GLOBAL REACH 

or 

GLOBAL LEECH?  

As working people, we've gotten used to seeing global corporations abandon our communities, taking jobs and capital overseas. The usual suspects are manufacturers, pharmaceutical companies, textile companies. But in the past three years a new industry has joined the ranks of global expansion: healthcare. 

Cartoon: ©Huck Konopacki

The hospital corporations, HMOs, and healthcare workforce reengineering consultants that are afflicting my union and every other healthcare union here in the U.S. are now peddling their products all over the globe. They are inserting themselves into publicly accountable healthcare systems in other countries, hoping to privatize and reap the profits. The idea is to siphon off the tax dollars that support these national healthcare programs.

STOPPED AT THE BORDER 

The good news is that sometimes they are stopped at the border. This spring, when Columbia/HCA, the world's largest healthcare corporation, tried to purchase a public hospital in Adelaide, Australia, public opposition stopped them cold. The doctors, nurses, and community activists of Australia marshalled the facts on Columbia/HCA's record in the U.S. -- the quality of care scandals, the bilking of taxpayers in Medicare overbilling, the anti-union behavior -- and mobilized a successful movement to keep Columbia out. 

U.S.-style healthcare does not enjoy a stellar reputation in other countries. While we may be renowned for technological advances, when it comes to basic humanity, the American record is a disgrace: To begin with, we have the worst infant mortality rate of any industrialized nation, and 18 percent of our residents have no health insurance. This is the only industrialized country where a serious illness or the need for chronic care can actually bankrupt a person. We spend more than any other country on healthcare while leaving 42 million uninsured (see the chart). 

Even so, U.S. healthcare corporations and consultants have made inroads, even in England, which has a national health service that covers all residents. While the design of the English healthcare system is good, it has been starved of adequate funding by years of cutbacks by conservative Prime Minister Margaret Thatcher, and now the hospitals are staffed by disgruntled doctors and underpaid nurses. The cuts have undermined public support and opened the way for more privatization of services in England, and to intrusions by American companies. And yet there is significant opposition to this: Most Britons don't want an American system of healthcare.

UNWANTED 'CONSULTANTS' 

The American-style "consultants" aren't much welcome either. Many of these consultants are the very same sharks who have already feasted on workers in manufacturing, retail, communications, and banking. Now  they're heading into healthcare, and going global as well.  
 

Nurses rallied at the U.S. Capitol last year.

Photo: ©Bill Burke, Impact Visuals

Fortunately, they sometimes run smack into unionized healthcare professionals who figure out early what they are: promoters of downsizing and de-skilling. Visiting nurses from the U.S. and Canada let Australian nurses know what to expect when the consulting firm Booz-Allen came to Australia. Now they know the drill: The "total quality management" teams that Booz-Allen is trying to institute are basically an effort to unbundle patient care and rebuild it into an assembly line model.

A NURSES' ROAST 

Then there's the story of American Practices Management (APM) and the intrepid Manitoba Nurses Union of Canada. APM likes to say they "only do healthcare consulting" to legitimize themselves as the preeminent consultants in the field. They pocket handsome fees on care models that reduce the skill level of caregivers, cut the workforce, and promote expensive technological products made by other companies.  

For example, APM's Connie Curran sits on the board of the Pyxis Corporation. Pyxis makes ATM-style medication dispensing machines placed on hospital wards to monitor inventory and the times medications are given. It's no wonder that Pyxis machines often end up in hospitals where APM consults. And they cost upwards of $40,000 each. 

APM arrived in Manitoba Province in 1994 to "advise" the Canadian provincial government on hospital workforce reengineering. (This kind of practice is commonplace ever since NAFTA opened the door.) APM advised Manitoba to deeply cut the number of licensed practical nurses and also the number of registered nurses employed in the province's hospital system, and to replace them with unlicensed nursing assistants with less training and lower pay. For this advice they charged the province $3.9 million. 

'AMERICAN BOUNTY HUNTER' 

But Manitoban nurses knew what was up. The Manitoba Nurses Union invited APM consultant Connie Curran to their annual meeting, where she showed her "total quality management" slides, complete with Canadian flag logos in the corners. After the presentation, she was roasted by the nurses. One nurse called her an "American bounty hunter" after nurses' jobs. The local media filmed the festivities. Everyone in the Province of Manitoba learned about Connie Curran and her American-style plans for their hospital system.  

Soon after, the union began running TV spots warning of the effects of the planned cutbacks. The union made healthcare cuts the central issue in the next provincial election, and several incumbent politicians were turned out of office as a result of their healthcare stance. The Manitoba nurses and their allies were able to stop many cuts and to negotiate funding for retraining. However, some nurses did lose their jobs. 

CANADA PRIZES EQUITY 

In Canada, healthcare is administered by each provincial government, which must meet the five principles of the Canada Health Act of 1984 in order to receive federal funds (see the box). Canada's system prizes social equity -- much like the Labor Party's program for universal healthcare coverage, which is similar in its simplicity and content. 

In the past five years, conservative Canadian politicians have been calling for healthcare privatization and funding cuts. Fortunately, though, 85 percent of Canada's nurses are unionized, and they and their allies are working hard to maintain adequate support and standards for healthcare in Canada, and to keep the politicians in check. 

We are not as fortunate in the U.S. Since Americans aren't all in one risk pool with equal healthcare benefits, we don't have the same sense of unity. Instead, we have a system of multiple risk pools: Medicare, Medicaid, and various kinds of job-based insurance. Each plan has its own rules for what is covered. Each has administrative layers that pay the bills and scrutinize our eligibility for coverage.

SUPPORT FOR SYSTEM UNRAVELS 

It doesn't have to be this complex, or this expensive. Medicare and Medicaid spend less than 4 percent of their money on administration, while some HMOs waste up to 30 percent of the healthcare premium dollar on administration. (This includes processing claims as well as profit, the cost of mergers, CEO compensation, and investor returns.) To say American healthcare is a mess would be an understatement. All you have to do is read the daily paper in any town to see how public trust in our fragmented system is unraveling. 

Profit-driven HMOs and hospital chains are engaged in an insatiable quest for dominance in a system that considers competition and even profiteering to be perfectly appropriate. Meanwhile, politicians tinker around the edges of our healthcare system's dysfunction. Given this state of affairs, union members, community activists and everyone else who is affected will have to shift the terms of the debate and turn up the heat. There are some encouraging signs. Among them: 

* A group of doctors and nurses has begun a grassroots effort to get thousands of signatures on a letter calling for a moratorium on for-profit conversions of HMOs and hospitals and for public forums on the direction of our healthcare system. This letter by the Ad Hoc Committee to Defend Health Care will be published in the Journal of American Medicine, and many of the conveners are highly respected academics and public health professionals. 

* The past year has seen a flood of state and federal laws to create new rights for patients in dealing with their insurers. 

* Some communities have mobilized to prevent large for-profit chains from purchasing their non-profit community hospitals.

IT ISN'T ROCKET SCIENCE 

Corporate power is entrenched in our healthcare system and has global ambition. We have to think globally as we talk about healthcare in our unions and communities. Why do we spend more than any other country on healthcare, yet leave 18 percent of us no coverage? It's not rocket science. With our healthcare dollars, we fund profit, outrageous CEO compensation, and industry mergers and acquisitions. Trade unionists and their political parties in countries with universal systems have only to look here to see the downward spiral they'll be descending if they allow U.S.-style healthcare to cross their border.  

We Americans have a stake in helping our counterparts abroad to defend their universal healthcare systems -- without them, it will be much harder to win our own. 

--Kit Costello  Kit Costello is president of the California Nurses Association and the Labor Party's co-chairperson.  

Hurt by HMOs 

The American experience with for-profit healthcare and HMOs has been abysmal, on balance. The California Nurses Association, through a public campaign called "Patient Watch," has been collecting the stories of  
people victimized by HMOs. And there are lots of them. 

Kathy  

Olsen 

"An $800 scan could have saved what my son lost  -- he lost his vision and he's got cerebral palsy. He was screaming when we left the hospital, and we asked if we could have a scan. They said no. It's not like it  
wasn't a covered benefit. We even offered to pay for it, but they  
wouldn't do it. You're paying for insurance. It's not just for them to  
make money, it's for them to take care of us." 

Linda  

Ross 

"My mother died after waiting in the ER for six-and-a-half hours. All they had to do was start the blood-thinning agents that would have saved her life, and she would be here now . . . If I meet someone who says 'I love my HMO," I say, have you really been il