FNHP organizers are there for health care workers who are saying...
"We Can Do It!"

In what was a clear sign of increased interest in and opportunity for health care organizing, more than 50 AFT organizers and staff attended a four-day union health care organizers conference held outside Washington, D.C., this winter.

The national conference brought together AFT staff, as well as some member volunteers, who work throughout the nation with health care employees who have expressed interest in organizing new unions and building and strengthening existing unions. Their mission was to prepare for and share information on organizing in today's health care environment. That translated into a jam-packed agenda of small-group interactive sessions for basic skill building and technique sharing.

"In health care, we're at the point of seeing more action than we've ever seen," said AFT department of organization and field services director Phil Kugler, who addressed the Jan. 23-26 gathering. "There's a lot of change out there and it's not change for the better."

Both health care workers and consumers have a lot of anger and resentment over the fact that health care quality is being redefined--and sometimes ignored--by bureaucrats who are more and more involved with delegating, downsizing and detachment. Because of that, there is a "growing focus on the possibility of collective action to do something to modify these trends," said Kugler.

Judging from the statistics, the AFT is the right union to choose. Over the years, the AFT has had a 75 percent to 85 percent success rate in elections. Rather than pat ourselves on the back, Kugler added, the AFT created an official division for helping to organize and serve health care professionals: the Federation of Nurses and Health Professionals. And to make sure the union can respond quickly and appropriately to the interest among health care workers in joining the union, the AFT has brought on board a director of FNHP organizing--John August, who joined the staff late last year (see below). Additionally, more FNHP staff have been hired at the national office and more organizers are being trained and put into action.

"President Sandra Feldman has made an incredible commitment to this effort," August said. There's support for all of the health care affiliates in one form or another from the AFT, said August, who noted that we're sharing resources across the country, broadening staff capability, and expanding the budget for health care organizing.

Profits up, coverage down
FNHP division director Mary Lehman MacDonald was also on hand to give the organizers--who came with varying levels of experience--a clear and current picture of the industry in which they're organizing.

First of all, the economy is in great shape--"we have never had it so good--we're in a boom time," said MacDonald. Corporate profits were up 95 percent between 1991 and 1998, the stock market was up 194 percent, inflation down from 4 percent to below 2 percent and some 17.6 million jobs were created.

"However, prosperity is not being evenly distributed," she said. In terms of real dollars, wages are down since 1970, the percent of full-time workers covered by health insurance went down from 97 percent in 1980 to 76 percent in 1997 and workers are paying more for health care coverage...not to mention the increasing number of workers who have to pay for part of their coverage. The percentage of the U.S. population that is uninsured is now 16.3 percent (1998 figures), up from 14.1 percent in 1991.

"Health care access is worse than it ever was and there are serious concerns about quality," said MacDonald. At the same time, national health care spending in this age of managed care totaled more than $1 trillion in 1998Ña 21.5 percent change in four years!

In 1990, 13.5 percent of the U.S. population was enrolled in health maintenance organizations; in 1997, the percentage rose to 25.2 percent. In order to remain competitive--and sometimes just to remain alive--hospitals are becoming part of a chain or multi-hospital system. Today, most of the health care industry is concentrated in three huge corporations: Aetna, CIGNA and United Health Care. And while each has revenues in the billions of dollars, in 1998, the total profit margin for all three was down slightly. "The response will be to cut even more in staff and other costs," said MacDonald.

Even with the profit margin down, the CEOs of Aetna, Cigna and United Health Care managed to pull in some amazing salary and option packages in 1998Ñamounts that could have paid the yearly salaries of hundreds of health care workers.

Generally, CEO pay represents approximately 200 times the pay of the average worker, said John August. The CEO salaries at the top three health corporations are approaching 400 times that of the average worker!

These are no longer the good old days, said MacDonald, when patients chose their own doctors; doctors determined treatment; providers determined the pricing; and insurance companies paid the bills.

Under managed care, you don't choose your doctor; insurance companies shop for the cheapest providers and look for the fewest services at the lowest cost. That translates into less care, less time in the hospital and even to patients being kept out of the hospital all together, said MacDonald.

The pressure to lower costs is resulting in hospital deaths due to accidents and errors. Out of 1 million people injured by errors during hospital treatment each year, 120,000 people die as a result of those injuries. That's nearly three times the number of people who die in motor vehicle deaths. "There's no check on how low quality can get," said MacDonald.

This state of affairs has also resulted in a majority of nurses being concerned with the quality of care they can give. A 1998 survey in RN magazine, showed that 82 percent of the nurses surveyed in all areas of care are dissatisfied by the care they give due to short staffing.

The upshot for workers is that they are now more frequently seeing--and wanting--the benefits of organizing to change and challenge the balance of power where they work. "We're starting to see a lot more interest in organizing in health care," said MacDonald. "There are more elections going on and the wins are going up."

Besides having more control over working conditions, how care is delivered and whether they are safe to act as patient advocates and to improve the quality of care, unionism has a definite economic benefit to its members. For the unionized registered nurse, median weekly earnings are $771 compared with $695 for the nonunion RN. For nursing aides, orderlies and attendants the difference is even more evident: For non-union workers the median earnings are $292 and $403 for those who are unionized.

Not only are collective bargaining contracts in health care expanding to address staffing, quality, training and job security issues, unions are also making an impact on the quality of care being delivered by banding together to push for protective legislation. Already, state legislation--in California--has been passed that will set the level of staffing for nursing care to force higher quality.