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Labor Rallies for Health Care, But Keeps it Vague

It’s no secret that the union movement is divided on health care reform.

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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.”


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.