By Sandy Eaton
“The market has spoken”. This could be an appropriate epitaph for Steward Health Care’s fourteen years of lies, corruption and greed. It could also be the motto of the Healey-Driscoll-Walsh Administration, as well as of House Speaker Ron Mariano and Senate President Karen Spilka.
The health reform task force of the Massachusetts Nurses Association (MNA), chaired by Doctor Judith Shindul-Rothschild, looked at the deterioration of public-sector health care in Massachusetts in 1991. The privatization juggernaut, begun modestly under Dukakis, reached full force with the Weld-Cellucci regime and wreaked havoc among the state’s most vulnerable, with its first major target being prison health, contracted out initially to a for-profit outfit from Florida. We witnessed this, and accurately foresaw that the private-sector deregulation then being enacted by the Democratic-led legislature and the Republican governor would extend this havoc to the private sector.
Chapter 495 of the Acts of 1991, the deregulation of hospital financing, unleashed a cavalcade of consequences that set the stage for our current disaster. Changes mushroomed rapidly, with mergers, acquisitions and closures creating giant conglomerates; massive job reengineering; heavier managed-care penetration; and the invasion of for-profit investor-owned hospital chains. In the midst of the chaos of the ’90s, we fought back.
First, the nurses rallied on the steps of the State House in June 1993, uniting RNs and LPNs, student nurses and patients. We launched a statewide campaign for safe care in 1994. This campaign soon focused in on legislation to create enforceable safe staffing standards. Facing stiff opposition from the hospital industry and its allies, we spent years pushing the legislature without success. MNA and its many allies finally took it to the ballot box in 2018, only to face a crushing defeat there, vastly outspent. So this battle continues, hospital by hospital, often requiring bitter confrontations.
Then many unions and their allies in Jobs with Justice launched the Massachusetts Campaign for Single Payer Health Care, or Mass-Care, in 1995. The goal has been to enact a publicly-financed state trust to replace commercial health insurance, removing payment at the point of service and weakening healthcare disparities by valuing each person’s health – and life – equally. Prospects at the federal level have waxed and waned, so Mass-Care’s concentration has been on winning Massachusetts Medicare for All. This piece of legislation, updated and sharpened with each two-year legislative session, has never been allowed out of committee for a vote, no matter how many union presidents, policy experts or busloads of seniors flock to the State House to lobby, rally and testify. And no matter how many local non-binding ballot questions are handily passed (around sixty so far), reflecting the overwhelming support across the Commonwealth for fundamental reform. The Democratic Party has held a veto-proof supermajority in both chambers of the legislature for as long as anyone can remember, yet this just financing mechanism has remained bottled up despite the fact that it’s a plank in that party’s platform.
And clinicians, primarily MDs, launched the Ad Hoc Committee to Defend Health Care in 1997 with the publication in JAMA of the statement “For Our Patients, Not for Profits: A Call to Action,” with 3,000 signers, and a reenactment of the Boston Tea Party by the dropping of cases of insurance rejection forms into the harbor. The Ad Hoc Committee went on to build a broad coalition to reform Massachusetts health care by putting Question 5 on the 2000 ballot. Three goals were pursued: a managed-care bill of rights for patients and clinicians, the creation of a universal system of health care by July 2002, and a moratorium on for-profit conversions of facilities and services until such a system was in place. In July 2000, the legislature passed a partial remedy. Since that lacked the universal system and the for-profit moratorium, the split coalition carried on to November, narrowly losing 48% to 52%, despite $5 million in around-the-clock attack ads. This close call so frightened the health insurance industry that Blue Cross Blue Shield created a foundation in 2001 to turn Massachusetts’ policy priority away from access to care toward access to insurance coverage, paving the way for the 2006 neoliberal insurance reform.
In 2010, marketplace medicine reached a new low with the creation of Steward Health Care, funded by Cerberus Capital Management, a New-York-City-based, globally-active private equity outfit. Starting with the six Caritas Christi hospitals, Steward-Cerberus acquired four more financially-troubled acute-care hospitals and a rehab facility within a year, making it the third-largest hospital chain in Massachusetts. Despite glowing promises made to eleven communities, it soon began cutting needed services it deemed unprofitable and stripping assets to generate cash flow for expansion out of Massachusetts into the MidWest and Deep South, and even as far as Malta. The wise Maltese were the first to cry foul and fight back, but the emperor’s clothes were soon seen by all to be threadbare.
When Steward finally declared bankruptcy in May 2024, the very politicians that let it work its Ponzi scheme for fourteen years refused to take any responsibility, or remedial action. The people of Quincy, Norwood, Stoughton, Dorchester and Ayer have been left with hollow shells instead of ready access to quality care. Steward’s founder, Ralph de la Torre, and his henchmen, as well as Cerberus, raked in the wealth and have escaped any penalties. Their enabling politicians now strive to put it all behind them, pretending that “the market has spoken,” so they bear no guilt for exposing so many diverse working-class communities to care deserts. They refused to listen to the nurses, the unions, the physicians and the suffering patients for thirty years. Only a powerful organized movement can become the irresistible force that will overcome the immovable object that is corporate rule in Massachusetts and nationally.
We need to turn this system on its head, not just tweak it around the edges. In a decent society, a public authority would assess each community’s current and projected healthcare, public health and environmental needs, and meet them, not by allocating trillions to war in a futile attempt to maintain global hegemony.
Massachusetts Peace Action and its working group Fund Health Care Not Warfare are committed to this project, repeatedly demonstrating our solidarity with all other peace and justice forces here and globally. When the City of Boston or the Commonwealth of Massachusetts claim they have no money to stop the spread of care deserts in Massachusetts, we point to the untold billions diverted to wars, occupations and military bases around the globe. Build the united front against austerity, racism, war and fascism!
Sign this petition to Keep Carney Hospital and Nashoba Valley Medical Center Open!
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Sandy Eaton, RN has spent fifty years delivering care at the bedside, organizing with Local 1199 and then the Massachusetts Nurses Association to build a countervailing force to the growing corporatization of health care. Having been on MNA’s varied elected leadership bodies, Sandy chaired National Nurses United’s Legislative Council. Eaton has written and spoken extensively on nursing, labor and healthcare issues, and is active with Mass-Care, the Labor Campaign for Single Payer and the Fund Health Care Not Warfare working group of Massachusetts Peace Action.