You've been distracted, so you can be forgiven for not paying attention.
Much of your focus lately on the government front has been centered on the $19 billion that the government will spend on healthcare information technology. You've also probably been paying a lot of attention to the healthcare reform ideas in President Barack Obama's 2010 budget. Those two issues represent potentially the two most drastic changes that healthcare has faced in the past several years, so it's understandable that you haven't spent much time thinking about perhaps the most important challenge to your hospital or system's labor relations—as well as its balance sheet—in your lifetime.
If you haven't figured it out by now, I'm talking about legislation making its way through Congress called the "Employee Free Choice Act." Sounds great, doesn't it? Of course, most bills coming out of Congress sound great if you're only reading its title. In crafting legislation, congressmen and women could give even the most savvy consumer advertisers a lesson or two on puffery and outright lies. But in this bill, I don't know if I've ever seen a more flagrant case of false advertising.
Right now, most of you are probably operating non-union hospitals, and you're probably happy about it. Those who do have unions on campus won't say so publicly, and I don't blame you, but I know from off-the-record conversations that you'd change places with your nonunion colleagues in a New York second. We've all heard horror stories about nurses who won't work and other healthcare workers who have no fear of being fired for gross incompetence because the union protects them. But at this moment, at least the decision on whether to bring a union in to negotiate for workers has been a free and fair secret ballot process overseen by the National Labor Relations Board. If management is being unfair to workers, they can expect an organization attempt and an election they can expect to lose.
This bill attempts to change that by taking away the election component of a unionization attempt. Under the bill, only 50% of workers with similar responsibilities in an organization need sign a "card" in order for a unionization to take place. You'll hear it talked about as a "card check" process. Think of it as a petition.
Why is this process unfair? Well, for starters, it opens workers up to intimidation on the part of the union attempting to organize workers. It also fails to protect workers' right to privacy. Under card check, the identities of those who want the union will be open for all the world to see. The converse is also true.
How would you feel if there was a bill to make public your vote in national elections? Local elections? What if you voted for the losing candidate in a mayoral or city council election? Think there wouldn't be retribution? Think again. The first time you call that city councilman you didn't vote for with a complaint about a pothole on your street, you'll be on that enemies list, and you'll know I'm right.
Unions have been taking on healthcare with increasing alacrity in recent years as their core constituencies at manufacturers have dwindled due to offshoring. I don't have a problem with unions' attempts to organize hospitals. Healthcare is attractive to unions because it's a growth industry, and it can't be offshored very easily, even though a few folks are traveling to lower-cost overseas destinations for elective surgeries.
I don't mean this column as anti-union. Certainly if unions had never formed, we'd still have low-paid workers slaving away in coal mines and sweatshops with no benefits, little protection, backbreaking hours, and even smaller wages. Just take a look at China if you doubt me.
I'm all for organization if 50% of employees feel that management is doing such a poor job of handling employee concerns that a union is necessary. The very threat of it keeps management in check. Similarly, the secret ballot election process keeps unions in check—preventing them from intimidating workers into supporting organization attempts.
Under the card check system, they'll know who the supporters are and who to put on the enemies list. I have yet to hear a convincing argument about how this bill would make the union organizing effort fairer, or freer, than what we already have.
It is incongruous that a president who makes so much of healthcare's inefficiency and high cost would support this legislation: But make no mistake. If this bill reaches the president's desk, he will sign it. He said so in the campaign last fall. And with a heavily Democratic Congress, chances of its passing are greater than ever.
Lobbying groups, such as the American Hospital Association, are fighting against it, but it's your job to contact your congressman and make sure card-check legislation never happens.