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Case studies on union busting by healthcare corporations and trade union resistance
Lucy Redler is a qualified social economist (with a focus on the politics of healthcare) and was responsible for care and health on Die Linke’s national committee from 2016 to 2021. She is active in union and solidarity work with hospital workers, including in the support campaign for the workers fighting for more staff and better pay at Charité – Universitätsmedizin Berlin.
The outbreak of the global coronavirus pandemic has dramatically placed the issue of health right in the very centre of our attention. The vulnerability of our own health, as well as the health of people in at-risk groups, became the decisive topic in politics, the media, and in discussions with friends and neighbours almost overnight.
But it also quickly became apparent that such medical dangers are essentially linked to the capacity of the health system—to whether, for example, sufficient protective equipment is available, but above all to whether hospitals and nursing homes are equipped with enough beds and staff to provide decent care. It quickly became clear that chronic staff shortages were making it impossible to deal with the increased numbers of patients. But the lack of material resources, such as ventilators or laboratory capacity, was also apparent.
The problems and crisis-ridden developments that have unfolded in hospitals and nursing homes in recent years have now been exposed as if under a magnifying glass. We are currently witnessing how cost pressure and incessant cost cutting in the healthcare sector is costing human lives all over the planet. Wherever equipment spending is cut, capacities are decreased, and especially where staff numbers are reduced, not only are working conditions catastrophic, but the very provision of healthcare itself is at risk of collapse: this is true during a crisis as well as under ordinary circumstances.
If we contrast this woeful situation with a different reality, the causes of the problem emerge: in 2019, health companies such as Orpea, Korian, and Fresenius made profits in the millions and sometimes even in the billions. While the provision of healthcare is trimmed for efficiency and cost reductions, multinational, publicly traded companies record profits that they hand on to their shareholders. The dangerous cuts in the healthcare sector, which have become evident in the present crisis, are thus a result of turning healthcare into a business. For years, health and care services have been transformed into a lucrative market where private companies now compete, sometimes employing extremely questionable methods, for the largest slice of the pie.
This is the situation that the present study sheds light on: by investigating the business strategies of four significant, global healthcare companies, it demonstrates how their business model functions at the expense of their staff, and how they systematically attempt to repress and destroy union structures, or do not even allow them to develop in the first place. But the study also shows how workers are not letting this happen without putting up a fight. On the contrary, unions and workers are grasping the increasing influence of private companies and the market-based reorganization of the public health sector as one of the primary sites of social conflict.
The present study not only offers insights into the struggles in the healthcare sector. It also reveals the necessity of putting a stop to privatization and commercialization, and of turning the healthcare sector back into publicly funded, democratic, and social infrastructure. Understanding how the business models of the big players impact the healthcare market makes it possible to identify where to attack and where to intervene, in order to hinder further profiteering from healthcare. With this study, we aim to encourage people to participate in union and civil-society struggles towards a healthcare system that is needs-based and democratically controlled.
1 The Healthcare Sector as a Lucrative Investment
1.1 The Rationalization of Healthcare
1.2 Demographic Shifts (Trend 1)
1.3 Market Concentration Through Mergers and Take-Overs (Trend 2)
1.3.2 Aged care
1.4 The Entry of Private Equity Firms into the Healthcare Market (Trend 3)
2 Union Busting and Union Avoidance
2.1 Definition and Origin of the Term
2.2 Union Busting Tactics
Four case studies
3 Orpea: Healthcare Corporation with a Real Estate Division
3.1 Company Profile
3.2 Main Business Strategies
3.3 Wages and Working Conditions
3.4 Union Busting at Orpea
3.4.1 France: Spying and Cover-Ups
3.4.2 Germany: Brutal Practices at Celenus in Bad Langensalza
3.4.3 Poland: Fighting Unions From Day 1
4 Korian: Healthcare Corporation Hunting for Profits in Europe
4.1 Company Profile
4.2 Main Business Strategies
4.3 Wages and Working Conditions
4.4 Union Avoidance at Korian
4.4.1 Overview of the Situation in Belgium, France, and Italy
4.4.2 Germany: Keeping Works Councils Small and Preventing Collective Bargaining Agreements
5 Fresenius: From Bad Homburg to the World, with Questionable Practices
5.1 Company Profile
5.2 Main Business Strategies
5.3 Wages and Working Conditions
5.4 Union Busting at Fresenius
5.4.1 Combating Unions at Fresenius Medical Care
5.4.2 Anti-Union Tactics by Fresenius Helios in Germany
6 Ameos: Swiss Hospital Company Majority-Owned by a Private Equity Firm
6.1 Company Profile
6.2 Main Business Strategies
6.3 Wages and Working Conditions
6.4 Union Busting at Ameos
6.4.1 Restructuring as Tactic, and Targeted Intimidation in Hildesheim, 2016
6.4.2 Dismissals and Threats of Closures in Saxony-Anhalt, 2019–20
7 Comparative Evaluation: Common Trends and Connections
7.1 Main Business Strategies
7.2 Wages and Working Conditions
7.3 Union-Busting and Union Avoidance
Conclusion: Challenges and Methods for Union Counter-Strategies