NEWS & LETTERS, Janurary-February 2010
Workshop Talks
Profits and MRSA rise
by Htun Lin
The much-heralded healthcare reform bill that is finally coming out of Congress puts some limits on insurance companies. But those few restrictions pale in comparison to major provisions that will create a boon for the industry. The compromise legislation is mostly a product of deal making meant to placate right-wing and corporate interests. The central issue is, who will pay for reform. It is workers who got stuck with the tab, not only through their surplus labor in the form of taxes but in more concrete ways not even addressed.
While President Obama and Congress were obsessing over cost issues, real healthcare reform is an ongoing struggle among those who deliver care on the shop floor all across the country. Workers have been struggling for the right to provide quality care for the last two decades, while healthcare restructuring only focused on cutting costs. That has been a recurring story at Kaiser, the HMO where I work, which is considered one of the most efficient "low cost" providers. Under the new mandate that nearly everyone buy insurance, Kaiser is poised to gain millions of those newly insured.
The pharmaceutical industry is also anticipating a windfall from the healthcare bill, which they helped write, and which prohibits consumer co-ops from seeking cheaper prices from other than U.S. companies. It is a monopoly with deadly consequences.
Whatever bill passes, it will not change the daily battle over miserable shop floor conditions produced at HMOs. Unending cost-cutting measures by HMOs across the country produce chronic staffing and bed shortages. In any industry, speedup causes accidents, leading to death and injury to workers. In healthcare, however, speedup causes death and injuries both to workers and to patients.
One type of "accident" is the frequent and unwitting infecting of patients with MRSA. Methicillin-Resistant Staphylococcus Aureus infections, which spread among people in close quarters, is a global public health crisis. There are 19,000 unnecessary deaths from MRSA in the U.S. alone each year.
The primary cause is the overuse of antibiotics promoted by the pharmaceutical industry, which gives financial incentives to doctors to prescribe them.Overuse actually promotes MRSA's spread by helping it transform itself into more resistant and virulent strains.
The key to prevention of MRSA is proper hygiene and screening, followed by isolation. This low-tech method has been proven to work. Norway, which prohibits the over-use of antibiotics and carefully follows hygiene and isolation procedures, is now nearly free of MRSA infections.
BILLING TRUMPS SCREENING
Kaiser, for example, has an extremely large database in a billion dollar computer system, which is used very efficiently for cost recovery, often overcharging patients. We are supposed to track critical information such as MRSA. However, human beings have to be able to take time to analyze the data and take concerted action. In the case of MRSA, that means thorough screening to catch those who should not be sharing a room.
Everyone knows this, yet workers feel too rushed in day-to-day work. A lot of us on the job feel as though we are set up for failure. We all know how often MRSA patients have gotten into shared rooms when they shouldn't. Management looks for individuals to blame, but not its own systemic failure at prevention.
SPEEDUP KILLS
For us workers it is clear that the main cause is cost-cutting and speedup. Also, out of fear, employees often come to work despite having some kind of illness or infection, which is precisely what the Norwegian healthcare managers discourage. Kaiser managers say "stay home if you're sick," but we all know they are not serious. Workers get pulled into the manager's office at the end of the quarter for using their sick time.
Dr. David Lawrence, our former CEO at Kaiser, once said that "if [the HMO industry] were in the airline business, we would have been shut down a long time ago." Obama has touted nationwide "electronic record-keeping" as part of his healthcare "reform." We at Kaiser have been living that digital nightmare.
Real healthcare reform involves careful attention to "mundane" details. Key to success is adequate sharing of information through cooperation. We need to ask how we can free ourselves from the fetters of capital to fully engage in healthcare as a human activity.
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