By Maurice Chikiar, February 4, 2021
Racist healthcare rationing is nothing new under capitalism. Enabling enough people to work and produce profit is the major imperative. There is no need for universal health care unless the economy is threatened as we see with the Covid-19 pandemic. Wealthy people can always buy themselves the care they need, whether it’s meds for Covid-19 or HIV drugs. As Cuba, China, the USSR, and Partners in Health in Peru and Haiti (Netflix’s Bending the Arc) proved, public health workers can take health promotion and treatment to millions of poor people through prioritizing health as a social good and organizing community members to deliver care and prevention. Unfortunately, without workers holding power, these improvements can be defunded and eliminated.
The article below describes the life-threatening situation when hospital administrators ration vital supplies and staff in a respiratory therapy unit in Chicago and how workers opposed these practices. It is part of our series on organizing at work and in the community.
It was interesting to me to hear that healthcare rationing was happening in California and other states that are overwhelmed by Covid-19 infected patients. I was a respiratory therapist for over forty years, and I recall healthcare rationing going on in hospitals in mostly Black and Latin communities on the South and West sides of Chicago for years.
The main ways rationing is practiced in these minority neighborhood hospitals is through lack of staff and supplies. In a large medical and trauma center in Oak Lawn, Illinois, where most of the patients are white, there were two respiratory therapists in the emergency room 24 hours a day. In one of the busiest trauma centers in Chicago, on the West side, a therapist would be assigned to cover one or two patient floors, in addition to the emergency room.
Many times, we were busy giving care on the patient floors, when we would have to stop and scurry to the emergency room for a trauma emergency. The patients on the regular floors were shortchanged in their care, because we would be unable to be in two places at the same time. On many occasions, treatments could not be given because we were occupied attending to patients in the E.R. In still other instances, patients in the E.R. would be waiting for treatment while we attended to patients on the regular floors or other seriously ill patients in the E.R.
The short staffing was not restricted to patient floors and the E.R. I’ll never forget the night I had to take care of eleven patients who were all on ventilators in the intensive care unit. We had to keep track of our productivity during the 12-hour shift. On that night my productivity was over twenty hours, and this form of speed-up was not unusual. They stopped requiring us to track our productivity when it was obvious that all too often, we did more than 12 hours’ worth of work, and it became the basis of complaints.
Lack of equipment was also a common problem. I remember many times I had to look for necessary equipment, like a flowmeter, used to deliver oxygen, or other equipment and supplies to set-up a ventilator used to help patients breathe. We were forced to use devices that were obsolete; spare parts were no longer being made for some of the breathing machines.
We fought back with a petition that over sixty people signed, demanding more staff and better equipment. The hospital bosses started a witch hunt to find out who was behind the petition drive. But instead of workers being intimidated, many spoke up about the racist working conditions. We got more staff and new equipment, but like most reform victories under this system, it didn’t last long. When workers left, they would not be replaced, and the equipment was not maintained by management.
At another time, the hospital bosses tried to separate workers organizing a union drive. We included the registered nurses and respiratory therapists to join with the lowest paid and mostly minority workers who are nursing assistants, secretaries, housekeepers and dietary staff. The Administration knew this would strengthen us and tried to divide us along “professional and non-professional” lines. When that attack did not work, they confronted individuals and threatened them if they stood with the union.
The union campaign was unsuccessful but has created a foundation of workers uniting across job titles.
A group of over thirty workers confronted the president of the hospital in the hall and demanded better working conditions. She scurried to try and hide in her office, but we pursued her, and one of the nurses told her, “thirteen or more patients to myself on a unit is not what I signed up to when I became a nurse. Staff turnover is high due to short staffing, low pay, and because management doesn’t respect our voices. That’s why we need to stand together to fight for our patients and our profession.” When workers unite against a common oppressor, we step closer to building a movement that will get rid of capitalism, once and for all.
Covid Conditions: Structural and Systemic Racism Kills
Inadequate, dangerous health care hurts patients and hospital workers. The Covid-19 pandemic even more exposes capitalism’s public health failures. It exacerbates the shortages of supplies and therapists that under resourced hospitals already face. Healthcare workers need protective equipment, ventilators, and related tools to help patients survive as well as adequately funded public health departments. In 2020, Chicago had approximately 2200 ventilators; if a surge happened, hospitals would need 4100. The Chicago Department pf Public Health employed 2,000 workers; after the 1990s it only employed 500. Public health educators and community-based outreach workers serve vital functions to educate the public and help them navigate a fragmented system.
Covid-19 highlights gross racist inequities. Black workers make up 30% of the population in Chicago but 72% of the reported Covid-19 cases. Black workers are seven times more likely to contract and die from the virus than other workers living in the same city. On the West side of Chicago, life expectancy is 69 years, while six miles away in the Loop in downtown, life expectancy is 85 years.
Many black families live in areas served by small hospitals that have limited ICU capacity while larger, better equipped hospitals serve families with private health insurance, largely white patients. Transferring poorer and sicker patients to these medical centers is a difficult process. The struggle for health care and against health care rationing, especially in underserved areas of Chicago continues. As recently as January 26th, many people testified against closing Mercy Hospital, the first chartered hospital in the city in 1852 that serves mainly Black, Latin and white working class patients. Trinity Health, a ten-billion-dollar corporation that owns the hospital, proposed opening a clinic in lieu of the hospital. The state board voted against building the clinic, but the efforts to close the hospital continue.
Our hospital’s deliberate short staffing and lack of equipment serving mostly Black and Latin communities is racist health care. It leads to unsafe working conditions and substandard care or rationing. This gap is a result of capitalist oppression of all workers, but especially of Black and Latin workers. Capitalists worship money and profits above workers’ health, and systemic racism is their number one weapon to keep workers divided and keep society unequal. We must fight for better healthcare for all, and especially for people denied good health for centuries.