A discussion of craft and industrial divisions in health care that leads to the debate between the IWW, FORA, and other revolutionary unions over the relationship between unions in capitalist and post-revolutionary society.

Healthcare today is built around key divisions of labor between craft specialities. It is highly regulated and the state plays a strong role in determining who can do what work, for how much money, and under who’s authority. There are strong differences across borders and within, but within the US the schema is roughly like this. To keep it simple, we’ll ignore all the crucial technical crafts for the sake of argument. The main players are doctors, nurses, and pharmacists. Doctors diagnose and prescribe treatments. Pharmacists check and dispense the treatments (when they’re medications). Nurses administer the treatments prescribed and monitor/assess the patients course of illness. This is a gross simplification, but it’s instructive.

Where did these divisions come from? Healthcare is not only divided by crafts, but other social factors divide the workforce. For instance we need to add to this the highly gendered nature of the work. Male nurses still represent only around 10% of the US workforce and nurses are the largest trade in the entire country. Florence Nightingale herself reinforced the patriarchal thinking of her day, either unknowingly or exploitively, in helping form nursing under the strict control of physicians giving nurses only a subservient role due to the prejudices of her time. Physicians are becoming more diverse, the rigid hierarchies between doctor and nurse themselves have proven difficult to break with nurses on the bottom in terms of power, respect, and working conditions.

It’s worth questioning the divisions all together. In frontier medicine in the US nurses often played the role of doctor, nurse, and pharmacist. The history of midwifery is riddled with other ideas about performing medical servies than the model of physician-nurse-techs we have today. Pharmacists used to prescribe medications and still do in some countries. Much of what doctors did 30 years ago is now done by nurses. The divisions between the trades are fluid and constantly changing, and are far from any natural division. An even deeper question we should ask is are these divisions of labor the best for society and individuals, or could we do better by transforming how health care is done?

Under capitalism, crafts compete and seek to improve their situation often at the expense of other groups. Doctors maintain tight control over their profession and try to stave off incroachment from other groups be it nurses, pharmacists, new agey practitioners, bureaucrats, whoever. What advances a craft doesn’t necessarily help society, and American doctors are an obvious example of this; guarding their craft privledge against the health and well being of society in supporting the awful private system of medicine that makes their country continually a global loser in terms of health outcomes.

There’s a long debate in the workers movement over industries and crafts, trade unions and industrial unions. Today Service Employees International Union (SEIU) represents a union that generally organizes industrially by uniting all staff within a workplace in the same union. National Nurses United (NNU) is one of the main craft unions within healthcare only organizing nurses. NNU is known for it’s willingness to strike and it’s championing reformist social causes like universal healthcare, environmental reforms, and other center-left reforms. SEIU on the other hand is one of the most conservative unions with frequent sweetheart contracts for bosses, repression of union democracy, and other unsavory tactics. Still NNU is also known to exploit nurses’ standing against other trades in organizing and break solidarity with other trades for the benefits of nurses. SEIU as well engages in attacking other more militant unions and trying to undermine organizing that challenges employers opting for a collaborative model.

Both crafts and industries reflect the needs of capitalism to organize and divide work. Those divisions are contested and reshaped by workers struggling to improve their situations. Those struggles reflect both the society they exist within and potential aspirations towards something better. At the end of the 1920s revolutionary unions faced mounting difficulties brought on by repression by fascist governments and dictatorships, political competition from a wave of Marxist-Leninist parties, and most significantly the erosion of the base of the unions through changes in production and the assimilation of immigrant communities into various nations. Revolutionary unions tended to have their members in unskilled industries such as mining, forestry, shipping, agriculture, etc., all industries that would in short order be drastically transformed in the decades that followed.

The difficulty of the end of the 1920s gave an opportunity for reflection on strategy and vision of the revolutionary movement. This happened mainly within the International Workers Association (IWA-AIT) which at the time likely involved millions of workers across the world, but also within the IWW. The subject is poorly studied with minimal resources in English, most of what is publicly available is about the IWA and that can be reduced to a few articles. The debate was wide ranging covering union structure, future society, revolutionary methods, amongst other subjects. Part of the discussion focussed on whether revolutionary unions should adopt craft or industrial unions as their primary structure.

The IWW was built around a form of industrial unionism believing that the industrial structure was a revolutionary innovation that gave the class new powers to defeat the rulers no longer held by by craft competitions. There was a technocratic bent to the IWW and writers would often appeal to raw economics in a simplistic manner. Justus Ebert saw capitalist industry as the highest form of evolution and the basis for socialism [1]. This idea was a thread in IWW thought amongst others like Ebert who came out of marxist social democracy. Big Bill Haywood argued similarly in Industrial Socialism that the IWW formed the future basis for world government which began with the industrial structure of society [2]. Today some of the IWW views on the potential of industrial structures read as incredibly naive. Within 20 years of the IWW’s peak in the late 1910s this theory was proved wrong as the CIO built industrial unions that not only were reformist but formed the basis for renewed capitalism. The unity of the class did not materialize with industrial organizing, with political and financial divisions persisting. Today looking at unions like SEIU or HERE the case is pretty clear against any use of industrial structure itself as having radical potential. Whether craft or industry, fifedoms of union officials, backwards unions, and divisions amongst workers remain the norm.

On the other side of the debate was Argentina’s Federacion Obrera Regional Argentina (FORA). The FORA’s leading voice was the brilliant theorist and agitator Emilio Lopez Arango, a self-educated militant and baker who’s militancy led him through Spain and Cuba. Lopez Arango eventually settled for most of his life in Argentina where he became a key militant in the FORA and editor of the daily anarchist paper La Protesta, one of the largest and longest running radical papers at the time and in history. The FORA held roots going back to anarchist union efforts in the late 1800s and inheritted ideas and structures from First International libertarian thought. Its sections were organized by trades (gremios) and resistance societies grouped around local and occassionally common issues such as women’s resistance societies, education, etc. This was a model shared by many revolutionary unions such as the CNT at the turn of the century and continued in Latin America through today. The FORA ended up being one of the largest revolutionary unions in history having a peak with more than 100,000 members, participating in insurrections where cities and regions were seized for periods, was the dominant force in labor for decades in Argentina, and even in decline lead strikes until the most recent dictatorship in the late 1970s.

Lopez Arango argued that adopting the industrial model reproduced the capitalist organization of society and would strengthen the potential for counterrevolution [3]. Capitalist industry meets the needs of capital. Taking capitalist industries as the “shell of the new world” would be to hitch ourselves to the exploitive divisions and destructive structures capitalism imposed on us; something which must be overthrown and transformed as Lopez Arango argued. The FORA’s critique went even further calling for the abolition of unions, who are formed by workers to fulfill their needs within capitalism, with the revolution itself and replacing them with institutions built around human needs and desires.

The IWW and industrialist currents partially won the battle with all major revolutionary unions in Europe adopting the industrial structure and in some instances individuals and groups adopting the IWW’s technocratic and economistic ideas. At the time the IWW’s perspective seemed secure, but looking back today the naivety of the IWW is obvious and perhaps explains in part the minority of IWW organizers who went on the build the CIO and abandon their revolutionary ideology. The FORA was decades ahead of their time in their critiques with ideas that are shockingly relevant and seen as innovative today as when these positions were first debated.

Only in Latin America and Japan did the FORA’s positions find support, and in fact in countries across Latin America adopted those positions in opposition to the IWW organizing there and abandoned the IWW in Chile and Mexico in favor of groups built on a forista or finalist basis in the 1920s where the IWW sections folded to form the CGT in Mexico and the FORCh in Chile. The FORA takes its name from an aspiration towards internationalism and one of the most thorough going anti-State and anti-nationalist currents in radical history. The FORA inspired sister unions throughout Latin America many with similar names such as FORU (Uruguay), FORP (Paraguay), FORCh (Chile) and unions in Peru, Colombia, and Bolivia just to name a few. In Japan the anarchist communist and syndicalists alike argued anti-industrialist positions and like the FORA put forward a startlingly early libertarian ecological perspective critiquing the destruction of the earth by capitalist industries. Though the German FAU-D adopted industrial structures a minority critiqued those moves within the IWA-AIT debates in line with the FORA and FORU’s positions [4]. The debate would actually continue through the 1930s with the FORA withdrawing from the IWA-AIT for a period over disagreements with the CNT entering government, and the FORU as well putting forward critiques tracing the CNT’s political faltering around questions of structure and goals to the failures of the revolution [5].

The second piece of the arguments against industrial structure were weak however in accepting crafts or trades as an alternative. For some reason FORA and its allies did not see the same hand of capitalism in craft divisions as industries. Yet it is clear that the divisions between crafts are just as arbitrary and destructive as industries. Applying the FORA’s critique to crafts as well is intuitive, and again leads to the idea that revolution must involve a broad social transformation disrupting capitalism’s divisions and rebuilding society on a new basis. Within capitalism today we have to start somewhere, and here it seems the fixation of both industrialists and anti-industrialists is wrong. Both craft and industry have repressive potential, neither are revolutionary, and both must be overcome. If all that is right, industrial unions are no more harmful than craft unions and both can form part of the struggle to defeat capitalism.

Today the IWW has no industrial structures despite its industrialism and worldwide revolutionary unionism has faced difficulties finding a new basis for organizing as states across the world gradually integrated labor within their attempts to stabilize capitalism, and later as labor has been weakened by neoliberalism. With the global balance of power shifting and previous regimes of work being dismantled and reassembled globally, its likely new forms of workers struggles can emerge that may form the basis for struggles towards that transformation Lopez Arango and the FORA sketched nearly 100 years ago. Now it’s safe to say we see that structure is a secondary question behind the ideals, methods, and revolutionary aspirations; all things that the forista currents took seriously and elaborated. With the failure of both sides of the debate to take hold in a libertarian society, we should be looking to a type of forismo of the future where new forms of workers struggles form the basis for the death of capitalism and the construction of a new society overturning the arbitrary and alienating labor of capital for living.

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[1] Ebert, Justus. (1913). “Is the IWW anti-political”. IWW Publishing Bureau; Cleveland, OH.

[2] Haywood, William and Bohn, Frank. (1911). Industrial Socialism. Charles H. Kerr Press. http://www.iww.org/history/library/Haywood/IndSocialism

[3] Lopez, Arango. Means of Struggle. https://libcom.org/library/means-struggle

[4] Damier, Vadim. (2009). Translated by Archibald, Malcolm. Anarchosyndicalism in the 20th Centry. Black Cat Press; Edmonton, Alberta. See particularly Chapter 8. The text is available from Libcom.org online however it is missing crucial references and information so the book is preferable.

[5] Ibid, see chapter 15.