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FAU and IWA – looking back to look ahead
Dresden FAU participation in “Solidarity Without Limits”, 2016.
In December 2016, the IWA, formerly the International of revolutionary syndicalism and anarcho-syndicalism, expelled its sections in Spain (CNT), Italy (USI) and Germany (FAU), thereby losing at least 90% of its members. The decision at the IWA congress in Warsaw came as no surprise. It concludes at least 20 years of agony for an IWA which has gradually abandoned its roots and the principles of its foundation in December 1922.
Translated by Emal Ghamsharick
This text represents the view of the International Secretariat of the Free Workers’ Union of Germany (FAU) on the development of the IWA and the fault lines of the past decades. We relied several times on two current posts on the blog “Amor y Rabia,” because we couldn’t have said it better. [Translated here: 1 and 2.]
Although we are sad about this break in our history with the IWA, we still hope that new opportunities for a more open project will arise. A project with a new outlook connecting – or even uniting – revolutionary syndicalists, anarcho-syndicalists and unionists worldwide. This might help overcome old divisions and this momentary split.Formation of the IWA in 1922 and rebirth in the 1970s
The IWA was founded as the International of all revolutionary-syndicalist and anarcho-syndicalist unions in Berlin in 1922. In the early years, some of its member organizations had hundreds of thousands of members and very different approaches to unionizing. The organization was held together by mutual aid, a commitment to the “principles of revolutionary syndicalism” and trying to evade the influence of the emerging Leninist parties, who aimed to convert unions across the world into pawns of their party politics.
Still the IWA’s influence on the history of the workers’ movement remained limited. During the Spanish revolution of 1936, the CNT – the largest IWA section with more than half a million members – did play a decisive role. But the defeat of all revolutionary hopes for a liberated society in Spain also accelerated the decline of the IWA. Many national sections had already been smashed during the rise of fascism throughout Europe and Latin America. The brutal hegemony of Leninism, followed by Stalinism, throughout labor unions worldwide increased the pressure. By the start of World War II, all IWA sections had been destroyed, save the Swedish SAC.
The SAC also faced pressure in the early 1940s, but not from fascism, as in Germany, Italy and Spain. The Swedish government decided to task labor unions with managing pension and unemployment claims. The tacit goal was to force all workers into the toothless social-democratic union and to marginalize the SAC. Fearing this development, the SAC made a U-turn in 1942 and began to participate in managing the government’s social security funds. This included the creation of an official apparatus. It was not until 2009 that the SAC decided to re-radicalize most of its strategies.
This was the backdrop for the 7th IWA Congress in 1951, the first one in thirteen years and after WW II. The SAC’s strategic turn was heavily criticized for weakening revolutionary syndicalism by making the union an extended arm of government and as a pacification strategy against workers. As a result, the SAC stopped its membership payments to the IWA and opted to leave the International in 1957.
The IWA thereby lost its last member to be an actual union. It began transforming into a federation of mere propaganda groups with no tangible influence on class struggles. The peak of the Cold War was a “march through the desert” for the anarcho-syndicalist movement. It also had to endure a series of strenuous conflicts within the Spanish CNT. The members of this largest IWA section were either exiled or lived under the constant threat of being persecuted, killed or locked up by Spanish authorities.
In the 1970s finally some hope began to reappear. The student movement, wildcat strikes, the crisis of 1973 and the resurrection of the CNT starting in late 1975 paved the way for several new anarcho-syndicalist organizations, such as the FAU in Germany (1977) or the Direct Action Movement (today called Solidarity Federation), founded in 1979 in Britain. The revived USI, the historic Italian IWA section, held its first congress in 1978. In the late 1980s the CNT-F in France caused a stir with its first collective actions. Small groups of unionized activists from other countries also began joining the IWA. So the 16th IWA Congress in 1979 was the first in a long time to see the admission of several new organizations. Many were still small, but very motivated to join the class struggles in their regions.The split in the Spanish CNT and the works council question
The first throwback came soon, once again from Spain. Here the CNT had risen like a Phoenix from the ashes after the death of the dictator in 1975. Hundreds of thousands of workers joined within a few months and celebrated their new confidence in July 1977 with a meeting hosting nearly 100,000 at Montjuïc in Barcelona. Parts of the Spanish government began seeing the CNT as the greatest threat to the country’s development towards capitalism, so the “Democratic Transitional Government” did everything to keep the CNT out. For example it closed the Moncloa Pact, which promised legally guaranteed participation through works councils plus subsidies to unions. In return the participating unions had to accept severe restrictions, on the right to strike for example.
A bitter conflict broke out within the CNT on whether to join this Moncloa Pact. One side argued that being the only labor union to factually slide back into illegality would weaken workplace organizing efforts. The other side, with a view on Swedish experiences, warned that joining the Pact would tame the revolutionary union for the benefit of the capitalists.
As a result of this conflict and a number of other factors, such as workers’ disillusionment and depoliticization caused by the “democratic transition,” the CNT’s inability to integrate such masses of new members in such a short period, and attacks by the secret police on the CNT’s reputation, membership figures crashed. At the fifth union congress in 1979, the first one after the dictatorship, the delegates represented just 30,000 members, while two years earlier, the CNT had still counted around 200,000.
At this 5th Congress a majority of CNT syndicates decided not to join the Moncloa Pact and not to participate in works council elections. As a result, several syndicates left the union and founded their own organization in 1979, which today is the CGT.
The conflict in Spain affected the IWA as a whole. More importantly, however, the bitter, sometimes even judicial dispute in Spain made it impossible to openly discuss the underlying problem: How can a revolutionary-syndicalist or anarcho-syndicalist strategy on the company level be successful, without being pacified by the works council model or becoming irrelevant in the workplace? Because this question was not openly discussed within the IWA in the early 1980s, many new sections had to tackle the same Sisyphean task which had plagued Spain and Sweden.Crisis in the CNT-F – good-time problems
It began with the French CNT in the early 1990s. The union had succeeded in founding a large and very rebellious branch within the Paris Metro cleaning company COMATEC. The workers, mostly from North and Sub-Saharan Africa, had very precarious contracts, but promptly organized a first successful strike. To shield its members against the heavy conflicts with management, the CNT-F participated in employee delegate elections in 1991. The same happened at SPES, another cleaning company, where the CNT-F had built a strong branch.
This tactical participation in union elections to protect threatened members was approved retroactively at a CNT-F congress, but still caused heavy tensions, leading up to a split in November 1992. One part founded a union comprising nearly all branches – originally named CNT-Vignoles after its Paris headquarters – which supported occasional tactical participation in works council elections. The much smaller part held its founding congress in May 1993, was named CNT-Bordeaux after the seat of its coordinating committee and strictly opposed any kind of participation in workplace elections. Both organizations claimed to be members of the IWA.
This was the beginning of a sweltering conflict for the IWA because, for one thing, the “French problem” also affected the Spanish CNT. The children and grandchildren of Spanish exiles in France had helped make the CNT-F successful and mostly supported the CNT-Vignoles. However, a dominant sector in Spain fully supported the CNT-Bordeaux, This led to heavy quarrels within the Spanish CNT and finally to the resignation of the Spanish IWA General Secretary, who had tried to negotiate instead of choosing a side.
What made the conflict permanent, however, was how the 20th Congress of the IWA (Madrid, 1996) finally dealt with the situation. The only agenda topic was an “open debate about the situation in France.” Therefore, most sections, whether attending with delegates or only by written mandate, had not made any particular resolutions. At the congress, the Spanish CNT and the tiny Norwegian NSF then suddenly made a motion – under breach of IWA procedures – to expel the CNT-Vignoles and recognize the CNT-Bordeaux as the only French section. The motion was actually voted on, in a very heated atmosphere, and so it happened that the majority of French IWA members were expelled through an unworthy and unprecedented maneuver, supported by only three sections and against the vote of the FAU. The vast majority of sections present abstained, since they could have no mandate for motions they had not been informed of in advance.
This slammed the door on any amicable solution for the French situation. Another result of the Madrid Congress was, that the decades-old option of recognizing multiple sections in one country was struck from the IWA Statutes.The crisis in Italy
In parallel with the split in France, a conflict also developed in the Italian section, the Unione Sindacale Italiana (USI-AIT). Here too, the challenge was finding a suitable strategy for workplace unionizing. However, the question in Italy was not whether to participate in works councils, but about its relationship to the other Italian grassroots unions, which were mushrooming since the early 1980s. One part of the USI (called USI Rome due to its regional focus) supported dissolving their union into alliances with other grassroots unions. The other part wanted to maintain the USI as an independent union with its own profile. The conflict led to a split in May 1996, where the pro-independence part held a congress without the USI Rome in Prato Carnico.
At first, delegates of both organizations attended the 1996 IWA Congress. After the USI Rome delegation left the general meeting in vocal protest, the Congress declared that this meant the withdrawal of the USI Rome from the IWA, and that the USI-AIT was the legitimate Italian section.
The USI Rome never accepted this decision and calls itself USI-AIT to this day, causing frequent confusion. They have even taken advantage of this situation to torpedo numerous collective actions of the real USI-AIT. Italian legislation requires that strikes be declared to the authorities in advance. The USI Rome has used this to call off strikes started by the real USI-AIT by sending letters to the authorities and has thereby effectively broken these strikes.Prohibitions and distrust instead of cooperation
As described, the conflicts within the CNT-F and the USI, the two largest sections after the Spanish CNT, peaked just before the IWA congress in 1996 and were decided here. Originally, the 20th IWA Congress intended to fortify the reborn IWA by adding many new members. But since the agenda was manipulated and the Congress was troubled by the unworthy behavior of several delegates and visitors, it actually triggered a fatal internal dynamic in which the Spanish CNT played a crucial role.
The first step had been taken several years earlier – at the 1984 IWA Congress in Madrid, a motion by the Spanish CNT (which had just experienced the worst split in its history) was passed, which prohibited formal relations between IWA sections and the Swedish SAC. The reason for the motion was the SAC’s financial support for the CNT splinter group in Spain, the later CGT. The resolution left room for interpretation, which led to future conflicts.
The mentality expressed in this motion soon began to poison the atmosphere throughout the IWA. Seeing splits in its largest sections, the International started acting like a wounded animal and no longer trusted anyone. Trust, the basis for any federalism, was therefore replaced by control. Sections were threatened with penalties whenever this seemed necessary or appropriate.
A resolution at the 21st Congress (Granada, 2000) upheld this logic. A procedure euphemized as “contact rule” and passed upon the initiative of the Norwegian NSF now requires that in countries with existing IWA sections, all contacts with other organizations must go exclusively through this IWA section. This logic, which aimed to replace federalism with a sort of confederate feudalism, had dire consequences. Just as in the manipulative expulsion of the CNT-F, the FAU made use of its right to reject this IWA resolution as non-binding.The sorcerer’s apprentice
The poisoned atmosphere and the increasing self-isolation of the IWA were aggravated by the nomination of the new IWA Secretariat in 1996. What would have been needed was a balancing leadership to calm things down and build bridges. Instead, the Spanish CNT nominated its former general secretary, José Luis García Rúa as the IWA General Secretary. Over the three years of his mandate, he managed to pour fuel into the fire at every occasion.
Starting in the late 1990s, transnational movements sprang up, many involving workers, which mobilized against capitalist globalization and its strategies of exploitation without borders. These movements mobilized large and militant demonstrations against the summits of the ruling classes, where we often joined unionists on the street, whose syndicalist organizations did not or no longer belonged to the IWA.
Instead of leveraging the new situation and the great demand for a transnational response to exploitation and domination, the IWA General Secretary started searching for “enemies of the IWA.” And he found them everywhere! Not among governments or capitalists, though, but in the IWA, SAC, CGT, CNT-F and various other syndicalist organizations outside the IWA. And of course also among those within the IWA, who saw the “enemies” elsewhere.
Starting a witch hunt instead of using the opportunities would not have been possible without the tacit or active support by a majority of IWA sections. In this respect, it became striking that starting from the mid-1990s more and more small groups were given full IWA membership, without actually having the chance to develop any unionizing experience. Many of these very young organizations proved to be very volatile and prone to dogmatism. Combined with the practice that IWA resolutions are passed by one vote per section, regardless of size, groups began to dominate who had a firmer grasp of history books than of the reality of class struggle.The FAU and i2002
The turn of the millennium saw heavy internal hostilities, not just against the USI, who was heavily attacked by the new Russian and Czech sections (and others) because it dared participate occasionally in the umbrella organization Rappresentanze Sindacali Unitarie (RSU).
Just after the 1996 Congress in Madrid, FAU delegates had warned that the Congress would trigger a long phase of division and sectarianism, instead of building bridges between the various revolutionary syndicalist, anarcho-syndicalist and unionist organizations and currents. In the following years, the FAU tried to oppose all tendencies which threatened to turn the IWA into an exclusive debating circle without contact to social struggles. This included making use of its statutory right to reject IWA congress resolutions, which promoted division instead of understanding.
To offer a positive alternative to the IWA’s growing paranoia, the FAU held an International Solidarity Conference (i2002) in the German city of Essen in 2002. The conference aimed to follow in the footsteps of the i99, which had just taken place in San Francisco.
i2002 deliberately avoided sending formal invitations to unions or other organizations or their official representatives. Instead, the invitation went to all members and activists of all revolutionary syndicalist, anarcho-syndicalist and unionist organizations, who were looking to discuss, socialize and make plans for a few days. For the small FAU, this successful conference was also an enormous effort, a milestone in its development and a confirmation of its assumption that beyond all the divisiveness and distrust there is space for ideas, our experiences and common projects.
But not everyone was happy about the conference and the exchange it enabled and promoted, or about the FAU’s insistence on freely choosing its forms of action, in line with the principles of revolutionary syndicalism. In the run-up to the i2002, the IWA Secretariat and a majority of its sections had heavily attacked the FAU’s presentation of i2002 at an IWA general meeting and countered it with all sorts of verbal abuse.The “FAU Act” – dictatorial powers for the IWA Secretariat
It came as no surprise that the IWA’s most dogmatic members now saw the FAU as their main adversary. At the 2004 IWA Congress in Granada, it was once more the former IWA General Secretary García Rúa who brought a motion by the CNT for an “FAU Act,” a unique provision in the history of the IWA. It gave the IWA Secretariat exclusive power to dismiss the FAU with immediate effect, if ever it should find that the FAU continued to disregard the principles and resolutions of the IWA. Almost needless to point out that this motion again was not listed on the previously published agenda, and therefore was not covered by the mandate of the attending section representatives. What had begun in 1996 as a vicious, manipulative exception was now developing into a real method.Should we stay or should we go now?
Facing the developments after the 1996 IWA Congress, the FAU discussed for many years whether it made any sense to remain in this self-isolating International. Several exit motions at FAU congresses failed, such as the first one in 2001 or later ones in 2005 and 2014. Either the majority opinion was that the FAU should not leave on its own, or there was a clear exit majority, which failed to reach the three-quarters majority required for such fundamental decisions, because some syndicates still hoped that the IWA might change its self-destructive course and return to its founding principles.Final act of the tragedy
In the years following the congress in Manchester (2006), the situation inside the IWA calmed down somewhat: The French section stopped denouncing the FAU for its links to the CNT-F – or was rather busy dealing with its own upcoming split. Criticism of the FAU’s casual contact with the SAC became quieter. In Spain, the tables had started to turn, and the part of the CNT which emphasized collective action over ideological debates was about to put the dogmatists in their place. The Spanish CNT and the USI tried limiting the dominance of micro unions within the IWA by proposing a minimum size for unions and voting rights proportional to membership. As expected, the proposal was denied.
The FAU’s wish to establish connections to the Polish “Workers’ Initiative” (IP) – a spin-off of the local anarchist federation – led to an escalation, as the IWA had already taken in the ZSP as a Polish section, which had been founded by former IP members. The ZSP considered the FAU’s contacts with this supposed “competitor” a breach of solidarity, although the FAU’s primary support still went to the ZSP and their joint actions. One reason why the FAU maintained contact with the IP was that they were involved in labour conflicts with multinational corporations in the German-Polish border region, and the FAU wanted to learn about organizing in large companies. The FAU therefore stated that it needed no permission to make contacts, because it had not accepted this particular IWA resolution.
After a member of the ZSP was elected as IWA Secretary in 2013 and the FAU formalized its links with the SAC, the CNT-F and the IP, the new IWA Secretariat immediately suspended the FAU in September 2014 and cited the “FAU Act” of 2004 as justification. This meant in effect that the FAU was barred from all internal communication in the IWA and lost its right to vote – although it stayed a member section of the IWA until the congress of December 2016 in Warsaw (where it was officially disaffiliated, along with the Spanish CNT and the USI). This meant the IWA Secretariat acted with executive powers, which it should never have had under its federalist principles, which were also thrown overboard in 2004.
The fact that the “majority” of all IWA sections (which represents barely 10% of the members) confirmed the suspension at an extraordinary congress in 2014 in Porto was the last straw for the Spanish CNT and the USI. At its 2015 congress, the Spanish CNT pushed the reboot button and invited all IWA sections to build a new foundation for the International and begin an international project to revive the IWA’s founding principles.
Of course, solidarity with the FAU wasn’t the only reason for the Spanish CNT’s break with the IWA, as is currently claimed. The USI, the CNT and the FAU had to accept that the IWA in its current shape serves only itself, but not as a driver for self-organised class struggle on the basis of revolutionary syndicalism. This might be painful to realize, but in the difficult times which are upon us, it’s no use for us to keep flogging a dead horse out of nostalgia.A new project in difficult times
If we see the signs right, we’re about to live through a stage of populism unparalleled in recent decades. The aim is to divide workers and the oppressed by nationalist and racist rhetoric. Against the project of a world full of new walls running along borders and through our minds, we need a project to tear down all walls and instead connect workers to organize solidarity and mutual aid. We have no more time to cultivate differences – let’s instead search for what connects our struggles for better living conditions and for a world without exploitation and oppression.
The Spanish CNT, the USI and the FAU have therefore decided to jump-start a new international project. An initial conference with unions and affiliated groups from eleven regions on two continents took place in the Basque city of Barakaldo. We hope this will be a new beginning for the small but radical part of the international workers’ movement. Today, more than ever, we insist that the working classes and their exploiters have nothing in common and any hope in states and political parties is not part of the solution, but part of the problem.
The International Secretariat of the Free Workers’ Union (FAU)
[Originally posted February 14, 2017 on the FAU’s website.]
Labor movements have always tried to find ways to wrestle control over working conditions away from the boss. Workplace injuries and deaths are still at epidemic levels which in some industries in particular can mean life and death. Health care still suffers from disproportionately high levels of injury in in-patient settings such as hospitals, rehab centers, and nursing homes. Led by nurses, the movement for safe staffing has sought to create hard limits on the amount of patients that can be assigned to health providers for both the safety of the patients and their care givers. Following decades of militant action California nurses and nurses in provinces in Australia achieved safe staffing legislation which research has vindicated in improving care, reducing mortality, and avoiding provider burnout. We interviewed Jenny, a Maryland nurse involved in the movement to spread these measures about her experiences as a nurse and the movement.
Was there a moment or event at work convinced you that safe staffing is needed?
I didn’t focus on safe staffing fully until I had left the hospital. I wasn’t aware of the problem fully until I became a legal nurse consultant, and it made me look back on my experience, and I realized I had been incredibly lucky that no one died while they were under my care before I left the hospital.
But because hindsight is 20/20 this is my story. I interviewed for two positions in the city of Chicago. The first one (the one I should have taken) was a night shift at another hospital that was working towards Magnet status. However, I knew nothing about Chicago and saw the neighborhood around the hospital and saw that it was dilapidated and run down, and decided it wasn’t a safe neighborhood. The second one was on the lake front and appeared to be in the safer neighborhood. My first clue that this was a bad job for a new nurse, and later for any nurse, was that they were honest with me, and it had been a decade since they had hired a new nurse. I was honestly flattered that they thought I would make a good fit as a new nurse at their organization, and I needed a job. So I accepted. I got a signing bonus, because at that time everyone got a signing bonus, and I was supposed to get training and mentorship that was the common standard for new nurses as the time (2006). After about 6 or 8 weeks I was considered ready to take on my own patient load without supervision, and was “assigned” a mentor. The mentor I was “assigned” was my boss. Having your boss be your mentor doesn’t work, at least for your first mentor, it may work down the road once you’ve had some experience and you can recognize what your boss has to offer. It wasn’t long after I started off on my own that I realized that something (and what that was I didn’t know yet) was going to have to give if I wanted to do the job well. It turns out the something was not only patient safety (which was a misnomer to begin with at this organization), but my personal health. Not long after I became a floor nurse I was regularly in charge of 6 patients over the course of a shift, a slow night saw me down to three with discharges, and within 3 months of me being on my own I was expected to manage vent patients- training consisted of this is how you suction, this is how you silence alarms- it was only later that I learned about breath support, changing settings and how to better understand the patient on the vent, now you can take care of a vent patient. New nurse on a telemetry step down unit (my unit) and now responsible for six patients, with one on a vent regularly. It’s a wonder that I didn’t kill anyone. I’m still amazed. At about the one year point, I was diagnosed with shingles, which my primary care physician directly related to stress on the job. It was right after this (the timeline starts to get fuzzy at this point, so it may have been right before this) that I came in one day only to find the dedicated charge nurse had a family emergency and as the second most experienced nurse on the floor I was being trained to be charge nurse, on top of my patient loads. Needless to say this was not pretty. Not only was I a charge nurse but many nights we had ANOTHER new grad whom I was responsible for training as well. Talk about the blind leading the blind. About six to eight months after this I was in a hurry passing medication and had two patients located in the same room, as with most of the rooms being double, and a good night resulted in many of the patients being in the same rooms, because then there was less travel, I put the medications for both patients in my pocket, and forgot to do one more check at the bedside, administering the wrong medications to the wrong patient. I had been written up for any number of things since I had become a nurse, but a wrong medication error was too much and I was fired from the job.
Have you gotten involved in other social movements because of your activism on safe staffing?
Before this year I wasn’t aware that there were safe staffing movements outside of Magnet Hospitals or California. While I recognized the importance of it I wasn’t aware of anything being done outside of those areas. Legal Nurse Consultants are, in my experience, treated like we’re either second class nursing citizens, or somehow that we failed as nurses, rather than those who have a unique perspective to nursing, and a unique impact on the role of safe staffing.
How have you experiences organizing affected your perspective at work or within the health system?
I think it’s made me hyper aware of the problems faced by staff nurses, and I now ask about it when I’m in a new facility. I recently had the chance to visit an acute care rehabilitation hospital where staffing wasn’t ideal but it was significantly better than the standard at 1:7 or 8, and I got to talk with the nurse manager about some of the difficulties in getting that and some of the benefits that have allowed them to maintain that level of staffing, including less patient falls, and better outcomes in the care surveys sent to the patients and better discharge outcomes. She also said they were able to better respond to patient acuity needs with lower staffing numbers. It was heartening to hear that it has worked well.
Where do you see this movement in 10 years?
Assuming we do not win safe staffing we need to move forward to continue to push back against the people who say it costs too much, who say that nurses need a bachelors or put other barriers in place. Part of the biggest barrier against safe staffing include the number of employed nurses. If we do not consider all possibilities in encouraging safe staffing the movement will fail within 10 years.
Assuming we win national safe staffing ratios, what next?
Enforcement of the laws. If there is no financial reason for enforcement, many places will not enforce them. Ensuring that enforcement includes more than just the hospital, ensuring that enforcement is in place in the nursing home, assisted living, and long term acute care facilities as well.
Why do you think we have unsafe staffing essentially across the country, and in reality in most places in the world?
Money. Money is at the heart of the problem. Also a lack of understanding into each others roles. I posted an article to one of the safe staffing websites that I found interesting because the administrator admitted that their staffing ratios contributed to the problem, and there was an immediate attack on the consultant that was being called in to help resolve the problem. Is there something else that the consultant could bring to the facility besides the facility paying them money to pay for what they already know? Sometimes a new set of eyes can identify another problem that is overlooked by the staff because it’s status quo. We don’t need to be afraid of consultants, we need to embrace the importance interdisciplinary relationships, even within the field of nursing.
What can everyday healthcare workers do to ensure safe staffing today in their jobs and neighborhoods?
Talk. Talk about the role of safe staffing, share stories of staffing gone right and staffing gone wrong. The stories of things going wrong are important, but the stories of things going right are almost more important. Its not just killing PAT, but it’s the times in which safe staffing saved a life that’s important too. People need to know that it makes a difference. They need to respond to it on a personal level, and when the neighborhood, when the community at large recognizes the need for safe staffing, and the importance of it, they’ll start demanding it, but as with most things, until it directly impacts them, they don’t recognize the importance of it.
At the same time its important to SHOUT IT from the rooftops because the squeaky wheel gets the grease.
Jenny has been a registered nurse for 10 years, currently residing in Maryland and is a certified legal nurse consultant. Her speciality is nursing home malpractice, but she’s worked in Workers Compensation, telemetry/stepdown, private duty and home health nursing.
Our #healthseries was conceived and collected throughout 2016 at time when the Obama administration was winding down, and before the ascent of Trump or the more recent rumblings of the right in Europe. For workers in the health industries the changing political winds are part and parcel of the day to day conditions as funding and regulation changes continually intrude on the work, caring for other human beings who often have no other options. The debate in the United States over how to provide health care to a nation increasingly burdened by the costs and dissatisfied with the status quo has returned with a vengeance. One of our editors and contributors, S Nicholas Nappalos, comes at these issues as a nurse and organizer, and tries to unpack the implications of the growing health crisis, what alternatives we really have, and what health for-and-by workers and the community could look like.
What’s at Stake in the Health Care Debate?
S Nicholas Nappalos
The 2016 election cycle has shown that health care is lining up to be a key fight in the next few years. The Affordable Care Act (aka Obamacare) is looking increasingly weak as soaring costs of insurance, drugs, and equipment are eroding whatever meager benefits there were in reigning in the all consuming burden of the American health system.1 Bernie Sanders made a medicare-for-all proposal a cornerstone of his campaign, something which the National Nurses United (NNU) and Our Revolution has vowed to keep fighting for.2 Colorado had a similar single-payer plan on the ballot where insurance bureaucracies would have been replaced by a state-run insurance program, but would retain private health institutions and medical industries.3 Hilary Clinton fended off the insurgent challenge of Bernie supporters, but not without having to pay lip service to their cause.4 Poll after poll demonstrates popular support for nationalized health programs across Americans.5 While Clinton indicated a need to revisit the vague “public option” Wikileaks later exposed her method of dividing her private positions, disclosed to Wall Street firms in her infamous paid speeches, and a separate public one.6 None of this is earth shattering, but it shows that all the power brokers have been honed in on health.
A slow moving crisis
It looks to become even more central however. Estimates are the medicare funds will have to reduce benefits within two decades.7 States that did not expand Medicaid have offered private market based plans that within a few years are already not affordable even with subsidies.8 Where Medicaid was expanded projections for expenses are to rise significantly putting strain on already underfunded systems that suffer from severe shortages of specialists and resources.9 In reality we are witnessing the slow unfolding of a multi-decade health care crisis. Health-related spending makes up roughly a quarter of the entire federal budget and is expanding rapidly. Medicare, Medicaid, and Children’s Health Insurance Programs alone represent 16% of the federal budget and are projected to grow substantially.10 It is the largest portion of federal spending outpacing both social security and the military.
The drivers of this are our nearly singular combination of unregulated profiteering industries and particularly pharmaceuticals, medical equipment, and a multi-layered mediating bureaucracy that introduces inefficiencies into an already top heavy industry. The American health crisis is deepening not only because of excessive bureaucracy introduced by the byzantine insurance system, but also due to its embrace of both protecting industry through strict intellectual property rights and placing barriers to any regulation of prices for pharmaceuticals and equipment. It’s worth noting that health insurance and hospitals themselves are barely profitable with the median around 3% which is near inflation levels only. The profit tends to go to all the feeder industries selling products used by patients and purchased by health institutions.11 An Institute of Medicine report identified nearly 800 billion dollars in waste created by unnecessary services, excess administration, inefficient service delivery, overcharging, fraud, and failing to utilize potential preventative measures.12
These factors have made it the most expensive health system in the world.13 The people of the United States pay more than any other country for our health care, and with poor outcomes across a wide array of metrics. The political implications of this are not hard to see. The more political discourse digs in around the health system as a test of capitalism itself, the stiffer the resistance to reforming the obvious and preventable issues with it. The main players still see defense of vested interests in health care as an ideological defense of capitalism.
Holding to that position increases public spending however and is increasing the federal deficit each year. Dismantling the drivers of those costs, in private hands, would lead to real economic losses with implications for the world market. Some authors have noted that pharmaceuticals were the stars of the market for decades, and have been in a decline that has not been recovered.14 Further cutting into those losses may have more disruptive effects in an economy that already has challenges ahead represented by geopolitical conflicts in Asia and Europe, and an anemic recovery to the global economic crisis of 2008.
With the failure of Colorado is to forge ahead (and other states before it) and the victory of the Republicans across the board in this year’s election, meaningful reform seems quite unlikely in absence of a movement that can force their hands. Some other states may try the route of the ballot initiatives that failed in Colorado, Oregon, or Vermont’s legislature’s push. The disparity of forces between vested capitalist interests and their lobbying power and the electoral process itself makes it a near certainty of failure without a widespread popular change in attitude and action.
Can single-payer save us?(Photo by Michael Nigro) (Sipa via AP Images)
These problems will not go away for the rulers simply by ignoring them. With a single-payer program there would be substantial savings for the country as a whole and indeed millions of people will have their lives changed for the better. Any reduction in the vast waste that we’re chained to and an expansion in access to quality care is something we should cheer and fight for. Single payer would reduce some of these costs, in part through eliminating unnecessary layers of bureaucracy and negotiating lower prices through economies of scale. This has been the traditional progressive answer for these reasons to all things health related.
Despite whatever positives however the fundamentals would remain, with much of the control in the hands of the same drug companies, equipment and product manufacturers, and broken institutionalized practices of American medical professionals (such as reliance on specialists, the persistence of fee for service payment, and over use of capital intensive health techniques). Cutting the costs of the insurance industry would be a positive step, but it’s not a panacea, and it’s not clear whether it could prevent a crisis that is already happening.
Universal Medicare would certainly be more expensive than the system of the Veterans’ Administration (VA). One Congressional Budget Office study showed the VA to be twenty one percent cheaper than care under Medicare.15 The VA which shares some similarities to the National Health Service of the UK wherein the system owns the entirety of health services from hospitals, pharmacies, equipment, and hires the staff. By eliminating paying outside private entities, the VA and NHS thereby reduces the profit otherwise paid to private companies at each stage. While Medicare-for-all would eliminate insurers as secondary payers, such companies are deeply entangled in Medicare itself. Private companies provide supplemental plans for necessary services not covered by Medicare and as well as processing claims for Medicare itself.16 Without an elimination of private billing for services those additional administrative costs would remain. Medicare-for-all would not mean an end to Blue Cross, Aetna, or United Health necessarily.
Nor should health advocates glamorize European style public health. Across the world public health is under attack. Right and left governments have target slashing spending and limiting access. Ideology certainly is a component of this, but objective budget pressures are driving these forces. Universal public health care is worthy, but it is not a panacea. Americans would likely face the same attacks even were there such a victory as institutional pressure to put the burden of care onto the working class will remain.
If legislation granting universal Medicare is unlikely, VA-for-all is a lone voice in the wilderness. One could imagine the resistance likely to nationalizing private hospitals, clinics, and pharmacies. And yet if there is no substantial reform, what is the real cost paid to all of those services with a shrinking working population, jobs being lost to automation, and a growing base of those who will need care for decades? Should conflicts heat up, what would be the effect on the market if health advocates won such a struggle and take health institutions outside of the world of profit so to speak?
Health care is at the center of stressing both market and state forces and this presents an opportunity for movements that challenge capitalism. This crisis in health is not just about the policies of different players (liberal and conservative, socialist and reactionary), but about more fundamentally capitalism’s capacity to provide for health needs. Market allocation and private industry are central to the failures of the American system, things not easily hidden when confronted head on. Globally speaking the industries that profit off health, both public and private systems, have been some of the leaders for investors generally. Losses within health care could spell deep trouble for the economy across the board and perhaps tip us back into recession or depression in the context of a world that has not fully recovered from the shocks of 2008. Even in countries with overtly state-provided healthcare similar elements of crisis have been building in the past decades around run away costs, shortages, and declining quality of care. Health care is a key sector for radicals to make our case and put the ruling class on the defensive.
Health is bigger than our health care
Demanding universal health care has been a broad call amongst US progressives for the past 50 years or so. Is that really the main issue though? At its heart single-payer is about how we allocate existing health resources. Yet we do not only want to more equitably and economically distribute health, but also improve it. If you think about it, universal health is a fairly open demand. It could be redirected to any number of outcomes including universally terrible health. There is an insidious medical apartheid that punishes various sectors (workers, women, blacks, latinos, and indigenous, etc.) while granting luxury health services to a tiny elite. There is a clear move towards diminishing care for the public in general with overall declining standards of living. This year life expectancy declined for the first time in decades without much protest or reaction from the political establishment.17 Instead we are utilizing our collective resources towards the high-tech capital intensive care that benefits a tiny section of the population. Merely asserting universal care without contesting the monopoly on wealth and power that the entrenched capitalist class wields would not fundamentally change the exclusion of the working and under classes from quality health care.
What we want then is not only universal health access or affordability, but a different vision of the health of our society. Supporters of the status quo are already starting at a weak point: saddled with debt, their various solutions failing, and objective stresses that make reforms hard going. We can challenge them by putting forward proposals for health based on liberatory and solidary values that addresses our everyday reality, and show how capitalism and the state work against health.
There is a key role for health care workers to play in this fight by exposing the injustice we see, advocating for our patients, and leveraging our power as workers to move the discussion in a more radical direction. Healthcare workers networks could provide the structure and voice of struggles that mobilize the communities receiving the services and challenging administrators and legislators tasked with imposing austerity and maintaining our unequal health system. The power brokers fear the attention health workers draw with the clear sympathy of the community, and their capacity to turn public opinion against their enemies with public actions. Direct action by health workers is a powerful tool that could oppose the Trump presidency’s anticipated attacks where the disarmed liberal opposition will likely stand idly by.
At the same time mobilized movements of patients and communities could destabilize the government’s attempts at austerity and create political crises. Such pressure can be transformative when we go on the offense and not merely get saddled with defending a system under fire in a crisis that is not our own. Mobilized patients and workers together would prove a particularly difficult body to demonize, and may be strong enough to split support traditionally held in check by fear mongering against health reform. An anarchosyndicalist approach in particular, with it’s emphasis on direct action, self organization, and advocacy of anti-state and capitalist solidarity within workplace and community organizations, is well positioned to take on the systemic aspects of the crisis and at the same time organize local alternatives to daily needs of workers and patients.18 The uniqueness of the convergence of forces (state, work process itself, and society as a whole) give a special power to workers action directed against the state and towards the collective health of society.
In general we should fight for whatever we can get. That being said, it’s important to contest the debate and the form it takes as the limitations with Medicare-for-all above demonstrate. If we don’t, we will get whatever serves the interests of the same groups that have mangled the present system. A full theory of health is beyond this short article, but is a clear necessity given the scarcity of progressive proposals that go beyond access and reform of service delivery.
Any strategy for fundamental change in health care will have to grapple with immediate, medium, and long term issues. The focus here will be on the medium and long term as they are consistently neglected due to the previous desperation to achieve single-payer of any kind. The lack of a clear alternative vision does weaken the movement by giving the impression that the present is inevitable, and privatization the only way. The incoming Trump administration has already made noise around cuts to Medicare and Medicaid, attempting to privatize Social Security, and perhaps going after subsidies in the Affordable Care Act.
In the short term health movements face a steady current towards further privatizations that will increase costs and thereby further endanger both public safety nets and the health system in general. This may represent intentional crisis mongering to justify further austerity in some cases. We should defend against any such attacks. Yet it’s important to recognize that pure defense is likely to allow conservatives to draw lines that are favorable to them (unending escalating costs, poor quality of care, need for more choice/options, etc). For that reason in the short-term it will be important to formulate places where we can expose the failure of the entire system to provide needs, mobilize people around those barriers, and use direct action to improve the care we’re providing and receiving. One response that addresses costs is to call for integrating privatized services within health systems to reduce administration and bring for profit enterprises under public or community cooperative structures. Likewise much of the costs are related to unnecessary and ineffective treatments related to industry-led medicine and a model of treating illness that is widely acknowledged to be problematic. Demanding a shift to preventative population health approach including addressing psychosocial could provide substantial savings and increase the quality of care for individuals while addressing our poor performance on national health metrics.
Issues in focus should include the amount of time allowed with providers (which is set by reimbursements and the system of payments amongst all insurers), rationing of services that have strong evidence demonstrating efficacy and preventative capacity (physical therapy, access to strong multi-disciplinary holistic care for certain chronic diseases, robust patient education, etc), how electronic health record software is allowed to dominate care time for the sake of largely bureaucratic and legalistic concerns (to the benefit of the bloated software industry and with poor outcomes for patients). Thus a short term strategy should combine defense of safety nets with going on the offense in ways that seek to open up care while exposing the vested power interests bankruptcy in providing real solutions. Such fights could build the foundation of a health care movement in the medium term as well as in other sectors.
In the medium term, there must be a shift from contesting elements of the present system to transforming the underlying structure and logic that perpetuates these cycles of crises, inequity of health, and health oppression. In order to make those necessary changes profit and hierarchical power have to be removed from the functioning of the health system altogether. This cannot be done under either a state or private system as both rely upon the reproduction of wealth and power relationships for their basic functioning. The focus then must be upon struggles that provide a connection between fundamental aspects of the health system and the experiences of the exploited and oppressed.
For one inequality and the domination of health resources by the wealthy is a clear problem. Any solution must propose reallocating health spending away from the skew towards capital intensive medicine for the few and in the direction of population health for the many. This will involve significant struggle not only around state allocations and taxes, but also in terms of local struggles to ensure communities are treated equally across different counties and regions and contesting wealth extraction within workplaces and population areas. This can be achieved in different ways taxes being the most obvious, but we shouldn’t rule out direct expropriation to collective structures outside the state. The double edged knife of state-provided health is that you inherently hand over key decision making power of those effected. An alternative would be to obtain control of common self-governing health institutions and fund them through expropriating wealth of the capitalists where capital cannot be completely defeated. There are many smaller steps that can be taken in that direction in the meantime.
One thing that must be put on the table is to gain more direct control over how health programs are implemented, funded, and distributed. A productive conflict is to be had in taking on state and industry monopoly of decisions here. Particularly in the case of women, marginalized racial communities, and workers the necessity of having those effected gain a direct role in shaping the priorities and realization of health care. Health institutions reflect the societies they develop within and reproduce power relationships that exist throughout society. This is to say our health care is a racist, sexist, ableist health care and one in which the decisions over the health of the exploited and oppressed are held in the hands of people who neither understand nor share the interests of those served. Both the oppressive power exerted against populations can be attacked as well as imposing the right to assert autonomy over care of those effected. It is likely that the incoming regimes will be vulnerable on these points as they prove unwilling to accommodate clear inequities and institutionalized health racism, sexism, and oppression of those with chronic diseases.
Organized collectivities asserting the legitimacy of their place in organizing their experience of the health system could provide energy towards further struggles in health and beyond. Along with patients, workers themselves have clear knowledge of the issues within the field which should be married to such a movement in discrediting the positions of management, capital, and the state. Workers movements should likewise contest more control over policy, direction and administration of health institutions, and do so under self-organized workers councils allied with organized communities. This could take the form of combative communal structures uniting neighborhood, municipal, and regional community councils with horizontal workplace councils which expropriate and demand wealth from both the state and capital, and challenging the control of existing public decision making bodies.
Most importantly there is an opportunity to change what is considered a part of health. Health is not merely treating existing diseases or avoiding potential disease. Human flourishing is an expression of good health. It is also something that societies can inhibit or promote. Many things that have been constructed as natural are in fact socially shaped illnesses. For example, suicide, traffic fatalities, and concentrated urban violence represent challenges to the capitalist city and of course are significant causes of morbidity and population health burdens. Such phenomena have deep impacts on multiple points of the health system. A robust health movement could challenge urban space, transit, education, and even the type and availability of work itself in the medium term. Bringing these issues under debate and organizing actions around such, patient and workers movements could further weaken the enemies of public health and broaden the appeal of a direct action movement aimed at the welfare of society as a whole.
The automation revolution underway threatens to make our bodies mere appendages with sedentary work becoming the norm. The pantheon of chronic diseases associated with inactivity have an inherent connection to these capitalist led shifts in the production process. It is another point for a liberatory health movement to demonstrate the connection between systemic exploitation and epidemics. Liberation of time for physical activity and the fight for more human scale work that incorporates the needs of bodies could be a powerful challenge to narratives try to put the blame on individuals.
Growing social isolation is a recognized health danger and obviously connected to broader social ills. Massive resources are poured into creating infrastructure for commerce and consumption, whereas much of social planning overtly tries to minimize social interaction. This has in turn been internalized to an extent with a culture in the US of anxiety towards social interaction. Yet there is already a current underfoot of people longing to connect and interact with others outside of their chosen social circles. Health advocates can demonstrate the impact of organized social isolation arising from the priorities of the planners, legislators, and capitalists who organize collective resources in the interests of the powerful. Part of our fight is to assert new ways to utilize the time and spaces available to us for restorative and necessary social experience, and to fight for expansion of those basic human desires. As capitalism seeks to harness our time and bodies towards profit alone, such a movement can raise awareness of that tension and counterpose it to a society based on solidarity and collective enjoyment of what can be developed in common.
These few examples are far from a comprehensive list of what might be raised in a thorough rethinking of our health. But what about our long term goal? What is an alternative view of health if not a private or state-led system? We should not put too much stock in speculation and crafting blueprints. Any society-wide plan could only be created through the experimentation, input, and crafting of countless individuals. That doesn’t mean we couldn’t or shouldn’t propose broad outlines that can serve as inspiration and ethical guides. The basic functioning of any health system is to help individuals and populations achieve the greatest capacity their bodies and minds can attain. Health in short would be one portion of our quest for meaningful lives. A true alternative to the present would be a system that seeks to mobilize resources on the basis of social solidarity toward maximal expansion of individual development. This would require orienting towards health demands of the population rather than a supply oriented system such as those we see at present.
What this looks like is actually relatively simple. Workers and the community make the decisions over how to produce and distribute health resources. Workers would organize how they produce, but under the priorities and direction of community needs. Health resources would be distributed based on the needs presented with changes coordinated in realtime by workers councils and effected communities. This system would eliminate the administrative infrastructure and replace it with self-organized communal and workplace structures. It would likewise cut the vast waste and harm from unnecessary treatments aimed at profit, insulate the public from the machinations of power which today operate through money and control over hierarchies within the state and health institutions, and could provide society in general with a thriving population with positive ramifications throughout. We also have historic models we can look such as the CNT’s health services during the Spanish revolution of 1936 which approximates such in key ways.19
A revolutionary health movement’s job is to put things like this one the table. Inherent to this is the fight to social space for living and play, meaningful social lives, the capacity to build families and circles, to be able to use our bodies each day and not merely for those who have time and money to afford it, and to develop our full mental and physical capacity to our own self-chosen ends without the exploitation of our bodies by workplaces, businesses, and governments. We are living in a time of unparalleled opportunity for this movement. The challenge is to now find ways in our daily lives to bring together others into an organized force that can disrupt the grip the powerful hold over health, and coalesce into a movement for more fundamental change.
1 Lazarus, D. Sept. 20, 2016. Sick: The biggest increase in healthcare cost in 32 years. http://www.latimes.com/business/lazarus/la-fi-lazarus-rising-healthcare-costs-20160920-snap-story.html
2 Our Revolution. https://ourrevolution.com/issues/medicare-for-all/ Accessed Dec. 2, 2016.
3 Luthra, S. Nov. 9, 2016.Ballot Initiatives: Voters Reject Calif. Drug Pricing Measure; Colo. Single-Payer System. http://khn.org/news/calif-voters-reject-high-profile-drug-pricing-measure/ Accessed Dec. 2, 2016.
4 Newkirk, VR. (2016). Medicare for more:
Hillary Clinton’s new proposal to expand coverage for middle-aged adults provides a glimpse at how she would make Obamacare her own. The Atlantic. Accessed 12/15/16. http://www.theatlantic.com/politics/archive/2016/05/clinton-new-medicare-proposal/483806/
5 Kaiser Family Foundation. Feb. 25, 2016. Public Split On What to Do About the Health Care System. Accessed Dec. 2, 2016.
6 Wikieaks. HRC Paid Speeches. https://wikileaks.org/podesta-emails/emailid/927 Accessed Dec. 2, 2016.
7 Sahadi, J. Jun. 22, 2016. Social Security trust fund projected to run dry by 2034 http://money.cnn.com/2016/06/22/pf/social-security-medicare/
8 Tolbert, J., & Young, K. (2016). Paying for Health Coverage: The Challenge of Affording Health Insurance Among Marketplace Enrollees. Kaiser Family Foundation. http://kff.org/health-reform/issue-brief/paying-for-health-coverage-the-challenge-of-affording-health-insurance-among-marketplace-enrollees/
9 Cassidy, C. (2016). Rising cost of Medicaid expansion is unnerving some states. Associated Press. Accessed 12/15/16. http://bigstory.ap.org/article/4219bc875f114b938d38766c5321331a/rising-cost-medicaid-expansion-unnerving-some-states
10 Congressional Budget Office. (2016). The 2016 Long-term budget outlook. Accessed 12/15/16. https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/51580-ltbo-one-col-2.pdf
11 Kliff, S. (2015). 8 facts that explain what’s wrong with American health care. Vox. Accessed 12/15/16. http://www.vox.com/2014/9/2/6089693/health-care-facts-whats-wrong-american-insurance
12 Smith, M., Saunders, R., Stuckhardt, L., & McGinnis, J. M. (Eds.). (2013). Best care at lower cost: the path to continuously learning health care in America. National Academies Press. Accessed 12/15/16. http://www.nationalacademies.org/hmd/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx
13 Squires, D., & Anderson, C. (2015). U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries. The Commonwealth Fund. Accessed 12/15/16. http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective
14 For example Pain, E. (2011). A Pharma Industry in Crisis. Science Magazine. Accessed 12/2/16. http://www.sciencemag.org/careers/2011/12/pharma-industry-crisis
15 Congressional Budget Office. Dec. 2014. Comparing the Costs of the Veterans’ Health Care System with Private-Sector Costs. https://www.cbo.gov/sites/default/files/113th-congress-2013-2014/reports/49763-VA_Healthcare_Costs.pdf Accessed Dec. 2, 2016.
16 Rover, J. (Jan. 22, 2016). Debate Sharpens Over Single-Payer Health Care, But What Is It Exactly? Accessed Dec. 2, 2016. http://www.npr.org/sections/health-shots/2016/01/22/463976098/debate-sharpens-over-single-payer-health-care-but-what-is-it-exactly
17 Stein, R. (2016). Life expectancy in U.S. drops for first time In decades, report finds. National Public Radio. Accessed 12/16/16. http://www.npr.org/sections/health-shots/2016/12/08/504667607/life-expectancy-in-u-s-drops-for-first-time-in-decades-report-finds
18 For more on anarchosyndicalist organizing, see Solidarity Federation. (2012). Fighting for ourselves: anarcho-syndicalism and the class struggle. Freedom Press. http://libcom.org/library/fighting-ourselves-anarcho-syndicalism-class-struggle-solidarity-federation
19 See the chapter on the socialization of health services in Leval, G. (1975) Collectives in the Spanish revolution. Freedom Press: London. http://libcom.org/files/Gaston%20Leval%20Collectives%20in%20the%20Spanish%20revolution.pdfTweet
Now is the time for both women and men across Scotland, the UK, and internationally to take to the streets to demand an end to violence against women and the attitudes that support it.
The cuts which have descended on the public sector fall heavily on women, and aid and abet violence against women in all its forms.
It is likely to be women that are most severely affected by the changes to housing benefit and to working tax credit. It is likely to be women who will pick up the slack as social services are slashed and subsidies for childcare disappear. It is likely to be women who absorb the rising anger of a generation of youth cast aside unable to obtain either employment or further education.
As radial activists, we need to take advantage of all opportunities to put forward a socialist and feminist perspective on violence against women, including all budget cuts. We must make our position clear: capitalism and patriarchy breed violence.
What we are confronting today, in these austerity budgets, is systemic violence that includes poverty, unemployment; and inadequate housing, childcare, mass transit, social services, and access to education and training– all coupled with discrimination and bigotry based on gender, age, sexual preference, and physical appearance and ability.
Massive layoffs and budget cuts are guaranteeing further disintegration of the public sector– a global crisis that is causing an upsurge in the level of all forms of violence against women.
March 8th — International Women’s Day– is our day. It’s our opportunity to come together to speak out for a world where democratic, anti-authoritarian, socialist feminist values and programs enable people to live lives in ways they never will be able to under capitalism and patriarchy.
We join with others to say zero tolerance of the abuse of women. Defend and expand the public sector. Reverse the budget cuts. Tax the rich.
Member of the Industrial Workers of the World, Spirit of Revolt/Archive of Dissent, and the Scottish Peace Network, Glasgow, March 2017
About IWD History…
1909: The Woman’s National Committee of the Socialist Party of America calls for a national day of protest on the last Sunday of February to support women’s suffrage in the context of the broader movement for women’s rights, workers’ rights, and social justice.
1910: The Women’s Congress of the Socialist International meets in August in Copenhagen and approves the call for an international day of protest. The specific date is left open to the participants in each country.
1913: Russian socialists begin celebrating International Women’s Day. Their intention is to organize rallies for the same day as that set in the United States, but since the Julian calendar lags 13 days behind the Western calendar (not used in Russia until 1918), the events take place in early March by our reckoning.
1917: The date of March 8 for International Women’s Day gets established when tens of thousands of women, demonstrating on that day in Petrograd, the capital of Russia, spark a revolution that topples three centuries of czarist autocracy.
About IWD and Peace….
In August 1914, World War I erupted, leading to the slaughter of millions. International Women’s Day became a focal point for those calling for an immediate end to the war. On February 23, 1917, (March 8 on the new calendar), tens of thousands of Russian women celebrated International Women’s Day by surging onto the streets of Petrograd demanding peace. These militant protests led to the downfall of the czar and, soon afterward, Russia’s decision to leave the war.
Senseless wars continue. Once again we are told that military action is intended to promote freedom and peace, and once again we know the real reasons are about power and wealth. As we demonstrate our opposition to war and occupation this and every International Women’s Day, we commemorate the heroic actions of the women in Petrograd in 1917 and all of us since then who fight back against capitalism and patriarchy. In doing so, we maintain an unbroken link in the struggle for peace, justice, and equality.
About IWD and Power…
International Women’s Day is about power: theirs and ours. Their power puts courts and legislatures in charge of whether or not a woman can have an abortion. Our power leaves this decision where it belongs: with the woman herself.
Their power resides with greedy corporations owned by an ultra-wealthy few that deplete the world’s resources and exploit its people. Our power depends on building a mass movement for a new society rooted in cooperation, equality, and workers and community control.
Their power dumps toxic waste sites in our poorest communities, and builds dams that destroy the livelihoods of countless farmers in our poorest countries. Our power demands environmental justice. Their power busts unions. Our power is at our worksites, talking with our co-workers about the connections between workers’ rights, human rights, and women’s rights. Their power is so-called reforms like Workfare that push women into low-paid, dead-end jobs. Our power is the fight for the creation of good jobs with pay equity and benefits, and the full funding of quality child care, education, and social services.
Their power dupes young men and women into signing away their rights and often their lives for the sake of national glory. Our power gets the word out on alternatives to military service and calls for huge cuts in the military budget. Their power blames hunger and poverty on over-population. Our power blames hunger and poverty on policies and practices consciously designed to protect and enrich the global capitalist class, in particular the agribusiness of the most developed countries.
Their power gets channeled through politicians whose primary allegiance is to the economic requirements of global capitalism. Our power gets exerted through political action completely independent of the mainstream, capitalist parties. Their power resides in exploitation, inequality, domination, violence, and deception. Our power resides in cooperation, compassion, respectful communication, justice, and collective action.
March 8th — International Women’s Day– is our day. It’s our opportunity to come together to speak out for a world where democratic socialist feminist values and programs enable people to live lives in ways they never will be able to under capitalism and patriarchy. That’s the truth. That’s our power.
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Medicine is draped in the language of commerce and science that hide the social forces that sustain and shape health in society. Gender is particularly central both to the experience of health industries and in the sustenance and production of health. Our contribution today comes from Melissa Sepúlveda Alvarado, a Chilean medical student and anarchist organizer. Her argument shows not only how patriarchy shapes health, but also how medicine reproduces patriarchy itself.
Translation by Sara Rahnoma-Galindo
Lately, I have been pleasantly surprised, after many years of feminist pleading, by the existence of a particular intention within the popular movement to incorporate a feminist perspective in its analysis and praxis. It is now so common to use inclusive language in assemblies and meetings, to the point that the words are uncomfortable to those who aren’t used to them. Nonetheless, when the time comes to apply this intention to the plans for struggle by the diverse social movements developing in the Chilean and Wallmapu [Mapuche territories and universalities], the lack of tools for a day-to-day feminist analysis is evident.
The objective of this article is to contribute to the construction process of a feminist perspective in the healthcare sector, and to strengthen the building of programs that are evolving within the Movimiento Salud para Todas y Todos, MSPT (Health Movement for All). To achieve this, it is fundamental to identify the ways in which patriarchy operates and is reproduced within health clinics, be it those administered by the state or those provided by other social agents which women and children tend to utilize.
To my judgement, the first central point is to recognize patriarchy as a system of domination, different from and preceding capitalism, the latter nourishing from it to exploit women and girls throughout the world. The health model is directly related to the prevailing systems of domination, articulating the worldview and social relations that determine the economy, politics and culture of societies. The health system meanwhile, is the materialization of this model and is expressed as a series of formal knowledge, expertise and practices exerted from the state institution or outside it for health control of the population. This framework, particularly within capitalist societies, was conceived with the objective of guaranteeing a “healthy” mass of workers who could fulfill production duties, and in the case of women, to ensure the reproduction of this working class. Consistent with this, the biomedical system – focused on individual pathologies that ignore the social determinants of health, builds the existing healthcare system in Chile, which remains, despite academic attempts showing its inefficiency to achieve a healthier population, because it achieves its productive and reproductive objectives.
On the other hand, it is necessary to acknowledge that the hegemony of this healthcare model is directly related to colonization and western led genocide, strengthened via the fight against other and former ways to carry out medical practices: machis [traditional indigenous Mapuche healers], midwives, healers and doulas were excluded from technical medical knowledge, and all forms of knowledge not coming from institutional scientific backed standards were displaced. Therefore, the first big task is to acknowledge, within the analysis of the healthcare model we live under, that it corresponds to a patriarchal, capitalist and colonial model.
I propose to identify at least four levels in which patriarchy operates in the hegemonic healthcare model and system. These are related to one another and are expressed in the daily practices of healthcare.
i) Historically, the biomedical model had has an androcentric character, that is, one that identified men as the center of reality from which the system and worldview are derived. The subject addressed by the healthcare system is masculine and based on it, a universality is established, being unable to observe gender as a determinant of health conditions and ailments. For example, it is affirmed that being a woman is a risk-factor for developing mental pathologies, though the social conditions that increase the likelihood of psychoaffective pathologies are not taken into consideration. On the other hand, the healthcare system’s approach toward women has been mainly through their reproductive functions, relegating social roles of mother and wife, in a way that their health has been mainly linked, in western medicine, to their reproductive physiology, that is to say: gestation, contraception, family-planning and recently, menopause.
ii) Patriarchal link to the healthcare system. It is irrefutable that in our society exists a customer relationship with the healthcare system, inherent in the [capitalist] market model. What we highlight is that this link is possible due to the patriarchal relations that hide much more than the buying-and-selling of healthcare and that is incorporated early on in our first socialization space: the family. In the [nuclear] family structure, the one who condenses all power is the “pater,” including [the power of] life and death of children, wife/wives and slaves. The stability of this model that we know well is based on dependency. The condition of vulnerability posed by an ill body makes us look for protection, and while this link is reflected in men and women, the latter are particularly dependent on the healthcare system, as they are the most seen – be it [treated] as patients or as caregivers.
iii) Medical violence against women and others with non-masculine identities. We observe the daily infringement of basic rights in healthcare practices. The prejudices and lack of gender perspective by healthcare professionals, translates into violence, where the lack of knowledge about our bodies is transformed into fertile terrain for medical authoritarianism. The abuse towards women and transexuals with mental health disorders, special needs or obesity, as well as obstetric and gynaecological violence, are only a few examples that reveal the inability to recognize women and other identities within the healthcare system derived from the androcentric model of healthcare.
iv) Female subjectivity regarding the health-illness process. Directly relating the patriarchal link to the healthcare system, us women do not perceive ourselves nor are we socially identified as subjects with the capacity for self-determination, thus the incorporation of favorable changes in our health is continuously boycotted. For example, we can assume that there exists a process of feminization of obesity in western societies, particularly among poor women, related to low self-esteem and self-sufficiency when it comes to incorporating changes to their eating habits.
We need to build a new model and system of healthcare that can dignify our peoples, that can decentralize the production and reproduction of capital, and prioritize health over the administration of pathologies and that can actively contribute to the dismantling of patriarchal relations. This will be a long road of reflection, self-criticism, generating new knowledge and recuperating ancestral knowledge. Fortunately, we have taken the initial steps. The invitation to join this process is now on the table.
1. Tell us a bit about yourself. What kind of work do you do, and how did you get involved in the health workers movement?
My name is Al. I’ve worked in the public health sector, off and on, for most of my adult life, both in New Zealand and Australia. I’ve worked in Public Hospitals as a Laundry Assistant, Cleaner, Orderly and currently as a Nurse Assistant/Hospital Aide.
In all this time I’ve been a member and often a workplace delegate of whichever Union has represented workers in each area.
A couple of things have always frustrated me when it came working in the health sector. They are the internal hierarchies and the divisions created by having so many different Unions organising workers in this sector. I see this as hugely divisive as we lose our collective strength when we organise separately.
At times management/bosses will use these division to play workers off against each other, as we have recently seen with the dispute between Ambulance Officers/Paramedics from FIRST Union and St John. There are also currently five separate Unions competing for members and not working cohesively or cooperatively.
I’ve been inspired by the methods of anarcho-syndicalism and especially the activities of the IWW, Solidarity Federations in the UK and Seattle Solidarity Network in the USA. It really was the ideas of the IWW which got me thinking about establishing the Health Sector Workers Network, with the possibilities of one day seeing the ‘one big union’ approach taken in the health sector.
Just to note… the following questions have been answered and edited by a few of the HSWN members, so express a collective view, rather than just mine.
2. In October thousands of Junior Doctors (the equivalent of doctors-in-training in the US) went on strike over working conditions and safety. What conditions led to this strike and what happened with it?
Recent Junior Doctor industrial action has taken place after failed Multi Employer Collective Agreement (MECA) negotiations between the Resident Doctors Association (RDA) and the District Health Boards (DHBs). In Aotearoa/New Zealand there are 20 DHBs – which are different health boards for different regions of the country. Each of these are ‘employers’ and the MECA is the collective agreement between all workers (i.e. doctors in this instance) across all of these health board employers. Negotiations began initially in January 2016. The primary issue in this round of contract negotiations has been working conditions and patient safety. The RDA is pushing for a contractual commitment to reducing the duration of consecutive working days from 12 to 10, a maximum of 10 days per fortnight, and a change from seven consecutive nights to a maximum of four. The DHBs have not agreed to these changes. To date RDA members have gone on strike for two days in October 2016 and and three days in January 2017. A further planned strike in November was aborted after the Kaikoura earthquake. The RDA / DHBs may be moving closer to resolution but as of 22 January 2017 this has not been achieved. It is notable that the, debatably, most dangerous roster practice of 15-16 hour days (often done back to back over weekends) is not been part of proposed changes in rooster practices. The reason for this is not clear.
3. Similar strikes have happened lately in Europe, do you seen any reason why now junior doctors are organizing?
Speaking for the NZ situation this is not the first time in recent history the RDA has undertaken industrial action in the context of failing MECA negotiations. For instance, there were strikes in 2008 when RDA demands for a salary increase (on a debatable rationale of increasing staff retention) were declined by the DHBs. However, on the face of it, the basis for 2016-17 action (working conditions-patient safety) is different. It is possible that Junior Doctors, as part of wider health system changes, are recognising and placing greater emphasis on patient safety and are feeling able to question the status quo more than they have done historically. Health funding in NZ has been declining for sometime and there can be parallels drawn between what is happening here with the UK, where junior doctors went on strike as the British Government have been trying to impose changes with no increase in funding. We may well see similar attacks on our public health system as those happening to the NHS in the UK. We have a similar situation in which health funding has been declining as a proportion of GDP. This is all related to the general crisis in capitalism.
5. You’re involved in the Health Sector Workers Network of Aotearoa / New Zealand. How did this network come together and what work do you do?
HSWN is a solidarity network setup to connect workers throughout the health sector. Our aim is to bring different workers together to organise and act on issues. In Aotearoa/New Zealand, there are a number of Unions which support workers along trade/profession lines. This means often doctors are separate, social workers are in a group and Nurses are their own union. There is a lot of division in our sector, we are trying to see if we can overcome this.
So far we have:
-organised solidarity rallies for the striking Junior Doctors, joining their protest/pickets when they have twice been on strike.
-organised street collections for Ambos from FIRST Union and from doing so been effective in helping them win a backdown from St John on the 10% wage deduction for taking low level industrial action.
-participated as first aiders at a blockade of a weapons conference in Auckland.
-participated in direct actions to prevent the eviction of a tenant from a state house.
-put out a number of solidarity statements in support of other health sector workers direct actions i.e. Junior Doctors and Ambos.
-organised an education evening in Auckland.
6. What are the political goals of the project?
As we have only been in existence for just over one year, these goals have yet to be fleshed out. At this stage network members would all be in agreement that we are trying to build solidarity amongst all workers in the health sector and that our intention is to bring together the most radical health sector workers.
We are also aiming at building links with indigenous and minority groups. We are part of an ecosystem of organisations and movements. Ultimately, building connections with a wide range of groups is part of this project to build a voice and create action towards a more holistic, person centred health sector.
Where we go from here will depend on our activities but as things heat up in the health sector due to massive cuts/underfunding we will hopefully see more direct action that will attract new members.
7. What is the state of the health system in New Zealand and what are the main tasks for a health workers movement in the coming years?
There has been a massive amount of underfunding for the last 6 years, which is making it hard for workers in the health sector. Some figures put this at $1.85 Billion over this time. This is on the back of progressive neo-liberal changes to the health system since the late 1980s (i.e. increase in private providers and NGO, reduction in union membership, diversification and professionalization of workers, etc).
There is significant unmet need and inequalities across New Zealand. This has been growing year after year. The health system is trying to cope with this, but can only do so much.
We imagine the health worker movement needs to realise their potential strength, unite under a collective banner and push for change. The immediate focus concerns funding, but additional struggle around bringing back stable public funded providers, improve availability of union benefits (i.e. bargaining power) and challenge neoliberal capitalist agendas in the health system.
As well as opposing capitalism more generally, one of our goal we have discussed is to articulate a positive vision of a post-capitalist health system. What would it look like? How would it work? This is something that we and all health sector workers need to reflect on and push for in the future. It’s not enough to be critical and resist, we need to build and have vision.
8. Do you see parallels with the issues of health care and health workers in other countries?
The effects of austerity measures are pretty much everywhere. Health systems/services globally are in crisis. As the effects of capitalist economics continue to expand the inequalities inherent in class society we need to start articulating a post-capitalist vision for the health system. We need to build power from below and develop new ways of resistance.
9. Do you have any suggestions for how we can build a truly international movement for health workers and health?
The idea of solidarity should not be a radical concept. There is much that unites us and we need to articulate this through extending solidarity internationally and building links to health sector struggles everywhere. Maybe down the road we may see international federations of radical health sector workers formed and with the rise of far right politics globally, together with resurgence of nationalism, all of our collective efforts to organise are becoming more crucial.
El sindicato de base y desde abajo IWW de Bristol tendrá un taller de introducción a derechos laborales en GB para migrantes y refugiad*s.
¿Cuándo? El sábado 25 de febrero de las 10.30 a las 12.30.
¿Dónde? En The Station, Silver Street (en el centro).
¿Quién puede acudir? Migrantes y refugiad*s de cualquier origen.
¿De qué hablaremos? De derechos fundamentales en el lugar de trabajo, como: tipos de contratos y trabajadores, salario mínimo, como hacer una reclamación y/o organizarse con colegas si hay problemas…
El idioma principal será el inglés. Info en el folleto
The IWW is a union for all workers. We oppose all forms of discrimination. Therefore, we stand firmly against Trump's recent travel ban targeting Muslims. This step towards official discrimination is an attack on all of us.
The IWW stands for organizing and building power for the most vulnerable workers, including all low-wage workers and immigrants. We are heartened to see the massive resistance that sprang up immediately after the order, with people showing their outrage at airports across the country. We are particularly excited by the New York City taxi workers who stopped service at JFK airport, and the airline workers who refused to comply with the ban. There is a palpable feeling that all decent people understand that we need to stand together on this until every non-citizen is allowed entry into the country without fear of reprisal or repercussion.