“Show Me the Money” Labor and the Bottom Line of National Health Insurance

Source: Marie Gottschalk, Dissent, Spring 2008

…Organized labor has enormous potential to be the pivotal player in raising these economic and moral questions and anchoring a reform coalition that fundamentally reshapes the health care debate. For well over a century now, labor has been instrumental in the development of the U.S. health system. It established some of the first prepaid group practices and health maintenance organizations, was the leading voice for national health insurance up until the mid-1970s, and was decisive in the establishment of Medicare and in the expansion of other major social programs, like Social Security and the Great Society. The employment-based system of health benefits is largely the product of a collective-bargaining regime established during and immediately after the Second World War. That system is under siege today. Without unions to act as a brake, today’s downward spiral in health benefits for union and nonunion workers would be even faster. Divided and hemorrhaging members, organized labor still has formidable resources to influence the course of health care reform.

At one pole is Andrew Stern, president of the Service Employees International Union (SEIU), the nation’s largest union, and arguably the best known labor leader today. He stridently contends that health care reform must be pitched primarily as an economic competitiveness issue, not a moral one. Stern also has indicated that the single-payer approach, for all its virtues, is a political nonstarter. At the other pole is the growing number of national unions, locals, labor councils, and rank-and-file members pledged to the single-payer solution. Somewhere in between is the AFL-CIO, the nation’s largest labor federation, which in March 2007 endorsed the idea of “Medicare for All” but carefully avoided mentioning the “s” word, that is, single-payer.

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