LOS ANGELES, CA — An indicator that capitalism is a sick system and needs to be replaced is when doctors, who generally live very comfortably, become disgruntled and burnt out from the “assembly line” our healthcare system has become. They recognize the harmful effects it has on patient care, particularly the most vulnerable: poor, black, Latino and immigrant patients.
For the last year, our “not-for-profit” HIV organization has almost doubled its first quarter profits, $95 million to $181 million from the 1st quarter of 2012 to the 1st quarter 2013. It has continued its attacks on our wages, benefits, scheduling and the staffing of our clinics. Short of rumblings in various staff meetings or side conversations, these attacks have gone virtually unchallenged until recently.
For the last three months, the providers (physicians, nurse practitioners, physician assistants) have been meeting in secret trying to figure out how to respond. It’s been a truly heartening experience to deepen ties with this group as venting sessions after work quickly morphed into serious conversations that moved beyond talks of our individual pay and productivity and into conversations about our coworkers and our patients. With leadership from a Party member in this circle, the group decided to unionize. Now over 85 percent of providers have signed the petition to unionize.
Clearly, this is a far cry from being communists and joining PLP, but this growing solidarity and anger, which have trumped much of our initial fear, are part of the process of learning how to fight back. With the use of CHALLENGE and communist leadership we can continue to learn how to fight and recognize the limits of unionizing and reformism. As to be expected, there are many illusions about what the union can offer us (even if there are short-term gains).
This HIV organization is one of the largest in the world, and we will be the first to unionize here in the U.S. We recently found out that a group unionized in South Africa, although at this point we know very few details. However, the president of our company has used our passion for treating HIV as a mechanism to pay us less while overworking us. This organization makes profits off its pharmaceutical sales because it can buy highly expensive HIV medications at 30-40 percent off (called 340B pricing) and then bill at full price the insurance companies or Medicaid/Medicare, AIDS Drug Assistance Program (ADAP). The remainder counts as profits. Like the Walmart of HIV care, this company is expanding by swallowing up smaller HIV clinics that do not have their own pharmacies and with cuts in reimbursements from Medicaid cannot afford to survive. Like a virus that preys on and weakens the immune system, this company preys on the sick while making millions in the process: a model company under capitalism.
“Healthcare” under capitalism, in this period of economic crisis and war, means that there will have to be more and more cuts and attacks on workers and patients while Obama and others spread the illusion of increased access to care. We’ve already seen, here on our job as well as nationally, what Obamacare really means for our patients.
 Patients at our clinics who now qualify for “Healthyway LA,” a new insurance for the poor, get less access to medications than they had on ADAP. Moreover, if they need a referral to see a specialist like oncology (cancer specialists), they have to go to the County system just as they would have without health insurance. The County system has been continually dismantled over the last several years. In other words take your insurance and get in line, an ever-expanding line!
What will this mean for our undocumented patients who are not eligible for insurance? The federal government will likely stop funding ADAP, the only source that pays for their HIV medications and care. Once again, it is the illusion of access and the reality of more racism, illness and death!
And what will this mean for those of us with so-called good “Cadillac” health insurance? The sick irony is that we can get a glimpse by taking a look at what is happening right now to retired workers in Detroit (home of GM, makers of Cadillac). To save the bankers and government from bankruptcy, they are targeting retired public workers who currently have better coverage through Medicare and will force them into “choosing” a new health insurance plan which the New York Times (7/29/13) admits will mean inferior care and increase payments for the patients.
Like good Nazis, the Detroit bankers and politicians are starting with the elderly, those deemed no longer productive to society, who Hitler called “useless eaters.” This is fascist healthcare. From the “Charitable Foundation for Institutional Care” that collected money from the families of children murdered by the Nazis to Obama’s “Affordable Care Act” we must recognize the essence of these changes so as not to be complicit. Fighting back against these attacks on the job is the first step to recognizing the much greater problem of capitalism as a whole, and fascism as merely an expression of capitalism in crisis.
We’ve had many discussions on the job, but these broader conversations about our role under fascist healthcare and how to fight it have yet to occur. One friend and fellow provider has seen the most recent CHALLENGE and has read the rough draft of this article. There are three other providers that I will definitely show the next issue of CHALLENGE to, and hopefully, this article will be the beginning of a series that documents our progress and the growing challenges within this reform struggle. The fight for real healthcare means the fight for
communism!
Barefoot PA