Editor's Note -
The following article about private equity firms is relevant to health care because they are aggressively moving into buying health care institutions (such as nursing homes and hospice services), but also doctor's practices, such as emergency room physician practices.
Batten down the hatches!! The "fun" has just begun.
- SPC
Opinion | Private Equity Is Gutting America — and Getting Away With It
Mr. Ballou is an attorney and the author of the forthcoming “Plunder: Private Equity’s Plan to Pillage America,” from which this essay is adapted.
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“Private equity” is a term we’ve all heard but which, if we’re honest, few of us understand. The basic idea is simple: Private equity firms make their money by buying companies, transforming them and selling them — hopefully for a profit. But what sounds simple often leads to disaster.
Companies bought by private equity firms are far more likely to go bankrupt than companies that aren’t. Over the last decade, private equity firms were responsible for nearly 600,000 job losses in the retail sector alone. In nursing homes, where the firms have been particularly active, private equity ownership is responsible for an estimated — and astounding — 20,000 premature deaths over a 12-year period, according to a recent working paper from the National Bureau of Economic Research. Similar tales of woe abound in mobile homes, prison health care, emergency medicine, ambulances, apartment buildings and elsewhere. Yet private equity and its leaders continue to prosper, and executives of the top firms are billionaires many times over.
Why do private equity firms succeed when the companies they buy so often fail? In part, it’s because firms are generally insulated from the consequences of their actions, and benefit from hard-fought tax benefits that allow many of their executives to often pay lower rates than you and I do. Together, this means that firms enjoy disproportionate benefits when their plans succeed, and suffer fewer consequences when they fail.
Consider the case of the Carlyle Group and the nursing home chain HCR ManorCare. In 2007, Carlyle — a private equity firm now with $373 billion in assets under management — bought HCR ManorCare for a little over $6 billion, most of which was borrowed money that ManorCare, not Carlyle, would have to pay back. As the new owner, Carlyle sold nearly all of ManorCare’s real estate and quickly recovered its initial investment. This meant, however, that ManorCare was forced to pay nearly half a billion dollars a year in rent to occupy buildings it once owned. Carlyle also extracted over $80 million in transaction and advisory fees from the company it had just bought, draining ManorCare of money.
ManorCare soon instituted various cost-cutting programs and laid off hundreds of workers. Health code violations spiked. People suffered. The daughter of one resident told The Washington Post that “my mom would call us every day crying when she was in there” and that “it was dirty — like a run-down motel. Roaches and ants all over the place.”
In 2018, ManorCare filed for bankruptcy, with over $7 billion in debt. But that was, in a sense, immaterial to Carlyle, which had already recovered the money it invested and made millions more in fees. (In statements to The Washington Post, ManorCare denied that the quality of its care had declined, while Carlyle claimed that changes in how Medicare paid nursing homes, not its own actions, caused the chain’s bankruptcy.)
Carlyle managed to avoid any legal liability for its actions. How it did so explains why this industry often has such poor outcomes for the businesses it buys.
The family of one ManorCare resident, Annie Salley, sued Carlyle after she died in a facility that the family said was understaffed. According to the lawsuit, despite needing assistance walking to the bathroom, Ms. Salley was forced to do so alone, and hit her head on a bathroom fixture. Afterward, nursing home staff reportedly failed to order a head scan or refer her to a doctor, even though she exhibited confusion, vomited and thrashed around. Ms. Salley eventually died from bleeding around her brain.
Yet when Ms. Salley’s family sued for wrongful death, Carlyle managed to get the case against it dismissed. As a private equity firm, Carlyle claimed, it did not technically own ManorCare. Rather, Carlyle merely advised a series of investment funds with obscure names that did. In essence, Carlyle performed a legal disappearing act.
In this case, as in nearly every private equity acquisition, private equity firm benefit from a legal double standard: They have effective control over the companies their funds buy, but are rarely held responsible for those companies’ actions. This mismatch helps to explain why private equity firms often make such risky or shortsighted moves that imperil their own businesses. When firms, through their takeovers, load companies up with debt, extract onerous fees or cut jobs or quality of care, they face big payouts when things go well, but generally suffer no legal consequences when they go poorly. It’s a “heads I win, tails you lose” sort of arrangement — one that’s been enormously profitable.
But it isn’t just that firms benefit from the law: They take great pains to shape it, too. Since 1990, private equity and investment firms have given over $900 million to federal candidates and have hired an untold number of senior government officials to work on their behalf. These have included cabinet members, speakers of the House, generals, a C.I.A. director, a vice president and a smattering of senators. Congressional staff members have found their way to private equity, too: Lobbying disclosure forms for the largest firms are filled with the names of former chiefs of staff, counsels and legislative directors. Carlyle, for instance, at various times employed two former F.C.C. chairmen, a former S.E.C. chair, a former NATO supreme allied commander, a former secretary of state and a former British prime minister, among others.
Such investments have paid off, as firms have lobbied to protect favored tax treatments, which in turn have given them disproportionate benefits when their investments succeed. The most prominent of these benefits is the carried interest loophole, which allows private equity executives to pay such low tax rates. The issue has been on the national agenda since at least 2006, and three presidents have tried to close the loophole. All three have failed.
Most recently, in 2021, as part of his first budget, President Biden proposed to end the benefit for people with very high incomes. But as he made his pitch, private equity opposition surged, and the largest firms each spent $3 million to $7 million on lobbying that year alone. One firm, Apollo Global Management, employed the former general counsel to the House Republican caucus, a former senior adviser to a past speaker of the House, a former chief of staff to another speaker and a former senator, plus more than a dozen other former officials.
As the plan wound its way through Congress, it grew weaker, and by the fall of 2021, the proposal to end the benefit was no longer a part of Mr. Biden’s budget negotiations. Instead, Congress approved an amendment that largely exempted small and midsize companies owned by private equity firms from a new corporate minimum tax. It was an obscure but important consideration, and with it, private equity firms managed not just to protect a preferred tax advantage — the carried interest loophole, which benefited people like Blackstone’s Stephen Schwarzman, whose income in 2022 was 50 times that of the chief executive of Goldman Sachs — but also to win a new one.
The story further explains why the actions of private equity firms often have such sorry consequences for everyone except themselves. By protecting favored tax benefits, firms receive disproportionate gains when their strategies succeed. But, insulated from liability, they face little consequence if those plans fail. It’s an incentive system that encourages risky, even reckless behavior like that at ManorCare, and is designed to work for private equity firms and no one else.
But if private equity firms are powerful, so too are ordinary people, who’ve had surprising success confronting firms regarding unaffordable prison phone calls and surprise medical bills, among other issues. Even if we’re unlikely to fix our tax code soon, activists and others can still push to update our laws and hold private equity responsible for its actions. Congress can clarify that firms can be sued for wrongs committed by companies they effectively control. States and cities can do the same when portfolio companies are based in their jurisdictions. By making private equity firms responsible for their own actions, we can build a better — and fairer — economy, and make tragedies like that at ManorCare less likely. All we need is the courage to act.
https://www.nytimes.com/2023/04/28/opinion/private-equity.html
Nearly a third of nurses nationwide say they are likely to leave the profession
Maine Legislature may restrict ‘facility fees’ charged by hospitals
The legislation was drafted after a Press Herald investigation revealed that some health care providers add the fees without disclosure or explanation.
by Joe Lawlor - Portland Press Herald - April 28, 2023
Maine lawmakers will consider a bill to strictly regulate – in some cases ban – so-called facility fees that are sometimes tacked onto medical bills and can add hundreds of dollars to the cost of routine hospital visits.
The charges are controversial, with consumer advocacy groups arguing that they unfairly shift costs onto patients without warning and hospitals maintaining that the fees are needed to support an array of uncompensated services they provide.
Senate President Troy Jackson, D-Allagash, and House Speaker Rachel Talbot Ross, D-Portland, are sponsoring the bill, indicating it’s a priority among Democratic leadership.
Jackson drafted the bill after a Press Herald investigation revealed that health care providers are adding – and sometimes hiding – surcharges called facility fees to patients’ bills, often charging hundreds of dollars simply because an outpatient procedure or test was performed in a hospital. The newspaper’s investigation, published last August, reported that patients are surprised, confused and frustrated by such charges, and that insurance companies are not covering them, leaving patients stuck paying the bill.
In one example, a Portland patient complained of being charged a $510 facility fee for a few minutes of care for a sliced finger at Northern Light Mercy Hospital in Portland.
Jackson said Thursday that the legislation will help make health care more affordable and accessible.
“The goal is to clamp down on so-called facility fees and protect patients from being nickeled-and-dimed at every turn,” Jackson said. “We need to make sure that our health care system centers patients, not profits. Prohibiting unwarranted facility fees would mark a step in the right direction.”
A spokesman for Gov. Janet Mills did not respond to questions about whether she supports the bill. But in comments last year, Mills said she is “determined” to “see what more can be done to protect Maine people” from surprise and hidden medical bills.
The bill would ban facility fees from outpatient clinics and other non-hospital locations. For certain procedures, hospitals also would be barred from charging facility fees.
The Maine Department of Health and Human Services would be required to create a list of services for which patients could not be charged facility fees. The list is not spelled out in the bill, but common screenings such as colonoscopies, blood tests, MRIs, mammograms and other routine care would likely be targeted. The legislation also would require DHHS to submit to the Legislature an annual report about facility fees.
Ann Woloson, executive director of Consumers for Affordable Health Care, which advocates on behalf of patients before the Legislature, said the fees are especially anti-consumer because they “are often unknowingly charged to patients.”
“(The bill) provides an initial but measured approach to limiting when and where facility fees can be charged, and requires reporting by hospitals that will help policy makers better understand this particular cost driver,” Woloson said. “If passed, the bill will also certainly help ease a portion of health care cost burden that Maine consumers face.”
Hospitals have contended that facility fees are needed to help recoup the costs of operating hospitals, including treating patients who don’t have insurance coverage or the ability to pay and Medicaid patients who are covered at lower reimbursement rates than patients with private insurance. Unlike hospitals, many private medical practices limit the number of uninsured or Medicaid patients they will care for.
Jeff Austin, vice president of government affairs for the Maine Hospital Association, said the bill would regulate rates, which the state is not set up to do for private insurance.
“We don’t have a (public utility commission) type body set up to do rate regulation,” Austin said. “We shouldn’t be regulating rates in one-off bills by the Legislature.”
Austin said where the state does regulate rates, in the combined federal-state Medicaid program, the state only pays 76% of the cost of hospital services.
“The state has a track record of setting rates that makes us nervous,” Austin said.
Austin said hospitals provide many money-losing services that independent outpatient centers can’t or won’t do, such as clinics in rural areas. Limiting fees could result in reduced access in parts of rural Maine, Austin said, as hospitals look to contain costs.
Proposals to regulate facility fees are in the early stages in most states, if they are being proposed at all. Connecticut was the first and, so far, only state to aggressively regulate hospital facility fees.
Expectant Mom Needed $15,000 Overnight to Save Her Twins
It was Labor Day weekend 2021 when Sara Walsh, who was 24 weeks pregnant with twins, began to experience severe lower-back pain.
On Wednesday, a few days later, a maternal-fetal specialist near her home in Winter Haven, Florida, diagnosed Walsh with twin-to-twin transfusion syndrome, a rare complication that occurs when fetuses share blood unevenly through the same placenta. The doctor told her that the fetuses were experiencing cardiac issues and that she should prepare for treatment the following day, Walsh said.
Her OB-GYN told her that, without immediate surgery, her twins had a high chance of perinatal death, and she could also die.
Both doctors referred Walsh to a fetal surgeon about four hours away, describing him as an expert on the condition.
As Walsh prepared to leave, she received a call from the surgeon’s practice, the Fetal Institute. Walsh said a billing representative told her that before surgeon Ruben Quintero would see her, she needed to pay in full for the consultation, surgery, and postoperative care — a total estimate of $15,000.
Although Walsh had insurance, the biller said the surgeon was not in any private insurance networks nor did he offer payment plans.
“I burst into tears,” Walsh said. “’I don’t want to lose these babies.’”
Her mother agreed to give her money, and Walsh also called her insurer, who advised her to apply for a waiver that could allow them to reclassify the care as in network.
Late Wednesday, Walsh and her husband checked into a hotel near the practice’s office in Coral Gables. The next morning, she handed her credit card and then her mother’s credit card to the clerk at the Fetal Institute. Quintero said her case had advanced to stage 3, meaning there were problems that could cause heart failure in one or both fetuses.
He performed surgery later that day at a hospital about 90 minutes away. On Friday morning, she traveled back to his office for a follow-up. In the following weeks, she had two more consultations.
About five weeks after the surgery, Walsh gave birth to twin girls. They were premature but otherwise healthy.
Then she waited for her insurance reimbursement to come.
The Patient: Sara Walsh, 39, is covered by Blue Cross and Blue Shield of Texas through her employer, a national newspaper publisher.
Medical Service: Fetoscopic laser surgery for treatment of twin-to-twin transfusion syndrome, as well as pre- and postoperative evaluations and X-rays.
Service Provider: The Fetal Institute in Coral Gables, Florida, a practice that specializes in treating rare pregnancy complications.
Total Bill: $18,610 over multiple visits for surgery; pre- and post-surgical consultations; and two follow-up consultations for potential complications that didn’t ultimately require more treatment. Walsh ended up putting $14,472.35 on her and her mother’s credit cards. Her health plan eventually paid the Fetal Institute $5,419.44. Walsh was later partially reimbursed but ultimately paid more than $13,000 out-of-pocket.
What Gives: Walsh’s case falls into a gray area of medical billing between emergency and elective care. Despite being insured, Walsh paid most of the full charges upfront and out-of-pocket for care that three doctors said she urgently needed to save her twins. And she knew the surgeon was an out-of-network provider.
Within 20 hours, Walsh gathered the thousands of dollars she was told she needed to pay before the surgeon would meet with her and prepared to undergo surgery in an unfamiliar hospital. “That 20 hours was just insanity,” she said.
When Walsh called BCBS before her procedure, a representative told her that Quintero was in its network at a few facilities but not at his private practice, where he would evaluate her. Laura Kersey, a billing representative with the Fetal Institute, confirmed to KFF Health News that the practice accepts Medicaid — which covers nearly half of all births in Florida — but does not contract with private insurance.
“Our highly specialized practice sees patients from across the globe,” Quintero said in a statement to KFF Health News. “It would be impractical to join all health plans. If any patient is unable to pay in full for a procedure, we offer them CareCredit or an alternative payment plan, on a case by case basis.”
Neither option was available to Walsh. Approval for CareCredit, a medical credit card, would not have come in time for her next-morning procedure. Walsh said the Fetal Institute denied her request to pay half the bill upfront and the rest over time.
Kersey said requiring upfront payment is the Fetal Institute’s “normal practice.” She said they are transparent about their billing practices and disclose them to potential patients ahead of time. If someone cannot pay, she said, the Fetal Institute sends the person back to the referring physician to find another option.
Walsh said the BCBS representative advised her to complete a waiver intended for patients who receive urgently needed care from an out-of-network provider when it is not feasible to see an in-network provider. Walsh did not have the days or even weeks needed to undergo the insurer’s formal preauthorization process, which could have told her in advance whether BCBS would cover the claim.
Walsh and her mother had paid the Fetal Institute nearly $13,000 related to her surgery, hopeful that BCBS would reimburse them.
In the weeks before Walsh gave birth, the specialist in Winter Haven sent her back to Quintero twice. Both times Quintero evaluated Walsh and sent her home without further treatment. She paid nearly $1,475 more for those visits.
Walsh said she had trouble getting all the documentation BCBS said she needed. In early November, she received the letter of medical necessity explaining the diagnosis.
The letter, signed by Quintero, said that twin-to-twin transfusion syndrome, when left untreated, results in pregnancy loss in 95% of patients.
But Walsh’s situation didn’t count as the type of emergency that could have qualified her for federal billing protections, said Erin Fuse Brown, a law professor and the director of the Center for Law, Health & Society at Georgia State University.
Walsh sought care that was “knowingly out of network, even though there was a figurative gun to her head,” Fuse Brown said, referring to the potential loss of her twins or even her own life.
The federal No Surprises Act, which took effect last year, months after Walsh’s surgery, protects patients who receive emergency services inadvertently from out-of-network providers and only in certain settings — particularly emergency departments and urgent care centers. It also covers nonemergency services received from out-of-network providers, but only at in-network facilities.
Federal laws requiring public access to emergency services apply only to hospitals, not individual providers in their offices, Fuse Brown said. Physicians generally can refuse new patients and charge what they want, if they are transparent about costs, she added.
“It’s not a surprise medical bill if it’s not a surprise,” Fuse Brown said.
Only about 30 to 40 hospitals nationwide can perform fetoscopic laser surgery to treat twin-to-twin transfusion syndrome, Yale Medicine estimates.
Walsh said the specialist who referred her for a next-day surgical appointment gave her just two options for providers in the region, only one of whom practiced in her state. That was Quintero, who is renowned for his work on the condition. He is credited with pioneering the procedure Walsh needed and, with his colleagues, also developed a way to assess the condition’s severity, known as the Quintero staging system.
But it turns out there was another option in Florida. Neither the specialist nor BCBS told Walsh about the possibility of getting care at the University of South Florida, she said. At the time, USF was the only other facility in her state that could have performed the procedure, according to Alejandro Rodriguez, a maternal-fetal medicine physician and an assistant professor at the USF Health Morsani College of Medicine in Tampa. Rodriguez said that USF accepts private insurance, Medicaid, and Medicare and doesn’t require patients to pay upfront for care.
“There was no mention of shopping around,” Walsh said. And with her doctors telling her the lives of her children — and potentially her own — were urgently at stake, she said it seemed her only option was to pay up.
“No parent should face the choice of ‘How much money can I raise in the next 12 hours and is it enough to save the lives of my children?’” Walsh said.
The Resolution: Walsh has spent more than a year trying to get reimbursed by her health plan, repeatedly explaining her complicated case as representatives tried to sort out the proper billing codes for the rare, newer treatment. “No one understood how a doctor charged me more than $10,000 upfront to treat me,” she said.
Walsh also reached out to a medical advocate, who she said concluded that Quintero had billed correctly.
Walsh’s insurance covered Wellington Regional Medical Center, the in-network hospital where Quintero performed the procedure.
The Fetal Institute also filed claims for Walsh’s care with BCBS, telling her they were filing on her behalf. BCBS processed the claims — including for Quintero’s surgical services at the in-network hospital — as out-of-network care and reimbursed Walsh for just a fraction of the more than $18,000 charged.
Her “explanation of benefits” documents stated that Walsh was on the hook for the balance between what Quintero’s practice charged and the $5,419.44 that BCBS paid.
Walsh said BCBS covered her pregnancy-related visits to other, in-network providers, adding that her plan fully covers all diagnostic and laboratory maternity care.
In early 2022, the Fetal Institute forwarded Walsh a check for about $1,282. According to the practice’s records shared with KFF Health News, the check corrected an overpayment on the full charges, totaling $18,610 — which Walsh’s payments and BCBS’ reimbursements had together fulfilled.
Walsh said she had not received any other reimbursement.
BCBS declined to comment on Walsh’s case, citing privacy concerns even though Walsh waived federal health privacy protections, which would allow the insurer to speak to a reporter about the case.
After a KFF Health News reporter contacted the insurer, Walsh said, a BCBS representative called to inform her that her claims had been “escalated,” but eventually determined that the reimbursement was “appropriate” because the provider was out of its network.
The insurer said that the full amount of her balance doesn’t apply toward out-of-pocket maximums in her plan.
The Takeaway: Federal billing protections are not designed to protect patients who choose out-of-network care, even when they find themselves in an urgent situation with few options and little time for comparison shopping.
And often only a handful of specialized providers can treat rare conditions. While that dearth of options raises ethical questions about whether it is OK for a doctor to demand payment upfront for lifesaving surgery, it is legal to do so, experts say. Many Americans would be challenged to raise $15,000 overnight.
“The patient did everything she could,” said Fuse Brown.
Worse, still, she said: When a patient pays upfront, there’s little incentive for providers and insurers to negotiate a fair payment or even cooperate to help patients get reimbursement.
The case shows how consumer protections are still lacking in many situations. “This could still happen tomorrow,” Fuse Brown said.
https://kffhealthnews.org/news/article/expectant-mom-needed-15000-overnight-to-save-her-twins/?utm
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'To Save the NHS,' Nurses Strike in Half of English Hospitals
Nurses and other National Health Service workers walked off the job in half of England's medical facilities on Sunday night amid an ongoing fight for higher pay and better patient safety in the United Kingdom.
The latest NHS strike comes after Royal College of Nursing (RCN) and Unite union members voted to reject the right-wing U.K. government's most recent pay offer, decrying the proposed 5% raise for this year and next as insufficient to offset the soaring prices that have resulted in real pay cuts and a devastating cost-of-living crisis.
Carrying signs with messages such as "strike to save the NHS," healthcare workers marched in London and other cities on Monday.
"I'm striking because claps and applause don't pay our wages."
RCN's work stoppage, which affects half of England's hospitals, community health sites, and mental health centers, is slated to last until midnight.
Ahead of the 28-hour action, a critical care nurse named Charlotte explained that she has "been so torn" by RCN's decision to strike. However, she said, "I know that this is the right thing to do for our patients, their loved ones, for ourselves, for our colleagues, and for the future of the NHS."
"I'm striking because claps and applause don't pay our wages," she continued. "They don't provide incentives for people to come into the profession, they don't improve staffing or patient safety."
"We are a kind, caring, and compassionate profession. We don't want that light to fade," she added. "We're striking and fighting to keep that compassion alive for our patients and for our NHS."
NHS England warned
patients to expect "disruptions and delays to services," noting that
staffing levels in some areas would be "exceptionally low, lower than on
previous strike days," including the massive walkouts in December, January, and February.
According toBBC News, the current strike marks the first time RCN members have "walked out of all areas, including intensive care," but the union has agreed on "some last-minute exemptions so nurses could be pulled off the picket line to ensure life-preserving care was provided."
As the outlet reported:
Around a quarter of trusts involved in the strike have been given extra exemptions for services such as transplant and cardiac care—to allow them to call in some striking nurses because they have not been able to find other staff to fill the rotas.This is to ensure a minimal level of cover—not normal staffing—as the RCN has to abide by trade union rules to ensure life-preserving care can be provided during a walkout.
In previous walkouts, services such as intensive care, chemotherapy, and dialysis have been excluded from strike action.
RCN general secretary Pat Cullen lamented that a strike was necessary and placed the blame squarely on the shoulders of Prime Minister Rishi Sunak and his fellow Tories.
"Only negotiations can resolve this and I urge ministers to reopen formal discussions" with RCN, Cullen said Sunday in a statement. "Nursing staff are looking for a fair settlement that shows the government values and understands their profession."
"We appear a long way from that currently, but I remind ministers it is entirely in their gift," the labor leader added.
The current strike comes ahead of a key Tuesday meeting between several healthcare workers' unions, cabinet ministers, and NHS administrators. While RCN and Unite have condemned the government's offer as inadequate, other unions have voted to accept it, with Unison leader Sara Gorton recently calling the proposed 5% wage increase "the best that could be achieved through negotiation."
Given that some nurses have been forced to rely on food banks, RCN is demanding a pay hike of 5% above inflation. Meanwhile, Britain's Enough Is Enough campaign against neoliberalism on Monday tweeted that lawmakers on the receiving end of "a 32% pay rise since 2010" and subsidized meals are "in no position to lecture a nurse who, since 2010, earns £5,000 less in real-terms about pay restraint."
\u201cIf you're an MP who's had a 32% pay rise since 2010, and have your meals subsidised by the taxpayer, you're in no position to lecture a nurse who, since 2010, earns \u00a35,000 less in real-terms about pay restraint. There's plenty of money; it's just going to the wrong places.\u201d
— Enough is Enough (@Enough is Enough) 1682935347
RCN's walkout was supposed to continue through Tuesday night, but a High Court judge ruled last week that the union's original plans would be unlawful due to the expiration of its six-month mandate for action.
"It is the darkest day of this dispute so far—the government taking its own nurses through the courts in bitterness at their simple expectation of a better pay deal," Cullen said in response to the ruling. "Nursing staff will be angered but not crushed by today's interim order. It may even make them more determined to vote in next month's reballot for a further six months of strike action."
Unite, meanwhile, is not facing the same legal constraints.
On Monday, Unite members at the Yorkshire ambulance service and Guy's and St. Thomas' NHS Trust in central London walked off the job, with the latter demonstrating in the capital, BBC News reported. On Tuesday, Unite members at South Central, South East Coast, and West Midlands ambulance trusts as well as workers at the Christie NHS Foundation Trust and Pathology Partnership, East Lancashire Hospitals NHS Trust, and Sandwell and West Birmingham NHS Trust plan to strike.
Unite leader Onay Kasab told BBC that if U.K. Health Secretary Steve Barclay tries to impose the government's pay offer, the union will take further action.
"We will ballot, and where we have current mandates—some of them lasting up to September—then we will continue taking action, and we will escalate," said Kasab.
The struggle over the future of the NHS comes as the House of Lords proceeds with its third and final reading of the Tories' so-called Strikes Bill. The legislation, already approved by the House of Commons, threatens to take away the right of nurses, ambulance workers, teachers, firefighters, rail workers, and others to strike.
Progressive critics argue that the proposal to fire striking public sector workers who refuse to comply with a mandatory return-to-work notice amounts to a "pay cut and forced labor bill" and would constitute a "gross violation of international law."
During a recent speech denouncing the anti-strike legislation, left-wing Labour Party MP Zarah Sultana said that the bill is about "shifting the balance of power: weakening the power of workers and making it easier for bosses to exploit them and for the government to ignore them."
Enough Is Enough, for its part, has stated: "You're either with nurses, teachers, firefighters, and frontline workers. Or you're with the Tory government. It's time for everyone to pick a side."
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