Wednesday, June 1, 2011

Attacks on Medicare and Medicaid: heralding a Toyota-style mode of production in healthcare

The long term care unit that I work in at the nursing home has had 1/4 of its beds empty for the last month or so. Our beds usually fill up pretty quickly (like 2-3 days) but this time, it's been a long spell. Surprisingly enough, they didnt put us on low census *yet* though we are constantly nervous that they will (more work, lost pay = bad combination).

I know we usually have a chunk of our beds filled up with Medicaid patients. I wonder if the cuts to Medicaid have some kind of relationship to the empty beds. Maybe the facility can't get reimbursed?

There's now an official policy at work where we cannot work overtime cos they can't afford to pay time and a half. My nurse comes in in the morning to do the paperwork from the day before without clocking in. They told one of the CNAs to leave early because she had stayed late the day before. They say that without doing this they will have to lay off the workers. Translate that into: speed up and unpaid labor.

The world of Medicaid and Medicare legislation is so confusing and frustrating to sieve through. Here are some articles I came across today. I think they are revealing how the Toyota Lean Model, a form of neo-Taylorism that is based on time-based efficiency production models used for automobile production, is now being used in Healthcare. These policies that are discussed below:

1) Obama Administration Obstructs Right to Medicaid

2) Medicaid to Quit Paying for Preventable Events 

3) Medicare plan to reward cheaper hospital care

The Obama administration plans to establish "Medicare spending per beneficiary" as a measure of hospital performance, just like the mortality rate for heart-attack patients and the infection rate for surgery patients.
[Hospitals] are apprehensive about Medicare's plans to reward and penalize hospitals based on untested measures of efficiency that include spending per beneficiary.

A major goal of the new health-care law, often overlooked, is to improve "the quality and efficiency of health care" by linking payments to the performance of health-care providers.
This performance-based/"efficiency" policy is the same kind that is also pursued in public schools and paving the way for charter schools and the neoliberalization of education as a sector, as well as explicitly investing in education merely as a way to churn out future workers with technical skills, stratifying students from a young age to determine their future positions in the working class. (I went through such a an education system where I grew up and it was very an awful experience.)

Now, these policies are making headway also in the realm of healthcare. Treat human bodies like cars -- efficiency and performance is most crucial. It sounds absolutely crazy. How can you measure body health and changes like you measure the efficiency and performance of a car? Where all you care about/what is rewarded is the production of efficiently performing cars (bodies that are absolutely productive and work-able), and anything else can go to hell. You can bet this will further change the kind of care available to patients, and also change the working conditions and stratification also within the healthcare labor sector.

I recently read a piece called "The Proletarianization of Nursing" (email if you want a copy) and the piece talks about how bedside nursing used to be the modus operandi for nursing/healthcare. But with the construction of hospitals and the centralization of healthcare into profitable institutions as opposed to the personal/private practice of individual nurses and doctors, the field of nursing also changed. There was more of a division of labor based on race and education -- dividing nursing staff into the layers of the RN, LPN and CNA/"orderlies". Certification and licensing became a way for the highest rung of the nursing hierarchy, the RN, to maintain their position, pay and privilege as predominantly white womyn, while womyn of color were pushed down to the bottom doing the unskilled/less valued labor within hospitals. Other works by Evelyn Nakanno Glenn (titles I don't recall now) have zoomed in on case studies involving Asian women in healthcare/nursing and white women under this division of labor.

Point being: understanding how these stratifications within caring work and models of commodified care for patients have developed due to the changing modes of production within capitalism, can help us shed light in understanding how further changes will take place under the imposition of the Lean Models/Toyota-models in healthcare that changes in Medicare and Medicaid policy seem to be centered around.  This can also help us shed light on organizational forms that need to be built and battles that need to be waged that can combat this division of labor/mode of production.

I am inspired by this paragraph from Harry Cleaver's Reading Capital Politically, as he describes the Italian Autonomist movement and the ways they integrated workers self activity into understanding and defeating capital:

[...] analysis of how autonomous working-class struggle overcomes capital's divisions and forces it to reorganize production in the factory and broaden its planning to higher levels. (110) [Panzieri] is thus able to situate the new phase of capitalist planning of the 1930s, identified by the Frankfurt School and James, within a general theoretical framework for analyzing the revolutions of capitalist technology and workers' organization within the dynamic of class struggle. In fact, what emerges from his work is the concept that, ultimately, the only unplannable element of capital is the working class. This constituted both a theoretical and a political advance beyond the Frankfurt School, which had seen only capitalist planning, and a theoretical advance beyond those who had emphasized autonomous working-class struggle against such planning but had not worked out such a general theory. The incorporation of working-class autonomy into the theory of capitalist development implied a new way of grasping the analysis of the class struggle in the evolving structure of the capitalist division of labor. Not only is the division of labor seen as a hierarchical division of power to weaken the class -- a certain composition of power -- but also, against this capitalist use of technology, the working class is seen to struggle against these divisions, politically recomposing the power relations in its interests. This, in turn, implied a new way of understanding both the nature of capital and the problem of working-class organization.
I wanna be part of workers organizing efforts that is self conscious and aware of our own roles in both being a component of, and yet also attacking this division of labor under capitalism. 

1 comment:

  1. We're doing a training for building patient & workers organizations here. Remind me to send you the training and article when we're done. Thanks for the article!

    Quick note, the toyota model is actually somewhat old in Hospitals. It's been there since the 80s, but became dominant in the late 90s-2000s. Now I think we're actually experiencing a transition because of the contradictions in the labor market. When the shortage is in full effect again once demand returns (if it returns) I think they're going to find themselves searching for new models. Because the wheels are falling off