Nurses strike leaves patients with tough choices
Guest Commentary
By Hank Kalet
Pulling past the entrance to Robert Wood Johnson University Hospital in New Brunswick, it was impossible not to notice the dozen or so men and women camped out along the street.
It was a sunny early September weekend, and my wife and I were driving down Somerset Street to the hospital where my sister-in-law had just given birth to her first daughter (she and my brother already had two sons). The baby was a little more than a month early and was still in the Natal Intensive Care Unit (NICU), where she would stay for about a week.
As we passed the entrance and the men and women denouncing hospital management and demanding better working conditions and wages, I felt a pang of guilt. Visiting the hospital meant crossing a picket line, something I have always made it a point to avoid doing.
But that’s a lot easier said than done when dealing with health care.
The 1,313 nurses working at the New Brunswick hospital, one of three Level 1 trauma centers in the state, went on strike Aug. 24. The strike occurred after a tentative agreement had been reached between union leadership and hospital management, but rejected by the rank and file, according to the Star-Ledger.
The hospital remained open during the strike, which was settled after the Sept. 18 ratification of a new contract, and was staffed by “nurses brought in through a national staffing agency,” the Ledger reported.
The strike at Robert Wood Johnson University Hospital was the second nurses strike in New Jersey this year and the eighth nationally, compared with five in 2005, according to the Bureau of National Affairs. And like these other strikes, the primary issue was health care.
The key issue, according to the Ledger, was “the deductibles the nurses paid for non-emergency medical procedures performed outside of the New Brunswick hospital or by doctors not listed as participating in their health plans.” The nurses had called the proposed co-pays a penalty for not using hospital-affiliated services, while management said it was a fair plan that offered quality health care to all nurses.
This focus on health care mirrors battles being waged between employers and employees around the country. Health insurance premiums have been increasing annually by double-digit percentages in recent years, “driven by a combination of rapid inflation in the costs for healthcare services and insurers' efforts to emphasize profitability in their pricing,” according to a 2003 report by the Kaiser Family Foundation. This sharp growth in costs has led companies to ask employees to pay a larger percentage of their overall health costs than in the past, either by increasing monthly contributions, bumping up deductibles or by imposing other co-pays or limits.
This has forced healthcare issues to the forefront of collective bargaining. In recent years, negotiations have broken down over health care in a number of industries, with several stand-offs leading to strikes. Transit workers in New York, supermarket workers in California, and employees of General Electric have all walked off the job in recent years as contract talks broke down over the shape and scope of their health plans.
Health care has become a flashpoint for workers, as important to their economic well-being as their wages and salaries.
“This is an issue that's only going to get worse,” Michael Chernew, an economist and professor of health management and policy at the University of Michigan, told the San Francisco Chronicle last year.
“Health care costs are going to keep going up and somebody will have to pay for them,” he said. “This will be a fundamental challenge for the country for decades to come.”
The issue is the American healthcare system itself. It is a hodge-podge of competing interests – with insurance companies, doctors, hospitals, nurses and patients all having a different stake in the system. Insurance companies are looking at their bottom lines, looking to maximize the amount of profit they can generate from their investments. Nurses and patients care solely about the level of care, while hospitals and doctors operate at a point somewhere along the profit-care continuum.
The theory is that these competing interests should balance themselves out. But the profit motive has taken over, skewing the balance in favor of the insurance companies. More and more, insurance companies are putting pressure on hospitals and doctors to reduce costs, which they generally do by tightening staffing, cutting wages and benefits and reducing the amount of time patients spend with doctors or in the hospital.
The approach is no different than that followed by other businesses – think of the mass layoffs in the automobile industry or the shipment not only of manufacturing jobs but service jobs overseas. It’s all about cost control, which leaves American workers in a tight spot.
This downward pressure on wages and benefits leads to frustration, forcing workers to turn to one of the few tools they have to defend their living standards -- the strike. The theory behind the strike is relatively simple: to disrupt the workplace. The idea is to cut into management’s profits by slowing or stopping production, to show that the workers are unified and to attract public support.
These days, however, strikes are risky propositions, especially given that American laws give management significant advantages. Workers can walk out of work (sit-down strikes in which employees take over companies are illegal), but cannot prevent management from hiring replacements. This allows companies to continue doing business with only the smallest disruption.
Several years ago, the workers at Farmland Dairies in Wallington walked out over the company’s attempts to create a multi-tiered pay structure that workers said would create divisions within the union, ultimately damaging or destroying it. Management responded by bringing in replacement workers.
The replacement workers made it easier for the dairy to withstand the strike, forcing the workers to engage in other tactics, including taking their criticisms to the public by distributing fliers to consumers at stores where Farmland milk was sold. The idea was simple: to encourage consumers to boycott Farmland products.
But the difference between the Farmland strike and the recently settled nurses strike in New Brunswick is that consumers cannot boycott hospitals – in most cases, they cannot even choose the hospital at which they will be treated. That decision generally is made by the patient’s doctor or insurance company – or, in an emergency situation, by the ambulance corps.
That alters the dynamic, greatly.
This point was brought home to me on another visit to the hospital to see my new niece. As I walked in with my brother Mark, who’s as liberal politically as they come, I told him I was working on a commentary on the nurses strike.
He said he wanted to be sympathetic, but his first concern was his wife and daughter. He didn’t have a choice of hospitals and was offended by the chants of “scabs go home” coming up from the street below.
“Who do they think is going to provide care right now?” he asked angrily.
I didn’t have an answer. My niece was still in the hospital, though out of NICU, and the replacement nurses were doing a good job of taking care of her. It was easy to see how the anti-scab chant could seem callous.
What I realized was that there were no easy answers, that the issue ran deeper than just this individual dispute over a contract between the nurses and management at Robert Wood Johnson.
Our reliance on private insurance companies to provide our coverage has been a failure – not only are our medical decisions ultimately controlled by accountants, but 45 million Americans have no insurance and a huge segment of the rest are underinsured, leaving them vulnerable to financial catastrophe should a medical calamity occur.
What is needed is real reform, not just a reshuffling of the deck or a small-scale expansion of Medicaid or Medicare. We have to abandon the HMO model, which has proven successful only at rationing care, and realize that a tax-funded, universal, single-payer system in which the government acts as insurer and sets the prices for the care is the only one that can address the basic inequities of the current set-up. Such a plan likely would have lower overhead — Medicare administrative costs are a fraction of those in the private sector — and it would cover all Americans.
Until something like that happens, we are likely to witness similar walkouts elsewhere -- and that does a disservice to everyone involved.
Hank Kalet is a poet and managing editor of two Princeton Packet newspapers, the South Brunswick Post and The Cranbury Press. Visit his Web site, Channel Surfing.
SIDEBAR: A POSSIBLE FIX
Number of uninsured in the state: 1,290,253
Number of uninsured in the country: 45,000,000
Source: US Census Bureau
US Reps. John Conyers (D-MI), Dennis Kucinich (D-OH), Jim McDermott and Donna Christensen have introduced HR 676, the United States National Health Insurance Act, in the House. It would “create a publicly financed, privately delivered health care system that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories.”
The bill continues to pick up steam, with 170 labor organizations endorsing it, but it’s unlikely that congressional Democrats will take it up this fall, with mid-term elections approaching. Their fear is real -- there is a ton of monied interest opposing any such plan. But Democrats would be smart to make this an issue – uninsurance and underinsurance are the type of “pocketbook issues” that might bring some wayward Democratic voters back into the fold of the party. But first the party leaders must stand up for something.
As this issue went to press, 77 representatives had signed on as co-sponsors of the bill. Rep. Donald Payne, who represents the 10th Congressional District, is the only co-sponsor from New Jersey.
-Jon Whiten
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