From America: The Hospitalization business (1977)

From the June 1977 issue of the Socialist Standard

When considering a subject such as the dispensing of health care to the working class a Socialist begins with a basic assumption, one which fits the real world of our times: The working class, generally, must be kept in some sort of adequate health if it is to function reasonably well and so requires a degree of medical attention along with the other items that go into producing and maintaining labour power—food, clothing, housing, transportation, luxuries of a sort. And it need hardly be stated that the well-being of the capitalist class dictates that the costs of producing and maintaining labour-power be constantly monitored and held in check. Hence, the continual hue and cry in the USA over the question of a national health programme.

As it is, today, there are various types of plans, some privately operated, with their own hospitals and staffs, by large capitalist industries and by some labour unions. There are also the state-regulated Blue Cross-Blue Shield Plans in which many employers of labour offer their help, totally or in part, as a “fringe benefit” (or equivalent plans sold by private insurance companies). And there are the Federal and State-operated Medicare (for 65-and-over) and Medicaid (for the indigent). But these plans are all expensive to operate and, in some cases, not too satisfactory in coverage and seem to invite a large element of graft and corruption. So, because the central organs of capitalist power are deeply involved, as it is, it is all understandable why opposition to some form of national health plan in this bulwark of “Free Enterprise” is steadily eroding.

In the meantime, the Carter Administration has stepped into the hospital picture and announced that it will seek to legislate a 9 per cent, per annum ceiling on hospital rate increases. (The going in-patient rate in Boston teaching hospitals, for example, hovers around $175.00 per day plus the various extra medical and surgical charges, and steadily rising. The costs of out-patient care, too, because of the sophisticated new equipment and highly trained technicians available, reach astronomical heights which can easily cause the uninitiated in other lands to believe that American workers are indeed wealthy). And hospitals, generally and understandably, are reacting unfavourably. The dispensing of health care might be their business but the proper balancing of books is equally important in a capitalist society, even for “non-profit” institutions. “We will have to cut back on patient care”, scream the administrators. And there are some interesting observations that can be made about the business.

For hospital administrators must steer a hazardous course between what to them are twin horrors: government “interference” (excepting when such interference is requested) and unionization of their personnel. Unions have made some inroads into American hospitals but they are by no means general and their strength is certainly limited. So, it is all but impossible for administrators to blame rising fees on union demands. But this is only half of the story.

There has sprung up a lucrative business of “union busting" public relations firms that has been meeting with much success in the hospital industry. In a column in Boston’s Real Paper for Oct. 16, 1976, we read:

Last spring, Massachusetts Hospital Workers began union drives . . . The hospitals responded by calling in heavy- duty outsiders, the Chicago-based labour relations firm. Melnick, Mickus and McKeown. which three years ago at B.I. (Beth Israel) helped defeat another organizing attempt. The Hospital Workers . . . added that the consultants cost the hospitals $150.00 an hour at a time when hospital rates are soaring . . .

Certain local politicians introduced a bill in the Mass. House aimed at such practices. The following quote from Vol. V, No. 13, of the MHA (Massachusetts Hospital Research & Educational Assoc.) Monday Report tells the story:

MHA membership reacted quickly and sharply last week, helping to thwart a bill outlawing certain labour relations expenses. The association had testified before the Health Care Committee in mid-March, opposing House 2889 which aims to remove from reimbursement any costs a hospital incurs when coping with union organizing efforts . . .

The member hospitals were alerted, the Senators contacted and the bill defeated, at least for the time being and the Health Care Committee promises to “follow it closely.”

Now the problems of hospital workers will not be solved by union organization notwithstanding certain advantages. Nor will workers, generally, be benefited if and when hospitals can no longer charge off union- busting costs to operating expenses. Hospital administrators are, primarily, business people and will always fix rates at what the market will bear. They are sellers of the commodity health care and that’s how it has been and will be until the working class gets rid of the commodity society—capitalism.

Harmo, WSP, Boston.