The current resurgence of COVID19 has overwhelmed important parts of the healthcare system. The images are well known: patients parked on gurneys in hallways, exhausted nurses staggering from shift to shift, and shortages of crucial equipment such as respirators.
A few statistics show the severity of the situation. At least 213 RNs have died from COVID. A staggering 258, 768 have been infected by the disease. In this situation, the 86% of nurses who reported suffering from anxiety in a Mental Health America survey have sound reasons for feeling that way. Another 1,200 non-nurse health care workers have died.
Forms of struggle
The crisis in healthcare has led to an increase in strikes and union activity by nurses and other healthcare workers. Marxist writer Mike Davis recently said, making a friendly but light hearted reference to classic communist terminology, “nurses are the vanguard of the proletariat.” He was absolutely right. The healthcare industry is the site of the most active working class struggles in this country today.
There have been a number of different forms of struggle taking place.
- Hospital strikes. (Albany Medical Center, Montefiore New Rochelle, MultiCare Indigo Urgent Care, East Liverpool City Hospital in Ohio, and St. Mary Medical Center in Langhorne, PA.)
- Nursing home strikes. (Infinity Health Care in Chicago).
- Strike authorization votes. (Riverside Community Hospital in Los Robles, CA, and SEIU Local 73 at Cook County Health in Chicago.)
- Campaigns against hospital closure. (Closing Mercy Hospital and reducing services at Providentin Chicago.)
- Campaign for a nurse in every school (CTU).
This article will look at some of the issue being raised by the strikes. The issues are very similar in all of them. They are patient staff ratios, hazard and basic pay rates, and the provision of adequate PPE.
Demonstration strikes
There are a number of issues raised by the health care fightback. In the labor movement, there are two types of strikes, “demonstration” and “unlimited.” In a demonstration strike, the union announces ahead of time how long—normally several days—the strike will go on for. An unlimited strike is what it sounds like; the workers stay out until they decide to return to work. Demonstration strikes have become increasingly common in hospitality and healthcare in recent years. Socialists, while welcoming any situation where workers flex their muscles, have generally favored unlimited strikes. We have seen these as being more able to bring pressure onto management than a strike which the employers know will end soon.
The vast bulk of the recent healthcare strikes have been demonstration or limited strikes. The Infinity Health Care strike in Chicago was an important exception. Here 700 members of SEIU Healthcare Illinois struck for twelve days.
Militants in healthcare are faced with a complicated tactical question. How long can popular support for a hospital strike be maintained during a pandemic? On the one hand, nurses are held in high public esteem at the moment. On the other hand, many people are desperate to see hospitals functioning as well as possible during the crisis.
Therefore, the length of a healthcare strike during a medical crisis is a thorny problem that unionists will need to think carefully about. Instant cries of bureaucratic betrayal may miss the mark.
Scabs
There is another aspect to the demonstration strike issue. Nursing is the sector of American industry where scabbing is the most common. Large national companies supply scab nurses to striking hospitals. These companies negotiate that a certain minimum number of days work be guaranteed for their scabs. In an increasing number of strikes, these guaranteed days turn out to be longer than the days of the demonstration strike. Therefore, there have been a number of instances where the nurses, having completed their demonstration strike days, have offered to return to work. Management, however, has locked them out, citing the days guaranteed to the scabs. Talk about adding insult to injury!
Nurses in some hospitals have reported unusually high levels of management hostility following their return. This has included unfair shift scheduling, disciplinary frame-ups of leading activists, and a barrage of anti-union propaganda.
This has been taken to extremes by Linda Evans, Mayor of LaQuinta, in California. Evans, who is herself a healthcare executive, has called on Governor Newsome to ban all healthcare strikes during the pandemic. She was prompted to do this by strike authorization votes by members of SEIU Local 121RN in her area.
Just in time production
The strikes have focused attention on a striking example of the irrationality of capitalism. This is just in time production applied in medicine. Just in time production is a form of industrial organization where only a minimal amount of material is kept on hand in the factory. The idea is that modern supply chains can quickly move supplies to where they are needed and there is no need for capital to lay idle in goods sitting around waiting to be used.
In industry in general, this has been an important component of recent capitalist thinking. In health care it’s sheer lunacy. Some hospitals only keep a pre-estimated amount of medication and supplies on hand. For example, certain hospitals only keep the state ordered statutory minimum of PPE at the hospital. According to the plan, if more is needed it will simply be ordered. This way no capital is lying dormant in “unnecessary” PPE. These procedures are taken to their logical conclusion by applying these ideas to human nurses, not just medical items. The minimum possible number of nurses are scheduled based on various studies and algorithms. If one wanted a laboratory pure example of putting profits before human needs, this would be it.
Successorship
1,100 PASNAP nurses won an important step forward at the Einstein Medical Center in North Philadelphia. Following a strike vote, they won a “successorship” clause in their new contract. These are days of constant corporate churning and reshuffling. The ownership of workplaces frequently changes hands. A successorship clause guarantees that the new employer will maintain the wages, hours, and conditions that the previous one did. It’s a real protection for workers. The Einstein workers made this part of their bargaining package when they saw what happened to members of their union at St. Christopher’s Hospital for Children. The St. Christopher’s workers lost their contractual protections when Tower Health and Drexel bought the hospital.
Solidarity
Healthcare workers face a very complicated situation today. One thing that’s not complicated is the tasks of socialists when faced with the struggles of these workers: do everything in our power to build solidarity with these courageous workers.
Adam Shils is a member of the International Socialism Project in Chicago.
