Miami IWW

By Scott Nicholas Nappalos - Miami IWW, June 17, 2015

Disclaimer: The views expressed here are not the official position of the IWW (or even the IWW’s EUC) and do not necessarily represent the views of anyone but the author’s.

Miami IWW Web Editor's Note: The IWW is has always been centered around the debate between trade unions and industrial unions. That debate has fallen by the wayside after the 1930s when industrial unions rose on a mass scale. Today’s article comes from healthcare worker Nappalos, where he explores division between trades, professions, and industry in today’s health care. Looking at a world wide debate between revolutionary unionists in the IWW’s heyday, he offers a critique of both craft and industrial unionism and suggestions to reform the IWW’s vision in light of this.

Healthcare today is built around key divisions of labor between craft specialities. It is highly regulated and the state plays a strong role in determining who can do what work, for how much money, and under who’s authority. There are strong differences across borders and within, but within the US the schema is roughly like this. To keep it simple, we’ll ignore all the crucial technical crafts for the sake of argument. The main players are doctors, nurses, and pharmacists. Doctors diagnose and prescribe treatments. Pharmacists check and dispense the treatments (when they’re medications). Nurses administer the treatments prescribed and monitor/assess the patients course of illness. This is a gross simplification, but it’s instructive.

Where did these divisions come from? Healthcare is not only divided by crafts, but other social factors divide the workforce. For instance we need to add to this the highly gendered nature of the work. Male nurses still represent only around 10% of the US workforce and nurses are the largest trade in the entire country. Florence Nightingale herself reinforced the patriarchal thinking of her day, either unknowingly or exploitively, in helping form nursing under the strict control of physicians giving nurses only a subservient role due to the prejudices of her time. Physicians are becoming more diverse, the rigid hierarchies between doctor and nurse themselves have proven difficult to break with nurses on the bottom in terms of power, respect, and working conditions.

It’s worth questioning the divisions all together. In frontier medicine in the US nurses often played the role of doctor, nurse, and pharmacist. The history of midwifery is riddled with other ideas about performing medical servies than the model of physician-nurse-techs we have today. Pharmacists used to prescribe medications and still do in some countries. Much of what doctors did 30 years ago is now done by nurses. The divisions between the trades are fluid and constantly changing, and are far from any natural division. An even deeper question we should ask is are these divisions of labor the best for society and individuals, or could we do better by transforming how health care is done?