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What I Learned in a Decade Fighting for the Labor Movement

Jane McAlevey writes in her new book, "Raising Expectations (and Raising Hell)," about creative and effective organizing tactics in the fight against bosses and national labor leaders.

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To go on from here, I need to explain a little about hospitals. Most health-care markets are served by a combination of five common types of hospitals: faith-based, academic medical centers, publicly owned, nonprofit, and for-profit. Actually, some states don’t allow for-profit hospitals health care, and that’s a good thing. My home state of New York, like most of the Northeast, does not permit publicly traded hospitals to operate at all. Many politicians and journalists I have met, and certainly most workers, don’t even know that there are states that entirely ban the kinds of hospitals that dominate Las Vegas. This is one reason there are so many good hospitals in New York and Boston: It is actually illegal in those cities to set up a hospital or health care company whose core purpose is making money rather than healing patients. Have you ever heard anyone with cancer say, “I am jumping on a plane to Vegas to get some quality care?” I didn’t think so.

The for-profit hospitals deliver the worst care in the country, hands down, and sue me for this sentence so I can depose all your records in court and have some real fun. This is not to say that the other types necessarily deliver high-quality care. Plenty of them don’t. But the worst patient care is consistently found in for-profit operations. Like all corporations whose purpose is to make money, the for-profits want the least regulation possible. That means no environmental groups or laws, no community organizations to account to or laws that mandate health care for the poor, and above all else, no unions.

For-profit hospitals didn’t even exist in this country until a regulatory structure that favored them was set up during the Reagan administration. And once for-profit hospital corporations had crawled out from under a rock, they headed straight for Las Vegas, and undid a lot of Nevada’s health care laws. The Las Vegas hospital market is now unique, in that it is actually dominated by national for-profit hospital chains.

Not coincidentally, Nevada is what is called a right-to-work state. The labor laws in Nevada are totally different from those in what are commonly called union security states. In a union security state, once the workers in a shop vote to form a union by a simple majority of the votes cast, every worker in that shop has to join and pay dues. In a right-to-work state, though a majority of workers vote to form a union, each individual worker can decide at any time to join or to leave it, which has all sorts of implications for how one goes about organizing and sustaining a strong union, which I will get into later. When you look at a map of the right-to-work states, you are also looking at a map of the “red” states in presidential politics, the states with the worst schools and the most poverty, teen pregnancies, and other community ills.

The Gloves Come Off 

To the Universal Health Services corporation, Las Vegas was like a freak oil well that never ran dry. In 2005, their Vegas hospitals generated 20 percent of corporate revenue, though they constituted a tiny fraction of UHS facilities around the country. From 2001 to 2005, the UHS hospitals in Vegas generated profits of $105 million, nearly as much as all the other Vegas-area hospitals’ profits combined. And that was just the figure they reported. There was another $85 million that they hid through an accounting maneuver called home office allocations: a corporation bills itself in one location and pays itself in another, so it can siphon money out of one region and stash it back home. Add that money back in, and the UHS hospitals in Las Vegas sent profits of $190 million out of the Nevada desert and off to King of Prussia, PA. UHS’s second most profitable regional operation was in New Orleans. Like Vegas, New Orleans was full of tourists (and thus of lucrative out-of-network health insurance billing), known for corruption, and located in a right-to-work state. This was the sort of business model one could expect from a cutthroat for-profit hospital corporation. 

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