John M. Laforge
Liberals & Dictators
Health Care Bargaining
2010 & Beyond
CFR & Obama
Laurence h. Shoup
Nicolas J.S. Davies
Robinson's Latin America
Zaps - 01-10
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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.
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AnnouncementsLABOR - May 1 is May Day. Workers of the world will celebrate the 124th anniversary of International Worker’s Day. Born out of a call for an 8-hour workday in the United States, this day is an opportunity for all workers to show their solidarity with one another, as well as to renew the call for labor rights.
FARM CONFERENCE - The Farm Conference on Community and Sustainability will be held May 24-26 in Summertown, TN, in partnership with the Fellowship of Intentional Communities. Tour green homes, see sustainable food production, learn about solar installations, alternative education, midwifery, and more.
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MOUNTAINTOP - The 2013 Mountain Justice Summer Activist Training Camp will be held May 19-27 in Damascus, VA. It will be a week of workshops, field trips to view Mountain Top Removal coal mines, direct actions, and service project.
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CHILDREN’S DEFENSE - July 15-19, join clergy, seminarians, Christian educators, young adult leaders and other faith-based advocates for children at CDF Haley Farm in Clinton, Tennessee, for five days of spiritual renewal, networking, movement building workshops, and continuing education about the urgent needs of children at the 19th annual Proctor Institute for Child Advocacy Ministry.
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WAR RESISTERS - The War Resisters League will hold its 90th anniversary conference, Revolutionary Nonviolence: Building Bridges Across Generations and Communities, August 1-4, at Georgetown University. The event will focus on the U.S.’ long history of antimilitarism.
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VETERANS - Veterans for Peace is holding the 28th annual convention August 6-11 in Madison, WI. This year’s theme is, Power To The Peaceful.
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OCCUPY - An Occupy National Gathering will be held in Kalamazoo, MI, August 21-25.
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COMMUNITIES - The Communities Conference is a networking and learning opportunity for co-operative or communal lifestyles, with workshops, events and entertainment; scheduled for August 30-September 2 at the Twin Oaks Community in Louisa, Virginia.
LABOR DAY - The 29th annual Bread and Roses Festival, a celebration of the ethnic diversity and labor history of Lawrence, MA, will be held September 2, in honor of the 1912 Bread and Roses Strike. There will be music, dance, poetry, drama, ethnic food, historical demonstrations, walking & trolley tours.
Contact: PO Box 1137, Lawrence, MA 01842; 978-794-1655; http://www.breadandrosesheritage.org/.
OCCUPY WALL STREET - September 17 is the two-year anniversary of the Occupy Wall Street movement. Events are planned in New York City and worldwide.
TEACHERS - The 13th Annual Conference, “Teaching for Social Justice: The Politics of Pedagogy,” will be held October 12 in San Francisco, CA. The free event features workshops, resources, and free childcare.
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HAITI - International Action, which brings clean water and chlorinators to Haiti, seeks office space capable of housing up to six people and their office equipment.
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MEDIA - The Union for Democratic Communications and Project Censored are sponsoring a joint conference on media democracy, media activism and social justice to be held November 1-3 at the University of San Francisco. Proposals for presentations, workshops and panels from activists and critical scholars are invited.