I first was exposed to non-profit health care as a kid, in Tampa, where the system introduced by the cigar industry workers through their social clubs (Mutual Aid Societies) was already unraveling along with the community that supported and patronized it. I had pretty much forgotten about it until I started reading "Tampa Cigar Workers - A Pictorial History", by Robert P. Ingalls and Louis A. Pérez, Jr. (University Press of Florida, 2003, pp 107-114). It is a book of early photographs of the Cuban/Spanish/Italian community of Tampa, between about 1890 and 1940. The following quotes are captions illustrating some of these old photos.

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"When we got to this country, we had to take care of ourselves. No one else would do it for us. These clubs provided a kind of hospitalization insurance that was unheard of in the old days. And they were more than that--they were social clubs with all kinds of activities."
(Manuel Tamargo, 1977)

"The Centro Español proved that little men of humble means can enjoy life to the brim simply by pooling resources for the common good. That obvious truth prompted the little band of cigar makers to organize in September of 1891 the tiny organization from which sprang the benevolent Centro of today, catering to the medical and recreational needs of 6,000 members." (Tampa Daily Times, December 10, 1941)

"Cooperative social medicine societies were established by the Tampa Latins as early as 1887 and have flourished ever since. Presumably they were the the first such organizations in the United states and have remained in continuous operation longer than any others in this country." (Stetson Kennedy, 1942)

"The clubs provided complete medical services for members for a small weekly or monthly fee. These services included clinics, doctors, medicines and hospitals...The medical services provided by the clubs were labeled socialistic and were strongly opposed by the local medical association." (Braulio Alonso, 1997)

"Cooperative medical service was launched in Tampa...before 'socialized medicine' became a controversial national issue. Soon after the cigar industry migrated to Tampa in 1886, a Cuban physician, Dr. Guillermo Machado, was conducting a mutual benefit society for medical aid. For ten cents a week, members of La Iguala ('The Equal') were entitled to medicine and services....In 1906 the Centro Español erected a $60,000 hospital where members could obtain medical care and hospitalization for their dues of $1.50 a week." (Federal Writer's Project, 1939)

"The club is not only the center of social activities, but also is a haven for the tired workers who are confined throughout the day in cigar factories. When the day's work is done, the workers may take
advantage of the gymnasium and pool, and afterwards spend their time in the reading room or the pool room. The attractiveness of this feature is shown by the crowd that fills the big structure every day of the week. Membership also includes medical attention in case of sickness and even treatment in the sanatorium. There are classes in English for the Spanish and classes in Spanish for the English-speaking. The institution also has a banking department." (Tampa Daily Times, December 14, 1922)

"Its sanatorium [El Centro Asturiano] has accomodations for 100 patients in the general ward and about 35 patients who may be suffering from contagious diseases in isolated wards." (U.S. Immigration Commission, 1911)

"The Asturians deserve the credit for launching social medicine on a large scale in Tampa. After seceding from the Centro Español, they...[constructed] the first social medicine to be built in the United States, its facilities the most modern available." (Stetson Kennedy, 1941)

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It is pretty clear these grass roots institutions did not arise from a vacuum. They are the result of a long tradition of community organization from not only Cuba, but from the immigrants to Cuba from Europe. This is non-centralized democratic socialism derived directly from blue-collar working people, the urban proletariat, just like the old 19th century socialists and anarchists envisioned it, not imposed by the government from the top down, or installed as a profit-generating machine by a private corporation. It may not be realistic to think of this system as something feasible in today's conditions, but surely we can learn something from these people. What they created in the backwater fishing village that was 19th century Tampa was an astonishing collective achievement.