Labor Advocate Online

Talk Presented At Missourians For Single-Payer
St Louis, November 19, 2009
by Bill Onasch

Let me begin by thanking Missourians for Single-Payer for this invitation to speak. I know there are knowledgeable labor folks dedicated to single-payer here in the St Louis area but I also know that an out of town speaker automatically qualifies as an “expert.”

I will begin by putting our present predicament in historical perspective. Knowing how you got in to a mess is often useful in devising a way out. Then I’ll give my take on the present state of “reform” and suggest what seem to me to be the indicated next steps for the single-payer movement.

Commodity health insurance, based on employer group plans, came to dominate American health care almost accidentally. It was established on a major scale under the exceptional circumstances of a war time economy during the Second World War. The mobilization of millions for the armed forces ended the Great Depression and created a labor shortage. But a wage freeze imposed by the government prevented employers from offering pay incentives while competing for help. To ease that problem the War Labor Board allowed bosses to offer what became known as “fringe benefits.”

Employer provided health insurance became the most important of these “fringes.” One of the biggest was established by Henry Kaiser for his shipyard workers on California’s Permanente River. It’s been a long time since Kaiser built ships but Kaiser Permanente is still around as a big national HMO.

After the war in Europe ended, Britain held a long delayed election. That great hero we’ve been taught to worship, Sir Winston Churchill, was given the boot in a landslide victory by the Labor Party, who pledged to enact a number of radical postwar reforms.

None of these were more important or enduring than establishing the National Health Service–the classic example of socialized medicine. Nearly all hospitals and clinics were nationalized and most health care professionals became public employees. Tax supported, its users have virtually no out of pocket expenses for anything concerning their health. Fiercely opposed by the Establishment at the time it was enacted, the NHS has proven to be so successful and popular that not even Margaret Thatcher dared talk about a privatized return to the old ways.

But here in the USA it was a different story. The mainstream union leadership that consolidated at the end of the War made a fateful strategic decision that contributes greatly to today’s crisis. Instead of emulating their British cousins they made no challenge to two-party rule even though there was a lot of sentiment for forming a Labor Party in 1946. And they decided to negotiate health benefits–and also pensions--in employer contracts. Health care remained a commodity, not a public service. Many foolishly thought this would be an aid in organizing–if you want benefits better join the union.

The United Auto Workers became the most successful in negotiating a broad range of benefits and were a pace-setter for the rest of the labor movement. For years these benefits were provided with little or no payroll deductions or out of pocket expenses. But even in the best of times this was not “free” coverage. It was all costed out and included in the final labor cost package agreed to by both sides. If the British or even Canadian systems had been in place much of the money devoted to health care could have been shifted to higher wages, or more paid time off.

Not only were these benefits costly–they were not “portable.” That wasn’t a big consideration when the employer based strategy was first adopted. Generally, once a worker got on with a union company having decent benefits they stayed on until retirement. There might be occasional short term layoffs but until the Eighties employment was by and large stable.

In the Eighties this started to change big time. First, new technology drastically reduced the need for workers in auto, steel, mining, and rail. This was followed by an explosion of outsourcing and offshoring–especially after NAFTA. Today, it’s estimated the typical worker will go through at least seven job changes over the course of their work life. And the benefits in the new jobs created in what was once called the “service economy” were inferior to what unions had negotiated–if they provided any benefits at all.

From the Seventies on, health insurance costs have steadily risen faster than productivity and inflation–devouring more of the labor cost package. Benefits displaced wages and working conditions as the most contentious issue in collective bargaining.

Single-payer, modeled on the system won by the labor party movement in Canada, became a serious topic of discussion in the USA in the late Eighties. Lee Iacocca, then iconic head of Chrysler, shook things up by saying,

“We save maybe 15, 20 percent by building a car in Canada because the Canadian government's paying that 15 percent for workers' health insurance. The United States has the most expensive health care in the world, and we don't have the best record, whether it's infant mortality or whatever. We're just not there with the rest of the world. How long can we tolerate that?”

After the defeat of Bush I by Clinton, a coalition of unions and others came together to press for single-payer. A key player was a long time leader of the Oil, Chemical & Atomic Workers, the late Tony Mazzocchi, who had gained prominence leading the successful fight to establish OSHA. He was later to become the “Founding Brother” of the Labor Party and at a party gathering explained the fate of this coalition,

“We had a broad coalition for single-payer. The single-payer coalition got conned into adopting, let’s not be for single-payer, let’s be for ‘universal principles,’ and the charge was led by Citizen Action into the Clinton health care campaign, which really unraveled our coalition.”

Of course, the Clinton “reform,” not much different than Obama’s, went down to humiliating defeat

Mazzocchi and the OCAW then decided to test the waters with a probe called Labor Party Advocates. As Clinton turned his attention to driving through NAFTA, and other measures promoting Globalization, LPA found significant support in a number of unions. A Founding Convention in Cleveland in June, 1996, which formally launched the Labor Party, was attended by over 1400 labor officers and activists. A Pittsburgh convention two years later drew a similar number.

A centerpiece of the new party’s program was its Just Health Care proposal. Worked out in collaboration with PNHP, the California Nurses Association, and economist Dean Baker, it covered all the bases.

All health care, including doctor visits; hospital and outpatient procedures; devices such as eyeglasses, hearing aids, pacemakers, etc.; prescription drugs; and dental care would be provided to all residents of the USA without any out-of-pocket expenses. There would be complete freedom to choose your own doctor or dentist.

The only things missing from what we have today would be the insurance robber barons and battles with the employers over health care coverage.

The detailed budget covering all of these needs also provided funds for a just transition for those who would lose jobs as a result of the elimination of the insurance industry–something unfortunately missing from HR676.

Even with all this expanded coverage, it was estimated that the percentage of GDP spent on health care would go down.

The Just Health Care campaign was well received even as the promising start for the Labor Party went in to decline. As late as October, 2004 more than 200 labor activists turned out for a Labor Party Midwest Just Health Care Conference, held at Teamster City in Chicago.

Unfortunately, the Labor Party today is back to where it was in the earlier LPA probe–although with even fewer resources than then. While far from dead, the Labor Party is certainly dormant except for a few local areas. We are hopeful that health care may become another “NAFTA moment”that led to our initial successes.

Labor Party affiliated unions–such as the California Nurses Association--and members play an important role, out of proportion to our current size, in promoting single-payer and exposing phony “reforms” pushed by the White House and Congressional leaders. Hundreds of unions have passed resolutions endorsing HR676 including the recent convention of the AFL-CIO.

Resolutions can be helpful in educating and mobilizing forces with great potential clout. But they can also be, as they are in most of these unions, cya gestures, considered lofty goals that unfortunately must be postponed. In the meantime we are told we must be practical–just as most of labor was practical in endorsing what the Republicans labeled “Hillarycare” 15 years ago.

Now I didn’t feel betrayed by Obama on health care. His reform was in line with his general pro-business agenda. He was doing his duty to those who put him in office and he has done it pretty well.

But my Irish side was aroused when I received a Dear William e-mail from the new president of the AFL-CIO the day following passage of the House bill and I quote,

“What a moment! Last night, 219 Democrats and one Republican in the U.S. House, including your representative, Rep. Emanuel Cleaver, voted to pass a health care reform bill that will end insurance company abuses, require employers to pay a fair share and establish a strong public option to lower costs and make insurance companies compete. And it won't tax the benefits of hard-working middle class families.

“Call and thank Rep. Cleaver today”

I replied with an offer to trade my Lucky Strikes for whatever he’s smoking but haven’t yet received an answer.

Of course, the passed bill will not end insurance abuses, will not require employers to pay their fair share–or any share, and the public option will cover only about two percent, mainly the sickest among us that the insurance companies don’t want, and will cost more than standard insurance to boot.

Brother Trumka also chose to ignore a couple of inconvenient truths such as imposing religious doctrine over human and medical decisions in family planning and excluding 12 million immigrant workers and their families from any coverage–many of them union members.

Now sometimes you are going to get whipped in struggle, even if you do all the right things, because the present relationship of forces against you are insurmountable. There’s no shame in that.

But when we are on the mat bruised and bloodied , while our opponent is doing a dance in the middle of the ring, for our leaders to declare victory is shameful.

We need to call out those labor leaders, and our so-called friends of labor in Congress, who put obedience to the White House agenda above advocating for our interests–or even being honest about our plight.

From what I hear about the Healthcare-NOW gathering here in St Louis last weekend the single-payer movement seems to have consensus that the pending legislation is not better than nothing and should be defeated. I think that’s absolutely correct.

We’ve learned some hard lessons around this latest battle. There were dozens of House Democrats who said they were with us but all but two abandoned us in our most critical time of need. If you get hosed once that’s shame on them. If we allow ourselves to get hosed again that would be shame on us. In my opinion, we need to continue to forge a broad, highly visible coalition that remains independent of the politicians. We need to spread the word and organize in the workplace, on campuses, and in the community. We should aim to assemble the forces that can take to the streets in demonstrations in far greater numbers than the cracked tea pot crowd has done.

Those of us in the labor movement have a special responsibility. Bad as things seem our unions remain the only genuine mass organizations of working people in this country. They still have great potential power. Building a party based on a union foundation, open to all who agree with its program, will be indispensable, in my view, to actually winning the fight for health care–and the many other crucial issues confronting those who work, would like to work, or retired from work. That is the lesson to be learned from success in Britain and Canada.

Such goals seem distant today. But history tells us that things can change rapidly and unexpectedly. The Irish freedom movement has an old motto, “our day will come.” I believe we should also embrace that sentiment, confident that our goals are achievable if we stick to our principles and continue to work hard.

Once again, thank you.

About the Author
The webmaster of the website is a paid-up member of UAW Local 1981—the National Writers Union. During the 70-80s, while employed at Litton Microwave’s Minneapolis operations, he was elected to various positions in UE Local 1139, including Shop Chairman and Local President. In 1980 he took a union leave from the plant to work on a successful UE organizing drive at a Litton runaway plant in Sioux Falls, South Dakota. When Litton began shutting down its four Minneapolis plants Onasch was selected to be a worker representative in a Dislocated Worker Project administered by Minneapolis Community College—where he became a member of the Minnesota Education Association. Returning to his home town of Kansas City in 1989, he soon began a 14-year stint as a Metro bus driver. During that time he published a rank and file newsletter, Transit Truth, chaired a union Community Outreach Committee that organized public protests against cuts in transit service, helped organize a privatized spin-off at Johnson County Transit, and served a term as Vice-President of ATU Local 1287. He has also been involved in US Labor Against the War and the Labor Party since those organizations were launched and represents Midwest chapters on the Labor Party Interim National Council.

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