Practices for Healthcare Workers in the Poor People’s Campaign: A National Call for Moral Revival
By Karim Sariahmed, Jacob Hope, Clarissa O’Connor, Noha Eshera, Zach Hershman
We define the “working class” as anybody who has to sell their labor. This definition includes “middle class,” “upper middle class,” and other vague divisions so normalized in society that we think of them as natural and true. As such, our definition includes nurses, doctors, scientists, social workers, case managers, therapists and many other kinds of healthcare workers. Despite these divisions, we all are exploited by a ruling class, those who profit from dysfunction and suffering in the healthcare system. With more and more of us living in precarity, we use the phrases “working class” and “poor and dispossessed” interchangeably.
More specifically, the source of the profit is a difference between the cost of the services we provide and the money we make. In other words, a surplus is collected by the systems we work for and the people that run them. Both “for-profit” and “non-profit” hospitals seek to maximize this surplus by pressuring us to see more patients, with measurements of our effectiveness limited to narrow, cost-focused measures of “value” and “quality.” Even our charting and documentation has little to do with outcomes. The primary motivation is to minimize liability for the hospital and maximize insurance reimbursement. Meanwhile our patients and our coworkers suffer in toxic environments at work and at home. We know intuitively that most of us are not faring well in this system, despite how hard we work. Our most fundamental interests are those we share with our patients.
“Burnout” has become a popular way to describe the way we feel in this situation. Our institutions have responded with various superficial psychological supports, ignoring the contradiction between accumulating profits and caring for the sick. Our particular place within the working class and within the healthcare economy puts us in a position to be exploited by the ruling class, which includes CEOs and shareholders of large health systems and pharmaceutical companies. A system that meets everyone’s needs cannot be led by people making millions of dollars. Relief from these conditions requires us to engage this fundamental conflict. We have to confront the exploitation which all healthcare workers and patients experience in this system.
Because of our technical skills and social authority, we are in a position to support either side of this conflict. We experience the conflict between the rich and the poor as a choice: we can emphasize the conditions we share with our patients, or the interests we share with our bosses and other people who want to horde the wealth moving through our healthcare system. The mounting defense against Medicare for All, for example, is funded by the insurance industry because they are clear about the nature of this conflict, and they want to protect their own interests. We can choose some middle ground, which usually means betraying the needs of the most exploited people in our class, such as undocumented, transgender, or incarcerated people. But if instead we get as clear about this conflict as the ruling class is, we can choose our needs and the needs of our patients over the agendas of our bosses and other people who extract profit from our honest work.
At every level of hierarchy in the healthcare system, many of us experience bribery which influences our perception of our conditions: higher pay, prestige, better hours, publications, grant money, administrative positions, sometimes even public office. It is much easier to accept conditions which neglect patients when our career paths promise these things. We believe the most fundamental interests all working class people are the same, although we occupy different positions in the class. If we develop a clear sense that we are part of the working class, taking those bribes becomes a tactic for supporting the interests we share with our patients. There is nothing morally wrong with wanting to pursue academics, or with looking for a way to work fewer hours. But whether these things motivate projects for the whole working class depends on our political education. We have to commit to seeing and naming the ways the interests of our bosses come into direct conflict with the interests of working class people. The clearest example of this is the pressure we feel from management to see an ever increasing amount of patients with the same inadequate support and resources.
Without clarity about this full context, we’re vulnerable to all kinds of misdirection that threatens our shared interests. The bribes we’re offered can certainly have this effect, even on those of us who know the situation absolutely must change. We might think we’ll be most able to effect change as special individuals by taking on privileged positions, such as those in academic medicine which can only be reached by playing by certain rules over many years. Or, if we remain isolated and without working class organizations, we might blame ourselves for systemic failures, or take out our frustrations on our co-workers or patients. By organizing instead, we break the isolation. With a disciplined commitment to the developing leadership of people throughout the entire working class, we can challenge our bosses and members of the ruling class in order to change our conditions.
When we try to change systems without a vision for the whole working class, we lose our sense of direction. As members of organizations of the poor and dispossessed, or as organizations in committed partnerships with them, we can improve our own leadership. Our participation in the movement to wrest our healthcare system away from the profiteers and make healthcare a human right is necessary and meaningful. It is absolutely our responsibility to take up the kinds of leadership enabled by our experiences, our knowledge, and our position. It is also our responsibility to commit time and resources to the leadership of people whose lives depend on the success of our movements.
Below are some principles to guide guide work that can awaken us to the fact that we are part of the working class. They can help us develop in ways that will allow us to provide effective leadership for the entire class when our conditions call us to do so, as they do now. We can abandon self conscious paralysis about authenticity in order to take action. We can be both bold and humble. We can be clear, connected, competent, and committed. We can heal.
- People are moved to take action because of relationships. Knowing this, we have to join organizations of the poor and dispossessed, and put in the hard work necessary to have healthy relationships with other members.
- The practice of building movements is the practice of building a base full of working class leaders with all the tools necessary to take action in a politically independent manner.
- We have to learn the lessons of existing (and extinct) organizations and work to make them better, rather than always rushing to found new organizations or coalitions. A coalition of organizations without disciplined base-building, leadership development, and political education does not build the power of our class. We often create these organizations in an attempt to put out political fires, and they often fail even in that immediate function. Experiencing repeated failures in this way burns us out and convinces us that organizing is too much, too hard. Bad process in our organizing can demoralize and exclude people who are newly activated in moments of crisis. We should try to finish what we start, but even when we can’t, we can have conversations about why things didn’t work out. This is how we build a culture of learning where we share our knowledge and constantly develop new leaders.
- Play to our strengths! Social media and strong communications are important. Targeting discourse is a viable tactic. But without the ground of in-person relationships, it may be ineffective. Even the most effective communications tactics may not have the power to create sweeping change in discourse when we wield them outside deep organization. The ability to build trusting relationships and nurture people who are different than us is crucial for building working class organizations, and strategies relying too heavily on social media fail to make use of these skills we have.
- The neglect and devaluation of primary care in the healthcare economy mirrors a neglect of relationships in our organizing work. There is a class-based divide between effective organizing work and advocacy work. The latter is heavily favored because it translates easily into social capital, regardless of its effectiveness in any given context. We can address this form of class bribery by choosing deep organizing more often, and using our advocacy work as a tactic within a project of the poor.
- Join unions as they are available to you, or start them. Rampant anti-union discourse in medicine, and particularly the idea that unionized nurses make the lives of doctors more difficult, betrays our patients and the collective interests we all share. Unions are the easiest place to start conversations about the power dynamics inherent in medicine. These dynamics are obscured by academic discourses about “patient safety,” “quality,” and “value” that dominate healthcare space. Unions help us shift that conversation and win better conditions. However, unions are for people with jobs, so we can’t maneuver as though Labor constitutes the entire class. Our definition of the working class includes people who are excluded from work and can’t join unions.
- Everyone has an ego, and sometimes it comes out when we want to be seen, loved, acknowledged, or appreciated. It happens in our work, it happens in our personal life, and it happens in movements. We can practice self-awareness about ego and self interest, and challenge ourselves to recognize the way these needs interact with our work. The trusting relationships we build when we take action with others can nurture us and relieve this burden of ego. That great relief is what solidarity feels like.