www.newsandletters.org
|
|
NEWS & LETTERS, July 2002
Workshop Talks column by Htun Lin
Managed noncare
As more companies are forcing their employees to pay for
the rising cost of health care, workers are increasingly striking over this
issue as in the recent strike at Hershey's. Frontline health workers at HMOs are
also in the middle of this raging conflict over "cost shifting." For we who started working at HMOs before the decade of
restructuring, our primary mission used to be to get the patient into a bed and
attended to by a caregiver as soon as possible. Thanks to HMO restructuring,
"managed care" is all about managing cost, not care. With increased
cost shifting we are to become the latest barrier to unprofitable care. Frontline service workers like us are sent to classes to
train us to "achieve revenue enhancement." We are told to dramatically
"change our organizational culture" by seeing ourselves not only as a
health organization but "as a business." Toward that end, not only do we learn "proper cash
handling procedures," we are also taught methods on how to handle angry
patients as they hear the bad news about their increased costs. For us, this
"cost shifting" is really about conflict shifting—from the picket
line to the shop floor, where a patient in need now becomes another opportunity
for "cost recovery." BETWEEN ROCK AND HARD PLACE During open enrollment, big employer purchasing groups
such as AT&T, GM or CalPers purchase HMO insurance for their workers. These
capitalists sit across the bargaining table from the managed care money managers
on the HMO side and duke it out over the amount of money to be transferred for
that healthcare. When the HMOs said they were imposing a 11% increase in
premiums this year, the employer groups, the HMO's real customers, countered
with cost shifting. This includes forcing workers to pay more of the
premiums, deducted from their paychecks, but employers also tell HMO
money-managers that they will have to squeeze the extra money, called
"co-payments," out of individual worker/patients. That's what has
filtered down to the level of us frontline service workers, who are caught
between a rock and a hard place—between the angry patient in need versus the
needs and dictates of capital, which must cut costs "at all cost." Our whole reorientation program is designed to get us to
focus on extracting more money from the individual patient as efficiently as
possible. Our primary goal now is to realize a higher co-payment "recovery
rate." Furthermore, we are told our role in this is going to
become more important as projected cost shifting will dramatically increase. New
"communications techniques" are meant to "manage"
anticipated increases in day-to-day conflicts. Over the years of restructuring
the business office mentality took over the nursing supervisors' functions.
Their roles were revised to keep staffing levels to a bare minimum. The business
office is now working on us frontline workers to internalize their priorities
through this re-education. This new priority is the source of heightened discomfort
in our everyday working lives. As one worker said, "Why are we made to put
additional stress on the patient, demanding a $250 co-payment, just when the
doctor has delivered the bad news of pancreatic cancer?" Their claim in
television ads is that "Nothing gets between you and your doctor." HMO CLASS WARFARE The capitalists are transferring the conflict between
workers and capitalists from the picket line to the health care shop floor where
we are made to nickel-and-dime the patient to death. In turn, we are told to
respond to patients upset about their new co-payments by pointing the finger
back at their own companies who are responsible for the new terms of their
health care package. For all workers, health care is a precondition of our
ability to continue to work. To capitalists it is either a profit producing
commodity or a costly overhead to be reduced as much as possible. Whether we are
talking about HMO capitalists or industrial capitalists, capital has a
singleminded determination to expand. Instead of being able to focus on the
simple priority of taking care of those in need, we are put in the middle of
contending capitalist interests. In the past, we health workers at Kaiser have gone on strike demanding contractual guarantees for quality care. Now a labor/management strategic partnership has changed all that. In effect, the union is helping management draft us into being foot soldiers in their inter-capitalist battles, putting workers and patients in the middle. Nothing can get around capital imposing its will unless all workers get together against capital's dominance. We need a workers' movement around "health care as a human right." |
|
Home l News & Letters Newspaper l Back issues l News and Letters Committees l Dialogues l Raya Dunayevskaya l Contact us l Search Published by News and Letters Committees |
