Re: Puzzle of the day

[charlie <charles1848@xxxxxxxxx>]

Michael Perelman asked:
>
Nurses are highly trained and in very short supply.  Why is it
then that nurses are having such a difficult time in the labor
market, especially with regard to working conditions. The recent
Supreme Court decision will undoubtedly make things worse, but my
question concerns with [what] the nurses' situation says about
the current labor market.
<

With the advent of HMOs -- health insurance groups that actively
manage the care they dole out to members -- hospitals must
cheapen their product.

This is possible because the patient faces several barriers to
asserting himself as a consumer: 1) his employer decides which
HMOs to offer him, 2) he must battle the HMO for every dollop of
medical attention, and 3) the patient has a difficult time being
an aggressive, intelligent consumer of a highly technical service
(it's like a mechanically illiterate driver trying to get decent
auto repair). Point three has always existed, but points one and
two are a decade or so old.

In this setting, hospitals try to get rid of expensive nursing so
they can get HMO contracts. They break down care as if it were an
industrial process, assigning tasks to less-trained and lower-
wage personnel. They look to drugs for solutions, then compel the
patient's family to be unpaid attendants. They speed up the
nurses and seek to convert some of them into supervisors willing
to implement these shoddy methods.

Nurses hate the expansion of patient-nurse ratios and the
consequent inability to watch each patient as an individual.
Speedup and the tension of professional responsibility under
unprofessional working conditions drive nurses out of hospital
jobs, to other settings or out of the profession.

This labor-market issue is really a issue of worker-and-consumer
versus health capital. In this respect, it is like education.
HMOs in health care have been more successful capitals than
education privatizers like Edison and Whittle.

Charles Andrews
Web site for my new book From Capitalism to Equality is at
    http://www.LaborRepublic.org
My 1995 book on health care was Profit Fever: The Drive to
Corporatize Health Care and How to Stop It (Common Courage
Press).