European healthcare companies are aggressively hunting profits and going on shopping sprees. They are buying up other businesses the world over and in doing so they are increasingly changing the healthcare sector as a whole. This often has devastating consequences for workers and patients. There is a total lack of internationally binding social and employment standards. These companies base their business model on maximizing profits. This turns health itself into a commodity and, as we have seen with the coronavirus pandemic, is leaving older people, the chronically ill, and low income earners in the lurch.
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.
These changes are by no means new, but the capitalist colonization of the healthcare sector is taking on new forms. The influence of financial investors from outside the sector on these private companies is continually exacerbating the contradiction between the need for a healthcare system based on the needs of workers, patients, and those in need of care, and the conditions of the healthcare sector in contemporary capitalism. The present study demonstrates how multinational corporations are increasingly relying on mergers and take-overs (market concentration), diversification of services, and international expansion, in order to maximize profits. A new trend can be identified in the growing number of companies and health and care facilities that have been taken over by private equity firms, which one of the experts cited below describes as the being on “the cutting edge of finance capitalism”.
Private hospital chains and care companies treat union codetermination, collective bargaining agreements, and decent wages and working conditions as a competitive disadvantage, which has led to circumventing collective agreements and social dumping in many cases. As in the healthcare sector overall, workers are overwhelmingly female, and many are immigrants, quite a lot of them work part-time, and the level of union membership is often low. As was already clear, staff shortages lead to higher levels of stress among employees and to health problems and complications for patients and nursing home residents. Turnover among healthcare staff is high due to tough working conditions and inadequate appreciation of their work. A lack of transparency in corporate structures and in the division of responsibility also makes the implementation of collective agreements and standards even more difficult. The oft-proclaimed goal of corporate representatives and politicians to increase remuneration for care and health work has failed to materialize.
As this study proves, union avoidance or even union busting tactics are by no means the exception for these companies; indeed they often form part of their very business model. How successful they are in employing such tactics depends on the strength of the unions, legal regulations, and the business strategies of the company. The author concludes that it is no accident that businesses dominated by private equity firms often engage in union busting, not least because sooner or later they will want to sell the business as a profitable one. But international, publicly traded companies in the healthcare sector also intimidate workers active in unions, threaten lay-offs, bribe and in many cases even surveil their employees. Their goal is either to avoid unions and the representation of workers’ interests, or else to limit the effectiveness of existing collective bargaining agreements.
This has repercussions not only for employees in the companies concerned, but also for working conditions and wages in the public sector. Thanks to higher collective bargaining coverage, German, Italian, and Belgian unions are generally in a better position compared with their counterparts in Central and Eastern Europe, the US, or in the Global South. In countries such as Poland or in the Global South, the arrival of such businesses constitutes a challenge that the unions, often recently established and already struggling with the hollowing out of workers’ rights, are unable to meet with their own resources and means.
But the possibility of doing so lies in stronger international networking between militant union activists, working in coordinated global campaigns for higher wages, better working conditions and standards of care; in effective, conflict-oriented approaches to organizing; and in the politicization of conflicts and disputes in the healthcare sector through the creation and involvement of new social alliances. The expansion of a few firms into Central and Eastern Europe entails serious challenges, but also new possibilities for constructing a lively and militant international union movement, and of creating, with the help of activists and social movements, a new kind of class politics, one dedicated to the issue of care.