There’s a notion in the study of American history, on the Left in particular, that Lincoln and the wave of Republicans who were elected in 1860 had no intention of ending slavery in the slave states.6 The Civil War, according to this view, was exclusively about preserving the Union. Supporters can point to several actions by Lincoln early in the war as evidence: a pair of executive orders in 1861, rescinding the freeing of slaves in Missouri and reversing the abolition of slavery, declared by a Union general, in three border states that had remained in the Union. In 1862, Lincoln even writes a letter stating that, if he could, he would end the war without freeing a single slave. The South was bad, sure, but the North was full of racists, too. The Civil War was a mistake and a sham.

All of this happens to fit fairly well with the second, more cynical view of American history that I described above. The Civil War was primarily about projecting power and authority and crushing rebellion, rather than the destruction of an odious institution: and why should it be otherwise, if the odious institution was designed from the beginning to be at the heart of American life?

As it happens, though, this reading also completely ignores what the abolitionist movement in America really was—the ideas behind it and the constraints it operated in.

While it does cost hospitals something to employ residents, they typically get paid twice for it: once by us, working for wages far below the revenues we help generate, and a second time by the federal government, which pays an annual lump sum for each resident (averaging $112,000) as well as a bonus on each Medicare bill submitted by a hospital that utilizes resident physicians.

Another way to understand these subsidies is to consider what it would cost hospitals to replace residents with nonphysicians who also treat patients with some autonomy—for example nurse practitioners. They perform many of the same tasks as residents but have less training and work far fewer hours. The savings residents provide to hospitals are vast. Here in Seattle, a recent posting for an emergency room nurse practitioner offered $32 to $48 per hour for a job with treatment responsibilities limited to patients with minor illnesses. Resident physicians working in the same emergency department, sometimes asked to treat far more serious issues—from hemorrhagic shock after a major car accident to cardiac arrest—are paid an hourly rate about a third of that.

For the most part, there is an unspoken consensus among residents that nothing can be done to change this.

The Residents Rise Up: How Congress and Colluding Hospitals Take Advantage of Doctors in Training

My wife is a resident at a hospital, and it’s been a pretty bad experience so far. She comes home upset, or at least unhappy, three days out of four. She works too hard, for too long, too often. 

As a result, I spend a lot of time and energy trying to lift her spirits, often to no avail. One thing that’s been on my mind lately is the possibility of the residents at Anna’s hospital forming a union or other collective bargaining unit to ask for better conditions, or at least better compensation. There are a bunch of barriers to that ever happening here: most residents accept that “this is just how residency is,” and attitudes in our state are pretty opposed to unions. On top of that, it’s literally written into their contract that they can’t form a union. 

That didn’t stop me from thinking about it a bunch last night and keeping myself awake fantasizing about what might be. There is at least one union for residents, and the National Labor Relations Board ruled earlier this year that residents should be considered employees rather than students in regard to their ability to organize. 

“Corporate America that wants us to buy their products every night on TV, buy this and buy that,” Sanders said. “Well, maybe they should start building those factories in America, so we can produce some of the products that we buy.”

He pointed out that 60,000 U.S. factories had closed in the past 15 years, and he told younger members of the audience about a time when shoppers could purchase products made in America.

Sanders said the largest private sector employer 30 years ago was General Motors, while today it was Walmart – which he said offered “low wages (and) minimal benefits, and (is) vehemently anti-union.”

“That is the transformation of the American economy, from a General Motors type economy, producing real products for real wages and real benefits, to a Walmart economy,” he said.