By Linda Huber

June 3, 2026

Automation and datafication are increasingly framed as the solution to the problems plaguing US healthcare: high costs, disparate access to care, and unequal health outcomes. Yet these emerging technical infrastructures too often harm, rather than help, patients and healthcare workers. In practice, they are used to reduce healthcare companies’ costs (through the automated rejection of health insurance claims, for instance)  and to enact austerity, as seen through automated removals from Medicaid rolls. 

Intensified datafication and automation also make healthcare more abstract and opaque, in turn making it difficult for patients to navigate these systems, or to participate meaningfully in their governance. Decisions about healthcare delivery and processes are increasingly centralized in the hands of a small set of professionals with expertise in extremely complex incentive structures, payment schedules, and the information and computational systems that undergird them. This centralization of governance and expertise distances patients and taxpayers from the control and understanding of basic healthcare infrastructures, and risks perpetuating the sense that such infrastructures are wasteful, and perhaps should be defunded altogether.

How can we disrupt these processes of abstraction, centralization, and opacity? How can we develop skills for the collective governance of healthcare at a grassroots level, including developing literacies in the financial and computational technologies undergirding the system? Finally, how might the experience of governing grassroots healthcare infrastructures increase our collective capacity and expertise to build accountable, caring infrastructures at the national level — in healthcare and beyond? 

To answer these questions, I draw inspiration from historical and contemporary practices of mutual aid to speculate about the possibility of grassroots, collective social insurance infrastructures — and the broader political impact that these infrastructures might have. The ways worker collectives and formerly enslaved Black communities have historically worked to pool funds and manage risks collectively help us to imagine what a future of digital mutual aid might look like.

Mutual Aid Societies And Questions of Care Governance

When imagining how healthcare in the US might be improved, we often look toward the socialized models of state-based insurance in other countries. Yet in a moment of increasing federal austerity and the intensified policing of care, accountable, caring, and supportive state-based healthcare feels almost unimaginable. Instead, we might look towards forms of socialized care that predate state-based insurance infrastructures.

The roots of state-based health insurance date back to the practices of German worker collectives, who would pool their wages in order to assist workers who might fall sick. State-funded health insurance was implemented by German Chancellor Bismarck in 1883 to undermine the popularity of socialist politics in the country. Likewise, in the United States after the end of slavery, African American communities created mutual benefit societies, wherein members pooled funds to cover funeral costs, support orphaned children, and to offer sickness and unemployment benefits. Mutual benefit societies often served not only as financial infrastructures to redistribute risks, but as social infrastructures, building a sense of community and trust among members.

These small-scale, collective funds required careful forms of collective governance. In her article “A Comparison of African American and Euro-American Mutual Aid Societies in 19th Century America” (1991), historian Susan Greenbaum highlights the difficult questions raised by the collective governance of Black mutual aid societies: “Should surplus funds be invested in profit-earning activities? Should office holders profit in exchange for valuable services? How to prevent office holders from cheating? How should membership be limited? Should democracy be traded for the efficiency of scale?” Relative to abstracted forms of governance rooted purely in actuarial principles, governance of these local mutual aid funds required concrete negotiations with neighbors, friends, and family members about how best to collectivize benefits and risks. 

Digital Infrastructures of Mutual Aid

Today, we see a wide variety of decentralized, digital mutual aid networks emerging, from community bail funds, to Minneapolis rent funds, to the funding of trans healthcare. GoFundMe and GiveButter accounts — or the simple re-sharing of Venmo links on social media — enable a kind of ad hoc redistribution of risk in response to emergent crises of friends and family. The history of mutual aid societies prompts us to ask: what might it look like to organize digital infrastructures of mutual aid in a more stable, pro-active way? How might we implement the collectivization and redistribution of funds in a way that looks less like charity, and more like durable infrastructures of solidarity?

This would require an entwined practice of social and technical governance. The creation and maintenance of a benefit society in a digital age would require careful conversations, not only about governance of funds, but what data should be collected about members, how it should be stored and kept private, and how it should or should not be used in the distribution of payments. Mutual aid expert Dean Spade has highlighted tactics for managing the legal and operational side of mutual aid funds — but digital and data infrastructures are also central. 

Building mutual aid groups among our neighbors, across our city, or within our workplace requires building out relationships of trust and care. This work is done slowly, and runs counter to corporate and tech-driven orientations towards speed and scale. Yet this relationship building — through one-on-one conversations, small community meetings, and outreach to marginalized community members, such as non-English speakers — is essential in order to get mutual aid funds off the ground. Building out this social infrastructure also requires developing muscles for collective governance, including navigating disagreements, and finding mechanisms for consensus-building and decision-making beyond majority rule. In turn, making informed choices collectively about the infrastructures of care requires developing both financial and technical literacies, not only among a small number of experts, but across all members of a group. Open source projects can point us towards concrete mechanisms for enabling broader literacy and participation in technical systems — including through robust documentation and transparency of decision-making.

While healthcare companies and the US federal government leverage datafication and automation to enforce austerity and police access to care, these same technologies could play a valuable role in mutual aid infrastructures. As healthcare continues to be defunded and access increasingly narrowed, formalized, digital mutual aid networks — recalling the “benefit societies” of previous eras — offer one potential path toward immediate harm reduction. Additionally, reskilling ourselves in modes of collective governance, including data governance, may help to undo the abstraction and alienation that seem inherent within contemporary healthcare infrastructures. Digital “benefit societies” represent just one speculative possibility: ultimately, decentralized healthcare infrastructures present an important pathway to rebuild our capacity, expertise, and the political will for large-scale social safety nets. 

Linda Huber is a postdoctoral fellow in social justice and technology at Swarthmore College. Her primary research focus is the political economy of computing and data, particularly within the healthcare industry. She is also an activist and organizer at the intersection of tech and academia. She holds a PhD in information science from University of Michigan.