IIt’s no secret that the union movement is divided on health care reform. Resolutions favoring “Medicare for All,” a single-payer system, have been passed by 558 unions, central labor councils, state federations, and other union organizations. Yet in practice leaders of many of those same unions have acted as if actual single-payer legislation (Representative John Conyer’s HR 676 and Senator Bernie Sanders’ S703) didn’t exist.
They’ve promoted milder changes that will leave private insurance companies in place, instead of kicking them out of the temple, as every other industrialized country—from Canada to Japan—has done. In effect, labor’s leaders are placing on the table first what logically should be their fall-back position.
They’ve gone along with the D.C. consensus that the most that can be won is a plan that includes a “public option” to compete in the marketplace with private companies. And they’re not wrong about the unwillingness of this Congress to buck the system. Conyers was asked in May, “What would it take this Congress to pass single payer?” He replied, “Nuclear weaponry.”
Even so, the staunchest single-payer advocates believe they will win most by continuing to agitate for what they really want rather than a compromise. These folks see large amounts of activists’ anger and energy wasted.
A big June 25 rally at the Capitol sponsored by the AFL-CIO and Health Care for America Now (HCAN), both of which steer clear of single payer, was attended by 7,000 people. But the organizers “didn’t know what to get them fired up about,” said Mark Dudzic of the Labor Campaign for Single Payer.
“It was a good, high-spirited group of people, who want to fight, who honestly believe they’re fighting for national health care,” he said. “A lot of the focus of the rally was to mobilize anger at private insurance companies, and it’s tragic where the leaders want to leave those folks.”
John Armelagos, grievance chair at the University of Michigan Professional Nurse Council, said the rally and subsequent lobbying visits were well-scripted but light on details. Every speaker, Democratic leaders and union heads alike, promised that any health care bill that emerged would include some “public option,” and most participants cheered.
“They thought that would save the day,” he said. “It was all very fluid and not concrete.”
When New York’s Senator Chuck Schumer kicked off the rally with a speech heavy on rally slogans, a large group of single-payer supporters in front began chanting “we want single payer.” He ignored them, and the rally marshals walked them to the back of the crowd.
Armelagos said the rally’s most specific speaker, AFSCME President Gerald McEntee, attacked a proposed tax on already existing health-care benefits, an idea gaining popularity among Democratic senators. The intent is to raise part of the estimated $1.2 trillion needed to expand coverage using the current private-insurance model. (Such a tax would hit many union members, who enjoy better-than-average coverage.)
Obama campaigned last year against John McCain’s proposal to tax benefits, but now won’t rule the idea out. Armelagos left D.C. frustrated that labor’s efforts are now devoted to fighting a position taken by Republicans in the last election, leaving wide open other crucial questions.
For instance, if most insurance will still be provided by employers, he asks, “does that mean people who don’t have jobs won’t have coverage?”
Madelyn Elder, president of Communications Workers (CWA) Local 7901, talked to rally participants who said over and over they’d prefer single payer “because it would be the cheapest and easiest way, but there’s no way we’d get it passed in Congress.” A subsidiary variation included, “I’d hate to lay off all those people who work in the private health insurance industry.”
While visiting senators, Armelagos’s group noted that Democrats outmuscled Republicans to pass Medicare four decades ago, making the program so popular that 13 GOP senators jumped on board.
He and other United American Nurses union delegates endorsed a single-payer health care system at their 2007 convention, but he’s convinced today’s Democrats don’t have the fortitude to stand up to the health care lobby. So, he thinks, it’s better to get something than nothing.
“If single payer doesn’t have a snowball’s chance in hell—even if three of four citizens want a national health plan—we’ve got to get something now,” he said. “There’s too many folks out there hurting real bad.”
BETTER THAN NOTHING?
Is something better than nothing? It’s too soon to predict what will come out of the wrangling—the insurance industry’s Harry-and-Louise-type commercials that helped sink health care reform in 1994 haven’t even started yet. But we can imagine three possible scenarios.
1. The whole reform debate collapses of its own weight.
Dudzic predicts that people will resist the unpopular elements that would have to be included to pay the high price of keeping private insurance at the core of the system. Those include “individual mandates,” as in Massachusetts’s plan, that require each person to buy his or her own coverage (like car insurance). Private insurers have lured away the healthiest of the population, saddling the state with the sickest and leaving Massachusetts’s mandates under strain. Limits were placed on enrollment this year and services, including dental coverage, were cut.
Taxation of existing health care benefits, a poison pill for unions, is also likely to be broadly unpopular. Members of Congress who get an earful from their constituents during the August recess may well decide that no bill is worth the cost of alienating many voters (and campaign donors).
2. Compromise legislation will be so unfavorable to working and poor people that even the most eager compromisers in the labor movement feel they must oppose it.
A tax on benefits, an HMO-like public option so restricted it’s doomed to fail, a subsidy plan that fails to relieve working people of the high cost of insurance—any combination of these could be a cure worse than the disease.
Even then, some unions could be tempted to support a bad bill in hopes it will serve their particular ends. A union focused on organizing low-wage workers, for example, finds the cost of benefits a main reason why employers fight organizing drives so hard. The Service Employees (SEIU), with its homecare, childcare, and security guard drives, is a case in point. If a new government health care program subsidized benefits for poor workers, perhaps their employers would be more open to signing deals that let the union in the door.
Another factor that could cause some unions to support even a bad bill is the desire not to displease the Obama administration. They want the Employee Free Choice Act, and they may hope that making nice over health care reform could win them points. This is the “if I let you kick me once, you won’t feel the need to kick me twice” school of unionism.
According to Dudzic, the desire not to make waves extends even to the insurance companies. “The view,” he says, “is that we can’t piss off the insurance companies because they’ll run Harry-and-Louise ads, but they’re going to do it anyway.”
3. A bill will be good enough that most labor leaders feel they should support it.
A bill that mandates that employers pay for insurance and includes a decent public option would be seen by some as a victory, by others as a livable compromise. SEIU paved the way this week when it released a letter co-signed with Wal-Mart that supports forcing most employers to offer insurance to workers.
However, this is the least likely of the three options. As Obama has signaled his willingness to go along with just about anything, more and more activists are convinced that any public option will be only lip service.
In fact, at an AFL-CIO meeting in mid-June, some affiliate representatives pushed AFL-CIO political operative Gerry Shea to say where the federation would draw the line on the parameters of a public option. Shea wouldn’t say, but some fear that the real answer is “wherever Obama tells us.” Mark Gaffney, head of the Michigan AFL-CIO, volunteered to write to the federation asking for clarity on its lobbyists’ bottom line.
One union, CWA, highlighted its demands as it dispatched hundreds of delegates from its yearly convention to the D.C. rally: a public option, no taxes on working people’s benefits, retiree health care for those not yet Medicare-eligible, and a “play or pay” option for all employers.
Taxing benefits is the deal-killer for most unions. Given how universally unions oppose such a plan, it indicates the disregard for labor in the administration and Congress that the idea was even floated.
Thirty-one union presidents signed a letter to senators arguing against such a regressive tax. Of course, in a tactic long used with members, union leaders may later claim that keeping taxation of benefits out of the final bill equals a victory.
THE DARK HORSE
Though it’s a long shot, the best outcome might be a bill that allows the states to experiment with single payer. Voters in California have approved a single-payer system for their state twice, only to be vetoed by Governor Arnold Schwarzenegger.
Senator Sanders of Vermont is backing such a provision, and Representative Dennis Kucinich of Ohio is organizing support in the House. Some single-payer lobbyists are trying to get a state option attached to other legislation.
“Enabling states to do single payer actually moves us closer to a single-payer solution than a public option does,” said Michael Lighty, the California Nurses Association’s director of public policy. Lighty said that a successful program in a big state like California would lead other states to follow suit. He pointed out that in Canada, single-payer health care was initially adopted one province at a time, leading eventually to a federal system.
“But if you pass a plan that’s watered down and bad, you’ve squandered the political moment,” Lighty said. “You’re going to fuel the cynicism and distrust so many people already have in what can be accomplished in Washington.”
Say you’re a union bargainer who thinks her members deserve a dollar-an-hour raise, but believes that realistically the company won’t give more than 50 cents. Would you start out by asking for 50 cents? Yet that’s what union lobbyists are doing, in effect, around health care reform in D.C. this year. It’s how labor has been doing its politics for a while now: behaving as supplicants rather than as actors trying to define the game, consenting to the accepted wisdom.
Ironically, the desire to be “relevant” and at the table is leaving much of official labor with little actually to say. The tragedy of this year’s morass, say unionists passionate about universal health care, is that any legislation that stitches insurance companies into the heart of the health care system now makes it that much harder to get them out of the way later.
Additional reporting by Mischa Gaus.
JANE SLAUGHTER writes for Labor Notes, where this article originally appeared.