Profile: Physician, Radical, William Bronston on Single Payer and How Med School Lacks Soul

At 79, Dr. William Bronston refuses to go gentle into that good night.

Born into a celebrity family, Bronston found a calling as a healer. But instead of a cushy medical career, he leaped into the struggles for the marginalized and disenfranchised: Organizing minority hospital workers, aiding the Black Panther Party movement, exposing inhumane practices in a New York state hospital system and fighting for single-payer healthcare.

“In terms of energy and in terms of purpose, I know that on some level I am profoundly different from almost everyone I know,” he said. “I’ve been a change agent and radical organizer all my life and not a drop has changed. Not ever. Not for a minute.”

Now, he is a leader in the CA Physicians for National Health Program and was a contributing author for the unsuccessful 1994 California single-payer initiative, Prop. 186. He is a graduate of USC Medical and did his Internship at Children’s Hospital of Los Angeles.

Dr. Bronston said he always wanted to be a doctor and wanted to serve. Even as a child, he had a yearning to care for others in a very deep and unconditional level. He was born in Los Angeles in 1939 and raised in Beverly Hills. His father, Samuel Bronston, was a major movie producer with films such as the King of Kings and El Cid, and he is the great-nephew of the socialist revolutionary figure Leon Trotsky.

He chose to enroll at USC Medical School in 1961 because of its preeminence for clinical medicine, and he was interested in serving poor people. But he was initially disappointed by what he was taught.

“Once I got to med school, I realized I didn’t want to be a businessman and I didn’t want to be a plumber, which is how I saw the medical community prior to making the final commitment. During my medical school career, the civil rights movement was blazing, the Vietnam War was blazing, and I hated my mechanistic medical education because it was lacking in humanity, tenderness and kindness. The culture of caring and the hidden history of progressive medical values and culture was not taught in my school, or other schools really.”

Bronston’s disenchantment quickly turned to activism as he and others organized medical, nursing and dental students nationwide into the “Student Health Organization” to push for then-Oakland Congressman Ron Dellums’ proposed legislation for a socialized healthcare system, support for the civil rights movement and demand radical professional school curriculum change, eventually expanding across the country. Activism became a major tool as his career progressed.

Then, as a conscientious objector, he began his Residency at Menninger School of Psychiatry at Topeka State Hospital where he organized an AFSCME union that seized administrative control of all Eastern mental health hospitals in an unprecedented union job action in 1968.

Moving to New York for a decade, he later told an interviewer: “I was on the street constantly, in demonstrations of every conceivable kind. I was heavily involved with the Black Panther Party, because I was the main physician to the Black Panther Party in that part of eastern New York. I was heavily involved with the new women’s movement, led by Gloria Steinem and that whole group. [Civil rights lawyer] Bill Kunstler was very close to us in a whole variety of legal rights struggles. The whole Vietnam War thing was still very much on the table.”

He became progressively involved with the emerging disability rights activists in order to connect them to a historic anti-institutional agenda. He became a clinical physician at a state-supported institution for children and adults with intellectual disability, Willowbrook State School, in 1970. The inhumane conditions shocked him, and he helped expose what was happening at the institution, which later closed due to the family outcry and a federal class action lawsuit he helped organize.

Returning to California in 1975, he became the medical director for the Department of Developmental Services and Department of Rehabilitation Services for the state of California for more than two decades.

Today, Dr. Bronston continues in, what he has called, “the perpetual struggle for justice.” He’s even more outraged by the alienating education that current medical and nursing students receive.

“It’s much worse today than when I was in medical school. There is a ‘corporatization’. There are impositions of cost and debt that are simply devastating to the medical community.” It forces doctors away from community service because it has become so expensive, he said. “Healthcare should not be for sale. What we have is a medical illness management system that essentially makes everybody a ‘hostage’ to which we pay ‘private ransom’ – we pay insurance bills.”

But corporate influence and the unceasing flow of money will not stop the single payer movement, Bronston said.

“Most of the people know that the insurance industry, Big PHARMA and the hospital cartels are their enemy. How long can that go on, while prices continue to be unaffordable, with less and impersonal care? There are stunning advances in health systems and medical research. And those developments will lead us to question, why are we not all benefiting from these advances? Why are these advances not being used universally? Why is wealth a determinant rather than being alive and human. Even though we have all the organized oligarchy money aligned against us, I think we are no more than ten years away from a radical change. It’s not going to happen in an evolutionary way, it’s going to happen in a lurch. Like every other major human rights transformation in history.”

Published for HEAL California

A Conversation About Death

Why are we so afraid of talking about dying? Most fathers and expectant mothers before and after a baby’s arrival get all sorts of advice. Shouldn’t the end of someone’s life be treated with the same respect and openness, medically and mentally?

As I near 50, my family constellation has become populated with fading family members. My mother and an aunt died of cancer, my father is sinking into dementia as his physical condition declines and three aunts are battling various ailments such as brain cancer, Alzheimer’s and a failing heart.

With all this death circling, and getting a close view of my mother’s, I’ve paid closer attention to how I want the end of my life to be. Instead of fearing it or ignoring the inevitability, I’m joyously embracing discussions of when the Grim Ripper arrives. (Hopefully, she will blame the canned salmon.)

I’m not having a Howard Beale moment and declaring that next Tuesday I will kill myself early enough to make the next day’s edition. I’m talking about how and what I want done or, more specifically, not done when I near death.

I’ve been fortunate that few in my family in my generation, so far, have become terminally ill: A polyp here and there, maybe a dash of hypertension, an uptick in bad cholesterol, but for the most part all clear. But that won’t last. So the death discussion has interested me.

What do we need to die well? The silly political discussion of end of life care, such as the ominous (and inaccurate) “Death Panels,” does little good. (Though that phrase conjures up humorous images of someone like the Soup Nazi yelling, “No chemo for you … Next!”) Instead, we should be discussing what a healthy last chapter of life could look like.

This is not morbid navel gazing. Baby boomers will soon be sliding into their twilight years and end-of-life care has become a crisis. Dr. Ira Byock, author of “Dying Well” and an expert on end-of-life care, has written that medical care for the dying is poorly planned, frequently ignoring the treatment preferences of the patient and family, and pushes for unnecessary medical treatment that prolongs someone’s life and contributes to their pain, isolation and suffering.

Some 20 percent of Americans die in an intensive care unit, part of the more than 50 percent who die in hospitals. Another 25 percent die in nursing homes. A majority of these patients are elderly.

It’s not as if most elderly people want to die in a strange bed hooked to tubes, drugged and completely unaware of their surroundings. In surveys about where people wish to die, 70 percent of respondents said if they had a choice, they want to die at home.

A few years ago, my mother and I went to see an uncle who had a stroke and had no chance of recovery. With aggressive medical intervention, he lived another year tied to a nursing home bed, blind, drugged, unable to communicate and fed through a tube. As we stood in the back of the room, my mother tugged my sleeve for me to hear her whisper, “If you ever leave me like that, after I die, I’ll come back to haunt you.”

Indeed, no one should die like that. So let’s talk about it.