Corporations Dominate the US Healthcare System. Nurses Are Fighting Back.

NEW BRUNSWICK, N.J. — Judy Danella, president of United Steel Workers Local 4-200 — the union that represents Robert Wood Johnson University Hospital’s more than 1,700 nurses — stands in a church basement before a room full of her union members. Her voice quavers slightly as she delivers grim news. The hospital management, whose top administrators earn salaries in the millions of dollars, has refused to concede to any of the nurse’s core demands. Friday at 7:00 a.m. they will be locked out of the hospital and on strike.

But it is not only the strike that concerns Danella, who is wearing a blue T-shirt that reads: “Safe Staffing Saves Lives.”

“It is 100 percent my belief that the goal is to break the union,” says Danella, who has worked at the hospital for 28 years. “This is about the future of nursing.”

The front line against corporate tyranny is not the ballot box. It is in the desperate struggle by the overworked and underpaid to prevent corporate behemoths from turning everyone into gig workers without health and retirement benefits, job security, sustainable incomes or equitable working conditions. Nurses, battered by the almost inhuman demands put on them during the pandemic, have been especially hard hit. Almost one-third of New Jersey’s nurses have left the profession in the last three years.

“We went from heroes to zeroes,” says Jessica Aquino, a nurse who has been at the hospital for 16 years.

RWJBarnabas Health, which owns 12 acute care hospitals, including Robert Wood Johnson University Hospital, and four specialty hospitals, is the largest healthcare provider in the state of New Jersey. Its 37,000 employees, including 9,000 physicians, care for more than three million patients a year. It has $6.6 billion in annual revenue. It is registered as a 501(c) (3) not-for-profit charitable organization.

The company, Danella suspects, plans to make the punishing working conditions and staff reductions permanent. Unchecked, they will continue to raise insurance premiums, which can cost a nurse with a family $500 a month. They will refuse to increase salaries, which range between $43 and $64 per hour, including the paltry $5 per hour rate, which the hospital management offered to increase to $6, for on-call nurses waiting at home. The union asked for the minimum wage for on-call nurses and then offered to drop the hourly amount to $10. The on-call nurses receive their standard pay rate once they clock in. They will, if union demands are not met, be denied retirement medical benefits and retention bonuses. The crippling attrition rate will continue.

At least 700 replacement nurses, known as travelers, from states including Alabama, Mississippi, Tennessee and Kentucky, have been relocated to New Brunswick in the last few days and set up in area hotels to replace the striking nurses. These travelers, paid as much as $120 per hour and given housing and travel allowances, earn more than the unionized nurses. But travelers have no control over their working conditions. If the union is broken, the profits made from slashing services and chronic staff shortages will more than offset their higher salaries.

The nurses know what they are up against, especially with the governor’s office announcing that they will remain “neutral.” This neutrality means that the heavy handed tactics of Barnabas, which includes a relentless propaganda campaign and “town hall” meetings in the hospital to turn union members against the union leadership, will not be restrained.

In a move that backfired, one of the deans from Robert Wood Johnson Medical School at Rutgers, Dr. Carol Terregino, sent an email to second, third and fourth year medical students asking them to volunteer when nurses go on strike. She said the students would be “answering call bells, checking in on patients and supporting the replacement nursing staff.”

The medical students refused, writing back that “the request to provide unpaid labor in jobs we are not trained to do at the expense of our own educational programming raises concerns about exploitation and risks creating an unsafe environment for patients.”

Congress, at the same time, is abetting the nationwide assault on our healthcare. Every proposed solution sees it hand more money and tax breaks to the healthcare industry, which lavishly funds congressional campaigns.

“My concern is that they are so saturated with money they will try and starve us out,” said Sarah Caley, a nurse who works in radiology and has been at the hospital for over seven years. “We are hoping they will crack, that they are all talk, but ultimately this is a drop in the bucket for them.”

"There is no incremental way that we can do this. We cannot work within the for-profit system to fix this problem. We have to nationalize our healthcare system."

The healthcare system has raised the costs for patients and shrunk the accessibility of medical care. In 1975 the U.S. had about 1.5 million hospital beds and a population of about 216 million people. Now, with a population of over 330 million people, we have around 925,000 beds. Fifty-six percent of Americans have medical debt and 23 percent owe $10,000 or more, according to a study by Affordable Health Insurance. The study found emergency room visits contributed to medical debt for 44 percent of Americans. Some 330,000 Americans died during the pandemic because they could not afford to go to a doctor on time.

“In the oncology unit the ratio of nurses to patients is one to five,” said Mary Silvestre, who has been at the hospital for 23 years. “When you give chemo you have to double check their height and weight and this could be at the same time you are taking care of a patient who is actively dying. You are trying to provide emotional support to this person and their family while giving chemotherapy. It is very difficult. We trained 10 nurses last year. Five are no longer there.”

Nurses in the intensive care unit often have to care for three patients. The union wants a two-patient-for-one-nurse ratio on the intensive care unit. Other ratios demanded by the union depend on the level of medical care.

Emergency rooms are increasingly staffed by physician assistants rather than doctors, whose salaries are higher. At the same time, many of the functions once carried out by doctors have been turned over to nurses. The heavy turnover means nurses with little experience are in senior positions in critical and acute care units, such as the ER. Nurses said they often come to work sick to spare their short-staffed colleagues an onerous workload.

“It’s profits over patients,” Danella said.

The seizure of the healthcare system by ever-larger conglomerates and private-equity firms has created a crisis in the healthcare system. Nursing shortages, Becker’s ASC Review reports, have contributed to one of every four unexpected hospital deaths or injuries caused by errors. A 2021 study, Becker’s ASC Review says, “showed that each additional sepsis patient per nurse was associated with 19 percent higher odds of in-hospital mortality.”

Meanwhile, the heads of these corporations are making obscene salaries. In 2022, the former CEO of Barnabas, Barry Ostrowsky, was paid more than $16 million. In 2020, the CEOs of 178 major healthcare companies collectively made $3.2 billion in total compensation, an increase of 31 percent from 2019, all in the midst of the pandemic. According to Axios, in 2020, the CEO of Cigna made $79 million, the CEO of Centene made $59 million, and the CEO of UnitedHealth Group received $42 million in total compensation. The CEO of Moderna, Stéphane Bancel, made more than $392 million from selling stock he owned in the company, on top of the $19.4 million he was paid last year. He also has a severance package — tied to Moderna’s stock price — potentially worth hundreds of millions of dollars, once he leaves the company. Moderna received $2.5 billion in public funds from the Trump administration to develop its Covid vaccine.

“The health insurance premiums continue to rise, the out-of-pocket costs continue to rise,” Dr. Margaret Flowers from Physicians for a National Health Plan told me in an interview I did with her on The Real News Network, “And there is a new level of atrocity. Because of the mergers, the hospital corporations have their own insurance [programs]. They own the labs. They own the practices. If a doctor is trying to provide too much care to their patients, they can just pull their health insurance, kick them out and they lose all of those patients.”

You can see my full interview with Dr. Flowers here.

“That’s what happened in Maryland through our nonprofit MedStar,” Dr. Flowers said. “They gave two days’ notice at one hospital that serves a majority of the Medicaid population. They shut down the entire pediatric department, including the pediatric emergency room and the center for children who’ve been abused.”

The solution, Dr. Flowers argues, is to provide universal health care coverage. Short of that, she argues, things will only get worse.

“We win this the same way that we’ve won every other battle,” Dr. Flowers said. “We have to educate ourselves and others. Health is fundamental. There is no incremental way that we can do this. We cannot work within the for-profit system to fix this problem. We have to nationalize our healthcare system. This means getting the profit out completely. Unfortunately, in the bills that are in Congress right now, they don’t take that step. They continue to allow the for-profits to operate within the system, but they’re parasites. They’re always going to take as much as they can. Every dollar they take means a dollar less for somebody getting the care that they need.”