by Nafis H.
On Wednesday, August 15th, the Boston DSA Healthcare working group organized a panel on an ongoing crisis in the healthcare industry – chronic understaffing and overworking of nurses leading to poorer patient care. The discussion centered around Safe Patient Limits, a proposal that is appearing as Question 1 on the ballot of the Massachusetts primaries on Nov. 6 and would push for a new patient safety act. The proposed law would limit how many patients can be assigned to each registered nurse (RN) in MA hospitals and certain other healthcare facilities; the max number of patients per RN would vary by type of unit and level of care. More details of the proposed law can be found on the Safe Patient Limits website.
The panelists consisted of a few Boston DSA members, including co-chair Beth Huang, and Jared Hicks, a campaign organizer with the Massachusetts Nurses Association (MNA); MNA is leading the charge on the “Yes on 1” campaign that is pushing for the patient safety law reforms through the ballot question. MNA also put the issue on the ballot after collecting the 150,000 signatures needed to do so over the past year. The goal of the panel was to host a discussion on how the safe patient limits ballot initiative related to Marx’s labor theory of value, the opposition to the campaign by the bourgeois class and how helping the campaign can fit in with Boston DSA’s goal of establishing socialism and liberation of all people.
Marx’s Labor Theory of Value
As a Boston DSA member described, the origin of Marx’s labor theory of value can be traced to Adam Smith’s description of how a free market is supposed to work:
“The real price of every thing, what every thing really costs to the man who wants to acquire it, is the toil and trouble of acquiring it. What every thing is really worth to the man who has acquired it, and who wants to dispose of it or exchange it for something else, is the toil and trouble which it can save to himself, and which it can impose upon other people.”
In simpler terms, this basically says that the price (exchange value) of something is derived from the amount of labor (human effort) put into it; the labor includes both the immediate labor of manufacturing, transporting, marketing and selling the thing, and also the indirect labor associated with the equipment required for such activities. This idea is also applicable for non-physical goods, and thus can be extended to services as well, such as caring for patients.
Marx took this idea all the way to the end, assuming a perfectly functioning capitalist free market, and showed that at the core of this idea is exploitation. He asked that if labor creates all the value, then where does profit come from? Profit, in a nutshell, is the surplus value, i.e. the difference between the value of what a worker produces in a given time and what the worker is paid in wages for the same time period. From the capitalist perspective, it wouldn’t make sense to hire someone if no surplus value can be obtained from that action, and therefore, exploitation is inherently built into the capitalist system. Historically, the surplus value that workers have produced, generations after generations, across societies, has all gone into the pockets of a certain class of people, the rulers and the bourgeoisie, who have maintained this vicious cycle through a combination of law, tradition, and force.
Capitalism further exacerbates the exploitation of workers in the modern era by 1) alienating the workers from immediate means of subsistence (we buy everything we need from the market, a concept Marx termed “generalized commodity production”), and 2) fostering competition between companies in the global market that forces them to reinvest that surplus value constantly. The latter also contributes to a cyclical capitalist economic crisis and environmental destruction. The exploitation of the workers can take many forms in the modern era, but the most profitable ones seem to involve speedup of work (shorter deadlines), increased workload, extensions to the workday (longer working hours), and the blurring of the work-life balance (checking work emails at home or over weekends). Therefore, to paraphrase Marx, what determines a working day is essentially the result of the struggle between the capitalist and the working classes. The class struggle is the fight over control of the surplus value created by workers – we can fight back by demanding higher wages, shorter working hours, better working conditions and less intense working pace. And these tenets are all in accordance with the logic behind the Safe Patient Limits ballot initiative.
Safe Patients Limit Ballot Initiative
The next segment of the discussion was led by Jared Hicks, a fellow Boston DSA member and a campaign organizer with MNA. Jared described the chronic understaffing at hospitals across MA, a problem that has been continuing at least for a decade now. The MNA has been leading the charge in fighting for both nurses’ and patients’ rights, not only in Boston (eg. the Tufts strike last year) but also across the state in western Mass. Nurses are the caregivers that spend most time with patients and therefore, are also liable for their patients. The profiteering nature of the hospitals lead the administration to force more workload on the nurses, thus subjecting nurses to cut interaction time with individual patients and reduce the quality of care that they can provide for such patients. This, in turn, leads to poorer patient care quality, increased number of preventable readmissions, and overall higher cost of healthcare. A fellow DSA member present at the event, Gemma, described how a nurse had caught certain irregularities in her father’s health condition which the doctor hadn’t picked up on, and how that helped her father get earlier treatment and prevent future medical expenses for her family.
The Safe Patients Limit initiative proposes a revision of the Patient Safety Act, and has been written by nurses for patients. Under the new law, which will go into effect Jan 1, 2019, if passed, different limits on nurse-to-patient ratio will be set according to the needs of the units. For example, in units with anesthesia, a 1:1 ratio will be mandated for patients under anesthesia and a 1:2 ratio will be mandated for patients recovering from anesthesia. Also, if this initiative passes, MA will be the second state in the US to have implemented a limit on nurse-to-patient ratio; CA passed a similar law in 1999, which went into effect in 2004.
Of course, the healthcare industry’s “ruling class” is not sitting idly by as MNA gears up their campaign. The MA Health & Hospital Association PAC, under the name “Coalition to Protect Patient Safety”, have funneled money into their opposition campaign against MNA’s “Yes on 1” campaign. The top contributors to this PAC are mostly made up of CEOs and top executives of healthcare companies such as Gene Green (President and CEO, South Shore Health System, Inc.), Mark A Keroack (President and CEO, Baystate Health, Inc.), Bruce Auerbach (President and CEO, Sturdy Memorial Hospital) and Joseph White (President and CEO and Trustee, Lowell General Hospital) (info obtained through MA Office of Campaign and Political Finance). While the publicly available donation amount may seem meager, it is an open secret that ballot initiatives cost millions of dollars and there is a lot of dark money in play, as exemplified by the charter school ballot question from 2016. The PAC is also supported by the American Nurses Association (ANA), the Emergency Nurses Association (ENA), and a long list of Chamber of Commerce boards with a few other industry organizations.
The main arguments against the ballot initiative include increased cost of healthcare that might lead to closure of hospitals, a shortage of nurses, federally mandated nurse-to-patient ratios and not enough money to hire nurses. Some of these arguments have been already proved false by the situation in CA. A 2010 study looking at patient outcomes across different medical units showed that since enactment of the staffing law in 2004, unfavorable outcomes in CA hospitals have decreased compared to hospitals in states without such policies. Additionally, nurses in CA hospitals were less likely to receive verbal abuse and complaints from patients families, experience job dissatisfaction and burnout, and in fact, suffered 30% less occupational injuries. The CA hospitals also showed increased retention of the nurse staff, and the staffing increased at a rate higher than compared to other states. Contrary to fears that overall skill level of nurses would fall because of the law, CA hospitals actually saw an overall increase in skill level of nurses.
The argument that hospitals don’t have enough money to employ more nurses is an age-old boogeyman pulled out by hospital administration everytime the workers have demanded higher wages and better working conditions. Given that hospitals have been found to stow away money in offshore accounts in the Cayman Islands, and that hospital CEOs have been making more and more money every year, this is a laughable argument. The most egregious display of such lies is probably the allegations that Tufts Hospital administration ended up paying a similar amount of money to the temporary nurses they hired during the nurses’ strike which they would have paid to the retirement fund of a certain portion of nurses on strike. An attendee at the panel discussion, Sheridan, herself a RN, attested that temporary nurses can get paid up to $3200 per week plus accommodations, which can pay the salaries of two or even three full time nurses.
“Yes on 1” — A Socialist Campaign?
Following Jared’s talk on the ballot initiative, a discussion led by Steve Stone explored the connection between MNA’s “Yes on 1” campaign and larger socialist ideals. Attendees argued that nurses, belonging to the working class, are easily exploited by the profit-driven healthcare industry where nurses’ wages are the low-hanging fruit when it comes to cutting costs. The workers below the RNs in the hospital hierarchy, such as nursing assistants, are similarly affected, while nurse managers and hospital administrations are not affected as much, thus creating an inequality among the waged laborers within the same industry. On the question of where the surplus value goes besides the pockets of the CEOs, Beth described the intricate relationship between the healthcare industry and finance/banking sector where hospitals will often take out mortgages to construct state-of-the-art buildings to attract consumers and end up with huge amounts of debt. This is directly in line with how a free market operates – capitalism forces constant reinvestment of the surplus value into the market to retain a competitive edge.
Often times, the workplace hierarchy in a hospital runs along racial lines. For example, Gemma described that in Philadelphia, nurses were mostly white working class women, whereas the nurse assistants were mostly women of color. Historically, the ruling class has often incited hatred among the different races in the working class, and therefore a socialist campaign to uphold the interest of working class must also take into account such racial, and in cases, gendered issues.
On the question of whether this campaign is a non-reformist reform or a reformist one, Beth articulated that a non-reformist reform is one where one campaign lays the foundation for a future,more progressive campaign. She described while the issue itself is not the most transformative reform for everyone, it certainly is for healthcare workers, which would set us up for a bigger campaign such as Medicare For All (M4A). Additionally, given that MNA is a critical ally of Boston DSA (the local had supported the nurses strike in Tufts in 2017), the presence of DSA members at the picket line, as well as canvassing with MNA, will strengthen the partnership. Other attendees agreed that this would help set up for the M4A campaign that DSA National has been leading across the country and will also better the conditions of one segment of the working class.
The MNA will bring this campaign to the General Meeting on August 25 and will ask for a chapter endorsement. In the meantime, they are holding weekly phonebanking events at Jobs with Justice (375 Center St.) on Wednesdays, 5-8 pm. There are also canvassing events coming up in the next few weeks, so if anyone is interested to help canvass for this campaign as an individual, please contact the Boston DSA Healthcare working group at firstname.lastname@example.org.