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To stay in the game, nonprofits like Sutter/CHS and Kaiser have started acting like the for-profit chains, keeping a sharp eye to the bottom line. Big clients can play one health care provider against the other. Every incentive in the system tends toward the cheaper, leaner, more profitable. And after the obvious excess is gone, there's not a lot to cut except people.
On a Saturday morning in April, about 100 people sit on folding chairs in the auditorium of the Plumber's Hall on Market Street, sipping coffee and munching doughnuts. The mood is decidedly upbeat; seriousness and uncertainty have been temporarily overshadowed by camaraderie and programmed encouragement. The occasion is an impending vote on whether to strike over unfair labor practices -- alleged coercion and intimidation of union activists -- at Visiting Nurses and Hospice.
VNH has been in turmoil for some time, marked by frequent turnover of management and consultants. More recently, an eight-month federal survey inspection threatened to end the agency's Medicare certification; the threat was deemed serious enough that VNH scaled back on taking new patients while the agency worked on making the government happy. Many home care workers, who are paid by the visit, are seeing fewer patients than they used to; now, the workers want a greater say in scheduling and other issues related to patient care.
The past six months have been marked by marches, rallies, candlelight vigils, luncheon barbecues, songs, and bullhorn-led chanting outside both the Visiting Nurses and Hospice offices and the California Pacific Medical Center. All the while, company security officers in gold coats have surveyed the scene. Video cameras have whirred; steno pads have been filled with names.
Here, on the stage of the auditorium, a television sits ready for the videotaped address to the troops from AFL-CIO President John Sweeney, a former head of the Service Employees International Union who has vowed to make health care the cornerstone of a union resurgence. But first, a parade of prominent Bay Area figures moves to the microphone, each pledging support.
Among them are the required: the San Francisco Labor Council.
The political: the Harvey Milk Lesbian/Gay/Bisexual Democratic Club, the Senior Action Alliance, and San Francisco Supervisors Tom Ammiano and Sue Bierman.
The indebted: the California Nurses Association, which the SEIU supported only days before in its strike against Kaiser.
The recently organized: Lusty Lady strip club dancers, the first strippers in the country to form a union.
The academic: women's studies and labor studies professors from San Francisco State University.
And, of course, the perpetual grand marshal: Mayor Willie Brown.
"I love every second of this struggle," Brown tells the exhilarated crowd. "And I will love the victory even more."
It's no big surprise that there are nearly as many community folks and union staffers present in the auditorium as actual Visiting Nurses and Hospice employees. This is but one battle in the war for health care.
One of the big issues here involves the health care of the caregivers themselves. A good portion of the 500 or so VNH workers are contracted on a "per diem" basis, with work hours that vary with their patient load.
These employees don't have health benefits, even though they work for a hospital.
The mood in the auditorium sobers, and the discussion turns to fear. Only days ago, California Pacific CEO Martin Brotman told the workers that it was "not the right time" for them to form a union. That speech is still replaying in their heads as they take turns offering testament for and against the strike. Most of them talk about what's happened to their jobs, and how it has diminished the quality of care for patients.
"Management has screwed this place over for two years. Workers didn't do that."
"We have doubts. I've had doubts since August. ... The bottom line is that we're all scared."
"Health care is in crisis. We need to be the little engine that could."
Finally, it's time for the big event.
For the first time in hours, the room falls into dead silence as workers stand with their right arms raised in a vote that may jeopardize the only income many of them have.
They remain eerily quiet while a handful of "official observers" move through the crowd, counting votes. Dusty banners proudly displaying labor history hang from the ceiling, ghosts watching over a new era of organizing. It's hard not to be moved, regardless of how many times you've seen this same scene.
The answer is also no surprise. The nurses, aides, social workers, and therapists of Visiting Nurses and Hospice have voted to serve legal notice of a one-day strike against the company to protest its unfair labor practices. The crowd erupts into cheers and hugs. Finally comes the chant -- "Union Power!" -- loud enough, almost certainly, that the company security officers outside the hall can hear it.
