Labor Advocate Online

Framing the Debate About Health Care
200 Labor Activists Gear Up For Labor Party’s
Just Health Care Campaign

by Bill Onasch

In 1999, I wrote in Labor Standard,

"Corporate health care is not in business for our health. They operate to make profits — end of story. If there is no oversight of their pricing, as was largely the case through the 1970s and ’80s, the sky will be the limit; they will encourage utilization of medical services whether they’re really needed or not. But if there is a major push to control costs — as we have seen over the past five years — the volume and quality of medical care will be slashed, again without regard to actual need, to maintain profits. If there comes a time when there is an insufficient level of profit in the industry they will shift their investment elsewhere.

"This stranglehold on access to health care will defy all efforts at incremental reforms. There is a fundamental conflict of interest between the drive for profits and providing health care based solely on sound medical judgment. We need to take health care out of the market and establish it as a public service. Nothing less will do."

Unfortunately, the experiences of the past four years have reaffirmed the futility of trying to patch up a failed system.

Most Countries Guarantee Health Care
Every other industrialized country, and many developing countries, guarantee access to health care for all of their population. This is not a recent, or even particularly radical concept.

The first major national health insurance program was instituted in Germany more than a century ago. The initiative for this pioneer effort came not from the left but from Otto von Bismarck — the "Iron Chancellor" who united modern Germany. This forward-looking architect of bourgeois development was no bleeding heart, but he understood that good health for all the Kaiser’s subjects was essential for Germany to become a world power. It also helped him steal some thunder from the socialist movement that was growing very strong among workers at that time.

The 1917 Russian Revolution established health care for all as a principle, and this example was followed in China, Eastern Europe, and Cuba after capitalism was overturned in those countries. National health insurance plans were also a part of the rebuilding of capitalist Europe in virtually every country after World War II. Canada was slower, but eventually, after some successful provincial programs were started by the labor party movement there, universal health care became a federal policy in our neighbor to the north as well.

Why Not in the U.S?
But the United States took a different course. We had neither a Bismarck nor a labor party. Instead of a vital public service, gratefully paid for by society collectively, health care in America has always been a commodity, subject to the laws of the market and the insatiable drive to realize profits from it.

Health care is a commodity needed and wanted by virtually everyone. Those controlling its access have great power that can tempt abuse. Few have resisted this temptation.

As everyone with a smattering of economics knows simple demand for a product is insufficient to interest capitalists. There must be effective demand — both a keen desire to acquire it and the ability to pay a high enough price to assure acceptable levels of profit. In the post-World War II period American health care capitalists found great effective demand from two major sources.

* The trade union leadership in this country — instead of fighting politically for national health insurance, like their counterparts in Europe and Canada — struck bargains with employers for privately-managed health insurance for their members only. This was paid for by deferring part of worker compensation that would have otherwise gone toward wages. Eventually private health insurance became a standard "fringe benefit" for both unionized and unorganized workers in most industries.

* In 1968, Congress established Medicare to provide taxpayer subsidies for health care to the elderly. A few years later a similar program, Medicaid, was launched to guarantee health services to the disabled and those on welfare. Most of these funds went to compensate private, for-profit providers.

As both employer-provided health insurance and government reimbursement programs grew enormously during the 1960s and ’70s health care access became a major industry. Now dealing with deep pockets, many providers greatly expanded testing and surgical procedures. While much of this reflected advances in medical technology, and promoted the health of our population, sometimes these services were of dubious medical value, used to pad income. The same could be said about drug development, which has flourished over the past thirty years. And very creative accounting methods in health care billing — not to mention a certain amount of outright fraud — became firmly entrenched practices, boosting the industry’s profitability.

A higher level of care was brought to millions of Americans—but at an exorbitant and ever-expanding cost. No longer a "fringe" benefit, health insurance began to eat up a substantial part of employee compensation, and a big chunk of the federal budget.

Employers started demanding that their workers pay more out of their pockets for this coverage — leading to tension in collective bargaining. Many capitalists began to question whether U.S. industry, saddled with this giant health care bill, could remain competitive with those countries with national health insurance. General Motors publicly testified how much they saved in labor costs in their Canadian operations solely because of the differences in health care costs.

Single-Payer Promoted—Then Abandoned
The Labor Party’s "Founding Brother," Tony Mazzocchi (shown left), was a life long advocate of genuine universal health care. Mazzocchi organized numerous delegations from the old Oil, Chemical & Atomic Workers (now merged with PACE), to visit Canada to see our neighbor’s far superior health care system at work. He was an important leader in a coalition—that once had significant labor support—in the late 1980s-early 90s, that came close to winning a "single-payer" system like Canada’s for Americans.

That single-payer movement was derailed by President Clinton’s "universal health plan." Mazzocchi later commented,

"We [the Labor Party] base our strategy on what happened in the last single-payer campaign [1993–94], and we’re trying to avoid that. 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.

"The coalition for single-payer ended up with four groups — UE [United Electrical, Radio & Machine Workers]; OCAW [Oil, Chemical & Atomic Workers]; the Grey Panthers; and the Health Research Group. Jobs With Justice, with the exception of one group in Boston, went the other way. There was total confusion."

Clinton’s "universal" plan would have made private health insurance compulsory—like car insurance—and would have allowed employers to dock their workers up to 25 percent of the costs of their plan. It also introduced the concept of "managed competition"—later embraced by health care capitalists.

Even though Clinton’s reform plan didn’t amount to much the insurance industry fights tooth and nail against any restraint of their greed. They mobilized a huge lobbying/attack ad campaign that shot it down. Since then there has been nothing from the major party politicians other than some minor skirmishes over inconsequential incremental tweaking of a fundamentally flawed system.

In the meantime the share of our national wealth being sucked up by the "health industry" has soared while actual delivery of quality health care has stagnated. A World Health Organization rated America #37 among nations in quality of health delivery.

Issue Number One
As this is written nearly100,000 are on picket lines in just three major disputes—southern California grocery stores; Los Angeles transit workers; and clerical workers at the University of Minnesota—that are largely centered on health care costs. It is in fact a major issue in almost every contract negotiation these days.

Over the past three years just the worker’s share of employer based family health coverage has jumped nearly fifty percent— to an average cost of 2,412 dollars. As these insurance premiums, along with copays and prescription prices, surge at many times the rate of inflation nearly all workers lucky enough to have health care coverage must tighten their household budgets in other areas to keep up.

More than forty million wage workers and self-employed have no health insurance. All too often they tend to defer routine preventive medicine and seek care only for serious problems. They are at risk both health wise and financially. A major accident or illness can bankrupt them.

The nation’s biggest employer, Wal-Mart, has done more than their fair share in helping America get to where we stand today on health care. While the average health care cost paid by employers is 5,646 dollars per year, virtually "union free" Wal-Mart spends only about 3,500. New workers must wait six months to become eligible. Retirees get nothing. The worker contribution to premiums and copays is so high that only sixty percent of those eligible sign up—compared to 72 percent for the retail industry as a whole.

The percentage of retired American workers who receive employer coverage at least until they become eligible for Medicare has dropped to 38 percent. Ten years ago that figure was 66 percent.

These are the reasons the health care crisis has not only been a focus of workplace clashes where workers are unionized but is also the number one political issue of concern to Americans today. Nonunion workers don’t have much bargaining power with their boss and plant closings have deprived millions of their employer based insurance. Something has to be done.

Labor Party Revives Single-Payer With Just Health Care Campaign

In 1998 the Labor Party, in consultation with groups such as Physicians for a National Health Plan (PNHP) and the California Nurses Association (CNA), launched a campaign known as Just Health Care.

Just Health Care is a single-payer national insurance plan that would provide cradle to the grave coverage no matter how many times you might change jobs or be unemployed. It would give everyone the right to choose their own doctor. And, by eliminating the greedy for-profit insurance companies, society’s total health care bill could even be reduced.

Because the Labor Party looks out for the interests of workers, Just Health Care also provides for retraining, and placing in new jobs, the many workers in the health insurance industry who would be displaced by the switch to single-payer.

Working with economists, such as Dean Baker, the Labor Party has worked up a realistic plan for how to pay for Just Health Care. Even after we take in the forty-plus million presently uninsured, and scrap the deductibles and co-payments that discourage many millions more from seeing doctors when they need to, we could still reduce the overall share of the GDP going toward health care. We would do this by eliminating profits, obscene CEO compensation, advertising, and the huge overhead involved in billing — factors that currently consume at least a quarter of health care spending while contributing absolutely nothing to actual health care—as well as establishing new dedicated taxes in place of money now paid in premiums. Some employers and wealthy individuals would have to pay a little more than they are now; most of the working class majority would pay less.

At a recent meeting of the Labor Party Interim National Council a decision was made to try to inject the Just Health Care campaign into the debate around the 2004 presidential and congressional elections. Candidates will be asked to declare their stands on this crucial question.

To help prepare for this effort it was decided to hold regional conferences around the country with a theme of "The 2004 Election and the Fight for Just Health Care." The pilot conference was called in Chicago October 17-18.

When I arrived in Chicago the day before I was a little apprehensive about attendance. The weather forecast was for a gorgeous weekend—perhaps the last of the year. The World Series was in progress. Many of the leaders of the UE who would normally be expected were instead at a district council meeting in Minneapolis.

Despite these distractions and schedule conflicts about 200 participated in at least one of the conference sessions.

They gathered in the beautiful auditorium of Teamsters Local 705 . 705, the second biggest Teamsters local in the country, is one of the most progressive unions around. Their chief officer, Jerry Zero, has helped bring the Labor Party, as well as US Labor Against the War (USLAW), into the day-to-day life of the union. The very next weekend they hosted the National Labor Assembly for Peace.

Leaders Closest to the Ranks
The big majority of those attending were local union officers and shop stewards— the leadership layer closest to, usually in daily contact with, rank-and-file members on the shop floor.

By far the biggest union delegation was from the Union of Needletrades, Industrial and Textile Employees (UNITE). The UNITE Midwest Joint Board, a cosponsor of the conference, did a good job in mobilizing their forces throughout the Midwest from as far away as Ohio. UNITE also shouldered most of the conference logistics including providing workshop rooms in their magnificent headquarters building across the street.

Other unions present included UE; the Paper, Allied-Industrial, Chemical and Energy Workers (PACE); Teamsters; Amalgamated Transit Union (ATU); National Education Association (NEA); International Brotherhood of Electrical Workers. There were also a few unorganized health care professionals who are Labor Party members.

A Detroit nurse soaks up facts and relates her own experiences

The conference packet given to participants was chock full of useful items.

*A Labor Party press release challenging all presidential candidates to endorse Just Health Care.

*Suggested questions to ask candidates.

*Tips for giving a speech.

*A sample speech.

*Sample letter to the editor.

*Sample letter to a candidate.

*Model union resolution.

*Labor Party Briefing Paper on financing Just Health Care.

There were also fact sheets and work sheets to be used in workshops: Ideas for organizing; Developing an organizing plan; Personal organizing plan; some Labor Party leaflets on Just Health Care; and a form for the petition campaign called the Committee of a Million.

As we assembled Friday evening we were warmly greeted by Jerry Zero of Local 705. Noel Beasley, Midwest Unite and chief architect of the event, gave us an overview of what to expect from the conference.

Noel Beasley, Jerry Zero, Mark Dudzic

An Effort to be ‘Interactive’
The next point was somewhat unusual, something I have never previously seen at a labor movement conference. The participants were asked to speak out before any of the major speaker presentations. Their questions, comments, and expectations helped the conference organizers to focus on priorities during our very tight schedule.

A sheet comparing the presidential candidate stands on health care was distributed.

As can be seen, none of the major contenders come anywhere close to what is offered in Just Health Care.

Mark Dudzic, Labor Party National Organizer, gave the keynote address. It was a good broad picture view of the strategy behind the Just Health Care campaign.

Early arrivals eagerly await start of session

Doctors Speak Out

Dr. Claudia Fegan, Past President PNHP, co-author, Universal HealthcareSaturday morning began with a power point presentation by Dr. Claudia Fegan (pictured left), from Physicians for a National Health Plan. She started by pointing out that even though the U.S. spends far and away the most money on health care we lag in many important measures of quality of care, including average life span and infant mortality. She proceeded to explain numerous examples, from a physicians point of view, of how insurance plan rules had adversely affected medical decisions for major patient population groups.

She was followed by another PNHP staffer, Ida Hellander, who explained how the rest of the world delivers health care (nobody else does it like us.) Basically there are three types as explained on the PNHP web site:

1. In a single-payer national health insurance system, as demonstrated by Canada, Denmark, Norway, and Sweden, health insurance is publicly administered and most physicians are in private practice.

2. Great Britain and Spain are among the OECD countries with national health services, in which salaried physicians predominate and hospitals are publicly owned and operated.

3. Highly regulated, universal, multi-payer health insurance systems are illustrated by countries like Germany and France, which have universal health insurance via sickness funds. The sickness funds pay physicians and hospitals uniform rates that are negotiated annually (also known as an "all-payer" system).

Countering Slander
Understanding how these other systems work is important in countering the lies and confusion spread by the insurance companies.

All of these countries spend far less than we do on health care and get better medical results.

Each of these three types of health care have unique advantages and drawbacks. The prevailing view among progressive health care professionals, as well as political activists, is that single-payer could be implemented faster, with fewer start up glitches, than the other two examples.

PHNP has a very useful FAQ about single-payer posted on the Internet.

Hellander announced that PNHP has speakers prepared to give presentations to unions and other interested organizations. She also invited all to freely download the wealth of resources on their web site.

Paying the Bill
Dean Baker (shown left), co-director of the Council for Economic and Policy Research (CEPR), outlined the basic components of Just Health Care financing:

* Keeps much of the existing health care financing in place -the government already accounts for half of health care spending

* Eliminates employer contributions to private insurance premiums -replacing them with a modest employer payroll tax of 5.5%

* Eliminates individual premiums including Medicare Part B and co-payments as well as 80% of out of pocket costs

* Creates no new taxes for workers (except for wealthiest 5% of Americans)

* Creates new funding sources that draw on the incredible wealth gained by the richest Americans over the last decade

* Protects health industry workers via a Just Transition

A complete, detailed briefing paper is available on the Just Health Care web site.

Confronting Candidates
We had a chance to lighten up a bit with a role playing presentation. Three volunteers from the audience did a credible job impersonating Democrat, Republican, and Green candidates answering health care questions at a League of Women Voters debate. Skills were sharpened for deflating cynical windbags.

Developing Organizing Plans
Picking up box lunches, we all broke up into workshops—including one in Spanish. This was perhaps the most encouraging part of the conference. These were no nonsense meetings, chaired by UNITE staffers, to develop organizing plans. The same methods used to plan union organizing campaigns, or preparing members for protracted struggle with their boss, were used in the workshops. We tried to anticipate, and have answers ready for, inevitable questions back on the shop floor. We discussed how to reach the majority of union members who don’t attend regular union meetings through newsletters and lunch room meetings. We talked about using the Committee of a Million petition among the ranks. By the end we all had a basic organizing plan to take back home as well as a personal organizing plan to guide our individual work.

In one last brief plenary session we heard reports from the workshops; greetings from Bill Gibbons, PACE Region IX; and an excellent summary of the conference achievements, along with an appeal to join the Labor Party, by Noel Beasley.

I think most participants felt the gathering was both educational and inspirational. We should see some concrete organizational achievements as a result.

The Kansas City Labor Party is sponsoring a public meeting with the same theme as the conference on November 15. I will be reporting back on the Chicago gathering and other unionists are being invited to speak as well.


Parts of this article are excerpted from an article by the author that appeared in the September-October, 1999 issue of Labor Standard.

Bill Onasch, a member of Amalgamated Transit Union Local 1287, represents Midwest chapters on the Labor Party Interim National Council.




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