On the train with a nurse

U.S. healthcare mess and autonomy

What $10 gets you on the Amtrack dining car.

Below, I summarize a conversation, (I mostly listened, he talked), ask some questions, and try to relate it to the autonomy of the Zapatistas.

I met a nurse today on my Amtrak. We are having breakfast together in the dining car. I went per a recommendation from Amtrak forums that the dining car is a fun social experience, because you get seated with strangers. I second this tip!

He is traveling to visit his daughter in California, from Connecticut. It’s his first time going more west than Niagara Falls. He works at St. Joseph's (I think or some other catholic name) hospital. He seemed normal, working class, nice. He said he likes helping people in his job.

I asked him if the Affordable Care Act has impacted his job at all. He said that no, he continues doing what he has been doing, that it doesn’t impact nurses much. But that his hospital’s budget keeps getting cut, because their governor (Malloy) hates hospitals. The nurses pensions were frozen for a number of years and his salary has gone down.

He said for upper management, it’s all a business. Their hospital was recently bought by a large national hospital company. The CEO makes 50 million a year. He said his pension is likely still getting funded. He said he doesn’t keep up much with politics, but his hospital is against TrumpCare, so he assumes it must mean it will cut funding for them as well. He said the hospital doesn’t really care about the patients, or providing care to the most needy, but just about money. It doesn’t affect the nurses much, except for sometimes they get emails from management to try to use less towels, which they ignore, because if someone is bleeding you give them a towel.

He said the problems his hospital faces are too many to be solved by any one thing. There is a lot waste. This includes people who keep coming in for alcohol withdrawal, people found on their floor with heroin needles, the obese. All problems he puts under waste. He says the hospital has whole floors continually devoted to treating and re-treating opioid patients.

Then, he says, that on top of that the US drug companies do all the R&D for the world, which isn’t fair, because then our drugs are way more expensive to make and we have to pay much more.

I asked him if he sees anyone with solutions. He jokes that the only solution is a big asteroid that comes and wipes out all of us and we have to rebuild the whole thing again. He blames over government regulation (gives the example of HIPAA compliance as overbearing and over-regulated). He also talks about patient satisfaction surveys as another imposed regulatory burden. They now survey patients to see if they were satisfied with their visit. If patients are not satisfied, he said they lose 2% of their federal funding. If someone comes in with a stomach ache and asks for oxycontin, the doctor is stuck. If he prescribes it, that is bad for the patient and the whole system, because it is the wrong treatment. If he doesn’t then the patient won’t be satisfied and he, or his hospital, will lose funding. So hospitals now convene hospitality boards to try to improve their scores. Another waste.

He points out that we are still seeing lots of underbrush and he can’t wait for it to change to a different landscape, as he gets farther west. He still has three more days on the train.

Over-regulation or capitalism? It seems to me that removing regulation might clear up some things (like HIPAA), but wouldn’t tackle the fact that everyone in upper management is in it for the money and that there is corruption and greed.

What he continually pointed out is that those doing the serving were essentially good, and it was management and bureaucracy that were corrupt. But it isn’t like management are another species of humans that are inherently more greedy than doctors. Maybe they go into it for different reasons, and you could argue that those are less altruistic possibly. But overall, it doesn’t make sense to me to blame anyone in particular for greed, because it’s obviously a societal problem and not a couple of bad eggs.

Is this waste necessary? Other countries seem to do it better. What are their solutions? Can this be fixed by federal policy change? What if we take his joke at face value, what does a total redo of our healthcare system look like? More importantly, where does the power for that change come from?

I am finally getting to the Zapatista chapter in Living at the Edges of Capitalism, after finishing the one on the Cossacks. My first impressions are that:

  1. Mexico is way more socialist than I realized. As far as I understand it, in the 1970s the government allowed people who worked land to apply for ownership over it. So this gave the people of Chiapas the ability to own a lot of their own land.
  2. The people in Chiapas have a long history of autonomous rule and are accustomed to living outside of government control.
  3. The EZLN was formed with a combination of Maoist socialism and Mayan/indigenous principles.

These things strike me, because Amherst, MA has none of these characteristics. It mostly isn’t inhabited by native people, I have never heard of workers taking over the means of production there, and we are very tied to many different layers of government for administration and aid.

In a couple of the zones that are under Zapatista control, they have cut themselves off from all government aid. It is hard to see that being a positive solution in Amherst. Or how a hospital could be better run like this.

Is decentralization/democratization the answer for us? Do we need more direct control over our region? I resonate with the criticism of capitalism in the Zapatista’s SIXTH DECLARATION OF THE SELVA LACANDONA:

Capitalism is most interested in merchandise, because when it is bought or sold, profits are made. And then capitalism turns everything into merchandise, it makes merchandise of people, of nature, of culture, of history, of conscience. According to capitalism, everything must be able to be bought and sold. And it hides everything behind the merchandise, so we don’t see the exploitation that exists. And then the merchandise is bought and sold in a market. And the market, in addition to being used for buying and selling, is also used to hide the exploitation of the workers. In the market, for example, we see coffee in its little package or its pretty little jar, but we do not see the campesino who suffered in order to harvest the coffee, and we do not see the coyote who paid him so cheaply for his work, and we do not see the workers in the large company working their hearts out to package the coffee. Or we see an appliance for listening to music like cumbias, rancheras or corridos, or whatever, and we see that it is very good because it has a good sound, but we do not see the worker in the maquiladora who struggled for many hours, putting the cables and the parts of the appliance together, and they barely paid her a pittance of money, and she lives far away from work and spends a lot o­n the trip, and, in addition, she runs the risk of being kidnapped, raped and killed as happens in Ciudad Juárez in Mexico.

The markets hides exploitation of people and the environment, and globalization accentuates this. We are hidden from the suffering we cause with our purchases and our consumption. Yet I believe we are still responsible, even if the problems we cause are collective and it is very hard to trace any individual contribution.

I also resonate with their recent thoughts on technology and science.

Not sure where this leaves us with our hospitals though.

Ohio? But really the whole ride looks pretty similar.