Labor and managed care: an uneasy alliance

Business & Health, June, 1997 by Helen Lippman

"How many people remain with a plan or leave it can be the best indicator of satisfaction," the report continues. "If the number leaving is high, it is important to find out why."

No doubt because many of AFSCME's civil service members work in health care, the union also stresses the importance of safeguards for health workers--a secondary concern for most corporate sponsors. If an HMO's staff is protected from toxic exposures, violent assaults and infectious agents, the report stresses, it's likely that its patients are, too.

Shaping public health policy is another common union activity. As a voice for service workers, the SEIU "tries to hit on all the areas," Engberg says. "We have someone on the NCQA who is working directly with FAcct (the Foundation for Accountability). We support managed care legislation, and we're involved in consumer advocacy coalitions, at the bargaining table and in the education of our members."

Also on the union's agenda: looking beyond what happens at the HMO level to see what kind of quality controls are in place at the hospitals and other facilities the health plans use. But most of the quality monitoring at the point of delivery, Engberg acknowledges, is done by the Joint Commission on Accreditation of Healthcare Organizations. And that, she says, is a flawed process: "Our contention is that the JCAHO is simply the industry monitoring itself."

With nearly half a million SEIU members working in health care, however, the union has "a unique insight," according to Engberg. "Our members see how their jobs are changing and see treatment of patients having to change and are out there raising quality concerns," she says. "And they're telling us the evaluation process is a joke."

On-the-job involvement and the insight that goes along with it are at the heart of the latest, and potentially the largest, managed care-union affiliation. Plans for a partnership between Kaiser Permanente and the AFL-CIO, of which the SEIU is a faction, were announced in April. If the 50,000 union members who work for Kaiser approve the deal, detailed in the box at fight, they'll not only have more input into the way Kaiser facilities provide health care but will nudge other unions to enroll their members in the giant HMO.

IT'S THE PROFIT THING

While it's too early to say whether the rank and file will give the go-ahead to the first national HMO-union deal, Kaiser has two assets in the eyes of labor: It's a union operation and a not-for-profit plan.

Much of labor's skepticism about the country's evolving health care system has more to do with competition and for-profit conversions than with managed care or HMOs per se. In the course of conducting interviews for this article, the idea that quality care and the profit motive are incompatible was a recurrent theme.

The UAW's Turner-Bailey, for instance, agrees with Robert Alpert: When UAW members join HMOs that have been carefully researched and reviewed, they know they're getting the best. While she stops short of saying unequivocally that there are no UAW-sanctioned for-profit health plans, Turner-Bailey calls non-profit status "an extremely held preference. We've always felt that since quality is the No. 1 concern, you do not want profits to get in the way."