just do it, to begin
establishing now the alternative institutions that will ultimately
replace the existing order. It is a goal of this article to show that
buyers clubs are a potential vehicle for this.

AIDS, anti-capitalism, and anti-statism
    Since at least 1987, anti-capitalism has been an important part
of AIDS activism, especially that of ACT UP (the AIDS Coalition to
Unleash Power). ACT UP's first demonstration occurred on Wall
Street on March 24, 1987 "to protest the alliance between the FDA
and Burroughs Wellcome in the interest of profit rather than saving
lives." It should be noted here that Burroughs Wellcome is the
corporation which held, and continues to this day to hold, a
government-enforced monopoly on AZT, the most effective drug
available in slowing the replication of the virus. At that time it was
selling the drug for around $10,000 per patient per year. (The price
today has been substantially, but not adequately, reduced.) A similar
demonstration occurred exactly one year later. On September 14,
1989 a third demonstration against the Burroughs Wellcome
monopoly took place on Wall Street. This one included a banner-
hang inside the New York Stock Exchange that stopped transactions
for five minutes, and was followed by a day-long demonstration
outside in which ACT UP members again lambasted the profit motive
and demanded access to free AZT for all people with HIV. By
criticizing the profit motive, these AIDS activists challenge, at least in
the AIDS treatment industry, the greed-driven relations of capitalism.
    Anti-capitalism takes an even more explicit form in the
literature of buyers clubs. One issue of Notes from the Underground,
the newsletter of the People With AIDS Health Group, the largest
buyers club in the United States (and perhaps the world), has said
the following with regard to the capitalist relations in the AIDS
treatment market:
    "In a country where healthcare is disbursed as a commodity,
those in need of care are forced to play the role of consumer. Supply
and demand are integral components in this scheme, and cost has
everything to do with access.  In the United States, as AIDS activists
have learned the hard way, the massive healthcare engine is fueled
almost solely by profit. It affects every aspect of healthcare delivery,
and informs every relationship between those who are sick and
those who would heal."
    Buyers clubs emerged as a reaction to this situation, formed
by people living with AIDS "in an effort to seize control over the
decisions being made regarding their treatment." Thus, in AIDS
activism in general and among the buyers clubs in particular, it is
well recognized that as long as the people with the power to heal
see each case of AIDS as a potential profit, the distribution of
treatment will continue to be unjust and inadequate.
    ACT UP is well known for its harsh criticism of the state as
well. By April 15, 1987, barely a month after the organization's
inception, ACT UP was already harshly criticizing the Reagan
administration and demanding the "immediate establishment of a
coordinated, comprehensive, and compassionate national policy on
AIDS; immediate release of drugs that may help save our lives;
immediate establishment of a $60 million fund to pay for AZT and
other drugs as they become available; immediate mass national
education; [and an] immediate policy to prohibit discriminaiton." The
FDA has also been the target of much criticism for its excruciatingly
slow trial periods for promising drugs, as well as for some of its
objectionable testing procedures. The "takeover of the FDA
[headquarters in Rockville, Maryland on October 11, 1988] was
unquestionably the most significant demonstration of the AIDS
activist movement's first two years." ACT UP's "accusation that the
government, by not doing enough, is committing genocide against
people with AIDS" is now commonly known. Yet this is not true
anti-statism, for activists are not demanding the abolition of the state,
but rather increased action by it. The danger of this approach is that
"a 'blame-the-government' attitude can, unfortunately, allow us to
deny individual and collective social responsibility and become
dependent on the state."
    Buyers clubs, on the other hand, can be said to be truly anti-
state since they combine a harsh criticism of the government with
efforts to deal with the AIDS crisis outside the state. The People With
AIDS Health Group clearly recognizes in its newsletter Notes From
The Underground that one role of the FDA is "protectingIthe
market monopolies of unscrupulous drug manufacturers" to the
detriment of those who need these drugs. But instead of demanding
government action, as ACT UP could be expected to do, PWA Health
Group and other buyers clubs actively seek to circumvent some of
these monopolies in a number of different ways, including obtaining
drugs like pentamidine much cheaper on overseas markets.

Buyers Clubs and Their Potential
    The term "Buyers Club" refers to a number of organizations
recently formed by people with AIDS as confrontational
organizations in an effort to seize control over the decisions being
made regarding their treatment. They were designed to respond to
people's needs, rather than to the dictates of a profit-driven, business
as usual system. Most clubs attempt to provide their members with
drugs that are either unavailable in the United States due to
government regulations or too expensive in U.S. markets. Many
drugs distributed by the clubs are obtained in foreign countries or
produced in underground laboratories.
    As noted by an FDA talk paper, "the groups apparently vary
widely in their procurement and distribution practices." Some, like
the Los Angeles Buyers Club, "have at times been very covert," while
others like the PWA Health Group, "look anything but underground,
with 800 members, sophisticated mail-order fulfillment operations,
and American Express." Some clubs are very responsible, functioning
as non-profit organizations, printing information on the drugs they
provide, telling members where to get more information on the
drugs, and publically explaining their pricing procedures. The clubs
which best fit the anarchist model, and thus are of interest here, are
the small (much smaller than the PWA Health Group, which has
3,000 clients in the U.S.), democratically self-managed ones which,
for obvious reasons, receive less press attention than the PWA
Health Group, and often operate at least partially undergound.
    One important thing to note about the buyers clubs is that
they have arisen spontaneously, formed by people to meet their
present needs, not to fulfill some long term political goal. At the
same time, however, they may have the potential to achieve such
long term goals. George Woodcock writes, "The more we build and
strengthen an alternative society, the more the state is weakened."
Thus, buyers clubs may be at once means and ends; by responding
to member's immediate needs today, they may also be undermining
the current economic and political structures. The question is, Do
buyers clubs meet the anarchist criteria for an alternative society as
enumerated above?

1. Decentralization. Relative to nationalized health care and other
state-sponsored methods of handling the AIDS epidemic, which
groups like ACT UP would apparently like to see instituted, buyers
clubs are certainly decentralized.  They exist in at least fourteen
cities around the United States and generally serve the communities
in and around those cities. Some of the larger ones, which as noted
above run mail-order operations, are more centralized than others,
but it is clear that some buyers clubs can and do function in a
centralized manner.

2. Egalitarianism. While some larger clubs, like PWA Health Group,
are organized hierarchically (Derek Hodel is PWA Health Group's
executive director), smaller groups are generally structured in a
much more egalitarian fashion. The Los Angeles club, for instance,
was small enough until quite recently to function without even a
board of directors. Thus, as long as they remain relatively small,
buyers clubs can certainly satisfy this criteria.

3. Self-management and empowerment. Formed by people with
AIDS "to seize control over the decisions being made regarding their
treatment," even the larger, more centralized buyers clubs are
empowering and to some extent self-managed. Again, however, the
smaller and more egalitarian the club, the more member-
empowering and self-managed it will be.

4. Being based on local needs. As noted above, buyers clubs arise
spontaneously to meet the needs of the people who form them.
Since they are generally local and decentralized, they can be
expected to meet local needs.  The more egalitarian they are, and
thus the more self-managing, the more responsive they will be to the
specific needs of their members.

5. Deriving support from other autonomous units in a non-
hierarchical fashion. This is the one area in which buyers clubs are
least adequate in meeting the anarchist criteria. To some extent, the
clubs collaborate with Community Research Initiatives which "carry
out decentralized research based on the needs of PWAs," and with
underground laboratories producing drugs, but they are still largely
dependent upon the research and production done by groups that
are part and parcel of the capitalist economy, and which would
hardly begin to meet these criteria. Buyers clubs can and do
constitute the very promising beginnings of an anarchist alternative
means of consumption. But until such alternative institutions exist in
the areas of research and production as well, the buyers clubs will
never be able to circumvent completely the institutions of the
capitalist economy.

    Finally, even if buyers clubs are able to circumvent the profit-
driven AIDS treatment industry, and even if they never succeed in
being a part of the formation of a new, utopian society, these clubs
will still be a success.  Large or small, more or less centralized,
completely egalitarian or slightly hierarchical, these clubs are today
getting drugs to people who sorely need them, often at lower prices
than can be found elsewhere. And at a time of crisis when the
traditional institutions are proving woefully inadequate, there is
precious little that can be said against that.

Notes for this article are available upon requestI

Bug is a journal for progressive analysis and opinion at Dartmouth
College. They can be reached at Hinman Box 5019, Hanover, NH
03755.

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