"Laws aren't enough - jump into action!" - Discussion on Healthcare Activism

Sandy Eaton, RN on struggles in Massachusetts to create a just healthcare system

Center for Marxist Education, April 13, 2015

Passing a law is never enough. From patient safety tweaks to major overhauls, corporations quickly game the system to get their way. What then must we do?

Text of Slides:

Laws Aren’t Enough: Jump into action!
Sandy Eaton, RN, Center for Marxist Education, April 13, 2015

Organization Gives Strength

Politics: Power, Power
Who's Got the Power?

Just Health Care

• Access: Can you get the care you need?
• Affordability: Will you go bankrupt getting it?
• Quality: Will you survive your encounter?
• Equality: Do you meet special barriers?

Access

• Insurance
• Geography
• Timeliness

Affordability

• Premiums
• Deductibles
• Co-Pays
• Out of Pocket

Quality

• Institute of Medicine (1999)
• ProPublica (2013)

Equality

• Race
• Gender
• Sexual Orientation/Identity
• Language/Country of Origin
• Geography

Original Sin

Neoliberalism Enacted:
Chapter 495 of the Acts of 1991
Deregulation of Hospital Finance

Bay State Health Care Neoliberalism

• Privatization: state, county, municipal (public mission undermined)
• Deregulation: finance, oversight (marketplace medicine)
• Cutbacks & Cost Shifting: Chapter 58 of 2006
• Job Reengineering (deskilling, substitution, layoffs)
• Managed Care Penetration (more management, less care)
• Merger Mania (fewer beds, speedup, fewer EDs, diversion)
• For-Profit Incursions (lower standards, more fierce competition for market share)

Responses:

• June 1993: First State House Rally for Patient Safety
• September 1994: Statewide Campaign for Safe Care
• November 1994: MNA Endorses Single Payer
• November 1994: Single-Payer Local Ballot Questions
• January 1995: Legislative Agenda Filed

Some Key Issues Identified

• Single Payer System
• Mandatory Overtime
• Safe Staffing

Struggle for Single Payer

• Mass-Care Founded: Spring 1995
• Single Payer Bill Filed: January 1997
• Local Ballot Questions: 1998, 2000, 2010, 2012
• MMS & Senate Study Supports Single Payer: 1999
• Question 5: Omnibus Health Reform: 2000
• Constitutional Amendment Campaign: 2006

Mandatory Overtime

• Quincy City Hospital Arbitration: 1986
• Contractual Language
• Strike Against Tenet (49 Days): 2000
• Brockton Hospital Strike (104 Days): 2001
• Language in Health Care Payment Reform: 2012
• Hospital Avoidance Campaign: Tufts Medical Center

Safe Staffing

• Victoria (20:5): 2000
• California (5:1): 2001
• Massachusetts (1:1, ICUs only): 2014

Safe Limits Campaign

• First Vague Bill Filed: 1995
• Ballot Question Considered: 2006
• Compromise Bill Passed House, Killed in Senate: 2006
• Compromise Bill Passed House, Killed in Senate: 2008
• Contractual Limits (UMass, QMC): 2012, 2013
• Ballot Question Campaign Mounted & Aborted: 2014
• Fighting to Use 1:1 ICU ratio despite severe opposition for hospitals: 2015
• Safe Staffing Act back in the trenches: 2015

“I’m not walking out. I am standing up!”

How to win:

• Partnership with the boss?
• Partnership with the DP establishment?
• “Ted Kennedy Incrementalism”?
• Tight organization & clear vision?

Lessons?
Beware … the pitchforks are coming!

Bibliography:

Eaton takes congressional committee on an RN’s view of health care changes
Sandy Eaton, Massachusetts Nurse, November, 2005

In Health Care Reform, Massachusetts Shows How Not To Do It
Sandy Eaton, Labor Notes, July 28, 2008

Labor & Healthcare Justice
Sandy Eaton, FORsooth, February 2011

Massachusetts’ Failed Experiment with the Individual Mandate
Sandy Eaton, National Nurse, March 2011

Health Care USA: Social Good versus Corporate Wealth
Sandy Eaton, CCDS Mobilizer, Spring 2011

How Many Die From Medical Mistakes in US Hospitals?
Marshall Allen, ProPublica, September 19, 2013

Resources:

Health Care for Massachusetts Campaign

Health Justice for Boston

Mass-Care

Massachusetts Nurses Association

Seachange Bulletin