NEWS & LETTERS, December 2009
Workshop Talks
Scapegoating cheaper than healing
by Htun Lin
Recently my shop was abuzz with discussions about the rape of a teenage girl at a high school dance in Richmond where I live. What bothered my peers was that 24 kids looked on without helping the 15-year-old while she was being gang-raped. We all agreed that this behavior is depraved.
Then I asked, where do you think these children learned to behave this way? They learn in this society that each one sinks or swims on their own. Our kids learn how to survive in a harsh cold world that they did not create, and that doesn't care where they end up.
It made me think how, even at the Kaiser HMO hospital where we work, management fosters a similar attitude in the workplace. A hospital is about collectively caring for others, but it has bureaucratic procedures for abandoning someone when they are down and most in need of help.
A patient who was a Kaiser member for 25 years lost her job in 2008. When, after exhausting COBRA coverage, she applied for a Kaiser individual plan, they rejected her because she had had breast cancer in 2004. She was shocked at this betrayal. She loved her caregivers who had cured her.
Kaiser just sent her a computer-generated form letter with a long list of pre-existing conditions that trigger rejection with the explanation that their "medical underwriting screening process" is how they remain "cost-effective." She then appealed with a letter from her doctor that stated she is "currently disease free." The computer then spit out a second rejection letter.
This patient thinks she may overturn these denials on appeal and the healthcare reform law going through Congress would outlaw this particular form of routine abandonment of those who are sick. However, the law doesn't overturn the way management's "cost-effective" imperative infects healthcare delivery itself.
Management undermines our natural cooperative spirit by fostering antagonism between us. New software tracks each individual employee's performance. The measure they obsess over is our co-pay collection rates, and fulfilling state-mandated documentations.
We workers know from practice that these tasks can be done better as a team. However, managers are fixated on individual scorecards. They want to have individuals to blame whenever the state finds the hospital in violation. They make us sit through canned computer-video compliance training, which drills into our heads that compliance is an "individual" obligation.
Work is oriented around answering to the computer, which is our new boss, foreman and disciplinarian. The mantra is, we can't stop "progress." Our relations with each other are greatly diminished. It is just each one for himself through the machine. This militates against cooperation. Patients come to be seen as the adversary that drains hospital resources.
To curtail the spread of infectious diseases, patients with tuberculosis and certain other infections must be placed in isolation. Patients with a variety of heart conditions require rooms with monitors, and a higher nurse-to-patient ratio. Yet management, to keep costs down, not only reduced the number of those specialized rooms, but keeps staffing levels too low.
Unassigned patients are subject to long waits. Yet, if the individual charge nurse fails to meet the state-required 24-hour deadline to place those patients, it is she who will be disciplined. Every manager is obsessed with passing the buck. This pervasive attitude even affects frontline workers. Each new admission is viewed as a drain on our time.
When our job has been dumbed down by the computer, management reminds us daily that we can be discarded at any time. Is it any wonder then that our kids, too, have problems with their self-esteem and feel that it is just the way of the world to not give a damn about anyone else but yourself?
Outlawing denial of care for pre-existing conditions is a good reform. But the problem in healthcare will not be resolved until we overcome capitalism and its "cost-effective" imperative, which alienates us from our own labor and from each other. We have to create our own social relations in production and liberate the cooperative power of our labor.
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