From the new March-April 2013 issue of News & Letters:
by Htun Lin
As Congress’s latest self-imposed sequestration crisis makes clear, not all cuts are the same. A campaign slogan of California Nurses’ Association (CNA) goes: “Some Cuts Don’t Heal.”
The looming full launch date of Obamacare in 2014 has the HMO industry imposing cuts, patient care be damned, in a race to the bottom to reduce costs, while competing for new subscribers offered by the Affordable Care Act. Where I work at Kaiser, the HMO carries out its massive cuts with the collaboration of their major union, the Service Employees International (SEIU).
Another union, the National Union of Healthcare Workers (NUHW), supported by the CNA, is now challenging SEIU in an election. NUHW correctly exposes SEIU lies and betrayals, such as secret deals with management to give back hard-earned benefits. But the contest appears to many in the shop to be no more than a competition over who gets our dues.
HMOs like Kaiser (with the help of company unions like SEIU) are distorting Obamacare’s cost-cutting language, meant to rein in Medicare fraud and overcharges, to their own ends. They are using this opportunity to cut labor costs and patient care expenditures, while still gouging the privately health-insured and government programs like Medicare.
Steven Brill’s Feb. 20 Time cover story, “Bitter Pill: Why Medical Bills Are Killing Us,” is getting a lot of attention. Brill rightly says Obama’s Affordable Care Act does not address the most obvious way to cut costs, which is to extend Medicare. Medicare is the most cost effective because, as a massive purchaser of healthcare, it uses its clout to keep prices down. The Affordable Care Act still leaves individual insurance purchasers subject to insurance-industry gouging.
WHO LIVES OR DIES
Obama’s reform efforts aim to curb runaway healthcare costs like the over-prescribing of state-of-the-art tests for people with Cadillac healthcare plans. But what about the more serious abuse: manslaughter through deliberate negligence?
A friend of mine I’ll call Tasha spent two weeks in the ICU at Highland Hospital in Oakland after an auto accident. Only after her discharge (perhaps prematurely, due to staffing shortage) to a skilled nursing facility did a nurse find the infection, caused by a super-resistant germ now lurking in hospitals, which would kill her within 30 hours.
Why did Highland Hospital miss detecting the killer bug which killed Tasha? Negligence–institutional, not individual, because of staffing shortages. As an inner-city general hospital, funded by Medi-Cal and Medicare, having a destitute patient population and a higher mortality and morbidity rate, Highland is severely understaffed and unable to fully cope with its tremendous patient load.
This speed-up costs almost 100,000 lives each year in hospitals private and public across the nation. We who tend to the sick every day have a lot to say about work conditions affecting patient care. Literally hundreds of thousands of lives of workers and patients could be saved if only we would be heard.
In the past, failure to deliver proper healthcare was deemed wayward, an anomaly, an offense warranting discipline and shortage of staffing or some other critical resource was recognized as a problem. Now chronic staffing shortage occurs by design.
HOW TO PROFIT FROM NEGLECT
Administrators don’t call it neglect, just part of maintaining the financial health of the company. For-profit chains like Sutter and Tenet, masquerading as “non-profits,” have gobbled up financially troubled community hospitals, then imposed severe cuts in patient services and staff to appeal to shareholders.
Karl Marx had warned us about this brave new world when he described how capital’s constant revolutionizing of instruments increases the monotony and speed-up of its factories to the point where all the human interest is taken out of the workplace.
Labor advocates today only speak about the cost to our bodies and our income. But what’s left out of the discussion is the cost to our minds. The monotony, speed-up and repetitive motion of the assembly line cause injuries not only to our bodies but to our minds.
Real healthcare reform cannot be achieved while the pull of capital’s dominant ideology traps one and all into the self-fulfilling dead-end thinking that “there is no alternative.” This kind of self-alienation infects everyone in society, even on the shop floor. A cure is afforded only when people who have to deliver that care reclaim not only their own labor, but the very meaning of labor itself, thereby reclaiming our own humanity.