Opinions to go Online

The occasion of Great Britain’s recent decision to suspend Northern Ireland’s fledgling, power-sharing, Protestant-Catholic government had me re-reading my notes from Gerry Adams’ barnstorming American tour last year. Florida was on the itinerary, and I listened to the Sinn Fein leader at the University of Tampa and at Colin Breen’s Four Green Fields Irish Pub near downtown Tampa.

Adams — who’s no Lucky Charms cut-up — can be pleasant and polite. But the tenor of his comments, in the context of the precarious state of the Good Friday Agreement, was as disarming as it was illuminating. Adams is brinkmanship incarnate.

The current deal-breaker, of course, is the IRA’s reluctance to turn over weapons — “decommissioning” as it’s called in the argot of disarmament. And to do it with enough specificity of detail to assure all parties of Sinn Fein’s commitment to non-violence and the 72-day-old, now suspended, Belfast government. As of now, talks remain broken off with the official disarmament panel of Gen. John de Chastelain of Canada. Secure Semtex supplies and caches of automatic weapons are reminders that the IRA is still armed and not ready for the alternative.

In his Tampa appearance, Adams made clear that the Good Friday peace accord and what was to become the shared-power experiment in self-government was merely a “short term, strategic goal.” Unification with the Republic of Ireland remained, unwaveringly, the long-term goal. And, according to Adams, “long term” is not all that “long” as demographic patterns continue to favor Northern Ireland’s Catholic population. More like “15-25 years out,” he said. In other words, a favorable self-determination scenario looms large.

“Irish unity will manifest itself in whatever society people want,” he stated a year ago. “Peace is not just the absence of violence. It’s also justice

Time was when South Florida’s Cuban exiles and pandering politicians were satisfied with holding veto power over United States’ policy toward Havana. Until Fidel Castro dies off, went their mantra, the embargo lives on. End of discussion — unless anti-embargo voices actually enjoyed the irony of being shouted down by undemocratic demagogues draped in the American flag.

That such lethal leverage, made possible by political expedience and cowardice in Washington, was not in the best interests of the Cuban people or American businesses was incidental. That it was inimical to U.S. foreign-policy credibility was irrelevant. That it was numbskull dumb and perversely unpatriotic was ignored.

The anti-Castro vendetta that masquerades as principled policy toward Cuba, however, has reached a new low with the custody crucible of the shipwrecked Elian Gonzalez. The six year old was found lashed to an inner tube off the coast of Ft. Lauderdale on Thanksgiving morning, after his mother, her boyfriend and nine others had drowned. Now it’s the best interests of a traumatized child that are being sacrificed by the exploitative exile community.

The usual suspects, led by the reactionary likes of South Florida Congressman Lincoln Diaz-Balart and Congresswoman Ileana Ros-Lehtinen, became human velcro in attaching themselves to Elian. They cast him as a victim of Communism in a cold war custody battle between his Miami relatives and his father and two sets of grandparents in Cuba, who have played major roles in his upbringing.

In reality, he was more a victim of reckless endangerment, as his mother’s boyfriend jammed too many smuggled passengers — at $1,000 a pop — into his small aluminum motorboat.

Amid the propaganda firestorm of jingoistic rhetoric and a backdrop of intimidating demonstrations, Judge Rosa Rodriguez of the Miami-Dade Circuit Court has granted temporary custody of Elian to relatives in Miami. Interestingly enough, the consultant who ran her election campaign is also a spokesman for the custody-battling Miami Gonzalezes.

Just days before Judge Rodriguez’s non-conflict-of-interest decision, the Immigration and Naturalization Service had ruled that Elian’s father, Juan Miguel Gonzalez, was the only person it recognized as representing the child’s best interest and should expect him home in Cardenas, Cuba by January 14.

For a state court to blindside the federal government — in the form of an INS order — is a bizarre delaying tactic, likely not legal and a mockery of expeditious justice. But it could work. Although Attorney General Janet Reno says the Rodriguez order has “no force or effect,” the Clinton Administration may, in effect, not want to continue to play the heavy to influential, South Florida fanatics in an election year. A full evidentiary hearing isn’t scheduled until March 6. That’s two more bribery-filled months of ice cream utopia, video games, Nike sportswear, Disney World visits, Universal Studios tours, cell phones, Gap Kids duds and skewed views of daily life in America.

Legally and morally, this is equal parts sham and shame.

Under U.S. law, when one parent dies, custody of a child belongs to the other parent — absent evidence, such as neglect or abuse, that the surviving parent is unfit. Being a card-carrying Communist living in Cuba does not disqualify Juan Miguel Rodriguez from custody of his son. Even if he has a framed glossy of Che and a velvet Fidel in his home. There is no exemption from doing the right thing because Cuba is involved.

What Elian Gonzalez has needed once he had recovered from his ordeal at sea, was the love and security of family members who had raised him — not status as a tug-of-war trophy. He’s at the epicenter of an anti-Castro circus, a pawn between propagandists on both sides of the Florida Straits. He belongs, not to an ideology, but to a family and a father. He is a little boy, not a geopolitical icon.

To date, the irrational, intolerant, Cuban exile community is winning the war of words and warnings. It is inimitably aided by the political ploys of North Carolina Senator Jesse Helms, Florida Senator Connie Mack and Indiana Representative Dan Burton. It is further fortified by the anti-Castro forensics of the Republican Six and the laissez faire-weather approach of the Administration and the men who would be the next Democrat elected president.

Oh, and Castro also wins. The Elian affair is propaganda manna for a dictator. He gets another welcome diversion to rally his island against the Yanqui bully that hypocritically equates material goods with family values.

When he was pulled from the sea, Elian had no idea he would later be thrown to the sharks.

HAVANA — Amid the mix of vintage Chevrolets, Oldsmobiles and Pontiacs, several Mercedes cabs, a few dowdy, Soviet-era Lada compacts, and the omnipresent, sidecar-affixed motorcycles, there was no missing the military truck. Towering over the traffic, it had showed some serious acceleration until it abruptly stopped in front of Parque de la Fraternidad near downtown Havana. Then out jumped two armed, sternly-visaged soldiers.

A dissident sweep, perhaps? Overkill in the war against street-corner speculators? The ultimate, strong-arm strategy in the inchoate, frustrating fight against pickpockets and prostitutes?

Hardly.

The two soldiers immediately hustled to the rear of the truck, where they opened the canvas flap. A frail woman, likely in her 70s, was then helped down by the soldiers. Next came a youth of maybe 10; then his bicycle. Then another two dozen civilians.

This was hitchhiking, Cuban style, a microcosm of the island’s indefatigable, make-do mentality. Outside Havana and other cities there are yellow-suited officials called amarillos who queue up hordes of hitchhikers and wave down state vehicles, which are required to stop and give a lift to a companero — or comrade.

It was a graphic reminder that Cuba is still very much in its “Special Period,” as the post-Eastern Bloc-subsidy epoch is known. In effect, in means “tough it out some more” while Cuba, a country reborn of revolutionary rhetoric and raised on ration cards, recovers from near economic collapse with a diet of dollars and a rapid-growth tourism strategy.

Cuba and its 12 million people have learned to live with the punitive U.S. embargo — called a blockade by all Cubans — and, indeed, Fidel Castro has been able to use it for his own anti-imperialist, scapegoating purposes. But it’s the dollars, legal tender since 1993, and the (mostly) European, Canadian and Mexican tourists that have morphed Castro’s socialist dream into some kind of perverse practical joke.

While the country formally celebrates the 40th anniversary of its revolution this year, the requisite, long-winded speeches — not the least of which, of course, are still by Castro — are now muted with caveats against crime and decadence. Both are directly linked to free-market reforms — such as limited free enterprise and legalized self-employment — and tourism. Especially tourism.

Recently Otto Rivero, the president of the Union of Young Communists, laced his revolutionary boilerplate with dire warnings about “…delinquency, economic crimes against state property, prostitution and its effects, consumption of drugs and the proliferation of children begging from tourists…”

While a pretty fair argument can be mustered for any kind of revolution that would have ousted the corrupt Batista regime in 1959 and introduced free medical care, education and food rations, it’s beyond irony that the seeds are seemingly being resown for the next revolution.

Castro himself warned of as much in a speech to police earlier this year urging a further crackdown on crime, which he compared to a “fifth column” of enemies attacking the socialist revolution from within.

“On you depends internal order, and if we lose the battle for internal order, then we lose everything,” said Castro, who, nonetheless, realizes he can’t woo free-spending tourists to a police state. Club Dread would be a hard sell.

Moreover, all such ideological skirmishes are fought in the context of a tinderbox economy. Cuban peso salaries, including those of professionals, currently average about $15 a month. Pensioners draw an average of $3 monthly. The juxtaposition of such Cubans — typically crammed into aging, tiny apartments within large, crumbling neoclassical structures — with affluent tourists coursing around town can foment frustration, disillusionment and jealousy.

The best stores, goods, accommodations, taxis and even hospital facilities are not for local consumption. Pesos are redeemable for only a half bottle of cooking oil, 5 pounds of rice and four eggs per month, when available. They’ll also pay for a baseball game, and a few centavos will also get you aboard one of the ugly, jam-packed, troop train-like buses called camellos (camels). Virtually nothing worth having, let alone luxury items, is available without dollars — often a lot of them.

No revolution yet known to man has been able, ultimately, to negate human nature. People have wants not satisfied by revolutionary slogans. No revolution has ever been able to justify a sense of low self-worth and second-class status in one’s own country. It’s why revolutions are fought in the first place.

No wonder, then, that an all-too-typical street scene in Old Havana includes an eclectic mix of sleek cabs, bicycle-driven rickshaws and fancy tour buses wending around European tourists, cigar hustlers, generic beggars, young hookers and restaurant touts. And it’s not just the Italians, Brits, Spaniards and Canadians who sport the occasional Tommy Hilfiger shirt, New York Yanqui cap and bad Nike knock-off. And audible somehow, somewhere over the street noise are the inevitable strains of “Guantanamera,” now a siren song for foreign tourists.

Literally overlooking such ticklish tableaus are locals peering impassively down from their laundry-bedecked balconies. What might be on their minds might be Castro’s worst nightmare.

“Castro’s done what he’s had to in order to weather the toughest of times,” says Harry Vanden, a professor of government and international affairs at the University of South Florida and an expert on Latin America. “But he’s had to take some pretty extreme measures to pull it off. They can get away with what they’re doing for a few years, but how long does a ‘Special Period’ last?”

As recently as 1990, Cuba hosted only 100,000 tourists; in 1998, it welcomed 1.5 million. The government, largely reliant on European and Canadian joint-ventures for its boom in hotel construction and renovation, projects 7 million tourists by 2010 — even if the bloqueo remains. (Total joint ventures between Cuba and foreign investors now number approximately 340. There were 50 in 1992. Moreover, total foreign investment, including telecommunications and oil and gas exploration, amounted to $550 million last year. As recently as 1995, it was a mere $80 million.)

“Special Period” concessions that have resulted in an influx of tourists, investors and media — and an infusion of hard currency — have turned doctors, attorneys, engineers and teachers into maids, waiters, bartenders, bellboys and cab drivers. Many moonlight; many more have simply forsaken their formal training altogether. Cuban law prohibits individuals from moonlighting in their professional areas, so doctors, for example, cannot see patients on the side. But there’s no proscription against, say, M.D. maitre d’s or cabbie-neurosurgeons, for that matter.

There have now evolved three classes of people in Cuba: Cubans with dollars; Cubans who can’t get them; and foreigners, mostly tourists, with plenty of them. It’s an increasingly volatile mix.

Besides panhandling, drug-dealing and flesh-peddling, the illegal or “anti-social” means of obtaining dollars are unauthorized rooms to let, unlicensed taxi drivers and a myriad of anti-government scams. These range from fishermen skimming a portion of their catch to sell to restaurants to government cigar rollers selling smuggled, contraband smokes.

Except for those with dollar-dispatching relatives and now friends in America, Cubans’ best chances of legally tapping into the dollar economy are through flea-market vending, farmers’ markets, small (maximum 12 seats), private, in-home restaurants (called paladares) and tourism-related positions that are top heavy in tips. (Merely working for a foreign employer isn’t enough, for the government directly collects Cubans’ salaries in dollars and, in turn, pays the workers in devalued pesos.)

“Some of these (nose-in-the-air gesture) tourists treat us as if we were just (ignorant, lower-caste) brutas,” noted Maria, a pretty and pleasant maid in the histo
ric Hotel Nacional de Cuba in the Vedado section of Havana. “I understand it’s that way in other cultures. But we are not brutas. We just have families to support.”

She was by training, she pointed out, an attorney — and bruta connotation notwithstanding — one of the luckier ones.And then there was Arsenio, a cab driver in his 50s who had been educated as an engineer. He had a prime spot in front of the Nacional — as well as a late model Mercedes. He had a track record for being “honest and punctual” he explained, and that qualified him to bid for the luxury cab, which, in turn, enabled him to work the better hotels.

Arsenio was a veritable tour guide and his insights ranged from the early Soviet years to the current “Special Period.”

The Cuban people, he said, were on to the Russians’ agenda from the start. “They arrived wearing sandals,” he said. “We knew why they were really here.”While he was quite capable of working himself into a geo-political lather over the American embargo, he opined that “Either extreme was not good” meaning the worst of capitalism and the worst of socialism. He chuckled in agreement that both Louis XIV and Robespierre had their failings.

But there was little room for levity in referencing the “Special Period.” His anecdotal accounts included the increased incidence of grave robbings (of older generation Cubans who were customarily buried with their jewelry) to the “apathy” of Cuban youth, who have no memory of the Revolution and are less enamored of Castro than older generations.

“They don’t want to go to school; they want what they see on TV,” said Arsenio. They also see an austere life in the midst of plenty as well as a bleak future continually mocked by socialist slogans and revolutionary rhetoric.

For Castro, the epitome of charisma and emblematic of all that is Communist Cuba, such alienation — not embargoes, CIA plots and the Soviet implosion — is his most formidable challenge in years, maybe ever.

It’s undoubtedly too late to rebottle the genie of tourism, and definitely too late for Castro to change. He made that clear enough late last month when he wrapped up an international economics forum in Havana with a declaration that the current global economy will eventually cease to function. He then predicted that the new world order would be “socialist, communist or whatever you want to call it.”

Some would certainly call it unrealistic as well as the philosophic rantings of one scrambling pragmatically to survive the loss of $6 billion in annual Soviet subsidies.

Too bad Castro never heeded the wisdom of Winston Churchill, whose words more than 40 years ago ring no less true today. “The vice of capitalism is that it stands for the unequal distribution of goods and services,” said Churchill. “The virtue of socialism is that it stands for the equal distribution of misery.”

Unless, of course, you have dollars.

D ANVILLE, PA — In piecemeal fashion, the doctors shuffled into Hemelright Auditorium. Most remained garbed in their lab coats; some still sported surgical caps and foot covers. Light banter was a no show; physicians wore the grim-visaged game faces of modern medicine.

These Geisinger Medical Center doctors — some 60 in number, including oncologists, nephrologists, cardiologists, radiologists and dermatologists — had not gathered on this September evening to hear about medical protocols, research findings or surgical procedures. They had assembled to hear about forming a union.

This is hardly what Abigail Geisinger could have envisioned in 1915 — nor what anyone who has ever taken the Hippocratic oath ever had in mind. Then again, Hippocrates never had to sweat the details of “downsizing” or reimbursement.

Welcome to the brave new world of managed care, where big medicine is very much big business. And that big, landmark campus on the hill — now a component partner in the merged entity known as Penn State Geisinger Health System — is hardly immune.

Sure, Geisinger, which began offering its own health-care plan to its employees in 1984 and is now the largest rural HMO in the country, is still known nationally as a near utopian sanctuary for the practice of big-time medicine in small-town America. But no less sure is that as hub of the PSGHS’s Central Region, it must deal with a current budget shortfall of $18 million. And for all its national acclaim, it is plagued by a ’90s track record of layoffs, outsourcing and flat physician compensation — amid an uneasy environment of competitive pressures and pricey technology.

Geisinger’s growing pains are largely a function of being paid less by the government as well as by insurance companies. Health plan premiums have been flat for three years — and that money represents $3 out of every $5 Geisinger takes in. And being relatively top-heavy in Medicare patients hardly helps.

Such fiscal concerns, however, are compounded, say many clinicians, by morale-sapping perceptions — from the humanistic to the strategic. Communication from the top down, for example, is often seen as arrogant and nominal. Various communication teams — strategic elements in the Geisinger 2000 master plan for change — include clinician input but are often viewed as window-dressing.

Some point to the new Women’s Center as Exhibit A for skewed priorities at a time when other services, such as the Geisinger Pain Clinic, are being pared back. Even casual observers note the juxtaposition of the Women’s Center construction to the nearby, 3-year-old Janet Weis Children’s Hospital — where one whole floor is closed and wards periodically are shut down. Then add worries about a “brain drain” and identity anxiety that Hershey, where PSU’s College of Medicine is quartered, will increasingly supplant the Danville-based Geisinger Medical Center as provider of first resort for most specialties.

It may not be paradise lost, but there is a sense of professional angst, voiced Cassandra-like by some physicians, that Geisinger could eventually become little more than a “very good community hospital” with helicopters.

<"Everyone expects some turnover, and ours may well fall within national figures," acknowledged another surgeon. "But that is just a number. What it doesn't show is the quality of people we're losing. Doctors on the high end, doctors who have started programs, built careers, who are the reason Geisinger has the reputation it does."

<"The compensation plan changes every year, " complained another physician. "We have no idea what the health plans are paying us. We don't have our own accountant. We just don't have enough information to galvanize us to fight this kind of problem."

<"We have nobody (rank-and-file physicians) on the (PSGHS) board; it's always denied," noted another doctor.

<"Morale is at an all-time low," pointed out another surgeon. "We're like sheep being prodded along with stun guns to keep us moving. We feel disenfranchised, devalued and seriously compromised."

And so it went, the rhetoric less of revolution than raw resentment. Some physicians, however, were clearly beyond venting.

“I’m at the end of my rope,” acknowledged a physician especially disturbed over a decline in available anesthesiologists. “I can’t keep working here like this. I’m very concerned about making mistakes. It’s only gotten worse.”

One “mistake” this doctor, who has been at Geisinger for more than a decade, was not about to make, however, was to “burn bridges” by allowing direct quotation.

“Look, I met my (spouse) here; we live on a farm. We have two kids. I love this area. They could make life miserable.”

A Hospital’s “Pilot Test Case”

The gathering was under the auspices of the Assembly of Geisinger Clinicians, the organization recognized by the administration as the collective voice of the more than 270 physicians on staff.

Adding some bite to the bark of the exasperated AGC is the restive, dues-collecting sub-group, the Geisinger Clinicians Group. The approximately 150-member GCG was formed two years ago, with each founding physician putting up $300 toward a legal fund.

At its inception in 1996, a GCG spokesman, Pediatric Surgeon Charles McGill, offered this rationale:

“…Geisinger has been a physician-led organization since its beginning. The clinicians recognize the complex nature of the decisions the business side of medicine must make to meet this challenge. The recent activities of the GCG have to do with the responsibility to be the patients’ advocates. The clinicians want to assure that significant input from the practicing physicians remain in the decision-making process at Geisinger. We feel that is essential as we seek to provide cost effective, quality care with compassion. This is what we feel our patients expect from us and what we expect of ourselves.”

To those ends, the GCG hired a Philadelphia-area law firm to help it address what it now considers its increasing sense of estrangement from, frustration with and even intimidation by the Geisinger administration.

As one key member of the GCG explained, “People are afraid to speak out, whether it’s about a ‘brain drain’ (of high-caliber, senior clinicians), lack of support staff, poor communication, compensation or whatever. People are tired of rumors and scared of reprisals, from subtle forms of harassment to being forced out…But ultimately people will have to put their money where their mouth is.”

For now, however, this surgeon does not want the words out of his mouth attached to his name — or even his speciality.

The GCG’s retained law firm, Beautyman Associates, represents doctors, medical staffs and health care providers in more than a dozen states. Recent clients include the medical staff of the Medical College of Pennsylvania (a beleaguered, Allegheny Health System constituent) and Community Hospital in Reading.

On hand to speak to the assemblage of physicians was Michael Beautyman, who had been brought in initially to either negotiate physician contracts with Geisinger or assist doctors in departing. His primary charge now was to help the physicians navigate the tricky — and possibly expensive — shoals en route to a collective bargaining unit — or CBU.

In addition, Roger Mecum, executive vice president of the Pennsylvania Medical Society, also addressed the group. The PMS, which has seen its membership, including that at Geisinger, erode in the last decade, is interested in lending support to the AGC as a quid pro quo for regaining dues-paying members. Geisinger could become a “pilot test case” for the PMS.

“We are not like we used to be,” acknowledged Mecum. “Physician needs have changed so much.”

In other words, socio-economic issues are now a priority for the PMS. Indeed, the organization even has a sub-division devoted to collec
tive bargaining.

But the PMS is hardly a rush-to-unionize proponent. Mecum used the metaphor of “guerrilla warfare,” which could entail, among other strategies, going public with physician grievances and even holding news conferences.

CBU in September?

Beautyman’s focus was the CBU and some of the legal challenges that would assuredly ensue. He also apprised his audience of results of a recent ballot that asked them to endorse the development of a CBU for Geisinger Clinicians. They were informed that 81% of those (148) responding supported the formation of a CBU and 96% of GCG members authorized legal counsel to contact the Board of Trustees.

“You are all employees of the same health care system,” pointed out Beautyman. “You fit into the parameters of the National Labor Relations Act.”

He also discussed who would be ineligible to vote — supervisors and managers — and assured all present that “No action can be taken (by the administration) for filling out a (union) authorization card.” To do otherwise, he emphasized, would be a violation of federal law.

Although Beautyman fast-tracked his audience through the CBU process up to the secret-ballot election conducted by the National Labor Relations Board, he had the less-than-favorable connotations of physician unions to contend with.Nationally, the number of physicians and dentists in unions has increased from approximately 20,000 to 44,000 in the last decade. Not coincidentally, the proportion of physicians with managed-care contracts rose from 61% in 1990 to 83% in 1995. No one thinks the numbers have gone anywhere but up in the last three years.

However, to many Geisinger physicians — a nationally respected group that is arguably as idealistic about medicine as it is naive about business– “First do no harm” is antithetical to the withholding of any service as bargaining leverage. And that could include a slowdown of paperwork as well as a halt in elective surgery.

“I don’t think collective bargaining will occur here,” flatly stated one physician familiar with speaking in the first person plural. “I don’t think there’s a fire in the belly.”

Perhaps, then, that fire is more like heartburn when doctors size up their perplexing situation on the Danville campus. For most, unions still conjure images of Jimmy Hoffa — not Albert Schweitzer.

Witness the following exchange:

First Doctor: “What is the difference between a union and a collective bargaining unit?”

Attorney Beautyman: “None.”

First Doctor: “Oh.”

Attorney Beautyman: “But one is more palatable. On campus you can call yourself anything you want.”

First Doctor: “I see.”

Second Doctor: “How about consortium?”

Attorney Beautyman: “Yes, consortium is fine.”

Among the myriad physicians uncomfortable with unionization is Danville-based Robert Haddad, M.D., senior vice president clinical operations/Central Region.

Haddad, who still stays active in the practice of internal medicine, said he is “disappointed that a group has elected to pursue that (course). Unions have no place in medicine. It’s not compatible with this culture.”

Echoing those sentiments is Stuart Heydt, M.D., CEO of PSGHS, who began as a Geisinger clinician 25 years ago. Heydt, who last year relocated to Hershey and recently sold his Danville home, termed physician unions “incongruous organizationally and professionally. It’s not constructive to head to a bargaining unit. There’s ample opportunity for those in the system to express their point of view.

“The idea that you can create a bargaining unit that will hunker down and set certain unequivocal demands in order to provide service is antithetical to what we’re about,” stressed Heydt. “I understand that people say they have a perspective and it’s not being heard. But people can influence decision-making if they go about it in an honest and constructive way. They also need to understand we’re at a time when we have to be creative and responsive to the fact that our resources are not infinite.”

Nor, apparently, is the supply of patience.

Whether it results in a CBU or not, the organizing process, which could conceivably include complementary roles for both Beautyman and the PMS, is moving apace. Beautyman has been authorized to send a letter to the PSGHS board putting it on official notice that Geisinger clinicians are heading, maybe inexorably, toward forming a more perfect union if their concerns are not addressed.

That letter, which reportedly was akin to a heat-seeking epistle in its initial draft, will still be packed with anecdotal reports that will not reflect well on administrative deportment or ethics.

There are accounts of physicians verbally agreeing to compensation compromises in order to retain support personnel, only to see those key staffers laid off six months later. Examples of errant communication skills feature the likes of a private E-Mail query responded to with an insulting, intimidating letter — copied to others.

“The tragic flaw here is hubris,” Beautyman said. “You’ve got to know when to compromise. Things haven’t gone well with the HMO. They need to reduce costs. There’s always unhappiness with downsizing.”

His characterization of the PSGHS’s overall manner of operations is that of a “Harvard Business School case study of how not to do it. You should be bringing people into the fold, the malcontents, if you will. But they’re not flexible; they stay in denial.”

Keeping It Personal

According to a number of physicians, there’s no denying that the dynamics at Geisinger have become entirely too personal.

Some overall, negative fallout was inevitable given the onset of managed care restraints that were already apparent when Heydt took over as CEO in 1991. But Heydt’s predecessor, neurosurgeon Henry Hood, was country-doctor friendly, charismatic and a veritable guardian angel of the Abigail Geisinger legacy. Indeed, he would begin all his formal meetings with a brief reflection on the Geisinger mission and a solemn reiteration that headquarters would never leave Danville.

Now, neither Hood nor headquarters are where they used to be. Hood is retired and relegated to nostalgic icon status, and headquarters — along with Heydt — is in Hershey.

“Stu Heydt is making unpopular moves and has the personality of a parson’s table,” assessed Ollie Bates, M.D., a recently retired Geisinger nephrologist. “But the administration has done nothing illegal. Personality, I think, is a major stumbling block. Dr. Hood was a profoundly charismatic individual.”

Heydt, a hard-driving executive given to “tough love” approaches with employees, is mindful — and even understanding — of the perception of administrative arrogance. He underscored “perception.”

“We’re not arrogant,” explained Heydt. “We are sensitive to needs. But it doesn’t surprise me a bit. It’s a translation from, ‘Hey, I’m frightened and anxious and need reassurance, and you don’t seem to be listening to me. You’re not accessible. I want you to look me in the eye and tell me I have job security and all the resources I want.’ When that doesn’t happen, you’re perceived as uppity, arrogant, standoff-ish…But I don’t believe for a minute that any member of our management team is aloof or uncaring.”

Perception, of course, is its own reality. And at Geisinger, reality now means serious talk about the National Labor Relations Act.

“The personal factor may be the biggest factor,” summarized Bates, the former Geisinger clinician. “And that’s a shame. Central Pennsylvania must have a Geisinger.”

Will Union Suit Docs’ Needs?

As Geisinger clinicians plot strategies to buttress their negotiation leverage, they have plenty to ponder regarding the ultimate move — the formation of a union. Since physicians who are employees of hospitals, clinics or HMOs are free to form unions, this is, indeed, a viable option for the Geisinger clinicians.

The American Medical Association estimates that between 14,000 and 20,000 physicians are members of a
union. While this is more than at any time since such unions came into existence in the 1930s, it still only represents an estimated 3% of physicians — and most of these are interns and residents. Among the unions (and their founding years) representing physicians are: The Committee of Interns and Residents, 1957; The Union of American Physicians and Dentists, 1972; and The Federation of Physicians and Dentists, 1981.

Always among the issues is the question of whether a given physician or group of physicians are “managers” or “supervisors.” Only “employees” qualify for an anti-trust exemption and the right to bargain collectively under the NLRA.

These are some other questions — and answers — regarding the CBU process that were presented to the Geisinger clinicians.

Q: Why do we need to form a CBU?

A: A CBU will provide us with the legal ability to require Geisinger management to engage in collective bargaining.

Q: Why is a CBU any different than the AGC or the GCG?

A: The AGC and the GCG are only informal associations that do not receive any protections from the federal government, whereas a CBU is legally recognized to engage in negotiations with management.

Q: What protections or advantages does a CBU have?

A: When properly formed, a CBU enjoys the protections enunciated under the National Labor Relations Act, which requires employers to negotiate in “good faith” with a CBU. Management is under no such obligation to negotiate with the Assembly of Geisinger Clinicians or the Geisinger Clinicians Group.

Q: Can Geisinger take any punitive measures against us?

A: No. The NLRA specifically prohibits management from singling out CBU organizers for termination. Any actions taken in violation of such a prohibition are punishable by law.

Q: How will the CBU be structured?

A: The CBU can be structured in several ways. The CBU could consist of all physicians on staff, or it may be broken down by smaller groups. For example, we may form a CBU for each Geisinger campus.

Q: Who would lead the CBU?

A: The leadership of any CBU is decided by a vote of its constituency. After the CBU is formed, its members would then elect the officers.

Q: How do we form a CBU?

A: Have at least 30% of all eligible employees sign authorization cards or a petition; an election petition is then filed; management can then challenge the petition; an election campaign is commenced; an election is held; certification of CBU if the majority of those voting approves.

Q: What actions can a CBU take?

A: A CBU is authorized to negotiate on behalf of its constituency as to terms of employment.

Q: What is the cost of a CBU?

A: Costs inherent with organizing a CBU depend upon management’s response. The process can be lengthy and involve numerous legal challenges. Therefore, your commitment to the process is required. Once formed, it is the decision of the CBU leadership to determine what annual dues its members will pay.

Q: Could Geisinger management choose to negotiate physician contracts with the GCG and without a CBU?

A: Yes.

OWENSBORO — George H.W. Bush came, saw and concluded: “I am the man to represent the values of Kentucky.”

He just might.

The signs were manifest among the overflow crowd of some 11,000 that greeted the vice president Tuesday at this city’s riverfront English Park. There was usual sea of campaign-issue, blue and white Bush-Quayle signs, but also a swell of the homemade variety — from “God Bless George Bush” to “Stop The Liberal Baby Killers.” Hottest bumper sticker was a “Gun Owners for Bush” item. Least-liked sign had to be “Bush-Noreiga in ’88.”

Western Kentucky is not Republican rich, bit it’s down-home conservative and a Reagan-Democrat bastion. That should do for a Republican redux in these parts. While Michael Dukakis was playing Peoria in front of city hall, George Bush was playing to Middle America — after some Cissy Lynn songs and a free barbecue by the banks of the Ohio River. Blueblood and bluegrass no longer seemed incongruous.

It was a pep rally for the status quo — and it worked wonderfully. The well-scrubbed, white crowd — embellished with high school bands, cheerleaders, ex-Kentucky Governor Louie Nunn and county-and-western patriotism — gloried in a celebrity visit and the sport of liberal-bashing. No lip reading needed here.

George Bush hadn’t added any new applause lines — just more credibility in delivering his right-wing credo. As he intoned, he’s for school prayer, the pledge of allegiance, capital punishment and a strong national defense. He’s against gun control, new taxes, abortion and American Civil Liberties Union card carriers.

So’s his audience.

Moreover, Bush flat-out looks presidential these days, and his handlers have largely de-whined him. America now knows he was a genuine war hero before he started building his well-touted, high-profile, government-service resume. He said he thought he did “reasonably well” in his recent presidential debate — and then let the crowd override his self-deprecating assessment in rousing fashion. There was no need to prove macho credentials with any “kick-ass” rhetoric. “Don’t let THEM take it away” carries the day.

There was also no sign of voodoo logistics. The well-choreographed event, now a Bush campaign staple, was precision perfect.

The vice president, aboard the Executive Queen riverboat, arrived in mid-“God Bless America” by country singer Jody Miller. The concrete stadium seats and adjacent hillside were packed. The crowd had been entertained with bad Hoosier jokes, prodded with anti-Dukakis one-liners, pumped by the “Notre Dame Fight Song” and “On Wisconsin,” and inspired by the “Star Spangled Banner.” Local politicians beamed as only they can; they had helped pull off Owensboros’s first presidential campaign rally since 1952.

And when it was over, and Cissy Lynn and the Coaldusters were back on stage and George Bush and friends were waving good bye from the Executive Queen , good old American free enterprise took center stage. While the GOP picked up the tab for 1,000 bowls of burgoo, 2,500 pounds of barbecued mutton and pork and plenty of soft drinks, it wasn’t nearly enough for the overflow crowd. Into the breach came the local Moonlight Bar-B-Q Inn, which set up a separate food stand. The entrepreneurial Moonlighters sold sandwiches to the thankful, hungry hordes who had gorged themselves on patriotism but had missed out on the free eats.

It was that kind of a day — and campaign to date — for Vice President Bush and the GOP.

The movie “American Graffiti” posed the post-pubescent query: “Where were you in ’62?” Seemingly, all those with a recollection were at a drive-in movie or a record hop. After all, Danny and the Juniors didn’t record “At The Library.” Memories of cramming for trig test, squeezing a combative zit, recoiling from romantic rejection or explaining much of anything to your parents now gets short-shrifted in the interest of nostalgia.

Sure, your folks couldn’t fathom Clarence “Frogman” Henry and loathed Jerry Lee Lewis way before he married his 13-year-old cousin. And come to think of it, they always wanted a son more like David Nelson, Ricky’s dull sibling. But who really harbors such memories anymore?

That’s why nostalgia is so appealing. It’s the sheer, refutation-free selectivity of it all. Truth be told, the era of happy daze consisted more of making do than making out. Nocturnal missions impossible were all too frequent, but what’s it matter now?

Nostalgia, however, has never mattered more.

The post-war baby boomers are now the prime target for the marketing industry. The generation that went from Wally Cleaver to Eldridge Cleaver now has the money as well as the memories. Everything from PTAs to nightclubs can make money off of a ’50s-’60s theme. And isn’t “Trivial Pursuit” really a paean to that same epoch?

Musically, it’s not just rock revivals featuring exhumed acts or Dick Clark reminiscing between emcee spots on “The $25,000 Pyramid” and “TV’s Bloopers and Practical Jokes.” Contemporary songs must vie with oldies for airtime. And, ironically enough, in form — as well as fashion — aren’t the Stray Cats little more than changeling copycats of yesteryear’s hep cats. New Wave, old precedent.

Locally, radio stations increasingly carry the sounds of the permanent wave set. They range from WRBQ’s “Lunchtime at the Oldies” to WHBO’s all-oldies format. Little Anthony is still big; “Long Tall Sally” is still short on clarity; and “Dedicated To The One I Love” is still a generic rush.

There are even a couple of Tampa Bay Area night spots that play nothing but those blasts from the past. Studebaker’s and Chevy’s in Clearwater are less than two miles apart, but light years away from the present for most of their patrons.

“I ain’t fakin’. A whole lotta shakin’ goin’ on.“

It’s designer clothes on untailored torsos, but nobody cares. Gold chains now replace hickeys as status symbols and epidermal jeans reveal bulging hints of a pedal-pusher past, but no one notices, much less minds. The fallout from push-up bras, however, still maintains a timeless quality. We’re not talking furtive glances here.

“Round, round, get around. I get around.”

It looks like the high school dance revisited by the 25th reunion crowd — sans Clearasil, curfews and Sen-Sen. A sock hop with wing tips. There are no upraised basketball hoops hidden from view; a jukebox, dance floor and a 1950 Studebaker Champion are very much in evidence. So are a couple of fernless bars.

“All the cats and chicks can get their kicks at the hop.”

It’s vintage ’50s-’60s, non-stop bop at Studebaker’s. Lines linger long out front for a chance to re-enter a time warped only by the passage of a generation and personas long since overhauled. Who cares if Chuck Berry now nears Social Security and myopia blurs the distinction between a come-hither look and a go-to-hell glare?

“My boyfriend’s back, and you’re gonna be in trouble.”

Although there are some pre-boppers going native and big band aficionados around for the free eats, this is largely a class reunion, circa 1960. No backgammon tables here. Maybe “A Rose And A Baby Ruth” after dancing to “Quarter To Three.”

“Why must I be a teenager in love?”

However disparate this graying, balding, baby-booming group, the music is the common thread. Accountants and attorneys, truckers and traffickers, married couples and swigging singles — most of whom never would have mixed during high school clique years. Bo Didley is more popular here than Bo Derek. Well, almost. But the players in this crowd can remember when “Get A Job” was much more than a parental directive. When “Mashed Potato Time” actually meant burning off calories.

“Come on baby, let the good times roll; come on baby, let me thrill your soul.”

It was a time when performers had colorful — almost chummy — names such as Fats Domino and Chubby Checker. For some reason, a Pudgy Parcheesi never came along. There was Elvis “The King” and Fabian who couldn’t sing — except when compared to Gary U.S. Bonds. Little Richard was outrageous enough to get away with countless variations on a “Tutti-Frutti” theme. Doo-wop remains a reminder of what harmonizing is all about.

“You can do anything, but lay off of my blue suede shoes.”

And incongruously enough, the uncool likes of Pat Boone, Lesley Gore and Patience & Prudence also belonged to that era. But then, so did Sam the Sham and the Pharaohs. “Wooly Bully” is now an escapist anthem of a whole generation otherwise caught up in making a living. Ah, to be a Sha-Na-Nabob again — even for a night. To revel without a cause — other than the desire to cavort down memory lane.

“Don’t be cruel to a heart that’s true.”

Selective recall has a way of making erstwhile backseat lovers and nimble rug-cutters of us all. The Tune Weavers could identify. They recorded “Happy, Happy Birthday, Baby” and nothing else. Oblivion City. One-hit wonders Harvey and the Moonglows would also understand. Their “Ten Commandments Of Love” was as close to a religious experience as peer pressure would permit. And ditto for Little Caesar and the Romans who sang the shibbolethian hit, “Those Oldies But Goodies.”

Still, they all had their moments — out of the charts and into our hearts with their winning-wax ways. The we-generation remembers.

“We’re gonna rock around the clock tonight; we’re gonna rock, rock, rock till broad daylight.”

The music transports a generation back to decidedly simpler times — before Buffalo Bob gave way to the G.I. Bill. When “going all the way” was a rite of passage, not a quid pro quo for dinner. “Scoring” also meant hitting a base-line jumper or beating the tag at home. The “hots” didn’t mean flashes and “mooning” was acceptably asinine. Promotions only catapulted you to the next grade, and riots were akin to food fights. The “British Invasion” had something to do with the War of 1812. When all those people in America’s closets stayed there.

Lee Harvey Who?

“Well, my bucket’s got a hole in it; don’t work no more.”

Nostalgia bender notwithstanding, one wonders how many former wallflowers are now in full blossom. Have the years done their pruning? Females dancing with each other now seem less inviting of new partners than caustic comments