The NYC nurses strike reveals a fundamental flaw in US health care

“The experts I’ve spoken with over the past few years generally agree that nurses are tremendously undervalued given the importance of their work in delivering quality health care. Research has found repeatedly that more nursing staff leads to patients reporting a better experience in the hospital and better health outcomes.
But the problem is, given the way health care in the US is typically paid for, hiring more nurses and making their work environment better doesn’t necessarily make good economic sense for these hospitals.”

“Nurses point to exorbitant executive compensation (which soared nationwide during the pandemic) and multimillion-dollar real estate deals to explain their decision to strike. They have a point: Hospitals behaving on pure altruism would spend more on clinical staff without their nurses needing to go on strike to force their hand.”

“Slashing executive pay (Montefiore’s CEO makes $6 million a year) can only pay for so many new nursing positions. Canceling a $38 million land deal in White Plains would make more money available, but when revenue depends on the number of services that a hospital system provides, buying land and building new facilities does make fiscal sense.”

“Under the fee-for-service model that still dominates American health care, where every physician service can be billed by the hospital where they work, hospitals have every incentive to expand their services but little incentive to hire more nurses to support that work. From a hospital’s accounting perspective, nurses are entirely a cost. They do not generate any revenue directly, even though they are necessary to providing quality medical care.”

““What we forget is when hospitals put profits over patients, they are operating well within the system of economic carrots and sticks that we created for them, and within the system we created, hospitals are acting completely rationally as any other economic agent would,” Olga Yakusheva, a health care economist at the University of Michigan, said. “There is no economic incentive, right now, for hospitals to invest in adequate nurse staffing, pay nurses well, or provide a good working environment for nurses.”

Until the US gives hospitals good financial reasons to invest in their nursing staffs, these labor disputes are going to occur again and again. As much as we want our health system to be focused on quality health care, in America, health care is a business.

Good health care and profitable health care are not always the same thing. The failure to value nursing in the way we pay for medical services, which laid the groundwork for NYC’s nurses strike, is a stark example of that.”

The Supreme Court hears a case this week that endangers workers’ ability to strike

“The Teamsters, the union in this case, allegedly timed a 2017 strike so that it would begin after some of Glacier Northwest’s mixing trucks were already filled with concrete, forcing the company’s non-union employees to race to dispose of this material before it hardened in the trucks. But the company was able to remove this wet concrete from the trucks before they were damaged, and there are a wealth of cases establishing that workers may strike even if doing so will cause some of their employer’s product to spoil.
In one case, for example, the National Labor Relations Board (NLRB) — a kind of quasi-court that hears disputes between unions and employers — sided with milk truck drivers who struck, even though their strike risked spoiling the milk before it was delivered to customers. Another case, handed down by a federal appeals court, reached a similar conclusion regarding striking cheese workers.

That said, there are also some cases establishing that workers may not walk off the job at a time that could result in truly egregious damage to their employer’s business. In one such case, for example, a federal appeals court ruled that foundry workers who work with molten lead could not abruptly walk off the job and leave the lead in a state where it could melt the employer’s facilities or injure other workers.

In any event, the Supreme Court’s decision in San Diego Trades Council v. Garmon (1959) lays out the process that employers must use if they believe their workers timed a strike so recklessly that the union should be held liable. In nearly all cases, the employer must first obtain a ruling from the NLRB establishing that their workers’ strike was not protected by federal law. Only then may they file a lawsuit against the union.

The employer in Glacier Northwest, however, wants the Supreme Court to water down Garmon considerably, potentially enough to render that decision toothless.

If that happens, it would be a tremendous blow to workers. One important reason the Garmon process exists is that it shields unions from lawsuits that could drain their finances and discourage workers from exercising their right to strike — after all, that right means very little if well-moneyed employers can bombard unions with lawsuits the union cannot afford to litigate.”

Freight rail strike averted, after frenzied negotiations

“The Senate voted Thursday to avert a freight rail strike just days before crucial drinking water, food and energy shipments were set to be sidelined, after hurried talks in both chambers of Congress and a visit to the Senate from two of President Joe Biden’s Cabinet secretaries — but a bipartisan push to add paid sick leave to the deal fell short.
Ultimately the Senate voted 80-15, with Sen. Rand Paul (R-Ky.) voting present, to pass a bill that would impose the terms of a contract negotiated among freight railroads and most of their unions in September. Four out of the 12 unions involved had been holding out for additional paid sick days, making a strike possible as soon as Dec. 9.”

““What’s frustrating is that the railroads know that their backstop is federal government intervening in a strike,” said Tony Cardwell, president of the Brotherhood of Maintenance of Way Employes Division, one of the four unions that rejected the tentative agreement. “The railroads would have come running to the bargaining table if they knew that we would have been able to go on strike. But they were reliant on the Congress stopping our strike, and therefore they bargained in bad faith.””

‘Could have gone either way’: Railroad union deal barely survived

“Steering clear of disaster required some 20 straight hours of talks beginning Wednesday that taxed Labor Department coffee supplies, kept West Wing office lights burning through the early hours and left everyone involved bleary-eyed and largely sleepless.”

What a rail strike could mean for you (and the economy)

“Tens of thousands of freight rail workers are prepared to go on strike on Friday at 12:01 am, which could have wide-ranging effects across the economy. It’s already causing some disruptions for rail passengers, freight companies, and others.

The cause is a dispute between the freight industry and the workers who make it run.

Most of the 12 unions representing the workers have already agreed to a proposal put together by a presidential emergency board established by the White House over the summer to try to help resolve the dispute. The proposal includes a 24 percent increase in wages for workers by 2024, but many workers have complained that it fails to address leave, on-call scheduling, and poor working conditions.

The holdout unions’ position is that pay increases aren’t enough to make up for some real downsides — and dangerous aspects — of the job.

The two most powerful unions involved in the negotiations, which represent engineers and conductors, are continuing to resist the proposal, putting both sides in a deadlock. If workers do go on the strike they appear to be hurtling toward, it would be the first such strike in 30 years.”

“If a freight strike were to occur — and especially if it’s long-lasting — it could have disastrous effects across an already fragile economy still reeling from supply chain disruptions and inflation.

“Rail moves a lot of the foundational, basic goods that we don’t think about day-to-day,” said Rachel Premack, editorial director at FreightWaves, which covers supply chains. “They’ll move sand and gravel that would then be crushed into concrete for roads or for laying home foundations. Railroads move the chemicals used to purify water or to compromise fertilizer for crops, soybeans that could become food for humans or [animals] that are then food for humans. It’s a lot of early-chain-type goods.”

Many passenger trains also run on freight rails, and their service could be suspended. Amtrak has already warned of potential disruptions and canceled cross-country trains in anticipation of a strike, though so far its Northeast service will not be affected.”

“Replacing freight with other forms of transportation is not easy if workers do walk out. Mike Steenhoek, executive director of the Soy Transportation Coalition, told Vox in an interview that one train has the freight capacity of 400 semi-trucks. “I don’t know of a shipper who just has 400 semis sitting in a garage ready to be accessed,” he said. He noted that for agriculture, the timing couldn’t be worse because of harvest season, adding more urgency for a deal.”

“Under the Railway Labor Act, Congress has the ability to block or end a rail strike. Since 1963, it has passed legislation more than 10 times to intervene in rail disputes.

So far, though, Democratic leaders have been reluctant to commit to doing so, while Republicans have been eager to pressure workers into agreeing to the terms set by the presidential emergency board.

If Congress were to intervene, there are a few routes lawmakers could take. They could require the unions and carriers to accept the presidential emergency board’s conditions, which included a pay increase but no acknowledgment of other demands like sick leave. They could extend the existing cooling-off period so both sides have more time to negotiate. Or they could turn the talks over to independent arbitrators who would be tasked with finding a resolution.

For now, congressional Democrats are waiting to see what might come out of the talks the Labor Department is leading between unions and railroad carriers on Wednesday before they lay out a policy response.”

Will America’s Military Reckon with the Reckless Murders Perpetuated by Its Drone Wars?

“Throughout America’s War on Terror, whistleblowers have been warning that drone strikes have frequently killed people who were neither terrorists nor insurgents, just innocent civilians trying to survive in a war zone.

Over the weekend, in a detailed, heavily reported two-part story, The New York Times documented how Washington’s “precision drone strikes” have been anything but precise. Not only did they repeatedly kill innocents, including children, but more often than not the military failed to examine adequately why these mistakes were made, failed to correct its procedures, and failed to hold anybody accountable.

When an ill-advised August drone strike in Kabul, Afghanistan, killed aid worker Zamari Ahmadi and nine of members of his family (including seven children), military officials first insisted the strike had hit terrorists plotting to attack the airport as American troops were leaving the country. Only after the media began investigating the strike did the truth came out. Yet last week, the Pentagon announced that no troops involved in the misbegotten strike would be disciplined. Pentagon spokesman John Kirby said, “What we saw here was a breakdown in process, and execution in procedural events, not the result of negligence, not the result of misconduct, not the result of poor leadership.”

An alternative way to read that quote, based on the massive Times report from the weekend, is that what happened to Ahmadi and his family was an example of how America’s drone program actually works. It has not, in fact, operated as a tool to surgically take out ISIS terrorist leaders and destroy individual cells, as Americans have been told again and again. The military will admit to killing at least 1,300 civilians in these strikes. That’s just the number of civilians documented in Pentagon reports the Times analyzed. The actual (uncertain) number of civilian deaths due to drone strikes is much higher—between 22,000 and 48,000.”

U.S. Drone Strikes Plunge Under Biden

“Airwars, an independent nonprofit that tracks strikes and casualties in conflict areas like Iraq, Syria, and Libya, provides regular assessments of civilian deaths. And in their latest data which spans the first year of Biden’s presidency, civilian deaths and strikes plunged in Iraq, Syria, Libya, Somalia, and Yemen.

The differences are striking, even keeping in mind we’re comparing just one year of Biden’s presidency with four years of President Donald Trump and eight years of President Barack Obama.

During the length of Trump’s four-year presidency, Airwars documented more than 16,000 air and artillery military strikes in Iraq and Syria, which itself was a decline of more than 1,500 strikes when compared to Obama’s second term. During Biden’s first year, there have been 39 total military strikes spread between both countries.

Alleged civilian deaths in Iraq and Syria skyrocketed under Trump’s four years in office to more than 13,000 compared to 5,600 during Obama’s second term. Thus far, Airwars reports only 10 under the Biden administration. There have been no reported civilian deaths in Somalia thus far during Biden’s term, compared to 134 under Trump and 42 under Obama over both of his terms. Strikes in Yemen, which had declined each year throughout Trump’s administration, have dropped to just four this year (Airwars did not provide civilian deaths for Yemen).

This follows reporting earlier this year that Biden had quietly imposed restrictions on the use of drone strikes outside of active war zones. Trump had eased restrictions and allowed the military and CIA to decide when to strike, thus explaining the dramatic increase in strikes and civilian deaths in Somalia during his term. Biden is now requiring the White House to vet and approve these strikes, for now, until the administration sets up new formal policies (about which we know very little, but observers hope will require more procedures to ensure that civilians aren’t killed).”