An archive of articles and listserve postings of interest, mostly posted without commentary, linked to commentary at the Education Notes Online blog. Note that I do not endorse the points of views of all articles, but post them for reference purposes.
Where
is the money for the most expensive health care system
in the world going? The cut of gross national health care expenditures
commanded by administrative overhead and waste has ballooned to an
estimated 30 percent; the portion that pays doctors and nurses has
fallen. Wealth
extraction, whether through excessive billing, under-delivery, or the
constant buying and selling of hospitals, has become the new normal in
American health care.
Once
upon a time, doctors and providers were some of the foremost defenders
of our for-profit system. But in recent years doctors and nurses have
had a disarming sense of clarity about the fundamental conflict between
caring for patients and delivering value to
shareholders. We think everyone should understand this fundamental
disconnect with our system.
That’s
why we decided to dedicate our August 2023 print issue to the business
of health care—the inner workings of the monopolies and cartels
extracting ever-greater sums for ever-lousier outcomes, and the policies
and protocols pushing doctors and nurses to the brink—and increasingly
into labor unions.
To
kick off the series, Maureen Tkacik and I wrote an overview of what’s
at stake in our corporatized health care system, both how it has gutten
patient care and the ways providers are fighting back. It’s available on our website today.
Today, we also present the story of Stephanie Arnold,
a young family physician who, after years of working several precarious
jobs owned by private equity, finally started her own direct primary
care practice to provide her patients affordable and comprehensive care
untouched by corporate greed.
It’s thanks to reader support that our newsroom has the resources to pursue stories this, Norman. You can help support this work by becoming a member today. All of the reader support we receive funds our editorial mission: illuminating stories about ideas, politics and power.
100 Days In, Brandon Johnson Is Steadily Shifting Chicago’s Political Terrain
Movement
organizers and political strategists assess the new mayor’s record as
he seeks to make Chicago a progressive beacon—while modeling
co-governance.
Chicago's 57th Mayor, Brandon Johnson.
Paul Goyette
In May, longtime teachers union organizer Brandon Johnson ascended to the Chicago mayor’s office,
becoming one of the most progressive leaders of any major city in the
United States.
Just months before the election, Johnson was polling at 3%, far behind the frontrunners in the race, and had little name recognition. “God bless. Brandon Johnson is not going to be the mayor,” said then-incumbent Mayor Lori Lightfoot on January 21, just over a month before the first round of the election.
Johnson’s win against the city’s most formidable political
insiders, including former Chicago Public Schools CEO Paul Vallas who he
faced head-to-head in the second round of voting, represented
a rejection of the status quo for a city that’s facing crises ranging
from the pandemic to police abuse to pay-to-play politics and decades of
disinvestment in Black and Latino communities.
“We can reject the false choices
that have been presented to us for too long,” Johnson, a former Cook
County commissioner and middle-school teacher, said during his victory
speech on April 4. “We
get to do it for everyone, Chicago. We don’t have to choose between
toughness and compassion, between the care of our neighbors and keeping
our people safe. If tonight is proof of anything, it is proof that those
old, false choices do not serve this city any longer.”
One hundred days into his term, Johnson has begun to
shepherd key progressive policy priorities through the City Council,
built relationships with President Joe Biden and Illinois Gov. J.B.
Pritzker, and taken steps to ameliorate the city’s migrant crisis that’s
been spurred by GOP officials around the country. He has also courted
some amount of controversy with some of his staffing decisions,
including the hiring of interim police superintendent Fred Waller (and
later, into the permanent role, Larry Snelling) and the firing of public
health commissioner Allison Arwady.
The 100-day milestone, though
arbitrary, has traditionally been a temperature check on the policy
priorities and leadership style of a new administration that has moved
from campaigning to governing. To better understand Johnson’s first 100 days in office and what it could spell for the next four years — or longer—In These Times spoke
to more than a dozen movement leaders, elected officials, researchers
and political strategists, including Johnson himself.
“We’ve laid a real clear
foundation that we’re going to need in order to build a better,
stronger, safer Chicago, and we’ve done that in the collaborative spirit
which we promised we would do,” Johnson tells In These Times.
In a late August interview, the new mayor recounted some of his biggest accomplishments, including advancing the Treatment Not Trauma
proposal and creating new deputy mayor positions related to
immigration, community safety and labor rights. Johnson also worked with
the business community and the Bring Chicago Home Coalition on a proposed real estate transfer tax
that would combat homelessness by lowering the real estate transfer tax
for most homebuyers and raising it for properties over $1 million.
NEGOTIATIONS FOOD FOR THOUGHT
1975 to 2022
GM auto worker pay of $6.25/hr adjusted for inflation would be $36.67.
BASICALLY THE SAME, except for tiers.
GM president Lee Iacocca pay of $292K
adjusted for inflation would be $1.7M.
Mary Barra yearly compensation $29M
SEVENTEEN TIMES HIGHER!
According to Barra Math and my calculations the auto worker should be making $600 PER HOUR!
Arguably my two leftmost political opinions are on display in this
delightful bit of news:
1) All workplaces should be unionized, and
2) If what it takes to overcome runaway corporate executive compensation
is to bring the economy to its knees through labor stoppage, then so be
it, let's have more strikes than a bowling tournament.
@Jerry Davenport Going bankrupt is a rather extreme way of calling their bluff, wouldn't you say? Yellow went under because of years of poor management, not because of union demands.
I was involved in my union for decades. Over the years I rose up through the ranks and was elected to a high position and sat on the executive council of our International Union. One of the largest in the country. The higher I rose in the Union, the less it was about the membership. It became almost solely about organizing new members (money) and politics. Whenever I voiced my concern and issues about the members I represented I was quickly shut down. If there was even a whisper of one of my locals going on strike I was immediately pressured to quash it. There was hardly ever any attention or dollars allocated to helping the members unless a local was attempting to decert from the Union. Then that local was flooded with organizers, t -shirts, etc. When I was reassigned to cover a different area the members were shocked to see me at the local meetings or worksites. Most members had never seen a union rep before.
Don't get me wrong. Organizing the unorganized and electing politicians who support workers are important. But if a union is not visible to their members and do not represent their concerns than that Union really has no power. The members do not support their Union if they don't see a return on their dues. I don't work for that Union anymore. But I do support unions and believe workers do need representation. This article gives me hope that maybe unions are changing back to listening to their members and representing them. Real power comes from the members
@Carter I spent nearly two decades working as an internal/external organizer at both the National field and state-affiliate level. Half the time at AFSCME, half at an AFT-affiliated nurses union. Agree in large part with what you expressed (and- I wonder if we may have even crossed paths).
As a worker in those settings (and as union member myself)- I was often frustrated by the decisions made by out-of-touch, entrenched, trollish leaders at every level of those organizations. From the bargaining unit level- all the way to the top-most brass on the National scene.
I spent much of my career trying to push the organizations I worked for to be more progressive, more inclusive, more aggressive, and more directly responsive to the rank and file. I wasn’t alone in trying. Many union members have been frustrated with the movement for a long, long while. And- they’ve been organizing internally to push for something better. This cultural shift we’re seeing now is - in part- a culmination of that.
From Detroit to Hollywood, New Union Leaders Take a Harder Line
Pushed
by angry members, unions representing actors, autoworkers and UPS
employees are becoming increasingly assertive under new leadership.
Shawn Fain is not a typical president of the United Automobile Workers union.
Mr.
Fain recently declined a symbolic handshake with the chief executives
of the major Detroit automakers, a gesture that traditionally kicks off
contract negotiations. He is seeking an ambitious 40 percent wage
increase for rank-and-file members — in line, he says, with the pay
gains of those corporate leaders over the past four years. And in a video meeting
with members this month, Mr. Fain threw a list of proposals from
Stellantis, the maker of Chrysler and Jeep, into a wastebasket, saying
it belonged in the trash “because that’s what it is.”
On one level, the circumstances that produced the union’s more aggressive leadership are idiosyncratic. Mr. Fain, who won his position in March,
is the first president in the union’s history, dating back nearly 90
years, to be elected directly by its members. The change took place
after a major corruption scandal engulfed two of his predecessors and several more union officials.
But
on another level, the forces that swept Mr. Fain into power are the
same ones that have borne down on unions across a variety of industries:
a feeling among members that they have spent years enduring
out-of-touch leaders, meager wage growth and concession-filled labor
agreements, which forced some to do similar jobs as co-workers for less
pay.
“We kept being told, ‘This is a
good contract,’” said Shana Shaw, a U.A.W. member who has worked at a
General Motors plant in Missouri since 2008. “And our members are
saying, ‘It’s not a good contract!’”
The
long-simmering rage helps explain why, in addition to Mr. Fain, several
prominent unions are now in the hands of outspoken leaders who have
taken their membership to the brink of high-stakes labor stoppages — or
beyond.
Sean O’Brien, president of the
International Brotherhood of Teamsters, has repeatedly referred to
corporate leaders as a “white-collar crime syndicate” and warned that a
strike of the union’s 300,000-plus United Parcel Service members
appeared inevitable. (The union recently reached a tentative agreement that members are voting on.)
Just after a union of more than 150,000 Hollywood actors called a strike in July, Fran Drescher, president of SAG-AFTRA, said
that she was “shocked by the way the people that we have been in
business with are treating us.” She added: “It is disgusting. Shame on
them!”
The companies, including UPS and the automakers,
have indicated that they are willing to increase compensation but
cannot jeopardize their long-term viability. The large Hollywood studios
have offered actors pay increases but say they must be able to adapt to the decline of traditional television.
Some
executives have called out the unions’ more confrontational gestures.
“The theatrics and personal insults will not help us reach an
agreement,” Mark Stewart, a top Stellantis official, said in a letter to employees after Mr. Fain literally discarded the company’s proposals.
And channeling
members’ anger is not without risk: It can raise expectations and make
it difficult for leaders to finalize contracts. Mr. O’Brien is facing a “vote no” campaign organized largely by UPS part-timers who argue that the union did not secure large enough raises.
Labor Organizing and Union Drives
New Leaders: Several prominent unions, representing groups from automobile workers to actors, are now in the hands of outspoken leaders who have taken their membership to the brink of high-stakes labor stoppages — or beyond.
The
populist approach is not unique to labor unions. The 2008 financial
crisis and the grindingly slow recovery produced a more militant style
of politics that upended established institutions aroundtheworld.
The crisis helped lay the groundwork for the unexpected support of
Bernie Sanders and Donald Trump in the 2016 presidential race.
If anything, unions were slower to adapt to the rising anger than other institutions, largely because they were less democratic.
In 2018, UPS employees voted down a labor contract negotiated by the Teamsters leadership, which created a new category of lower-paid drivers. The union’s president, James P. Hoffa, who had served in the position for nearly 20 years, used a procedural rule to impose the contract anyway.
But
even the change-averse labor movement could not withstand a final blow:
Covid-19, and union members’ anger over their perilous working
conditions as corporateprofits grew at one of the fastest rates in decades.
“There’s a historical memory of all the concessions they made,” said
Ruth Milkman, a sociologist of labor at the Graduate Center of the City
University of New York, referring to union members. “And they feel
shafted. The C.E.O.s are sitting pretty with all this pandemic money
that didn’t go into their pockets.”
Many nonunion workers saw their wages
rise rapidly thanks to a tight job market, but contracts negotiated
before the pandemic often locked union members into smaller wage
increases as inflation surged.
Mr. O’Brien has tapped into that resentment.
A vice president and ally of Mr. Hoffa in the mid-2010s, Mr. O’Brien ran to replace him in 2021, deriding his predecessor for foisting concessionary contracts onto members. He vowed to raise pay
for part-timers at UPS — an unusual concern for a would-be Teamster
president, even though part-timers make up a majority of the union’s
members there — and secured a significant wage increase.
Other union leaders have followed a similar arc. In 2021, Ms. Drescher
ran for president of SAG-AFTRA, the actors’ union now on strike, on the
union’s moderate slate and narrowly won. But she came to channel her
members’ anxieties over the rise of streaming, which has led to longer gaps in work for many actors and more limited royalties as shows are reused less often.
“The streaming
contracts negotiated back at the beginning of this, when certain
individuals thought this would be a fad, set us up for failure,” said
Linsay Rousseau, a SAG-AFTRA member who works primarily as a voice
actor. She said Ms. Drescher’s outspokenness had won over even members
who voted against her.
In some cases,
outraged rank-and-filers have taken matters into their own hands. Edward
Hall, a rail worker and local union official in Tucson, said he decided
to run for the presidency of the more than 25,000-member Brotherhood of
Locomotive Engineers and Trainmen in early 2022. The union’s longtime
president had arrived to hold a town-hall meeting about labor
negotiations that had dragged on for over two years.
But, Mr. Hall said, he was unable to provide frustrated members with a
timetable for a deal. (Dennis Pierce, the former president, declined to
comment.)
Mr. Hall was elected last fall,
shortly after Congress intervened to enact a labor agreement that
members of several rail unions had voted down. Many workers felt the
agreement did not go far enough to rein in a system of railroad
operations that sought to minimize equipment and employees.
“It
was profitable for them,” Mr. Hall said, referring to rail carriers.
“But for lack of a better way to put it, it made life on the railroad
hell for regular employees.”
The
combination of agitated members and more assertive leaders can sometimes
pry loose concessions from employers even without a strike, especially
amid a worker shortage. This year, rail carriers began voluntarily
addressing one of the workers’ biggest concerns: the lack of paid sick
days.
At UPS, Mr.
O’Brien spent months preparing his members for a possible strike, even
holding training sessions for strike captains and practice pickets. The
pressure appeared to yield significant gains in the recent tentative agreement between the two sides, including more than $7 an hour in raises over the five years of the contract.
In
an interview last month, Mr. O’Brien said the Teamsters’ actions under
his leadership had made the strike threat credible. “We’ve been striking
since I took over,” said Mr. O’Brien, pointing to other companies where
the union represents workers.
David
Pryzbylski, a labor lawyer at Barnes & Thornburg who represents
employers, said the strident rhetoric of union leaders often reflected a
genuine shift in workers’ attitudes. Still, he added, negotiations more
often hinge on fundamentals like a company’s profitability and the
union’s ability to disrupt operations through a strike, making it wise
for employers to ignore the bluster.
“A
lot of times that stuff stops: They go out and say what they wanted to
say, they send up a signal flare and move on,” Mr. Pryzbylski said. “If
you start responding, it stays in the news cycle.”
The full-throated demands can also backfire in economic terms. Yellow, a
trucking company with 30,000 employees, declared bankruptcy several
months after talks with the Teamsters broke down. The company’s chief
executive said in a statement that the Teamsters’ intransigence drove Yellow out of business, though analysts note that the company showed signs of mismanagement for years.
The risks may be even higher in industries under pressure to embrace a new business model.
The
major U.S. automakers have said that they need the ability to team up
with nonunion battery manufacturers to secure additional capital and
expertise. But Mr. Fain, the new U.A.W. president, has said
that the failure to organize more battery workers was a major failure
of his predecessors, and that battery workers must receive the same pay
and working conditions that union workers enjoy at the Big Three.
Many U.A.W. members say the tension between the automakers’ goals and the union’s
indicates that a strike will be hard to avoid when their contract
expires in mid-September. But they do not appear to be shrinking from
that possibility.
“We have an
extremely well-oiled machine,” said Ms. Shaw, who also serves as a
co-chair of the organizing committee of Unite All Workers for Democracy,
a reform group within the union that assembled the slate of candidates
Mr. Fain ran on. “We’ll be ready to go if happens.”
Noam Scheiber
is a Chicago-based reporter who covers workers and the workplace. He
spent nearly 15 years at The New Republic, where he covered economic
policy and three presidential campaigns. He is the author of “The Escape
Artists.”More about Noam Scheiber
Why Are School Therapists in NYC Revoting on a ‘Nothing’ Contract?
“The next step should have been to go back to the bargaining table. It was a fair and certified vote. It was not close. It was not compromised in any way.” - Alison Loebel Bertoni.
By Steve Wishnia
Almost 3,000 occupational and physical therapists [OT/PT] in New York City public schools are in the process of revoting on a contract they rejected by a 2–1 margin last month.
Officials of their chapter in the United Federation of Teachers say the union’s leadership refused to try to renegotiate the agreement, which members overall ratified by a 3–1 margin. The UFT says bargaining-unit members requested the revote.
“The next step should have been to go back to the bargaining table,” Alison Loebel Bertoni, a member of the OT/PT chapter’s executive board, told Work-Bites. “It was a fair and certified vote. It was not close. It was not compromised in any way.”
“Members of the OT/PT chapter considered possible options and next steps, and after consideration, it was the members of the chapter who asked for a revote,” UFT spokespersonAlison Gendar said.
The revote began Aug. 8, and ballots are due Aug. 29.
The bargaining unit was the only one of 12 in the UFT to reject the contract. Its members opposed ratification by 1,129-782, according to the results announced July 5. That margin covered a split among different occupations in the unit: OTs and PTs voted no by 1,074-545, while other members — school nurses, supervisors, and audiologists — voted 237-55 for ratification.
On Aug. 4, the UFT decided to put those groups of workers in a different bargaining unit. Loebel Bertoni says they had all asked to be removed.
‘Nothing for us’
“There was nothing in the contract for us,” says Mimi Greenberg, a member of the chapter’s bargaining committee.
Occupational and physical therapists work with special-education pupils. Physical therapists help them with gross motor coordination, Greenberg explains. Occupational therapists work with fine motor skills, such as whether pupils can use their hands well enough to write and use “manipulatives” such as the small blocks used to teach elementary math, and visual and perceptive skills such as being able to recognize numbers and write them.
“I don’t think the union has any interest in going back,” Alison Loebel Bertoni says. She describes UFT President Michael Mulgrew’s behavior as “dismissive” and “patronizing.””
Those children are “the most vulnerable people in our society,” Greenberg adds. She’s been an OT for 22 years and now works in Upper East Side schools.
Their main issue in the contract talks, she says, was parity with the other professionals who help develop the “IEPs” — individual education programs —required for each child in special education. OTs and PTs must have master’s degrees, but are paid significantly less than teachers, social workers, and speech therapists. Their top salary rate is more than $15,000 a year lower.
OTs and PTs get a 30-minute unpaid lunch, Loebel Bertoni says, while the others get a 50-minute paid break.
When the tentative agreement was revealed to the bargaining committee, Greenberg says, it included an unpleasant surprise: OTs and PTs normally do eight sessions a day, and a provision allowing them to do an optional ninth session had been added.
“It never came to the bargaining table,” Greenberg says, and chapter leaders had not been told about it. She fears that OTs and PTs will face pressure to do the extra session, or that the added workload could be used to reduce staff.
‘Scare tactics’
When the OT/PT chapter voted against the UFT’s previous contract in 2018, Loebel Bertoni says, the union “very quickly” went back to the bargaining table. They won somewhat better pay increases.
This time, she says, “I don’t think the union has any interest in going back.” She describes UFT President Michael Mulgrew’s behavior as “dismissive” and “patronizing.”
“The union tells the members this is the best we can get. We didn’t fall in line,” Loebel Bertoni says.
The OT/PT chapter is the only one in the UFT not led by the Unity Caucus, the group that has run the union since the days of Albert Shanker.
“I would expect a union leader to say, ‘you guys voted this down, there’s something wrong here, let’s try to get the city back to the table,’” Greenberg tells Work-Bites. “Instead, we got an email telling us what we would not be getting.”
“Your contract was voted down,” UFT Vice President Richard Mantell wrote in a July 10 email to chapter members. “As a result, all the new contractual benefits, including the pay increases and the $3,000 ratification bonus, will not be available for the therapists, school nurses, audiologists, and supervisors of nurses and therapists covered by this contract. You will continue to work under the terms of the previous contract.”
The latter groups got those benefits once they were separated from the OT/PT unit.
Both Greenberg and Loebel Bertoni call that message “scare tactics.” The UFT leadership said it got more than 1,000 emails from members asking for a revote after it went out, Loebel Bertoni says.
In a July meeting with chapter leaders, President Mulgrew “made it clear that the chapter had no good options,” Loebel Bertoni says; he told them that if they voted no, they wouldn’t get raises or new contract talks for years.
“They’re having a do-over on the same agreement,” Greenberg says. “Democracy has been stomped on.”
I
read your latest posts. I don't see that it's Aetn, Aetna, Aetna -- but
in a propaganda war the focus had to emphasize their faults. If the
come back with United Health that will be the focus.
But when I went to DC last week the focus was on the entire MedAdv program.
My
favorite daily watch/listen had a good segment on healthcare on
Wednesday with a reporter for The American Prospect which has been doing
a major work on healthcare.
She calls the entire healthcare
system fundamentally a criminal enterprise. Her segment probably starts
at around 20 minutes in. I have to listen to it again as I was taking a
walk and missed some points.
I think I'm going to start paying for the Prospect. I already pay $10 a month for Majority Report.
8/9 U.S. Healthcare: A “Sick” System; What’s Next For SAG-AFTRA w/ Moe Tkacik & Nicole Cyrille (M)
Sam and Emma speak with Moe Tkacik, investigations editor at The American Prospect, to discuss her recent suite of pieces in this month’s issue on the U.S. healthcare system. Then, they’re joined by Nicole Cyrille,
member of the SAG-AFTRA negotiating committee, to discuss the recent
developments in the strike and what to expect going forward. Sam and
Emma start off the show by reacting to the big victory in Ohio
surrounding Issue 1, the ballot measure that Ohio Republicans were
attempting to utilize to make it harder for Ohioans to codify abortion
rights into the state Constitution in the fall. Ohio Secretary of State
Frank LaRose spoke with Steve Doocy on Fox & Friends this morning,
to make clear that actually, it’s totally fine that his side lost by
millions of votes! Then, they’re joined by Moe to discuss her astounding
amount of reporting in this month’s issue of The American Prospect
about the U.S. healthcare system, and its frankly near-criminal origins.
Moe traces back how the healthcare industry as we know it, dating back
to the 1960’s, was essentially created by crooks, leading to the
essential codification of healthcare law that is rarely ever enforced,
and which essentially benefits a sprawling network of middlemen at the
expense of actual patients. The structure of this policy Moe claims,
ultimately leads to adverse outcomes: making patients sicker then
healthier, while a smaller group of individuals become richer and
richer. Moe also traces some of the history of the American Medical
Association (AMA), the standard for healthcare administration prior to
the 1960’s, as well as an organization characterized in opposition to
socialized medicine. Moe then tells the story of United Healthcare, one
of the premier organizations that characterized and revolutionized the
inequitable structure of U.S. healthcare through the advert of HMO’s, or
health maintenance organizations, and how, through their financing
structure, HMO’s make it extremely difficult for medical professionals
to maintain a successful practice via lowballing them, while also making
pains to only offer coverage for necessary care. Sam, Emma, and Moe,
discuss how United Healthcare and the HMO model is essentially a
vertical integration model, and how that model spread from United
Healthcare to other aspects of the industry, like drug pricing. Moe
enlightens Sam and Emma on the weird tale of Pharma Bro Martin Shkreli
actually *taking on* price gougers of a certain drug before he got into
his own troubles doing some price gouging of his own. Moe also breaks
down pharmacy benefit managers (PBM’s), the distributors of
pharmaceuticals and their presence within the supplying of drugs to
pharmacies and customers, and the inherently corrupt bargain that
legitimizes them in the healthcare supply chain. Moe finally breaks down
some potential solutions to the inherent corruption, grift, and
mismanagement within the U.S. healthcare system, including a more robust
enforcement of Medicare fraud laws.
