The unionization of the hospital nurses was a great victory with important implications. But, as I'm sure you know, there's no time to rest! The health care industry is changing in ways that offer new challenges. Capital is nothing if not adaptive.
To cut costs and increase profits, insurance companies have forced the focus of health care delivery to shift from the hospital to the home and, hopefully to a lesser extant, group homes. Try staying very long in a hospital nowadays, no matter what you're in there for. Once you're "stabilized" (i.e.. no longer getting worse) out you go. You recover at home. Hospitals have been closing or merging for some time now, as the need for beds diminishes.
Most hospitals are in dire financial shape, partly, perhaps mainly, due to the declining revenue from patients. The very hospital you've unionized--Allegheny General--is in some form of receivership due to the bankruptcy of the holding company that owns it. Hospitals' answer, like that of the insurance companies, is to cut back on the care provided, as you have explained. Nurses have been laid off, replaced by poorly trained general helpers. Today's patient rarely knows whether the person taking their vital signs, extracting blood, or controlling their medication is a nurse who knows what she/he is doing or some low paid helper, who is often oblivious to the kinds of signs a patient is having trouble or in danger that any nurse would recognize. So one thing unionization of hospital nurses can accomplish is to slow down and perhaps reverse the reduction in care, as you have pointed out. One problem is that it is hard to extract concessions from capital that is in financial distress. No doubt a major reason the vote for the union wasn't stronger was the vulnerability the nurses feel for their jobs and their hospital, both as an employer, and ultimately as an important institution in the health care industry.
Hospitals are fighting back by offering isurance themselves and through tying arrangements with doctors. Doctors have begun fighting back too. Only recently have they seriously started to combine (though there has always been a small union of fairly radical doctors--radical for doctors, that is). Petty bourgeios rich folk in the past, many of them have become merely higher paid employees of insurance companies who control most the major medical decisions doctors used to make. If a doctor gives out too much care, the insurance companies don't like it, and she/he risks being dropped from the rolls.
So there is a three cornered struggle for control of the enormous surplus value generated in health care. Until recently, the insurance companies threatened to gain so much control that they could essentially obliterate doctors and hospitals as major players. But the latter have gotten Congress and some state legislatures to intervene to try to lessen some of the more extreme forms of control by insurance companies. The California law you pointed out that fixes nurse to patient ratios is one example. Recently, one HMO, the most insidious kind of care denying insurance company, announced that they were giving back to doctors the right to make medical decisions. Made a good headline. But I haven't seen the fine print. There are many ways the HMOs control the behavior of doctors.
The good news in all of this is nurses, educated labor who still have something to say about health care provision. The movement from the hospital to home has, in particular, enhanced the role of nurses. With home care, the nurse is often pretty much on their own making decision and providing care, as doctors hide in their offices, occasionally darting over to the hospital to pop in on patients to tell them they look good and will be going home soon. I know this first hand. I took care of my mother in her home (Mark: do you know about Pennsylvania's wonderful Family Care Giver's Act, passed about 6 years ago (at the behest of then Gov. Casey) that subsidizes with money or services care giving by a relative as long as the care receiver remains a t home. It's specifcally designed to allow people to remain in their homes and get health care near the end of their lives. Wonderful stuff that that asshole Gov. Ridge has not yet seen fit to gut.). My mother's care was provided by the nurses and me; the doctor was some shadowy figure that we got to adjust medication when necessary.
More and more nurses now work in home care as hospital nursing staffs shrink. Also, hospice care is growing, as it branches out under Medicare from covering only terminal cancer patients to anyone thought to have less than 6 months to live, . That's home care too; hopices are not a building but a type of care. It also requires a special kind of nurse, nay, human being; hospice work is both brutal and enormously important.
Problem is, home care is typically run by small companies, usually starting out with a group of nurses who switched from hospital jobs. Some have tried to tie into hospitals--so they get the patients being released from there--and some are basically independent. But virtually all are small, low profit endeavors (assuming only minimal defrauding of medicare, which is where they get their revenue). Unionization of home care nurses is thus very difficult, made all the more so by the lurking presence of the reserve army of nurses trained in colleges and laid off from hospitals. Troublemakers are easily replaced.
If a home care nurse gives too much care, she can't see as many patients, and the company's revenue suffers (Medicare pays per patient). Unions would be attractive to many of the home care nurses I know, but they understand how vulnerable they are; if they complain or even if they try to do too good a job, they can easily be replaced by someone who will see more patients per day.
If home care is indeed the wave of the future, it's going to be important to find ways to organize all kinds of nurses to stem the decline in care being offered, and to challenge the hegemony of the various branches of capital over the health care system. What are your thoughts?
RO
Mark Rickling wrote:
> District 1199P/SEIU Press Release
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> AGH RNs Vote for Union To Protect Quality Patient Care, Gain a Voice
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> Major Improvements Seen in Health Care for Patients, Community
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> AGH nurses voted 731 to 634 form a union in a two-day election supervised by
> the National Labor Relations Board.