Unions and Health Care

Everyone is talking about government unions today. I remember being an administrator for a government institution at one time. I dealt with three unions and in the early 90's, unions were losing popularity. Japanese companies were coming in and creating worker oriented factories that cast off the burden of union hierarchy by promoting an unlimited rather than a limited view of the participation of the worker in the auto industry. As a result of labor laws and of philosophical altering of employee/employer relationships, very little of the old time union task is still needed in the modern worker's life. For this reason, the news today reports that the largest section of unionized employees is in the government. The stat has been out about a year, but people are talking about it today.

But I was not in the auto industry. I was an administrator at a State Hospital. I know what the union's role is when the boss is the government. I never belonged to a union as a laborer except when I worked at unionized State institutions, but when I became and administrator I was a HUGE fan. Ever since my short term experience as a Director of Nursing for a State hospital, I have believed that even though laws and relationships may genuinely make corporate unions unnecessary, the government worker has to have a union representative because he or she is dealing with the government, and does not have the government as an objective force to regulate his or her employer.

But as a government administrator, the unions were a blessing to me for a very different reason. The union had contractual expectations that I could hold employees to. The administration of our institution had dissolved into a mushy "family" of people who were sticking together to keep the State from cutting their institution from the budget and working order was horrible. Administrators had no reason to push for results but more than that, administrators were tired of pushing for results. Government work does not produce the motivation of pride by natural results of accomplishment like making a car or bringing energy to the nation. The government worker has to have a passion for the laws of the land that can keep him or her happy about doing the task at hand even if no results are visible. They must overcome the worry of being a brick in the wall due to the belief that the wall has a big picture purpose that is good. Most of the time they have to do this with full knowledge that they are restricted from doing things that would actually "work" in the moment due to the importance of the big picture. So when I was suddenly called on to serve, I was looking at a group with relationships that were so skewed into favoritism and false communication, the way a dysfunctional family interacts, that the only solid expectation I had to work with was that union contract. I'm not sure anyone else in my position had even read it in the last five years, but I clung to it like a Bible and got some order back in my department (not to mention respect).

So I developed a two fold reason for having unions for government workers 1) so that the worker is protected from his or her all powerful employer, and 2) so that the government can actually require work of people and fire them if they don't work.

But the word on the street today is that government unions are a drag on the budget and poised to ruin the country. I'd like to say that the answer to that problem is not to get rid of unions for government employees, but to reduce or at least not add to employment in the government. I am not addressing reducing at this time, but I have a very big concern about the area that might be added.

In the past, hospitals and health care workers were considered "ineligible" for unionization. This came from the old philosophy that the hospital was a charitable institution and for that reason, lower wages were considered a necessary part of keeping them going. Of course the issue of life and death in the face of a strike was also a big deterrent to compatibility with unions. People worked there for a purpose greater than earning a living, because they were healers, or in some cases totally committed to God (many early nurses were nuns and deaconesses with no families). As the lines between providing a service to the community and making money in a market have blurred, unions have been slowly gaining ground in health care areas. I do not sit and research before I blog. I think about my experiences and what I have seen pass, and I don't have the details on the approach of unionization in health care, but I did see that last year unions were planning to work in California on adding the 85% of nurses that are not represented by unions to their roles, so this is a very active issue. Both the fact that 85% were not represented and the fact that the unions were working to change the situation make this a current "to be or not to be" problem.

Hospitals were in the past what the Japanese car companies were trying to be in the 90's. The supervisors made rounds, and the administration took care of their employees. To place union intervention and rules of relationship in the middle of that employee/employer relationship would be like caging a bird. Nobody came to a hospital expecting that there was any great amount of money involved in the proposition, so everyone worked to keep dedicated people happy. Dedication and happiness were important when there wasn't money to compensate for the actual work.

But, the one place where hospitals were more likely to be unionized was when they were government hospitals. The private hospitals had boards of directors, and philosophies (usually religious) that an employee could use as a basis for appealing to good treatment, but the State has no such guiding principle. State facilities had to spell out in black and white what would or wouldn't be rewarded because no one had the right to make an independent judgement based on the sacred trust of the purpose of the institution. The State just doesn't work well with the sacred, it has totally different rules.

So where this draws me to for the current times is the importance of rejecting government health care where myriads of health care workers suddenly are employed by the government instead of independent institutions. I don't really know to what extent anyone has considered this, but it won't work. A public option for a health insurance plan would whittle away at the free market boundaries of assessment of resources, and a public service system would be unsustainable with the demands that government employment requires.

Unions served a role in industry to help workers because the pots of money were not being fairly distributed. There are not very many pots of money in the field of health care no matter what the commercials for pills make you think. Health care is a duty of love, which is very different from inventing and selling a new chemical. You can't buy love, and since the only commodity the government works in is money, they need to stay away from providing health care.