From the March-April 2015 issue of News & Letters

by Htun Lin

Dockworkers in Oakland, Calif., and up and down the West Coast, labor in an increasingly hi-tech workplace. They have seen their ranks decimated over the decades by automation accepted by labor bureaucrats of the International Longshore and Warehouse Union as “necessary progress.” Yet in February the rank-and-file dockworkers fought back against the machine. They have been able, after months without a contract, to show their power to shut down a sizable segment of the capitalist economy with a work-to-rule action.

Work to rule means doing everything methodically, correctly, without cutting corners. That’s essentially what mental health workers demanded when they struck for a week in January. Mental health workers and dockworkers showed that workers have the power to reclaim our labor.

Working in healthcare today is very alienating. It has been transformed in a way that is felt profoundly. The workplace is drowning in fancy hi-tech machines. Cadres of bureaucrats spend their working hours promoting the product of healthcare with marketing campaigns. The rank and file hear daily admonitions to smile more and are told, “Just be glad you have a job.” Bureaucrats preach “customers come first,” while cutting service and staffing.  Hospital and HMO executives are in a race to eliminate labor as much as possible in their “product.”

Conventional wisdom would have us believe that the union and labor officials are one and the same.  Conventional wisdom would also have us believe that health insurance is healthcare. In my own medical workplace, both assumptions are the dominant ideology.

That’s because we work at Kaiser under a Labor-Management Partnership (LMP). The LMP has been the dominant force for over a decade in our shop. The ideology of the LMP is what has brought us to the sorry state of healthcare at Kaiser today.

The HMO industry perverts healthcare reform’s “Affordable Care” concept to their narrow ends, cutting services wherever they can, in order to enhance their bottom line.

On the front lines, we know that healthcare is not a product but a human relation. Seeing that relationship under attack, many veteran doctors, nurses and health workers have thrown in the towel and decided to leave through early retirement. Those of us who remain at work struggle with the daily stress and health risks from ever-increasing speedup. What is eating at a lot of us more than speedup is the persistent dehumanization of healthcare. Patients are treated like commodities on an assembly line, and workers are treated like appendages to the machines.

ISOLATED AMID MACHINES

Nurses say they could now go for days in a ward while rarely having the opportunity to speak to colleagues down the other end of the long football field-sized hallway. The reason is both new physical architecture and new software architecture. Each worker, in their own respective pod, is tethered to the computer in isolation from others. All sorts of bells and alarms keep going off, and the human providing bedside care is unable to keep up.

Rank-and-file workers in the new Kaiser building say they feel like they are in a prison, constantly hounded by the warden over their performance scores, exacerbating the feeling of isolation. The cumulative effect of chronic stress from struggling with daily speed-up is causing many healthcare workers to seek mental health care themselves.

COMMUNITY HOSPITALS UNDER STRESS

But the system failure is nationwide, even in the public sector. Doctors Medical Center in San Pablo, Calif., faces the same problem all community hospitals across the country currently face. It relies on government funding to care for the poorest and sickest. It is forced to eliminate services because chronic budgetary shortfalls have been exacerbated by the proliferation of private HMOs enabled by Affordable Care Act’s (ACA) private exchanges.

Patients are dying because of closed emergency rooms in their community hospitals. In an ACA environment, the private sector through private exchanges is growing rapidly at the cost of publicly funded community hospitals.

We have to create a path out of this morass where extreme alienation comes from not only technology, the machine, but also machine-like thinking, dominating us and disconnecting us from each other.