Tossed aside for profit’s sake

I WORK as an Emergency Medical Technician (EMT) for a large hospital in Western Massachusetts. This hospital recently eliminated 354 jobs, 169 through layoffs. When telling people I work in health care, the response is often, "Oh, that's a good field. You'll always have a job." Recently, I've come to question this.

The hospital cited cuts to Medicare and Medicaid as one of the reasons for layoffs. Ironically, they also pointed to the increasing numbers of people opting out of health care due to joblessness. For these reasons, the hospital claims to have a revenue problem. This is suspect, however, in light of their profits last year of $73.8 million. What the hospital really has is a maintaining profits problem. And like any good business, the hospital will sacrifice their workers (and your quality care) to ensure such profits don't fall.

So it is, in a city where the banks have left so many homeless, our hospital can now add themselves to the list of forces devastating our communities. When we see layoffs in the headlines and read the large numbers that follow we should remember that each number has a story worth being heard, and I'm sure you've all heard your share. I'd like to go into the stories of those who received their pink slips, but I'll instead tell the story of my friend and co-worker, "X," who was fired beforehand.

While I'm always sad to see co-workers go, X was my partner on the ambulance and so him being fired was especially personal. His story also reminds me that firings are part of an ongoing terror against our working class, happening to anyone for any reason at anytime, not just when sizable layoffs warrant the media's attention.

A MONTH back, I swiped into work and read the message board: "Employee Update: X is no longer working here." In other words, X has been fired. My throat tightened and teeth clenched. Since starting here two years ago, I have always found the company's treatment of workers in such contrast to the compassion we are taught to have as care providers. In a department of roughly 90 people, I see someone fired about once every month.

The most dedicated workers are among the departed: mentors of new employees, members of workplace engagement groups or X, who was the most senior and experienced paramedic in the company, and perhaps in our city. I see peers let go for everything--from minor fender benders or moving violations, clocking in five minutes late, accidentally misplacing paperwork, or questioning the orders of emergency medical dispatchers, nurses or case managers. Many of us work long and awkward shifts. My 16-hour shift is not unusual, so the aforementioned violations often come as a result of fatigue.

As EMTs working for the hospital, we often do discharge transfers, transporting patients from the hospital to post-acute care--places like nursing and rehab facilities, or to their homes. X "no longer works here" because he respectfully questioned a case manager's orders to discharge a patient, believing the orders to be premature given the patient's condition. This led to a complaint against my partner and shortly after, he was fired.

While case managers play an important role in coordinating patient care, their job is also to contain costs and help the hospital turn a profit. Ideally, a case manager wants to move patients out of the hospital before their treatment costs exceed insurance reimbursement. With health care costs sprinting upward and insurance doing all it can to escape reimbursement, this task becomes extremely difficult and case managers are under intense pressure to discharge patients.

This is especially true in a working-class city like ours, where most patients have no insurance or rely on Medicare and Medicaid, both with much lower reimbursement rates than private insurance. Medicaid, for example, reimburses the hospital only 70 percent of its costs of providing care and this number will likely go down as politicians look to cut public spending.

The EMT course teaches us to advocate for our patients, to always keep their best interest in mind. In my partner's case, however, doing so ended his career. Sadly, health care falls victim to the innate contradictions of capitalism, where the quest for profits abridges human needs and goes against the good sense we were taught.

Hospitals should be places to heal or at least die in peace. However, under capitalism a hospital is a factory and patients are widgets. The same pressures that drive corporations to make money or wither also apply to hospitals. Thus, the boss gets angry when the assembly line slows down.

TO BE fair, management had other reasons for firing X. He was the oldest in the company and has poor health. This is typical of older EMTs. It's what you get from a job that cost so much to the mind and body, but gives so little back in pay and compensation. Many EMT-basics in our city start out at $10 an hour. It's a physical job of lifting patients through rundown apartments, only to treat them while unrestrained in the back of a cramped ambulance going over decaying roads.

It's an emotional job. Shortly before he was fired, X and I treated and lost a dying child. After clearing from the emergency room, we vented in our own way while cleaning our truck. Our process, however, was soon interrupted by our dispatch asking how soon we would be ready to take another call. Keep the assembly line moving.

A lifetime of this work equals a bad back and heart, among other things. Capitalism it seems turns every job into one of drudgery, even those based around the care of human life. I appreciate my partner's sacrifice--what he gave of himself to heal others. Conversely, I'm sure management saw his ill health instead as a liability and a cost. After all, a few months back a much younger EMT was fired shortly after being hospitalized for an asthma attack on the job.

Perhaps management dreaded paying out retirement money. X was close to becoming eligible for his 401(k). Or maybe it was my partner's frankness, especially at company meetings. After a lifetime in our field, I would say he earned the right to speak, but I'm sure management disagreed. The big kicker for me though was X's past as a union person with a history of organizing other ambulance services.

The hospital, unorganized, is well known for firing nurses who merely speak the word union, and I'm sure management was aware of X's history. With our most recent Gallop poll "Employee Satisfaction Survey" showing our morale and trust in supervisors at dismal levels, my partner being around must have made them nervous. Whatever reasons management had for firing my coworker, they can be sure the forbidden "U" word is now being spoken all the more.

At our annual meeting earlier this year, our company director responded to employee concerns. Mind you, I have only seen this person twice, and he has never worked on an ambulance. After listening to us speak, he said, "I think everyone needs to stop being so emotional and learn how to talk to each other. There's a lot of bitching going on here. We can take all the Gallop polls we want, but that's not going to change anything. It comes down to you and how you choose to work together."

A few weeks later, after picking up his last paycheck, X walked away for good. He quietly climbed into his beaten truck, now without retirement, without health insurance for his family, for his disabled wife, and drove off to meet the uncertainty of unemployment. Used up and spit out.

In part, our director was correct. It does come down to us. Lord knows we can't trust people like him. Our coming together as workers and taking control of our trades, communities and lives is our only chance at making the world a better place. I call myself a socialist, but I am not so extreme. I merely believe the obvious: a profit driven system is unsustainable. Capitalism cannot work because patients are not widgets and workers are not just values of labor.

I envision a future where people are valued as people and cared for as such, not left to rot once their labor is spent or the company's profits take a dip. As workers we are the majority with both the power and the interest to change our conditions. And although workers' power often looks like a fading ghost, I am optimistic. I have seen the spirit return to Wisconsin, North Africa, Europe and the Middle East and can feel the winds of change.