The Service Employees International Union sees the public face of labor's push to organize U.S. healthcare in Chicago's Rev. Dan Dale. Clergy, such as Dale, low-income patients and community activists-not union organ-izers-figure prominently in the union's 17-month-long public skirmish with Advocate Health Care, a not-for-profit healthcare system that the SEIU alleges overcharges the uninsured and harasses patients who cannot pay. "Untrue and untrue," responds Dan Parker, a spokesman for Advocate, based in Oak Brook, Ill. "The suggestion that we're charging outrageously high prices is in and of itself outrageous."
Nonetheless, the SEIU's allegations and efforts have tapped a rich vein of consumer frustration as healthcare costs climb, insurance coverage wanes and patients squeeze household budgets to pay a growing share of medical bills.
"Ours is a movement for social and economic justice," insists Joseph Geevarghese, who arrived in Chicago via Washington in 2002 to lead the SEIU's Hospital Accountability Project, a "significantly funded" advocacy arm of the nation's largest healthcare union, by Geevarghese's account, though he declined to give specifics.
Analysts and labor experts have another name for it: a corporate campaign.
The Hospital Accountability Project, headquartered in downtown Chicago with a staff of 25, has launched a high-profile and prolific campaign, scrutinizing the business practices, wages, benefits and working conditions at Advocate's hospitals while rallying neighborhood activists, politicians and religious leaders like Dale.
Such campaigns-also known as advocacy or comprehensive campaigns-are not new in labor or limited to healthcare. University of Iowa and Marquette University researchers counted at least 10 campaigns from 1976 to 1988 that squeezed employers, some successfully, to grant concessions as unions sought to organize workers or achieve their first contracts.
IRI Consultants to Management, Detroit, says at least a dozen unions have staged corporate campaigns aimed at 28 companies since 1981, including four targeted at healthcare companies by the SEIU or the California Nurses Association: Advocate; Sutter Health, Sacramento, Calif.; Tenet Healthcare Corp., Santa Barbara, Calif.; and Catholic Healthcare West, San Francisco, the last of which is often cited as an example of a successful corporate organizing campaign.
The SEIU's campaign involving the CHW began in 1997 and wrapped up in 2001 with a three-year contract covering 7,000 employees. The SEIU argued that the nine orders of nuns that operate CHW failed to uphold church support for organized labor; some religious leaders agreed and pressure mounted as a result, says Jarol Manheim, a George Washington University professor who has written two books on corporate campaigns.
Labor experts say such campaigns typically blend legal challenges and public protests-such as picket lines at annual shareholder meetings, for example-to frustrate and embarrass management, customers, regulators or owners, but such efforts must be ongoing and far-reaching to qualify as a campaign.
For Dale, pastor of a 98-year-old United Church of Christ congregation in Chicago's Lakeview neighborhood, the SEIU is an "important ally and partner" to hold Advocate accountable to its religious commitment to the low-income and uninsured. The United Church of Christ and the Evangelical Lutheran Church in America jointly sponsor Advocate.
For the union, enlisting clergy and community activists adds strength to a waning labor movement.
Citing the uninsured
In Illinois, the SEIU released a string of scathing reports, blasting how and how much Advocate bills its uninsured patients and alleging the system unfairly stymied workers' organizing efforts. The SEIU contends Advocate spent less to cover expenses of low-income patients than other Cook County religiously sponsored hospitals but charged uninsured patients more than what it billed "typical" insurers for identical care. The union's Web site includes supportive-occasionally strident-testimony from financially strapped patients and Chicago's religious community on Advocate's debt collection or workers' right to organize. "Churches and unions are two manifestations of the same world we are called to create," reads Dale's comment.
Corporate campaigns "hit the company from multiple sides all at once," says Manheim, a media and political science professor at GWU.
Employers' costs climb and their reputations suffer as public pressure, litigation and regulatory inquiries mount, he says. Organizers enlist community allies with common interests or distrust of corporations to exert public pressure on an employer, Manheim says. In healthcare, campaigns publicly pit hospital management against patients and clergy, a nightmare for a not-for-profit hospital's image. "You don't want to be fighting these people," Manheim says.
Critics of the tactics say unions orchestrate high-profile attacks on hospitals' wages or aid for low-income patients to boost sagging membership and flagging dues.
Proponents counter that such pressure is necessary to exert labor's influence in an increasingly consolidated and global marketplace. Public scrutiny of business practices and working conditions holds companies accountable as corporate citizens and employers, according to union organizers and supporters, who say such campaigns raise public awareness and give labor much-needed leverage in workplaces increasingly hostile to labor.
The strategy evolved as corporate ownership became more intricate and removed from the workers and communities where companies operate, says Kate Bronfenbrenner, Cornell University's director of Labor Education Research. "As corporate structures get more complex and diffuse, then the union strategy must be more complex," says Bronfenbrenner, who describes campaigns as creative, strategic and escalating. Organizers expand a network of local activists, politicians and workers to a national stage while broadening its campaign beyond an employer to its customers, suppliers and investor, she said, citing the SEIU campaign against Catholic Healthcare West as an example.
"We think what we do is run public education and public accountability campaigns," says SEIU Executive Vice President Mary Kay Henry, who argues the union's goal isn't boosting dues revenue but rather promoting healthcare reform. "We represent 1.8 million people and we listen to what they care about," she says. "We can't just think about wages, hours and working conditions if we're going to win on the issues that matter to our members. We can't win healthcare coverage at the bargaining table."
California Nurses Association spokesman Chuck Idelson says the union's goals reach beyond salaries and benefits for its rank and file. "Certainly we have an obligation of representing our members," he says. "The CNA is a patient-advocacy organization. It's a charge that we take very seriously."
Achieving critical mass
Improving access to healthcare and controlling patients' healthcare costs can't be done one contract at a time, Henry says. Unions must pressure policymakers and health systems to change, she says.
To do that, unions must rebuild membership and recruit activists with similar goals, Henry says. Labor alone "doesn't have enough strength," she says.
On this point all agree: Steadily waning membership has eroded unions' clout. Last year was no exception. In 2003, labor had fewer actual members-down 369,000 from 2002-and its share of the workforce shrank, to 12.9% from 13.3%, according to the U.S. Bureau of Labor Statistics.
In healthcare, unions struggled to hold their ground in 2003. Labor unions had 733,000 members among the nearly 6 million healthcare professionals and medical technicians employed in the U.S. in 2003. That's a slight gain in members but a drop in unions' share of that workforce, to 12.3% in 2003 from 12.5% in 2002. That doesn't include the nation's 2.8 million healthcare support workers, where union membership slipped in 2003 as well, to 11% from 12.4% of the workforce, federal data show.
Despite slipping membership, unions have scored some victories. Healthcare workers opted to join a union in 75% of representation elections overseen by the National Labor Relations Board in 2003, according to IRI Consultants. That compares with 58% of all union elections.
And elections governed by the NLRB, a federal agency, don't reflect all of labor's organizing efforts. Many seek "neutral" or alternative elections, according to BNA Plus, a research division of Washington-based publisher BNA. Neutral or alternative elections may bypass an NLRB ballot, secure greater access to employees by organizers or obtain a pledge from an employer to waive its participation in an election. By law, employers may make a counterargument to union campaigns but can't spy on, threaten, interrogate or make promises to employees as workers weigh their options, lawyers said.
An estimate by IRI Consultants put unions' election victories at 80% when employers agree to neutral elections.
How workers vote for union representation is often a contentious issue at the heart of a corporate campaign. Organizers, who say secret-ballot elections overseen by the NLRB fail to safeguard workers from employers' intimidation, push companies to agree to alternative elections or demand more access to workers and less interference from employers during an organizing campaign.
Champions of NLRB elections say alternatives to the secret-ballot election may leave workers vulnerable to union intimidation.
This tug of war over how to vote for union representation has spilled over to Congress, promoting hearings in the House of Representatives as well as legislation. "The well-advised employer knows how to manipulate the NLRB election process in such a way as to turn the concept of democratic free choice on its head," Nancy Schiffer, associate general counsel for the AFL-CIO, testified at a House subcommittee hearing on employer-employee relations in April. In the same hearing, Charles Cohen, a senior partner with the law firm Morgan, Lewis & Bockius and a former NLRB member, defended the federal agency's secret-ballot elections as "efficient and fair."
Legislation introduced in Congress in May by Rep. Charles Norwood (R-Ga.) pushed for a ban on alternatives to secret-ballot elections. That followed a measure, introduced by Sen. Edward Kennedy (D-Mass.) in November, that sought to expand recognition for a less-formal arrangement, called a card check, which would allow unions to use signed authorization cards from a majority of employees and bypass an NLRB election. Neither measure succeeded, but both will be reintroduced, say spokespeople for both lawmakers.
Healthcare ripe for organizing
Healthcare is vulnerable to organizing efforts and corporate campaigns, George Washington University's Manheim says. The jobs cannot be exported, unlike manufacturing, he says, and healthcare's growing workforce is largely unorganized.
The shortage of nurses, rising healthcare costs and public distrust of corporate governance-at both for-profit and not-for-profit organizations-give unions fertile ground to cultivate strong public support, he says, citing polls that show Americans' concerns over healthcare costs. An August poll by the Kaiser Family Foundation and the Harvard School of Public Health found 40% of Americans are "very worried" about being unable to afford necessary healthcare.
In Connecticut, Illinois and Maryland, the SEIU has targeted prominent not-for-profit health systems, alleging price-gouging of uninsured patients or depressed wages for workers-with some results. The Illinois Senate held hearings on Advocate's debt-collection methods. In Baltimore, Johns Hopkins Hospital enlisted three economists to respond to the SEIU's 42-page report linking the city's struggling economy to the prestigious hospitals' wages.
Though the SEIU represents 25,000 Illinois healthcare workers, none work at Advocate. Geevarghese says Advocate "aggressively" blocked efforts to organize workers. Parker, Advocate's spokesman, counters that the SEIU's efforts to unionize failed. "It's regrettable that the SEIU is choosing to pursue a corporate campaign to damage our organization's reputation when it appears that they don't believe they would win a secret-ballot election," Parker says.
A health system's best defense against a corporate campaign is to avoid one, says Douglas Topolski, a lawyer with McGuireWoods, Baltimore, who specializes in labor law, representing management since 1986.
Fighting a campaign is costly, he says. Health systems risk increased legal and security fees, a damaged reputation and lost business, grants or donations, he says. Some companies have battled campaigns by seeking injunctions against demonstrations or parade permits, or have filed lawsuits alleging unions wrongly damaged the company's reputation.
"Preparation is the best defense," Topolski says. If corporate campaigns seek to exploit tensions between a hospital and its employees or patients, he says organizations must pre-empt the effort. "You need to treat employees fairly and with respect," he advises hospitals and health systems. Be a good corporate citizen. Publicize contributions to the community. He adds: "Make your own reputation; don't let the union make it for you."
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