WHEREAS:

AFSCME represents approximately 100,000 workers in public general hospitals around the country; and

WHEREAS:

Public general hospitals have had a clear mission in this country to serve the health care needs of the community, regardless of ability to pay; and

WHEREAS:

Public hospitals provide specialized services, too costly for most private hospitals, to the entire community. These include burn units, trauma centers, emergency alcohol, drug abuse and child abuse centers, neonatal intensive care and poison control units, and increasingly assume the major responsibility for the alarming growth of the AIDS epidemic; and

WHEREAS:

Public hospitals are caught in a paradoxical position — the economic and political situation that threatens their viability also generates an increased demand for their services. Their financial situation continues to worsen due to cuts in Medicare and Medicaid, low local and state funding, the Reagan Administration's pro-competition policies, and the rising number of uninsured citizens. The result has been overcrowding, cuts in services, a rise in "patient dumping" by private hospitals, and threats to privatize or close hospitals; and

WHEREAS:

Public hospitals care for the increasing number of uninsured who are refused care elsewhere. The number of patients transferred from private to public hospitals because of their lack of insurance has taken on a new urgency in recent years. In many of the large urban public hospitals such as Cook County in Chicago and D.C. General in Washington, D.C., there has been an increase of 500% since 1980. Parkland Hospital in Dallas found that nearly 75% of its transfers in 1985 had no insurance; and

WHEREAS:

This alarming trend subjects public hospital workers to unbearable working conditions more patients, sicker patients and fewer resources. This is a nationwide problem that has serious and often fatal results; and

WHEREAS:

Uncompensated care represents an increasingly important area of concern for public hospitals and state and local governments. Bad debt and charity care has more than doubled since 1980. Public hospitals are responsible for 22% of all hospital care but provide 40% of all uncompensated care; and

WHEREAS:

Public hospital budgets have inflated less rapidly than the rest of the industry and operate as efficiently as other U.S. hospitals, but are at a disadvantage because of their teaching responsibilities, the high cost of specialized services they provide, and the disproportionate share they carry for the uninsured; and

WHEREAS:

Large public hospitals have lost millions in recent years because they are forced to transfer private paying patients to make room for the medically indigent; and

WHEREAS:

Many public hospitals occupy outdated physical plants that are especially costly to maintain or that need to be replaced. At the same time, public hospitals must spend all available revenues to cover operating losses and thus cannot afford capital improvements. Operating losses at public hospitals give them poor credit ratings; and

WHEREAS:

The precarious financial situation of public hospitals tempts public officials to privatize these hospitals. Handing over public responsibility to the same private interests that have been a major cause of the increase in the nation's health bill is not the panacea many thought it to be; and

WHEREAS:

In 1987, 79 hospitals in the U.S. closed, 14 of them public hospitals; and

WHEREAS:

Studies have shown that privatization of public hospitals has led to increased patient costs and Medicare costs. For-profit providers use significantly few staff, more part-time staff, pay low wages and offer few fringe benefits, all resulting in higher staff turnover rates and a lower quality of care; and

WHEREAS:

Privatization threatens equal access to care and public accountability is lost to business interests; and

WHEREAS:

The survival of public hospitals is dependent upon major reforms in health care financing.

THEREFORE BE IT RESOLVED:

That AFSCME shall continue to lead the fight against federal and state cutbacks in health care programs and support legislation to adequately compensate hospitals serving a disproportionate share of the poor and uninsured; and

BE IT FURTHER RESOLVED:

That AFSCME shall support federal and state legislative initiatives that will fund uncompensated hospital care and require public and private programs to provide health insurance to the uninsured; and

BE IT FURTHER RESOLVED:

That AFSCME work to ensure fiscal viability of public hospitals and to support policies which enable public hospitals to gain access to capital; and

BE IT FURTHER RESOLVED:

That AFSCME oppose efforts to privatize public hospitals and in the event that a sale or lease to a private operator occurs, to fight for protection against losses in wages, hours and working conditions, including union representation by AFSCME; and

BE IT FURTHER RESOLVED:

That AFSCME continue to support federal and state legislation prohibiting "patient dumping" — the transfer of patients from one hospital to another for economic reasons; and

BE IT FURTHER RESOLVED:

That AFSCME seek to climate the legal advantages that for-profit health care facilities enjoy over publicly owned facilities including the return of equity, depreciation allowances and tax breaks, allowances and tax breaks for interest expenses and for other acquisition costs; and

BE IT FINALLY RESOLVED:

That AFSCME shall work with community coalitions to create and expand support for public hospitals.

SUBMITTED BY:

James Butler, President
Louise DeBow, Recording Secretary
AFSCME Local 420, Council 37
New York, New York