Alternative services: the case of free clinics

The viability of a political mobilization and reform strategy based on the provision of care of alternative social service agencies is examined in the context of the achievements of free medical clinics in the United States. The development of genuine alternatives to the contemporary American health care system is limited by the monopoly of organized medicine, the scarcity of funds for preventive care, a class-based health insurance system, and the inadvertent role of free clinics in legitimating existing structures. American medicine constrains and shapes clinic activities through its control of certification, its specialist divisions and priveleges, and its pervasive ideology. Free clinics' responses to these constraints can engender: (a) high worker turnover, low morale, legal jeopardy, and curtailment of self-help programs; (b) the reproduction of medical hierarchies; and (c) patient-imposed limitations to the acceptability of alternative therapies and therapists. Clinics often pay dearly for the meager funds available to them; strings attached to special grants can change the character of free clinics, their social composition, and the treatment they offer. The usefulness of the free clinic as a safety valve and training facility may actually legitimate the current organization of health care. Free clinics provide an alternative form of care, but in the long run they cannot be a base for radical social change.