Time More Than Reason
Thomas Paine | Doctors Unionizing | Biden and the Unions | Friendshoring
Quote of the Moment
Time makes more converts than reason.
| Thomas Paine
Medical residents are the most overworked and powerless of doctors. Karim Sariahmed, a general internist who just ended a three-year residency at Montefiore Medican Center in the Bronx, relates the situation there, as ‘doctors-in-training’ are planning to unionize, supported by the New York State Nurses Association, who have long been dedicated to safe staffing issues:
Despite the horrible working conditions of residency (which can include 80 workweeks, 28-hour shifts, verbal abuse, or a maternity leave limited to a single week), doctors haven’t historically been big lifters in the labor movement. For Montefiore residents, this is the furthest any unionization effort has gone in decades. But if doctors at Montefiore and more broadly embrace the opportunity to tell a different story about who we are, we could contribute to one of the most important labor struggles of the coming year.
He recalls the trials of the early pandemic, and how the residents and nurses pulled together during those difficult times. And now, Montefiore is reorganizing care practices that these groups feel are unsafe and exploitative:
Montefiore has a reputation for being one of the most exploitative employers in the city. Whether on the floor with other health workers or waiting in line at the cafeteria, I was never far from someone who could relate to the sense that working at Montefiore felt like working in a factory, and that we were all being pressured to go faster by cutting corners. Guided by recommendations from McKinsey consultants, Montefiore recently consolidated its primary care practices, disrupting the care of thousands of patients at the Family Health Center clinic in order to reduce overhead. A broad coalition of community organizations and health workers united across professions fought this change, but they were left out of decision-making and could not put a stop to it. Montefiore already had a history of disinvestment from marginalized communities before McKinsey came along—it closed the ICU at Mt. Vernon Hospital during the height of the Covid-19 pandemic. In that instance, pressure from a coalition of patients and workers resulted in the preservation of some services in a hospital that had been slated for closure.
Sounds a lot like working in an Amazon warehouse. The burnout and disengagement sounds similar:
During the pandemic, more doctors have woken up to the fact that we may just not be that special. Many health workers, not just doctors, face mistrust, and that mistrust has sadly been earned by the exploitative structures we work in as well as the unflattering history of American medicine. For the majority of doctors, prestige will not protect us from increasingly grueling working conditions and occupational hazards, a loss of autonomy, or a demoralizing sense of alienation. These are conditions we share with everyone working in this system.
Biden and the Unions
One of President Biden campaign pledges was to be ‘the most pro-union President you’ve ever seen’, and he’s worked hard to walk on the Union side of the ongoing struggle between large businesses resisting the rising unionization efforts around the country.
To set context, I turn to Steven Greenhouse, author of Beaten Down, Worked Up: The Past, Present, and Future of American Labor, who recently reminded me of these awful facts:
The US is the only industrial nation that doesn’t have a national law guaranteeing workers paid family and parental leave or guaranteeing paid vacation or guaranteeing paid holidays. Similarly, the US is the only industrial nation that doesn’t have a law guaranteeing all workers paid sick days. Moreover, the US is part of a minuscule group of nations that don’t have a law guaranteeing female workers paid maternity leave – the only other nations are Suriname, Papua New Guinea and a few tiny Pacific Island nations.
Workers in the European Union’s 27 nations are guaranteed at least four weeks’ paid vacation, while in the US there’s no such guarantee, and many workers, especially low-wage ones, receive no paid vacation at all. As is well known, the United States is also the only industrial nation that doesn’t have universal health coverage. That can have cruel consequences; for example, the US is the only industrial nation where if a factory, call center, or retail store with 300 workers closes, those 300 workers and their families can lose their health coverage as a result.
So, Biden supports unions because they advocate for these policies, while corporate leaders often view unions as enemies, and in many cases, these leaders — like Starbucks’ Howard Schultz or Tesla’s Elon Musk — will resort to closing stores or factories to avoid unionization efforts. Schultz openly demanded ‘equal time’ with Biden after the President met with Laura Garza, a union leader at Starbucks’ New York City Roastery, and 30-plus other union leaders in May 2022.
The President is trying to broker goodwill at a live and virtual White House meeting last week between large companies like Ford, Kaiser Permanente, and Carrier Global, and union leaders from the United Auto Workers union, Service Employees International Union, and United Food and Commercial Workers union.
President Biden is trying to bridge the gap by focusing the discussions on lowering inflation. The backdrop however is the simmering tensions between unions and corporations, as in the case of the UAW’s efforts to get GM and LG Energy to recognize their rights to represent 900 workers at a battery cell manufacturing joint venture between the two companies, and as Reuters reports,
In May, Biden, in a trip to South Korea, expressed support for workers seeking to unionize joint venture battery plants. Detroit's Big Three automakers all have battery plants in the works with Korean partners.
Maybe he is the most pro-union President ever. He’s walking the walk. Let’s see what happens at the battery plants.
Sarah Kessler offers a dive into Friendshoring, which she defines like so:
The term, a cousin of “reshoring” and “onshoring” and a sibling to “nearshoring,” is shorthand for the practice of relocating supply chains to countries where the risk of disruption from political chaos is low.
She goes on to cite various articles and speeches exploring the term.
In U.S. Must 'Ally-shore' to Reassure Partners, Reassert Power of Democracies, Elaine Dezenski and John Austin repeat their position that
By leaning into what is, in essence, a highly machined, highly efficient global co-production system—but doing so with those countries that share our values and strategically ending overreliance on regimes that seek to harm us—ally-shoring meets more robust and interlaced economic, foreign policy and national security goals. It also offers a specific program to engage allies and demonstrate that by working together, democracies can trump authoritarian models of extraction, opacity and dependency-building like China's Belt and Road initiative.