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	Workers Vanguard No. 1030	20 September 2013

Brooklyn Hospital Crisis

Union Jobs, Services for Poor Under the Ax

For a snapshot of the irrationality and anarchy of the capitalist system one need look no further than to the current crisis plaguing hospitals in the New York City borough of Brooklyn. With a string of hospitals facing bankruptcy and their owners threatening to shut them down, medical services are under severe attack. Today, at least four Brooklyn hospitals—a quarter of the borough’s total—are threatened with closure. That could eliminate more than 2,000 hospital beds and greatly reduce access to emergency rooms. This wholesale slashing of health care services would overwhelmingly hit working people and especially black people, Latinos and other minorities. Thousands of union jobs are under threat.

Starving ghetto hospitals of public funds and forcing closures is as New York as stop-and-frisk. In the past seven years, fully 18 hospitals in New York State have shut down, including 12 in New York City. With the economic crisis that was touched off in 2008 and the recent cutbacks in Medicaid payments, more Brooklyn hospitals are facing bankruptcy. Those hospitals, whose patients include a high proportion of the poor and elderly, are especially vulnerable to cuts in Medicaid and Medicare reimbursement rates. One million Brooklynites, almost 40 percent of the borough’s population, are registered in the state Medicaid program. Additionally, as is true throughout the New York metropolitan area, those with commercial insurance are increasingly seeking medical care in Manhattan.

The Brooklyn hospital crisis is ground zero in a mounting wave of hospital closings and mergers nationally. This has been intensified by the impending implementation of President Obama’s Affordable Care Act (ACA), which comes with drastic cuts in the rates of Medicare and Medicaid reimbursement that hospitals will receive. The Act explicitly maintains the bar against undocumented immigrants receiving Medicaid. The ACA will also hit unionized workers in a number of ways, including by taxing so-called “Cadillac” health plans. We opposed the ACA from the start, pointing out that it was a “reform” Wall Street could believe in. While fighting tooth and nail against hospital closures and cutbacks, the health care unions should take the lead in the struggle for free, quality health care for everyone, including all immigrants. Such a fight would speak to the felt needs of millions and help revitalize the labor movement.

Bipartisan War on Health Care

Despite their misleading designation as “nonprofit” institutions, privately owned hospitals in New York State are, no less than their “for profit” counterparts elsewhere, subject to the laws of the capitalist market. If they cannot generate enough revenue to cover their expenses—that is, if they are not profitable—they will ultimately go under. And failing hospitals are not likely to see the kind of generous subsidies that Washington handed out to the banks and auto companies. In the eyes of the bourgeoisie, government expenditure on health care for the sick and elderly is an overhead expense that ultimately lowers the overall profit rate.

Democratic New York governor Andrew Cuomo has made it clear he will balance the budget on the backs of the workers and there will be no bailouts. Cuomo is intent on slashing $500 million in Medicaid funding, which would overwhelmingly hit the most needy and vulnerable, and on imposing massive cutbacks in personal care and other services for the disabled. He is also cracking down on “preventable” hospital admissions for drug-addicted and mentally ill patients.

Cuomo’s plan was based on the recommendations of the governor’s Medicaid Redesign Team (MRT), which specifically called for the elimination of 1,235 beds from Brooklyn hospitals. The MRT included George Gresham, president of the health care union 1199 SEIU, and was co-chaired by his predecessor as union head, Dennis Rivera. For years, the 1199 leadership traded on its “progressive” image as a defender of liberal social causes. All the while, the 1199 bureaucrats served to tie their working-class base to the capitalist Democratic Party, including by themselves serving as key party officials and operatives. Indeed, Rivera served as Obama’s point man in preparing the ground for the ACA by helping to forge a coalition of insurance and drug companies, along with the American Medical Association and the American Hospital Association and their lobbyists, that determined the bill’s contours.

Local 1199 SEIU and the New York State Nurses Association (NYSNA) along with smaller unions have rallied, lobbied, prayed, chanted and sent petitions to the state government in Albany in opposition to hospital closures. The union tops have also relied heavily on legal action in the courts to put speed bumps in the way of the closures. There have been many small demonstrations against the threatened Brooklyn closings, which the 1199 and NYSNA leaderships have used to promote Democratic candidate Bill de Blasio as the next mayor.

De Blasio has made the Brooklyn hospitals a key part of his mayoral campaign. He was arrested outside the offices of the SUNY University Hospital and appeared at many demonstrations, while also filing countless legal papers. In his capacity as New York City Public Advocate, he called for setting up a “super-authority” with “extraordinary powers” to oversee Brooklyn hospital restructuring—a body that would contain the same city and state officials who are overseeing and approving the closures right now. De Blasio holds Montefiore Hospital in the Bronx as a model for providing hospital services in a high Medicaid area. Montefiore has been buying up smaller hospitals and other facilities and in the process laying off workers.

By promoting de Blasio’s candidacy, the 1199 bureaucrats promote the lie that the interests of workers and the poor are represented by those capitalist politicians who strike a pose as friends of labor. No less than the Republicans, the Democrats are a party of the capitalist class, as illustrated by the fact that Cuomo’s attacks on health care largely echo the program laid out by his Republican predecessor, George Pataki. We say no vote to de Blasio or any other Democratic Party politician. The working class needs its own party: a workers party that fights for a workers government, which would expropriate the productive wealth of the capitalist class—including the health care industry—and build and develop a planned economy in which production is geared toward social need, not profit.

For a Class-Struggle Fight Against Hospital Closings

The next Brooklyn hospital on the chopping block is Interfaith Medical Center, which is located between the mainly black and Caribbean neighborhoods of Crown Heights and Bedford-Stuyvesant. Recent merger attempts with Brooklyn Hospital fell through, leading Interfaith straight to bankruptcy court. The shutdown of services has started, and the doors are due to be padlocked by the end of the year, with the loss of around 1,500 jobs. The closing will create a health care desert in Bed-Stuy, which has been officially recognized as “medically underserved” for years. The surrounding community has high rates of HIV, diabetes and psychiatric illness, which are endemic in impoverished neighborhoods.

Another hospital on the brink is Long Island College Hospital (LICH). Located in the upscale Cobble Hill area, it is the community hospital serving Red Hook, site of Brooklyn’s largest public housing project. The city authorities’ contempt for the project’s residents was all too clear in the aftermath of Superstorm Sandy, when they were left for two weeks before the Housing Authority bothered to check to see if they were still alive. This callousness continues. As state authorities approved the closure plan for LICH in July, management nearly emptied the hospital of patients. For over two months, ambulances were diverted to other hospitals, while security guards kept desperate patients from entering the hospital. While management continues to insist on closing down the hospital, LICH has so far been kept open by temporary restraining orders and other legal actions. On September 12, a state judge ruled that Albany’s regulations on hospital closings were “unconstitutionally vague,” erecting a further obstacle to the closing of LICH and possibly other hospitals.

Still LICH is confronted with the same fate that befell St. Vincent’s in Manhattan, which was closed in 2010 and sold for condos, leaving the Lower West Side without a single hospital. There are views of the Statue of Liberty from some of the windows in the LICH building, which is valued at up to $1 billion. State authorities took over running the hospital two years ago in a fiasco that was slammed by a federal judge. It was clear that the state government took on the hospital in order to sell the property as valuable real estate to offset financial problems at SUNY University Hospital, the other state-run Brooklyn hospital, where more than 200 union jobs are on the line.

When Mayor Michael Bloomberg finally deigned to comment on the hospital crisis, he intoned: “The reality is you can’t have a hospital on every corner.” In other words, the poor can just drop dead. In Bloomberg’s well-heeled Upper East Side neighborhood, you can’t jog ten feet without running into a world-class hospital or the office of one of the gazillions of psychiatrists and plastic surgeons in the area. A Medicaid recipient from Bed-Stuy trying to get into one these facilities would more likely get an arrest than a referral.

The members of 1199, the largest union in the city, hail from every corner of the planet and include a significant number of black Americans. As with health care workers generally, these union members represent a living link with impoverished minorities and immigrants who by themselves have precious little social power to combat their oppression. The fact that the current attacks on Brooklyn hospitals would strike a severe blow at the borough’s black and Latino residents underlines the need for the labor movement to champion the cause of all the oppressed.

Such health care benefits as the working class has won have been the product of class struggle. The dearth of strikes over the past decades has helped pave the way for the exploiters to butcher health care, pensions and other union gains with impunity. And they have gotten away with it thanks to the acquiescence of the labor bureaucracy, which shares the bosses’ concern for maintaining the profitability of American capitalism.

The union tops tell these workers to butter up the priests, pastors and politicians to achieve gains. The health care unions are not just another type of community group with a special interest in the welfare of the hospitals and residents—they represent the workers who make the hospitals and clinics run. The unions urgently need to fight in defense of every job and to organize the non-union health care workers. Linking up with other sections of the labor movement, these unions can fight not only on behalf of their members but for the black and Latino poor, the uninsured and underinsured. We need a fighting labor movement with a leadership that understands that capitalism must be replaced with workers rule.

It is through breaking the political chains binding workers and the oppressed to the Democratic Party that a workers party will be forged to lead the fight for free, quality health care, education, housing and jobs for all. The working people need socialized medicine, where doctors will be servants of the people, hospitals will be havens to heal the sick, and research on vaccinations, new medical techniques and improved drugs will be internationally coordinated and used for the benefit of all. This all points to the need for a socialist revolution to break the power of the capitalist vultures and lay the basis for eradicating all exploitation and oppression.