Labor Bargains for Too Little on Health Care and Gets Even Less

It’s been a frustrating year for supporters of single-payer health care reform—aka Medicare for all. They protested as their proposal, which they call the most comprehensive, humane, and economical solution to the health care mess, was sidelined from the beginning. Their jaws dropped as the House’s health-care bill, which subsidizes the private insurance industry by forcing almost everyone to buy private insurance, with some government help, was dubbed "socialist" and "fascist."

And their fight is not over. As 2009 came to a close, the Senate was grinding out a plan that may reject a public option, repeat the House’s curtailment of access to abortion, or tax insurance benefits. Jim Savage, a steelworker’s local president at a Sunoco refinery in Philadelphia, said, "We thought we elected the right people last year. We knocked on doors, made the phone calls, donated money—and we ended up with a shitty bill."

Will this year’s outcome feed cynicism in general, Savage asks, and give health-care reform a bad name? Now that it’s clear the final bill won’t even provide much of a "public option," single-payer activists are assessing the role labor played in the debate. "I don’t think you go into these fights with your compromise position as your opening position," said Tom Leedham, a Teamsters local president who sits with Savage on the steering committee of the Labor Campaign for Single Payer (LCSP). Leedham said it was a huge setback for single payer to be ruled out of the discussion. This left Congressional supporters nowhere to compromise from.

Mark Dudzic, who staffs the LCSP, got specific: "If labor had mobilized independently around single payer from the beginning and held people’s feet to the fire, it could have restructured the whole discussion. Instead of bailing out the insurance industry we could have ended up with something incremental to move us closer to single payer, like moving Medicare eligibility down to age 55. Instead they’ve ensconced private insurance at the heart of the system."

Feet To Fire

In countless actions throughout the year, single-payer activists inside and outside the labor movement did take the fight to the decision-makers. In Portland, Oregon, Jobs with Justice (JwJ) delivered an oversized $395,000 check to Senator Ron Wyden—"what the senator took in campaign contributions from the medical-industrial complex," explained JwJ director Margaret Butler. Single-payer advocates are looking to set up a free clinic for the uninsured—as close to Wyden’s office as possible.

In Detroit, the JwJ chapter invited Canadian unionists to a forum to explain how single payer works in practice. (Canadians were appalled at the stories from this side of the border.) In Los Angeles, union members were among those arrested for civil disobedience at Cigna, the health insurance giant, in late October.

Everywhere union supporters of single payer-trained speakers went to community meetings of all kinds, distributed fact sheets, ran radio ads, met Congressional delegations, and disrupted hearings that excluded single-payer views. Says Leedham, "It’s the easiest organizing I’ve ever done. People totally get it."

Leedham’s most effective handout showed when, given current trends, the cost of family health insurance will equal average household income. The two lines on the graph cross in 2025.

Why Didn’t Labor Lead?

Labor didn’t lead the single-payer movement. Almost all union headquarters devoted their political capital by exhorting members to call their Congresspeople in favor of a public option or against taxing benefits.

Why didn’t the official labor movement lead on single payer—even as a bargaining chip? No surprise here: unions—in particular the public worker teacher unions (AFT), and AFSCME, the state and local employees—are "dependent on Democratic local politicians for much of what they do in collective bargaining and what they’re able to do in new organizing," says one union staffer. "So they are held accountable by the Democrats to carry out Democratic policies." And Democrats from the White House to the statehouses made clear that single payer was untouchable. Add to this the usual acquiescence to "realism"—"I’d love to see single payer, but we’re not going to get it this year"—and the desire to be seen as a "player."

Some labor leaders may have hoped early on that the public option could be solid enough to form a step toward single payer. Indeed, proponents were buoyed by early estimates that half the working-age population, and their families, would enroll.

AFL-CIO President Rich Trumka said labor wouldn’t support a bill without an employer mandate to provide insurance, no taxation of benefits, and a public option. (The Service Employees’ Andy Stern and Teamsters’ James Hoffa, on the other hand, said the public option was not a deal-breaker.)

But the wrangling wore on and the House version of a public option was whittled down to 6 million eligible participants—just 2 percent of the non-Medicare population and far from an effective counterweight to insurance companies. Unions in turn "became wrapped up in the defensive fight around taxing benefits and a symbolic fight around preserving some form of public option," Dudzic says.

Even then, unions had to confront the Obama administration, which wasn’t committed to the public option and seemed unconscious of the unpopularity of taxing benefits that would hit far more people than just union members.

With no cost controls in place, Leedham warns that the tax floated by the Senate Finance Committee, on family plans costing more than $21,000, will hit most union plans by 2013 or soon after. Savage is worried about the tax. The Steelworkers spent months in 2008 convincing members to vote for Obama over McCain on that very issue. "If the bill ends up taxing health-care benefits, I think we’ve completely lost any credibility with the rank and file," he said.

Dudzic points out that an implicit goal for labor was to take health care off the bargaining table, because it eats up so much of the available dollars. That didn’t happen, although (assuming these provisions survive negotiations with the Senate), some small progress was made.

The expansion of Medicaid will help low-income workers, including low-income union members. The employer mandate and penalties for employers who don’t provide insurance will help equalize costs in partially unionized industries, making union employers’ costs not as far out of line.

A $10 million fund for set up for pre-Medicare retirees was described by UAW member Alan Reuther as "temporary" because it will pick up only part of the cost of catastrophic insurance and encourage employers not to drop coverage for retirees under 65.

Forward Or Backward?

As activists anxiously await the House-Senate compromise, opinions are divided on whether an inadequate bill sets back the cause of health-care reform or should be supported for the improvements it does include. Some say the weak public option will be a flop that makes any public health care look bad. Others will support just about any bill to avoid the appearance of a defeat, fearing that to weaken Obama would jeopardize labor’s goals, particularly the Employee Free Choice Act. Savage and others fear the bill will feed the cynicism that already exists about political involvement, recalling union members’ anger after Clinton busted a gut to pass NAFTA in 1993.

Despite piercing disappointments, there is no question that the movement for "Medicare for All" has strengthened in the last year. "We kept the issue in the game throughout the entire discussion," notes Dudzic, "because there was a real movement pushing it, not just insiders but people pushing from outside."

What’s next for the movement? Many groups will turn to winning single payer in their states, whether or not national lawmakers enact a waiver that would make that easier. (Obama’s chief of staff Rahm Emanuel was hyperactive in making sure the Kucinich amendment, which would have allowed such waivers, was killed.)

Geri Jenkins, co-president of the California Nurses Association, says, "Single payer may be something we have to push forward on a state level and prove it works before we roll it out nationally."

"A major barrier we need to confront is ideological," says Sandy Eaton, a member of the Massachusetts Nurses Association. "People are so used to worrying about getting the best benefit you can negotiate…rather than thinking, ‘I have a right to it.’"

Savage says "quit relying on elections and put your feet on the street."

The LCSP’s Dudzic is optimistic that the experiences of this year will win over more activists to the single-payer cause "when public-option advocates realize the public option won’t establish health care for all."


Jane Slaughter has written articles for Labor Notes for 25 years, covering the auto industry and other topics. She coauthored Working Smart.