Columnist E.J. Dionne: Health care heroes bypass government

Wednesday, April 7, 1999 | 11:51 a.m.

NEW YORK -- We'd all want to be taken care of by Carmen Oramas. She's a home health care worker for Cooperative Home Care Associates, headquartered on 149th Street in the South Bronx, a couple of doors down from a pawnshop.

Oramas assists a cancer patient who is in her mid-80s and was near death two years ago. "She began as a hospice case," Oramas says, adding with a proud smile: "She's much better now." Oramas made that happen by keeping a watchful eye on what her patient ate and on the medicine she took. Oramas measures job satisfaction with her patient's words: "You give me life."

Home care is one of the most important and most poorly paid of the health professions. The growth in America's over-80 population demands more devotion such as Oramas'. Yet pressure to cut spending on health care means less money for the tender mercies that help the fragile stay as healthy and as independent as they can be.

Cooperative Home Care Associates is what happens when a caring and entrepreneurial mind thinks about solving more than one problem at a time. CHCA is the brainchild of Rick Surpin, who has spent his life working on the problems of the poor. In the mid-1980s, he saw that the need for more and better-paid home care workers coincided with the desire of poor people, particularly those on welfare, for decent jobs.

So he built a for-profit company owned by its employees, many of whom were once on the public assistance rolls.

Because it's worker-owned, Surpin says, CHCA can afford better wages and benefits than the industry standard. But employees have at times been willing to forgo pay increases, since they share in the profits at the end of the year. Each of the roughly 500 worker owners has a share and a vote, on basic decisions, including elections to the Board of Directors.

This is not utopia. Wages run to about $8 an hour and CHCA can guarantee only 30 hours of work a week. But it's a hugely creative enterprise. Julia Bethea, a worker-owner, told a group of visitors from the Aspen Institute's Domestic Strategy Group that she had spent nine years on public assistance.

"I didn't want to fall back into that pattern of not completing anything." Now, she has work she enjoys, and a share in her company. "I never thought I would own anything in my life," she said. "It's wonderful."

But can this approach be reproduced? Through the Paraprofessional Health Care Institute, a parallel group, worker-owned cooperatives have been created in Philadelphia, Boston, Baltimore and New Hampshire. The institute has also set up training centers for health care providers in Detroit and Pine Bluff, Ark.

"Much has been accomplished," institute president Steven Dawson says, but it "has happened without (government) policy."

Cooperative Home Care Associates shows that innovation is not confined to high-tech companies, entrepreneurship is by no means beyond the reach of the poor and public money, if used right, can create paths toward independence. Instead of mourning the failure of old social policies, Oramas, Bethea, Dawson, Surpin and their colleagues are working to creating new ones.