Whenever my doctor talks about politics, he sounds like a moderate Republican. Now in his early 50s, he is carrying on a family tradition in medicine, with an office on Park Avenue and an affiliation with an upscale New York hospital.
He makes a good living, and right now he's probably thinking about his next visit to the fashionable resort where he and his family spend most summers. My doctor is not, in short, a likely candidate for union membership.
Or is he? I thought about him the other day when the American Medical Association, a rather conservative group that long opposed national health insurance as a form of creeping socialism, voted to create a new labor organization for doctors.
The subject of doctors unions had come up when I saw him for a physical a few years ago. He handed me a photocopy of an article from the AMA Journal denouncing health maintenance organizations, managed care and the insurance industry, for encroaching on the physician-patient relationship and interfering with medical care to increase profits.
In a small gesture against his corporate oppressors, he was giving this article to all his patients.
"You guys might have been better off supporting national health insurance when you had the chance, instead of joining with the insurance companies to kill it off," I suggested. "Now you find yourselves working for them on their terms, and you don't like it. Pretty soon you're going to find out that the only way to resist them is to form a union."
My doctor reacted skeptically to that suggestion, though not with nearly the horror expressed recently by a Texas AMA delegate opposed to the unionization proposal. "We are not mere laborers, we are servants," cried Susan Wynn, a doctor from Fort Worth. "We are care givers. We are professionals. The banner that we must carry for our patients is not the union label; it is the oath we took when we became physicians."
Wynn is the exception. Most doctors are receptive to unions now when they never have been before, precisely because they see no other way to uphold the Hippocratic oath against the onslaught of Health Care Incorporated.
Had the United States moved to a single-payer model like the Canadian system, the doctors would have been able to maintain their autonomy and their personal ties with patients. The government would have mandated controls to hold costs down -- but unlike the strictures mandated by the corporate masters of medicine, the governmental controls would have been subject to democratic influence.
Doctors who now contemplate the once-inconceivable step of forming a union don't seem intent on economic gains, although they may well seek to protect their diminishing earnings. Their primary interest in collective bargaining is to push back the insurance bureaucrats who presume to dictate the limits of medical care.
The AMA's union resolution only inaugurates a long, difficult process, including political action, to overcome the antitrust barriers that currently cripple private physicians' ability to form effective bargaining units. But in any field, unionization is always a form of siege warfare.
After trying for decades, the textile workers just managed to win representation at Cannon Mills in North Carolina. There is a lucrative industry devoted to "union prevention," an entire subspecialty of law designed for the same purpose, and an enormous lobbying apparatus in Washington that has successfully stopped any reform of America's antiquated labor legislation.
It's easy to understand why insurance executives and mill owners would want to maintain their employees in servitude, but the general public's indifference and even hostility toward the labor movement has always puzzled me. (The widespread support accorded the UPS strikers was an exception that may signal a welcome new trend.)
Certainly the people we tend to idolize, in particular both athletes and actors, have long used collective action to guarantee themselves higher salaries, better benefits and substantial power over their working conditions. I've always wondered why the AFL-CIO hasn't used more of those famous faces to tell what unions have done for them and their brothers and sisters. (Why not produce a TV commercial with a basketball hero, an Emmy-winning soap starlet and a great movie director, all flashing their union cards?)
It's true that the reputation of unions suffers from their imperfections, which are no worse than those of other human organizations (including big businesses). But media coverage of the labor movement frequently insinuates that there is something hopelessly old-fashioned about unions, a smug white-collar perception that the labor movement itself has only recently attempted to dispel.
Aside from economic self-defense against corporate employers who regard us all as just so many units to be downsized, there is another compelling reason to organize. Unions give a voice to the voiceless and power to the powerless. The movement that overthrew communism in Poland began among the shipyard workers in Gdansk, led by an electrician named Lech Walesa. (That was the only union the American media ever loved.) The movement for democracy in China is increasingly based not only among students, but among workers demanding the free exercise of their rights.
Now the most important organization of American medical professionals is seeking solidarity for its members. Some of our most educated citizens have finally figured out what workers around the world have known for centuries: That it doesn't necessarily matter whether the boss is called a commissar or a CEO. Either way, the advancement of human values sometimes requires collective action.