I've been a member of two unions, Carpenter's Local #, and AFSCME local at UCB. I got involved in turning the repair shop at UCB into a union shop. I am giving this background because I think I know what works.
The number one concern is security. Can you stop the boss from firing or laying off workers? The next question is there a professional union representative who can work with you available? Third, is there a free place to meet off the job? As to this union rep. Does he or she know what they are doing. Do they understand the situation, understand the interpersonal dynamics of the specific job cite? Then next, does the union have the intelligence and power to change those conditions or at least mediate them?
Now the structural problem. Much of healthcare service delivery is not done by giant corporations, but rather smaller scale businesses. There are some national scale operators, which can be tackled at the top level. Turning Kaiser for example. Another much smaller operation, but still national is National Seating and Mobility. They got to be big by collecting preferred provider status among national HMOs. A similar system has evolved among nursing home operators. So they are a target. But the smaller operators present a real problem for organizing because there are so many, and the work force is partitioned into smaller units of say ten to fifty here and there all over the place.
One of the things that trade unions like the Carpenter's did was gain a monopoly on skill and certifications. That's one approach to consider. The nurses, orderlies, attendants, and home care workers can be captured by gaining a monopoly on their skill and certification process. The way this works is through practical training and hiring halls. The business operator calls the hiring hall for skilled labor, ready to work, today. In other words the union provides an employment service to the employer. There are great advantages to this kind of system. First its free. Second the training system or certification system cuts back the risk of hiring unknown people.
There has to be a political wing, but its primary mission isn't supporting or not supporting this or that candidate. The mission is legislation to impliment and embed unions as part of the economic system. The trade unions were particularly good at this sort of lobbying. The basic design is that if companies receive municiple, county, state or federal funds through contracts or other means, then governments have the duty to require qualified labor, i.e. union certified workers.
There is an intense battle going on between the whole healthcare industry and Medicare regulations and their internal certification process. That's a key place to hit at the very top of the food chain.
Anyway those are some ideas on how to build union labor back.