Organized labor in the healthcare sector enters 1997 in an activist frame of mind but tempered in its militancy by the bruises of the past several years.
The AFL-CIO, under the invigorating leadership of former healthcare organizer John Sweeney, has raised the stakes. Certainly Sweeney gets credit for following through on his pledge to organize more workers. The federation also gained visibility for its drive to punish congressional Republicans for their anti-labor attitudes and Medicare policies, although its success on election day was less than overwhelming.
Perhaps if the Democrats had prevailed in Congress, unions would have a chance of altering the National Labor Relations Board election process, a continuing thorn in their side. The current setup, labor lawyers believe, tilts to the advantage of deep-pocketed employers, who can grind down labor organizers through an almost infinite series of appeals and hindrances.
At Columbia Sunrise Hospital and Medical Center in Las Vegas, the Service Employees International Union tried a different strategy. Organizers were sent from Washington and Boston to persuade workers to sign cards saying they want union representation. The union hopes to avoid the protracted and costly election process by obtaining enough signed cards that the hospital will cave in and recognize the bargaining unit.
Whether Columbia Sunrise will go along is far from certain. The SEIU and other unions feel that Columbia/HCA Healthcare Corp., which operates the hospital, is virulently anti-union. They are developing a national strategy to organize units at Columbia hospitals. The unions believe the company is skimping on staffing, equipment, supplies and all-around quality of care for the sake of corporate profits. Thus it makes a very attractive target for unions attempting to discredit the corporatization of the healthcare industry. Union officials portray themselves as defenders of quality of care and patients' rights.
Needless to add, Columbia also has a reputation as the "Terminator" of excess capacity-including jobs-as soon as it acquires a hospital. For that reason unions are also working their political connections to impede Columbia takeovers of existing hospitals.
The SEIU bears watching for its new policy of detente and creative accommodation with selected employers. President Andrew Stern wants the union to work with and not simply reject the dynamic change pulsing through the industry. Instead of being dragged kicking and screaming into an unhappy future, the union should work closely with the institutions it has organized to jointly envision a partnership that serves patients, employees and owners, Stern argues. Several contracts signed recently on the West Coast inculcate those ideas.
Not every union agrees this is the way to go. The California Nurses Association has largely parted ways with the SEIU, suggesting it has sold out for a few crumbs. The CNA sponsored the more radical of the two initiatives in California that, had they passed, would have subjected the managed-care industry to stringent regulation. The CNA believes activist nurses and employees are the only barrier that prevents a rapacious for-profit juggernaut from ramming inferior, possibly lethal care down patients' throats.
Healthcare unions are also devising strategies to organize managed-care companies, although this is trickier than organizing a hospital or nursing home.
The American Nurses Association, bogged down in many contested NLRB elections, now faces competition for bargaining units from numerous other unions, including the United Steelworkers of America, the Teamsters, the United Auto Workers, as well as the SEIU and established nursing groups. It appears also that doctors are more willing to consider organizing in collective bargaining units as they give up autonomy to become employees of other companies.