Wednesday, July 14, 2010

Musical Chairs vs Coliseum

In the old days, we played a game called Musical Chairs. There was one fewer chair than children, the music would play as we circled the chairs, and when it stopped, we fought over the chairs, and one kid was the loser. Then they took away another chair and it started again.

This was preparation for life under capitalism, where the jobs are always fewer than the available workers, but the music keeps playing and people leave jobs and people get jobs, so it appears that there is always a chair, or job, open.

No one plays those games anymore, so instead we have "American Idol" and "Survivor" TV shows, where cruelty reigns when throwing people out.

Because you can almost always find a "Help Wanted " sign somewhere, people with jobs are told that people without jobs are "lazy". They are told that they are working hard to support those lazy people, and that if it weren't for them, we would all be rich.

Remarkably, propaganda trumps actual life experience for many. We now have 8 million fewer jobs than we did in 2007. That means that there are 8 million Americans who became very lazy in the last three years. There are 6 Americans looking for work for every job that opens.

So, although people repeat the mantra "You can always work at McDonald's", there are at least 6 people for every hamburger flipping job that opens up.

Really, though, this is unrealistic. Some of the jobs that open up are for engineers, or nuclear physicists, or cement pourers. Anyone without those skills must compete for the limited amount of unskilled labor jobs.

I am a nurse. I became a nurse decades ago, when the wages were comparable to many other jobs.

In the meantime, luckily for me, my wages went up, while, unluckily for them, millions of other people's wages went down. So suddenly, comparatively, my job looks like a good one to have. The medical-industrial complex became very profitable, and some of those profits trickled onto me and my co-workers. But now, those profits are cutting into other corporations' profits, and they are screaming about it. Hence, "health care reform", which turned into insurance company profit enhancement without actually cutting health care costs. Something else must be done.

The ruling class, like the dinosaurs in the old horror movies, having devoured the first victims, slowly swings its giant head around, and its beady eyes fix upon me, hiding in the corner. Yes, that's the ticket, cut nursing salaries, that'll solve the problem!

You can't open a magazine, log onto a website, listen to TV, without hearing the news "Be a nurse! There's a shortage, and they make great money! Unemployed? Go to school. Be a nurse."

My previous boss told me that she had continuous pressure put on her to get rid of us experienced, better paid nurses and hire new grads, who make just a little more than half as much as we do. Upstairs, on Med Surg, they have continuous turnover, as new grads come in, work a year, get experience, and then head out to greener pastures, out of fly-over country, where nurses make more money than even the most experienced here. Then the hospital hires the new crop.

My boss resisted this, pointing out that it is better for the patients to have experienced nurses. She's not my boss any more.

I went to a class in marketing today. Apparently, part of the new health insurance company enrichment bill is a No Child Left Behind-like impossible goal.

Starting in 2014, the Federal government, sugar daddy to the health industry, will start grading hospitals on a percentile basis, based not on patient outcomes, like trauma or surgery or pneumonia, etc., but on patient opinion questionnaires.

The bottom few won't be paid, thus throwing them out of business, and resetting the stack with fewer hospitals, which will be paid on a opinion-based percentile basis, closing a few more hospitals, and resetting the stack with fewer hospitals, etc., etc., etc.

What????? The logical end to this is two hospitals open in the US, one of which will fall below the other, leaving only one.

The speaker today accepted all this, telling us that we were in a competition with the hospitals down the street and across the country and that we had to learn to please our customers, so as to get better ratings. Their loss is our gain.

He used the old - two men in the woods who see a bear, and one laces up his shoes, and the other one says "Don't be silly. You can't outrun a bear" and the other one says "I don't have to outrun the bear. I just have to out run you"- joke, but he was serious!

But this isn't outrunning a bear. This is being thrown into an arena and having the lions pick one off at a time. You're not outrunning the lions, you're just postponing your inevitable death.

I question the premise. Why would the Federal Government want to foster competition to close hospitals?

The emphasis used to be on quality improvement, as in improving patient outcomes, with increased survival rates, fewer nosocomial infections, and the such. Patient satisfaction, while important, is not the same as patient survival.

I can't imagine that closing hospitals, throwing more people into the remaining ones, is going to improve patient satisfaction at all!

People mostly are dissatisfied with waiting for hours! We need more clinics and doctors and nurses, not less.
But basic medical care is not profitable, so won't be pursued.


Anonymous said...

I once saw this thing on TV where two American girls and two Mexican girls were given this checkerboard with one checker and told that whoever could get their checker to the other side would win the game. The American girls kept moving the checker back and forth, back and forth. The Mexican kids helped each other to move the checker from one side to the other. If we are to survive, we probably could do better co-operating than competing. Of course, the only people who seem to cooperate nowdays is narco-creeps and tea-party poops.

Anonymous said...

Yeah, humans, ugly bags of mostly water, without good teeth or claws or ability to run very far, wouldn't have taken over the world without cooperation.

We're fed a line of bullshit about rugged individualism, but there were a lot more barn raisings and wagon trains than there were lone frontiersmen living off the land.

Who made their bullets?