We invite medical workers at Providence and across the country to write to us about the conditions they face as a result of the ongoing social crisis, the COVID-19 pandemic and the emerging threats on public health by the Trump administration.

The ongoing strike of just under 5,000 Oregon nurses against the Providence hospital network has now entered into its sixth week. Workers, who are members of the Oregon Nurses Association (ONA), are demanding equal pay at each hospital, as well as commensurate wages with other hospitals in the state. They also want retroactive pay for the time they have been without a contract, including thousands who have been without a contract for more than a year, a restoration of their previous health benefits and genuine safe staffing levels.

The determination of nurses to fight for their demands was demonstrated in the vote two weeks ago to reject by 83 percent a contract proposal brought by Providence and the ONA apparatus. There is also broad support among nurses for a struggle uniting with the rest of the 22,000-strong ONA across Oregon, as well as support from other sections of workers, especially in Portland, for their strike.

Arguably the most critical issue is safe staffing levels. Even before the onset of the COVID-19 pandemic, the nursing profession was hemorrhaging its workforce. Nurses have been facing burnout, workplace violence, inhuman workloads, PTSD (post-traumatic stress disorder) and suicidal ideations and actions. They also have been facing scapegoating by capitalist politicians and corporate executives for the many problems that emerge in healthcare settings, including medical errors and patient deaths.

The ongoing pandemic has exacerbated these problems, killing and crippling tens of thousands of healthcare workers and bringing the entire public health system to the point of collapse. And now under Trump and new Secretary of Health and Human Services Robert F. Kennedy Jr., 5,200 federal public health workers have been fired, including hundreds critical to pandemic surveillance, amid the 10th wave of the coronavirus pandemic and an emerging H5N1 “bird flu” pandemic.

These issues are the direct result of the subordination of medical care to private profit. More than two-thirds of the 6,093 hospitals in the United States recognized by the American Hospital Association are privately run, including those operated by Providence. Nursing positions are often the first to get cut when hospitals announce changes to “core operations” and “strategic growth,” euphemisms for shoveling even more millions to shareholders and executives. Conditions are no better in “non-profit” medical facilities, which use the designation as a tax shelter.

A key role in disarming healthcare workers is played by the pseudo-left organization Democratic Socialists of America (DSA), which has been instrumental in the sellout of New York City nurses in 2023, Michigan Medicine nurses in 2022 and other struggles. A faction of the Democratic Party, the DSA is a middle class organization comprised of union officials, Democratic Party functionaries and other careerists. Its chief function is to prevent leftward moving workers and young people from breaking with the Democratic Party and building a politically independent movement to oppose both corporate-backed parties and fight for socialism.

Nationally, the DSA is an open proponent of the pro-capitalist and imperialist policies of the Democratic Party. This includes US Congresswoman Alexandria Ocasio-Cortez (Democrat-NY), who has consistently defended the Biden administration’s support and funding of Israel’s genocide in Gaza. Ocasio-Cortez also joined two other DSA members in the House vote to ban a strike by 120,000 railroaders in December 2022.

Most recently, the DSA has sought to downplay the danger of fascism and dictatorship posed by the second Trump administration. This includes an article in the Jacobin, the de facto organ of the DSA, claiming that Trump’s fascistic rants, Elon Musk’s Hitler salutes and issuing of dozens of orders aimed at destroying the Constitution are not laying the framework for a presidential dictatorship.

In healthcare, the DSA endorsed the profit-driven policy of “herd immunity” as far back as 2020, originally promoted by the first Trump administration and the extreme right and which became state policy under the Biden administration. Jacobin has also favorably interviewed signatories of the pro-mass death Great Barrington Declaration in late 2020 and called for the reopening of schools, knowing they were significant vectors for the virus.

The organization has therefore been in political solidarity with policies which have produced the conditions which nurses face, including the near collapse of the healthcare system.

Oregon’s Safe Staffing law

In Oregon, one form this has taken is the promotion of HB 2697, the so-called safe staffing law, by Travis Nelson, a former ONA vice president who sits in the Oregon House alongside Farrah Chaichi. Both are part of the Portland DSA caucus, along with the DSA members on Portland’s city council, Tiffany Koyama Lane and Mitch Green.

Nelson has been an officer in the Democratic Party since 2017, Oregon’s co-chair of the delegation to the Democratic National Convention in 2020 and the chair of Oregon’s delegation for Bernie Sanders.

To support the proposed law, which was partially drafted by the ONA, Nelson wrote in 2023 that the bill would expand the previous nurse staffing law, provide an enforcement mechanism, allow nurses to take breaks and mandate adequate staffing. HB 2697 would force staffing levels that “are sufficient to allow nurses to take their meal and rest breaks,” he claimed, adding that “Significant fines would be levied against a facility if they do not comply with these minimum staffing standards.”

In reality, the law does nothing to enforce safe staffing ratios or allow for breaks. It instead institutionalizes understaffing by setting ratios that are worse than what nurses worked with before the law went into effect. As one nurse told the World Socialist Web Site, “Two years ago, there was a 3:1 patient-to-nurse ratio,” which “went to 4:1” after the bill came into effect.

Moreover, as the ONA bureaucracy itself admits, the law only sets out token fines for causing nurses to miss breaks or when a unit is understaffed, fines which cap out at $5,000. To even initiate a fine, workers must file a “valid” complaint to the Oregon Health Authority and cannot file a separate grievance or lawsuit for a missed break.

The law also creates “staffing committees” at each hospital. These are a form of labor-management partnerships comprised of equal numbers of union bureaucrats and hospital executives ostensibly responsible for overseeing staffing ratios at each hospital. They are allowed to change nurse-to-patient ratios in a given hospital or unit by setting up “innovative care models.” And if there is an impasse, the staffing ratios default to the unsafe parameters in the law.

In other words, the profit prerogatives of hospital management will always trump the needs of healthcare workers and their patients.

To add insult to injury, rural hospitals are exempt for two years from the law, a tacit admission by the union that those facilities are so understaffed that they cannot meet the new, lax regulations.

Alongside the ONA, the bill was supported by the Oregon Federation of Nurses and Health Professionals (OFNHP), Service Employees International Union 49 (SEIU) and Oregon American Federation of State, County and Municipal Employees (AFSCME). In a telling statement about the profit-focused character of the bill, it was also supported by Providence itself, as well as the Oregon Association of Hospitals and Health Systems, Oregon Health and Sciences University and Salem Health.

The ONA also recently held a stunt protest at the Oregon state legislature demanding that Providence be forced to disclose how much it is spending on scabs during the strike. In doing so, it promoted the dead-end perspective of pressuring the Democratic Party, as well as obfuscated the fact that it has done nothing to prevent Providence from using scabs in the first place. No appeal has been made to other sections of the working class to mobilize behind the striking nurses for a unified struggle against the attacks on democratic rights and public health.

The bill was also supported by Randi Weingarten, president of the American Federation of Teachers (AFT), under the umbrella of which the ONA operates. Weingarten, the unelected head of the AFT for nearly three decades, has overseen hundreds of school closures and the increase of student-to-teacher ratios, sometimes exceeding 50:1, and she has fought for unsafe school reopenings even as the coronavirus pandemic continues to rage.

Workers must understand the political forces arrayed against them in their struggle. The fight for real safe staffing by the rank and file means a struggle against the conspiracy of the Democratic Party, trade union apparatus and the DSA in service to corporate-controlled and profit-driven healthcare.

It means setting up their own organizations of struggle, rank-and-file committees democratically elected from the hospital floors to enforce the demands of nurses themselves. Providence rank-and-file committees will be able to collaborate with other workers in healthcare, public education and other workplaces in the US and around the world under the umbrella of the International Workers Alliance of Rank-and-File Committees (IWA-RFC).

Healthcare workers know that the greatest obstacle to providing critical care to their patients is the subordination of medicine to corporate profit. But the ending of for-profit medicine will not come from the DSA and Sanders’ impotent calls for “Medicare for All” or begging the ruling class to “pay their fair share.”

The oligarchy that rules America is oblivious to such pious wishes. Instead, in Trump it has consolidated a government of the super-rich, by the super-rich and for the super-rich. Its continued rule is totally incompatible with democracy, science and public health.

In the face of this, the Democrats are prostrate, more concerned about growing protests getting out of their control than with fascism. That is why the struggle to defend all democratic and social rights is the task of the working class, which must take political power, expropriate the private fortunes of the oligarchs and use the wealth created by the working class to meet human needs, including the provision of free, high-quality healthcare to all.