Unhealthy Debate

There's a new and nasty labor-management war. Health care is the battlefield. San Francisco is the front line.

The union managed to garner support from both the Republican and Democratic central committees, the California Congress of Seniors, the California Physicians Alliance, the Alameda County Firefighters, and a handful of local politicians.

But Sutter had a better weapon: money. Big money. The corporation spent more than $1 million on its campaign in favor of the purchase, outspending the union by about 6-to-1. Aside from television commercials, the money paid for advertisements in local newspapers, more than 15 mailings to prospective voters, and professional phone solicitors. It was the kind of electioneering generally reserved for statewide races.

The campaign worked. On April 22, 54 percent of those voting in the district election gave Sutter approval to purchase Eden Medical Center. And it appears to be a real deal. Sutter snagged Eden, with net assets of $52 million, for about $40 million. From now on, the Sutter corporation will take just under 2 percent of the hospital's operating budget for managing the place, which turns an annual profit of $8 million.

To say that Sutter is in acquisition mode is like saying that the Democrats were exploring fund-raising sources during the last election.

Until the mid-1980s, Sutter operated two hospitals in Sacramento. Today, the $2.5 billion corporation holds 25 hospitals, a handful of home health agencies, a health maintenance organization, 7,600 affiliated doctors, and more than 30,000 employees in its web.

That's the way the game works. And there is no place for the weak competitor.

Because of overbuilding in the 1980s, hospitals in the Bay Area average just 50 percent occupancy. Health care organizations are in a frenzy of buying, selling, and merging with each other. It is a process aimed at reducing the overcapacity and the costs of running the hospital capacity that does exist.

For-profit health systems -- notably Tennessee-based Columbia/HCA -- have shown Wall Street that bottom-line management tactics can increase profits in health care. And hospital profit margins have risen 10 percent since 1991, according to the government's Prospective Payment Assessment Commission.

To stay in the game, nonprofits like Sutter/CHS and Kaiser have started acting like the for-profit chains, keeping a sharp eye to the bottom line. Big clients can play one health care provider against the other. Every incentive in the system tends toward the cheaper, leaner, more profitable. And after the obvious excess is gone, there's not a lot to cut except people.

On a Saturday morning in April, about 100 people sit on folding chairs in the auditorium of the Plumber's Hall on Market Street, sipping coffee and munching doughnuts. The mood is decidedly upbeat; seriousness and uncertainty have been temporarily overshadowed by camaraderie and programmed encouragement. The occasion is an impending vote on whether to strike over unfair labor practices -- alleged coercion and intimidation of union activists -- at Visiting Nurses and Hospice.

VNH has been in turmoil for some time, marked by frequent turnover of management and consultants. More recently, an eight-month federal survey inspection threatened to end the agency's Medicare certification; the threat was deemed serious enough that VNH scaled back on taking new patients while the agency worked on making the government happy. Many home care workers, who are paid by the visit, are seeing fewer patients than they used to; now, the workers want a greater say in scheduling and other issues related to patient care.

The past six months have been marked by marches, rallies, candlelight vigils, luncheon barbecues, songs, and bullhorn-led chanting outside both the Visiting Nurses and Hospice offices and the California Pacific Medical Center. All the while, company security officers in gold coats have surveyed the scene. Video cameras have whirred; steno pads have been filled with names.

Here, on the stage of the auditorium, a television sits ready for the videotaped address to the troops from AFL-CIO President John Sweeney, a former head of the Service Employees International Union who has vowed to make health care the cornerstone of a union resurgence. But first, a parade of prominent Bay Area figures moves to the microphone, each pledging support.

Among them are the required: the San Francisco Labor Council.
The political: the Harvey Milk Lesbian/Gay/Bisexual Democratic Club, the Senior Action Alliance, and San Francisco Supervisors Tom Ammiano and Sue Bierman.

The indebted: the California Nurses Association, which the SEIU supported only days before in its strike against Kaiser.

The recently organized: Lusty Lady strip club dancers, the first strippers in the country to form a union.

The academic: women's studies and labor studies professors from San Francisco State University.

And, of course, the perpetual grand marshal: Mayor Willie Brown.
"I love every second of this struggle," Brown tells the exhilarated crowd. "And I will love the victory even more."

It's no big surprise that there are nearly as many community folks and union staffers present in the auditorium as actual Visiting Nurses and Hospice employees. This is but one battle in the war for health care.

One of the big issues here involves the health care of the caregivers themselves. A good portion of the 500 or so VNH workers are contracted on a "per diem" basis, with work hours that vary with their patient load.

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