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roosevelt institute
New Report Sheds Light on the Pitfalls of AI-Powered 'Gig Nursing'
"These apps are a symptom of broken healthcare infrastructure that is now victim to corporate takeovers. Failing to act on both fronts poses risks to our healthcare system and the workers who power it," wrote one of the researchers.
Dec 17, 2024
While gig work is fairly common in a number of sectors in the American economy, a brief released Tuesday by the progressive-leaning think tank the Roosevelt Institute details how the gig model now has its tentacles in the healthcare industry, and argues it is creating new hazards for workers and patients.
The brief, authored by Groundwork Collaborative fellow Katie Wells and King's College London lecturer Funda Ustek Spilda, sounds the alarm over "on-demand nursing firms" such as CareRev, Clipboard Health, ShiftKey, ShiftMed, and others which have gained traction by promising hospitals more control and nurses and nursing assistants more flexibility.
Practically speaking, these "new Uber-style apps use algorithmic scheduling, staffing, and management technologies—software often touted by companies as cutting-edge 'AI,' or artificial intelligence—to connect understaffed medical facilities with nearby nurses and nursing assistants looking for work," according to the brief.
The authors, whose research was largely based on interviews with 29 gig nurses, argued that these apps "encourage nurses to work for less pay," do not offer nurses clarity when it comes to scheduling and amount or type of work, are not sufficiently concerned with worker safety, and "can threaten patient well-being by placing nurses in unfamiliar clinical environments with no onboarding or facility training."
These platforms are also using the same tactics asthe ride-hailing serviceUber when it comes to lobbying state legislatures in order to shield themselves from labor regulations, according to the authors, who noted that larger hospital systems in the country have included gig nurses in their operations since 2016.
The researchers argued that while the rates on a platform like ShiftKey can be higher for nurses and nurses assistants, nursing on-demand platforms can create a race to the bottom for wages: "The nurses and nursing assistants who use these apps must pay fees to bid on shifts, and they win those bids by offering to work for lower hourly rates than their fellow workers."
When the nursing on-demand firms classify the workers as self-employed, nurses and nursing assistants are also exposed to higher risk because they are "excluded from the protections of local, state, and federal law on minimum wage, overtime pay, workers' compensation, retirement benefits, employment-based health insurance, and paid sick days."
Workers are also rated based on facility feedback and determinations made by the algorithm, and can be penalized if they cancel a shift because they are sick or have a conflict, per the report.
"In at least one case, a nursing assistant went into work at a hospital while sick with Covid-19 because she could not figure out how to cancel a shift without lowering her rating," according to the authors.
By way of background, the authors of the brief also argue that the often-invoked "nursing shortage" is actually misleading term. In fact, there is no shortage of available nurses and nursing assistants, but rather a "growing number of nurses and nursing assistants who refuse to accept chronically understaffed, underpaid, unsafe, and high-stress workplaces," according to the brief, which cites outside research.
In fact, many of the workers interviewed said they would continue working for nursing on demand services because broadly speaking they like the work. According to the brief, interviewees said "over and over again how important flexible schedules are to their lives, especially their own caregiving, be it for children, spouses, or elders"—though the authors of the study wrote that this does not mean the concerns expressed by the workers are not worth paying attention to.
The rise of gig nursing is taking place on the backdrop of increasing corporate ownership over the healthcare industry writ large, including the rise of private equity ownership of medical facilities and medical staffing agencies.
"Policymakers need to be proactive and step in to regulate these platforms and provide proper labor protections for all nurses, gig and non-gig alike," said Wells in a Tuesday statement. "But these apps are a symptom of broken healthcare infrastructure that is now victim to corporate takeovers. Failing to act on both fronts poses risks to our healthcare system and the workers who power it."
Wells also toldThe Guardian that the gig companies don't release data and the industry is unregulated, meaning the true extent to which the U.S. healthcare system is leaning on gig nurses is unknown—but she said it is clearly a growing trend.
These on-demand nursing apps can also have a negative impact on patients, according to sources the authors spoke with. One nurse recounted that "there have been times when I've been unable to access patient records or find supply closets."
"Other workers report that the lack of management and resources can result in major safety lapses for patients, such as gig nurses not being able to get updated information on patient medications or instructions about whether patients need help with feeding," the authors wrote.
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California's $20 Fast Food Worker Minimum Wage Kicks In
"Fast food companies can afford to pay $20/hour without raising prices or cutting hours," said the California Fast Food Workers Union. "Doing either is a choice. Don't let them tell you otherwise."
Apr 01, 2024
A new California law raising the minimum wage for most fast food workers from $16 to $20 an hour took effect Monday, a move cheered by labor advocates who dismissed—and debunked—claims by an industry reaping record profits that the pay hike would force restaurant chains to raise prices and cut jobs.
The law applies to restaurants at national fast food chains with at least 60 locations and that have limited or no table service. Restaurants inside supermarkets and establishments that bake and sell bread are exempt. Twenty dollars is just a starting point, as a state law also established a Fast Food Council that can raise wages by up to 3.5% annually through 2029.
"The vast majority of fast food locations in California operate under the most profitable brands in the world," Joseph Bryant, executive vice president of the Service Employees International Union, said in a statement. "Those corporations need to pay their fair share and provide their operators with the resources they need to pay their workers a living wage without cutting jobs or passing the cost to consumers."
As the California Fast Food Workers Union noted:
- From 2015 to 2023, California raised the minimum wage by 72%, from $9 an hour to $15.50 an hour;
- While the minimum wage was rising, fast food restaurants in California added 142,000 jobs; and
- The minimum wage has increased every year in California since 2015, and so has the number of fast food jobs in California, except for 2020, when the Covid pandemic hit.
California Fast Food Worker Union also pointed out that "numerous academic studies confirm: When states and cities pass big minimum wage increases, employers either add jobs or there is no or minimal effect on employment."
BREAKING: Today hundreds of fast food workers from across California are in LA to officially launch the California Fast Food Workers Union
We've won a Fast Food Council
We've won $20/hr
Now we're doing whatever it takes to win annual raises, just cause, and more#UnionsForAll pic.twitter.com/pykRKZF0PV
— California Fast Food Workers Union (@CAFastFoodUnion) February 9, 2024
The union highlighted various studies, including one in 2024 that found no fast food jobs were lost when California and New York increased their minimum wage to $15; another in 2018 that showed a slight increase in restaurant and food service employment in six cities that raised their minimum wage; and yet another in 2021 revealing hikes in state and local minimum wages had no effect on McDonald's opening or closing restaurants.
"According to the data, there's no reason why the new fast food minimum wage of $20 per hour in California should mean layoffs or increased prices," Alí Bustamante,deputy director for the Worker Power and Economic Security program at the Roosevelt Institute, said last week. "Profits in the fast food industry are sufficiently high to absorb the greater operating costs and ensure industry workers are paid fairly."
As More Perfect Union noted, McDonald's made $8.5 billion in profit last year, while Burger King's parent company raked in $1.2 billion, and Starbucks enjoyed $4.1 billion in profits.
Additionally, a new Roosevelt Institute analysis co-authored by Bustamante found that the 10 largest publicly traded fast food companies spent $6.1 billion on stock buybacks last year alone. This, while fast food prices soared by 46.8% over the past decade compared with 28.7% for the average of all prices. In 2023, fast food companies charged their customers 27% above their production costs. Critics have accused these and other corporations of "greedflation."
"In 2022, fast food industry employment in California had increased to approximately 553,000 workers—a 20.1% increase since 2014," the analysis notes. "Trends in the California fast food labor market have mirrored the national averages. Yet between 2014 and 2023, the federal minimum wage remained stagnant at $7.25 per hour, while California's minimum wage increased from $9 to $15.50 an hour—further evidence that California fast food firms can readily adjust to minimum wage increases."
The U.S. federal minimum wage of $7.25 an hour has not been raised since 2009, and that amount is worth far less now than it was then due to inflation.
"This is an insult to American workers and bad for our economy," former U.S. Labor Secretary Robert Reich said in a video published Monday by the Gravel Institute.
"It's simply a myth that raising the wage automatically means lost jobs," Reich asserted. "Here's the bottom line: If your business depends on paying your workers starvation wages, you should not be in business."
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Reports Expose Deep Harms of Corporate Tax Cuts and 'Trickle Down' Ideology
"Failing to reimagine a more ambitious and comprehensive use of corporate tax policy prevents us from achieving a more equitable, sustainable, and democratic economy."
Jan 23, 2024
Two new reports published Tuesday by the Roosevelt Institute argue that robust corporate taxation is key to creating a strong economy and improving the well-being of families and children—objectives that have been undermined in the decades since the Reagan era by regressive tax cuts enacted on the false premise that benefits would "trickle down" to the rest of society.
The first report, A Mapping of the Full Potential of U.S. Corporate Taxation to Enhance Child and Family Well-Being, examines what the authors describe as the understudied notion that "increasing corporate taxation will necessarily help children and families by providing additional revenue for essential public services."
That perspective runs counter to what the Roosevelt Institute's second report calls "a 'cut-to-grow' mentality" that rose to prominence in the 1970s and was enthusiastically embraced by the administration of President Ronald Reagan.
"Under this view, the thinking went, it was necessary to reduce the corporate tax rate to grow the economy—and that this growth would allow gains to eventually 'trickle down' from the rich shareholders to the middle class," the report states. "During this time, the corporate tax rate was gradually reduced to 35% before it was dramatically cut to 21% in 2017. These cuts resulted in corporate tax revenues falling to less than 10% of total federal revenues."
"Perhaps more than any other, President Ronald Reagan leveraged mounting backlash to taxation and government spending to dramatically reduce both, regardless of the consequences to American families," the report observes.
"Corporate tax policy since Reagan has been driven by the trickle-down economics narrative that cutting the taxes on 'job creators' will benefit less wealthy U.S. taxpayers."
The decades-long decline in corporate tax rates has severely undermined the federal government's ability to finance critical public goods, from education to childcare.
"Since regressive corporate tax cuts don't significantly increase earnings for working families (through either wage or employment increases), but they do reduce the government's ability to fund family income and care supports, childcare costs—which are already rising—can become a relatively more expensive line item in working parents' household budgets," reads the Roosevelt Institute's first report, authored by Emily DiVito and Niko Lusiani.
"When they can't afford childcare," they added, "parents face the difficult choice of having to cut costs in other places—often on the basic necessities that allow children to thrive, like food, clothing, and enrichment activities—or taking on additional caregiving duties themselves."
At the state and local levels, DiVito and Lusiani noted, "corporations' successful efforts to avoid their full property tax liability devastate public school budgets."
DiVito, deputy director for the corporate power program at the Roosevelt Institute, said Tuesday that "we have a false idea in the U.S. that corporate tax policy is unrelated to equitable social reforms."
"However, strong corporate tax policy is vital to all aspects of a thriving economy," she argued. "And the failing to reimagine a more ambitious and comprehensive use of corporate tax policy prevents us from achieving a more equitable, sustainable, and democratic economy and society for all families."
The new reports come a week after a bipartisan pair of House and Senate negotiators announced a deal to expand the child tax credit (CTC) for three years in exchange for a series of corporate tax cuts. The American Prospect's David Dayen estimated that "in the time period when all the tax credits are actually in place, the business tax changes are five times more costly than the CTC changes."
"Who knows if this deal can pass in time to take effect in the upcoming 2023 tax season, if ever. Sen. Mike Crapo (R-Idaho), the ranking Republican on the Senate Finance Committee, is already asking for changes to make it even more generous to businesses. That's in part a function of the dissembling that there is 'parity' in the deal. The truth is that this is not an equal trade. And it may extend that inequity well into the future."
That warning is in line with the Roosevelt Institute's new research, which argues that a corporate tax code generous to big business fuels inequality by "benefiting capital interests (i.e., business owners, partners, and shareholders) at the expense of workers and their families."
"When corporations enjoy low taxes on their profits, they face a trade-off for how to otherwise disperse them: make investments in the workforce and productive capacity (e.g., raise wages, hire more workers, and/or upgrade buildings, equipment, or technology) or distribute them to shareholders (i.e., pay out dividends and buy back stock to inflate prices). Data shows that executives typically choose the latter."
Reuven S. Avi-Yonah, a professor of law at the University of Michigan and the lead author of the new report on "cut to grow" ideology, said in a statement that "corporate tax policy since Reagan has been driven by the trickle-down economics narrative that cutting the taxes on 'job creators' will benefit less wealthy U.S. taxpayers."
"Such an idea is often offered in tandem with the notion that this is the only way tax policy can help American families," said Avi-Yonah. "But this just isn't true. In fact, this false 'cut-to-grow' narrative has made it very difficult to argue for a more expansive, progressive vision of corporate tax reform—contributing to a decades-long stalemate in efforts toward real comprehensive corporate tax reform."
"Now is the time," he added, "to reverse this trend with a more historically grounded support of the corporate tax."
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