Originally published in 1976 as a pamphlet by the Worker Patient Organization, under the titles:
Fight For Our Health & Our Lives
Our Understanding of the Health Care System
—Our Program • January 1976—
County Hospitals Worker Patient Organization
We are an organization of workers and patients at San Francisco General and Laguna Honda Hospitals. We have gotten together because we know that we have to be organized to win against the corporations and government who control the health care system. We’ve united as workers and patients because we know that the struggle for quality health care for patients and decent working conditions and wages for hospital workers is the same fight. We who are patients at SFGH are workers too. We all live in the same communities and pay the same taxes.
For the past several months, we have been looking at the health care system working people are faced with in the United States. We’ve been trying to find out what has caused the staffing and patient care crises in county hospitals all over the country. We’ve been trying to see where the money working people spend for health care through taxes and bills goes. We’ve also been looking at who profits from this system and what a health system which addressed our real needs would be like. This booklet presents some of our first conclusions.
What Would Good Health Care Be?
A humane health care system would have as its goal making sure that all people were genuinely healthy in all aspects of their lives, not just treating the symptoms of Individual diseases. What this would mean is making sure that everyone had enough nutritious food, adequate housing and sanitation, clean water and air, and safe working conditions. It would also mean educating the whole population about scientific principles of health and training more people as health workers-so that we could begin to understand how our bodies operate and what is good for them.
Health really means living in a society where people have the power to control all the conditions which affect their lives. The peoples of China, Viet Nam and Cuba have demonstrated through their courageous struggles that by kicking out the gangsters and profiteers they could re-orient their patients’ priorities and end famines and eliminate diseases. Working people in the United States have understood through struggles for civil rights, resistance to the war in Indochina and a long and growing history of strikes that this will not be a simple task. Liberal concessions to the demand for worker and community control, such as “consumer boards,” have shown themselves to be a sham. What we need to gain control over our health care system is the strength and unity of all the people who pay for it, work in it and use it. By challenging the system of medicine-for-profit with demands for real changes, we can begin to assert our right to be healthy and establish control over our lives.
Health Care in the U.S. Today
The U.S. is the richest and most technically advanced country in the world today, yet it has the worst medical care of all the developed countries. American working people have the bad health to prove it-one out of four people in the U.S. has some chronic disease, 30 million suffer from malnutrition or starvation, and a fifth of the housing and sanitary facilities are unfit for human beings. Over 100,000 people die each year from accidents on their jobs, and more than 2.2 million people become disabled yearly from occupational diseases and accidents. We breathe polluted air, drink bad water and eat toxic chemicals in our food. And this is taken to be the “normal” state of affairs!
The Rich Escape
The only people who escape these realities are the rich-who eat good food, live in comfortable houses, and if they work, do not have dangerous or unhealthy jobs. These people are served by a health care system completely different from the one we working people must use. The rich can afford regular medical and dental checkups even when they are not sick, high-priced specialists to take care of any illness, and the most advanced laboratory tests and preparations. The only way the rest of us get the benefits of such advanced medical science and technology is by having a disease that is unusual or “interesting” to researchers.
Medical care for the majority of the American people—the working class—is a totally different story. Millions of people in the U.S. never see a doctor until an emergency—when it’s often too late to save their lives. At least 25 million people in the U.S. have no health insurance and little or no savings—a serious illness means financial disaster to most families. The causes of many people’s health problems- such as hypertension aggravated by overwork, malnutrition resulting from exorbitant food prices or emphysema caused by industrial pollution-are ignored.
Women and Minorities Suffer Most
Racism also takes its toll here just like everywhere else in society. Black people, Latins, Asians, Native Americans (whose life expectancy now averages only 43 years), migrant farmworkers get sick more often and receive the worst care.
Women, especially women from national minorities, experience the brutality of the present health care system even more. They find "free” birth control and sterilization forced upon them by welfare laws; yet the rest of their medical needs go unmet. As mothers, they bear chief responsibility for their children’s health and usually are the ones who care for their children when they are sick. Yet women are often treated by doctors (usually men) as if they were children or passive, dependent beings for whom no explanation of their illness is due, no reason for treatment given.
Health care for working people in this country is mainly designed to keep people patched up enough to keep working. Since the only time we’re useful to the people who own and rule this country is the years when we’re working and making profits for them, the health system takes just enough care of our diseases and accidents to keep us at work. If we’re unemployed or on welfare, we get even less. Never is extra time or attention spent on preventive medicine or on our emotional or social problems. There’s just no profit in these areas. And once we’re too old or too messed up to work, we’re thrown on the scrap heap for good. Hospitals like Laguna Honda are places for old people, paraplegics and mental “defectives”—people from whom the owners and rulers of this country have squeezed every drop of work and profits.
Who Is Paying for Our Health Care? We Are!
We pay with our taxes, our work, our bodies and our lives.
Through our research and our own life experiences, the Worker-Patient Organization has come to see that it is working people in this country who pay the cost of all government services. This is particularly true of health care. For example, 97% of the operating budgets for San Francisco General and Laguna Honda comes from our tax money. Half comes from MediCal and Medicare, which is principally financed through state and federal income and sales taxes. The brunt of this is carried by working people- personal income and social security taxes made up 76% of Federal government revenues in 1974, while taxes paid by corporations were only 22%. Exxon Corporation, Ford Motor Corp., and Allstate Insurance, to name only three, paid no taxes at all last year.
The other half of the hospitals’ budget comes from city property taxes, which hit small property owners and renters the hardest-working class people. The majority of property taxes collected in San Francisco comes from residential property and since 1967, that portion has increased significantly. Property taxes impose the severest hardships on working class people. Dianne Feinstein built her political campaigns around the discontent of small homeowners who are screaming for tax relief, but she uses this as an excuse to cut back the city services that everyone needs and uses, rather than to tax the rich fairly. Of course, she does not have to use SFGH—the only time she’ll set foot in here is to scab. While she harangues about the "shiftless and lazy" and about "welfare cheats," we know who the real welfare cheaters are—big corporations like Bank of America who pay only minimal taxes on their huge office towers.
We Work and Pay
We also pay for health care through our work. If we are lucky enough to have a job that comes with health insurance, the boss will try to make us think that he's "giving" it to as a "benefit." In fact, what health care benefits we do have were won out of militant struggles of organized workers. The bosses then try to pass the cost back on us through speed-ups in production or trading the "benefit" for cost-of-living raises. City workers have felt the effect of this bargain: the pay raise won in the strike of 1974 has long been eaten up by inflation, and they still have no dental plan.
Hazardous working conditions also extract their toll from us. Workers’ compensation rates charged to companies are set just at a level which will cover a set number of workers’ deaths and a certain number of injuries and illnesses. Since the cost of compensation averages less that 170 of payroll in most industries, corporate bigwigs clearly have no incentive to clean up the workplace and will continue to poison, maim and kill us, as long as they can get away with it.
Those of us who work in hospitals wind up subsidizing the medicine-for-profit system through the low wages we’re paid. Those of us who use hospitals wind up subsidizing the medicine-for-profit system twice: first, through taxes that pay for the hospital (and its profits) and then through the health insurance premiums and fees (more profits). Those of us who work for and use the hospitals wind up subsidizing the medicine-for- profit three times—through our subsistence wages, our taxes and fees.
Who Profits From Our Health Care?
Let’s put the myth of “nonprofit” hospital to rest.
Health care as an industry is one of the fastest growing sectors of the economy of the United States. Like hogs at the trough, drug and hospital supply corporations, insurance corporations, construct ion companies and doctors are eagerly gobbling up people’s money for health as fast as they can. Drug and medical supply corporations earn billions of dollars in profits yearly. Over the last ten years, drug companies have time and again been rated 1st, 2nd or 3rd in profitability among all industries in the United States.
Whether they’re called “non-profit” or “for profit,” hospitals act as the host for these parasites. Representatives of drug, medical supply, insurance and other companies dominate hospital and medical school boards of directors to make sure the market for their products continues to expand. Bank and insurance companies also are getting into running hospitals, based on the Kaiser model in this way they can more directly control how health dollars get spent.
The profits these corporations earn means that the costs of health care to working people are skyrocketing. The cost of hospitalization has gone up 217% in the last ten years. The root of this inflation is the absolute control these corporations have over products that are essential for sick people. A dying person cannot afford to quibble over the price of a drug that can save them.
The rate of inflation in health care has far outstripped inflation in the rest of the economy. The health portion of the Federal HEW budget rose 10 times—from $2 billion to over $20 billion—in the 1964-74 period. Profits and doctors’ fees consumed a significant portion of this increase, rather than added services to more patients. Hospital workers haven’t received salaries increases of 1000% in this ten-year period; and they aren’t taking care of ten times the number of patients either!
Much of this inflation has to do with changes in how medical care is delivered. The work done in hospitals has for a long time been labor-intensive—most of the work requires a large number of people rather than machines as in a factory. This could only happen in our system if very low wages were paid, which meant that these jobs were generally filled by women, most of whom were black or from national minorities. Turnover was high and job security nil. It wasn’t until hospital unions were organized that hospital workers earned more than a minimum wage.
EVERY health care item—drugs, hospitals, etc.—is too costly for many families.
But now the use of technology is really spreading in hospitals. We have machines to run lab tests, lift patients, and monitor vital signs. The corporations who manufacture these machines need buyers for their products—so they make sure that hospitals have to equip themselves with all kinds of expensive new devices to keep up with the latest developments in science. This means that a county hospital can spend hundreds of thousands of dollars on respirators or dialysis machines and still not have enough soap. It also means that there are a lot more of these machines around than is really necessary. But as long as the corporations keep on making profits from them, the health care system will continue to waste our money this way. The use of unnecessary and overpriced technology is one main source for the incredible inflation in health costs.
Doctors Rich But Insurance Companies Richer
Doctors as a group also profit from our health care dollars. The medical profession is kept a small, highly-trained elite group. A doctor’s function—to heal the people and protect their health—is perverted by a health system which profits from human suffering. Instead of seeing their knowledge and training as something that should benefit all people, physicians are businessmen who use their skills as their personal property and try to get as high a price for them as they can.
Though doctors overall are losing power to large corporations such as insurance companies, they still are a very powerful, wealthy and highly organized professional group. Doctors now receive less than 207o of all funds spent on health care, but the average worth of an American doctor in his forties is still $120,000. The medical profession’s fight to hold on to this power can be seen in the current malpractice crisis, where many doctors are sacrificing their patients’ needs in a losing battle with the insurance companies. And of course it’s US workers who get laid off, while the doctors take a skiing vacation.
The university medical centers also have their own closely guarded interests, which place teaching medical students and exotic research far above our needs for health care. Although they act as untouchable private institutes, these medical centers are supported largely by our tax dollars, either directly like the University of California or by federal research and teaching grants.
This is the story that is hidden by the figures in the San Francisco city budget. SFGH's budget has increased from $10 to $40 million in the past ten years. Drugs and supplies have remained about 12% of this amount, but because of inflation, we wind up without enough toothbrushes, penicillin or clean laundry. The share extorted by the University of California has climbed nearly 50% in the past two years to over $4.5 million. Laguna Honda’s budget increased $4 million from 1973 to 1975; a good chunk of this was eaten up by rising food costs.
What's Happening In The County Hospitals & Why?
Hospitals like SFGH and LHH exist to keep working class people who are sick and dying off the streets and patch up their most immediate problems. The level of care is minimal by any standard. Because private hospitals can't make a profit caring for them, they save their beds for paying customers.
As the economic crisis worsens, the situation at hospitals like SFGH and LHH deteriorates. More people are dependent on public hospitals for health care, as they get laid off, lose their insurance and exhaust their savings. As people eat lower quality food, use less heat and live in poorer housing, they get sick mote severely and more often. Private hospitals, caught in the inflation crunch themselves, refuse to admit anyone who can't prove they can pay the huge bills. So, more and sicker patients show up at County as their last resort.
The relatively prosperous '60s have given way to a crumbling economy in the '70s. Our paychecks buy less and ever higher taxes pay for less social services of poorer quality. Cutbacks from the federal and state governments to the city level have slashed billions of dollars from hundreds of health and social service programs and tightened up restrictions and regulations such in childcare and food stamp programs. The city is also putting on the squeeze by hiking the property tax.
All over the country the numbers and benefits of civil service employees are being cut and their bargaining power eroded. The ballot offensives which cut the right to strike of police and firemen and the crafts pay section of the city charter show that the city is getting ready for future wage and staff cuts and trying to weaken city workers’ unions.
Some of these cutbacks in the county hospitals are dramatically visible. Three wards at SFGH and several at LHH have been closed. Since July, 1975, 321 jobs at SFGH and 129 at LHH have been either cut from the budget or frozen. Other cuts may not be so obvious but are just as important, like the shortages of paper cups and soap, and the cheap new IV equipment.
In a factory cutbacks and speedup may lead to a lemon of an automobile—in a hospital they can kill people! One Friday night, one of the busiest times for trauma and accidents, there was no technician in the emergency room to take xrays. On the weekends frequently one R.N. covers several wards, on the labor and delivery floor at night, despite the fact that women on the verge of delivering, hemorrhaging or acutely in pain arrive on the ward directly from the emergency room.
The increased pressure to provide more services with fewer people and supplies comes down in ways that are designed to divide and weaken workers’ resistance. Short staffing increases the conflict among workers. It creates hassles over work assignments, working out of classification, scheduling of days off and shifts, and “floating” (being temporarily transferred to unfamiliar work areas). The city freezes permanent jobs and then hires temporaries, often through federal and state grants, CETA, OEO, or U.C. Medical Center.
This weakens unions and makes it easier to get rid of so-called “troublemakers” who are temporary. And since temporary workers do not earn any benefits, the city saves money by not having to pay into health or retirement plans. These hiring practices also create tensions due to the many different pay scales in effect for the same job.
When staffing is cut, it’s the evening and night shifts that are the shortest and non-professionals who are cut first and in the largest numbers. The number of supervisory personnel at SFGH has actually increased, in order to get more work out of fewer people.
Of course, being in a hurry in a hospital means more mistakes in giving medications, more accidents sticking yourself with infected needles, more sprained backs from lifting and moving patients by yourself.
We Are Kept Divided
The Administration keeps the workers and patients in constant conflict. Ever lengthening waiting times in clinics and the emergency room are blamed on the registration clerks. Because the orderlies have the most patient contact on the wards, they get blamed for the patients’ discomforts and lack of attention.
Workers who really would like to give good care are prevented by the shortage of staff and supplies. They have to fight cynicism and demoralization, in order to resist seeing “demanding” patients as forcing them to work harder, but rather as people like themselves who deserve a better deal than they are getting, who have a right to better care.
Racism is a Policy
The strategy of setting working people against each other to squabble over the crumbs is no accident. Racism plays a large part. The hierarchy at SFCH and LGH look just like any other place in our society—white men (doctors and administrators) at the top, white people and some Asians in the nursing staff, and almost entirely Black, Latino, and Asian people among the kitchen workers, porters, orderlies and laundry workers. The Administration plays this to its advantage by turning one group against another. For many years a “color line” existed at Laguna Honda—white and black aides who ate lunch together faced harassment and firing. Since changes in the immigration laws in 1965, immigration among Asians has increased threefold, and among Filipinos nearly nine times. However, professionals, especially in health, face discrimination in licensing and often find themselves at the bottom of the job market. The Administration tries to exploit this by paying them low wages, threatening their job security and visa status and turning other workers against them.
Racism among the staff sometimes kills patients as well. In a recent outrageous incident, a white R.N. refused to listen to a Black respiratory therapist about a patient and angrily told him that she knew her business better. Within 20 minutes the patient was dead. The R.N. then tried to blame the therapist for “not forcing her to listen to him.” This patient died because a white person did not respect the knowledge of a black man and for no other reason.
The Corporate Solution
Now and then we hear that the city is planning to shut down SFGH or LHH completely, or else turn their operation over to a “non-profit” corporation. County hospitals are being closed all over the country; people who can’t afford private hospitals are being denied care. Nine county hospitals have already been shut down in California and Chope Hospital in San Mateo County is likely to close soon. With a non-profit corporation, the city would make one contribution to SFGH each year. If the hospital couldn’t make it on its own, they would have to charge patients higher fees, cut back services or lay off workers. The city would no longer be responsible for health care.
The SFGH Administration recently instituted a new billing system paving the way for it to become more and more like a private hospital. By forcing all those who are eligible to apply for MediCal and by milking our MediCal and Medicare money and our health insurance, the city Board of Supervisors thinks it can still get more money out of working people. Again we wind up paying two or three times over for a medicine-for-profit system—through our taxes, our bills for services and, for those of us who work there, through our low wages. The new billing system will not mean better care at the county hospitals. This is because additional money collected by the new billing system—like all money collected by the county hospitals—goes directly into the city’s general fund and not into the hospitals’ budget. What this leads to is clear from the example in New York. There, the Health Department brought in a tight collection system and increased revenues to the point where the municipal hospitals could have been solvent. But when the bankers demanded their interest payments, i.e. profits the Health Department budget was slashed. Thousands of workers were laid off and several hospitals were forced to close down. The money people had paid for health care went into the pockets of the Rockefellers and others like them, who own the banks in this country.
A New Hospital; Same Old Scandals
The opening of the new SFGH building has been heralded for months and years. Stories about the corruption and shabby dealings associated with its construction and financing abound. When it finally does open, we can anticipate the speedups and poor care, for we know it will take more nursing staff to care for patients in two-bed rooms, rather than on open wards. They have already used the new hospital and its new staffing practices to justify the budget cuts—messengers cut due to new pneumatic tube system, laundry staff down to half due to automated laundry chutes, and so it goes. The clinics are supposed to expand their hours but all requests for additional staff have been turned down. The consumer board, recently disbanded, was outraged to learn that no eating area would be available for patients or visitors. Once again, if the Board of Supervisors has their way, patients and workers get the shaft-and all of us as taxpayers end up paying the tab for the banks, construction companies, insurance companies, hospital supply corporations and management consulting forms who profit from this corrupt system.
What We Stand For
We stand for the fundamental right to human health and wellbeing. The medicine for profit system—like the whole profit system of American capitalism—is based on injustice and exploitation. Our labor and our taxes give us inadequate to nearly non-existent services when we are sick and poorly paid jobs when we are well. Why? Because most of our money is gobbled up as PROFITS!! Therefore, we stand for the abolition of private profit in our health care system. The medicine for profit system should be replaced by a fully nationalized, community-patient-worker controlled system. By fully nationalized, we mean not only doctors or hospitals—we also mean all health-related profit-making "health" industries.
Yet we know that the present ruling class (which includes the San Francisco Board of Supervisors) will not even listen to us: the demand for a genuine health system was put forward in the 193O’s—and Kaiser and Medicare was the profiteers’ answer. However, we can begin in small ways, NOW, to fight for improvements in our jobs and health care. We know that small battles are always a part of a larger campaign—even if we lose the small battles, we can and will win the campaign. One day we shall have to change the entire system of health care and maintenance in the U.S.-and the world, for that matter. But we have to begin where we are, which today is in San Francisco in the county hospitals. We have to pick up where other small battles left off. Today there are pressing and immediate problems and conditions that we must fight, fight in order to protect our jobs, improve our working conditions, improve the health care given at SFGH,LHH and other county hospitals.
Sexism and Racism
Let’s look at a few facts: 75% of all hospital workers, and 70% of all health workers are women. Furthermore, women use health care services two or three times more than men, principally because women have children and take the greater part of the responsibility for their care.
As a result, women and children carry the brunt of poor health services. We think women will play a leading role in demanding changes in health care, just as they have led many of the fights in recent years for equal jobs and rights for women, better schools, lower food prices and tenant and welfare rights. So the WPO stands absolutely against sexism in hiring practices, in working conditions, and in health delivery.
Some more facts: in the health care hierarchy the lowest paid jobs with the hardest working conditions are filled by people especially women, from the national minorities. Since the beginning, enslavement and genocide of national minorities has been a part of U.S. history. No wonder that national minorities have been leaders in resistance and demands for social change. The Black Liberation movement, Native American struggles such as Wounded Knee, and the Farmworkers struggles to unionize are recent examples of this leadership of national minorities. The WPO stands absolutely against the discriminatory hiring practices, treatment on the job and health services presently suffered by people from the national minorities.
National minorities are subject to class oppression: that is, they have the lowest paying jobs and are refused educational and job opportunities. This forces the national minorities disproportionately into the lower levels of the working class. However, in addition to class oppression, based on language and culture, there is also institutionalized white supremacy, which gets expressed in racist hiring practices and racist discrimination on the job and in patient care. We stand absolutely against racism and will fight it whenever and wherever we can.
The WPO is made up of workers and patients; but it is also made up of people from a number of national minorities: of Black people, white people and brown people. The WPO knows that it is class—our jobs, the wages for our jobs, our education, the opportunities we have had in life—that lies at the root of the differences in health care, working conditions, the lifestyle of our families, our own ability to create a life for ourselves in this society. We are members of the working class—and for most of us, given the wages paid health workers, we are in the lower levels of the working class. Racist America teaches us to hate people with skin of another color, or who speak another language—it’s the old “divide and rule” tactic that the rich have always used to stay rich and on top. For the rich to stay rich and on top, we have, to stay on the bottom and poor-and we’re getting poorer and poorer!!
We Must Stand Together
The first step we have to take is to stop fighting each other; stop resenting each other; stop thinking that one or the other of us is better than the other.
We have to unite—and to unite, we have to stop racism, we have to stop sexism, we have to stop national oppression. In order to fight for immediate improvements—and one day to win decent jobs and decent health care—we have to see that our common interests and needs as workers overrides any differences we have. This is not easy to see: working people are deliberately set to fighting each other, to keep us from fighting for the same things. So our first task is to get together—and in order to get together, we have to stop hassling each other because we’re Black, or female, or Asian, or a worker or a patient at the hospital.
We have to stand united on the job. But we also have to stand united in the community, workers and patients together. We all know how workers and patients are set against each other, how the system makes patients think that poor health care is somehow the workers’ fault. The strikes at SFGH would have been able to win a lot more demands if the community had been more united behind the hospital workers. We have to help patients to understand how the system works, and we have to educate everyone around the tax structure, how unfair property taxes are to working class homeowners and renters, when the big corporations earning billions of dollars pay no taxes at all! We all have to understand how the enormous, inflated salaries of doctors and the fantastic price of drugs cut into our tax dollars—and into the quality of our health care! Again we have to see our unity as workers, all victim of the same system, making the wealthy rich and healthy and ourselves poor and sick.
Start Here And Now
But unity is more than talking about how good it would be to get together: it is also taking the first steps to actually getting together by struggling together around immediate, concrete issues. The WPO has identified the following issues, around which we will begin to fight:
1. No Cutbacks for Staff or Services for the County Hospitals.
This means we will oppose the Board of Supervisors in their efforts to scoop money off the budget for services that are crucial to people’s health. We want the city hiring freeze lifted immediately. The hospitals need more staff, not just in nursing areas but in all support services. We want more services and supplies, those necessary for good patient care and those that make for good working conditions.
We will not be silent when the city officials get together to chop up the funds!
2. The rights of patients to quality health care.
No cutbacks in services is obviously very key to quality patient care. But there are other important aspects. Patients have rights to treatment that shows respect for them as living human beings, to privacy and confidentiality. They have a right to know who their doctor is; they have a right to refuse to be guinea pigs for research and teaching purposes. In a nutshell, patients must have some choice and decision making in their own care.
The WPO will be active in informing patients of their rights and will also fight for them.
3. Workers and patients want to know what is happening with the new SFGH.
It’s pretty clear that the Administration has many changes planned for the new hospital. Some may actually improve patient care, but many are designed to speed up the work force, lay more people off, and further divide, weaken and control us. We want answers to the important questions about the new hospital, not public relations smooth-talking tours which gloss over the problems. Is centralized staffing going to mean permanent floating and nothing to say about your days off? Our tax money is being used to build this hospital. City Hall has kept the facts and figures hidden away too long. How come there’s no money for wheelchairs or decent food?
We want to know where our money is going and how the new hospital will affect us. We have a right to some say in how the services of the new hospital will be run.