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Labor should not bargain against itself on Medicare for All

January 20, 2020

Topics: Quote of the Day

By Dr. Martin Luther King, Jr.
Illinois AFL-CIO Convention, October 1965

“At the turn of the century women earned approximately ten cents an hour, and men were fortunate to receive twenty cents an hour. The average work week was sixty to seventy hours. During the thirties, wages were a secondary issue; to have a job at all was the difference between the agony of starvation and a flicker of life. The nation, now so vigorous, reeled and tottered almost to total collapse. The labor movement was the principal force that transformed misery and despair into hope and progress. Out of its bold struggles, economic and social reform gave birth to unemployment insurance, old age pensions, government relief for the destitute, and above all new wage levels that meant not mere survival, but a tolerable life. The captains of industry did not lead this transformation; they resisted it until they were overcome. When in the thirties the wave of union organization crested over our nation, it carried to secure shores not only itself but the whole society.”


The Labor Movement Must Fight for Medicare for All — Not Employer-Based Plans

By Mark Dudzic
Jacobin, January 17, 2020

Unions have been at the forefront of almost every progressive policy advance for a century. So why are AFL-CIO president Richard Trumka and American Federation of Teachers president Randi Weingarten denouncing Medicare for All by parroting talking points crafted by health care industry lobbyists?

The spectacle of national labor leaders defending a system that is the biggest cause of strikes, lockouts, and concession bargaining is mind-boggling. For an entire generation now, unions in the United States have traded wages and other benefits for shrinking coverage by employer-provided health insurance (or for the ever-increasing employer contributions required to maintain similarly shrinking benefits from union-sponsored health and welfare funds).

Like it or not, employment-based health care is simply unsustainable. The Milliman Medical Index reports that the 2018 total health care costs for a family of four with decent employment-based coverage exceed $28,000 per year. That is $14 per hour worked for a full-time employee — almost twice the federal minimum wage. The employer pays $15,000 of that, and $13,000 is paid by the worker through co-insurance, out-of-pocket charges, co-pays, deductibles, and all the other myriad ways that the medical-industrial complex extracts money from our pockets. These amounts already exceed the average hourly wage in food services and retail occupations and are increasing two times faster than the rate of wage increases for all workers, putting them on track to exceed average wages in manufacturing and other core industries within the next decade. The percentage of total health care costs paid by the worker has gone up nearly every year since it was first tracked in the 1990s.

Employment-based health care is also a major driver of wage stagnation. Every worker trades wages for health care.

And even the best employment-based health care is not there when we need it the most: when we lose our jobs, change jobs, go on strike, or struggle with long-term illness.

Medicare for All would take health care off the bargaining table and increase union bargaining leverage in nearly every negotiation. It would allow union-sponsored health and welfare funds the opportunity to reallocate revenues currently sunk into the world’s most expensive and inefficient health care system. Savings could be applied to new “union advantage” programs such as enhanced disability benefits, supplemental unemployment benefits, tuition and training programs, legal services, child- and eldercare, and others. Some revenues could also potentially be reallocated to shore up endangered pension plans.

Medicare for All would also provide better coverage than any employment-based plan in existence today. Opponents of Medicare for All often conflate the constricted benefits offered under today’s Medicare program after more than fifty years of underfunding and privatization attempts with the greatly expanded and improved benefits proposed under Medicare for All – HR 1384 — Rep. Pramila Jayapal’s Medicare for All Bill.

I challenge any advocate of employment-based coverage to show me a plan that matches the level of comprehensive services, freedom of choice, and absence of out-of-pocket costs proposed by HR 1384.

Union members should be justly proud of the long battle that unions have waged to protect their right to access affordable, quality health care, and the Labor Campaign for Single Payer stands in solidarity with all workers everywhere who fight to protect these hard-won gains. But our movement is at an historic juncture. Now is not the time to muddy the waters or bargain against ourselves. We need labor to lead as we work to make this a key issue in the 2020 elections and to hold politicians accountable in 2021 and beyond. And we have the right to expect that the union leaders who represent us and the politicians that we support will do more than just parrot the talking points crafted by health care industry lobbyists.

Mark Dudzic is coordinator of the Labor Campaign for Single Payer.



By Don McCanne, M.D.

On this day we should consider what Martin Luther King, Jr. would have to say about the fact that workers’ health care benefits are not universal, and, for those who have them, that they have displaced wages that otherwise could help many more achieve the American Dream that King believed should be freely available to all.

Our brothers and sisters in the unions should join with the rest of us in the campaign to see that they and all others can be assured that health care will always be there when needed without having to sacrifice other elements of the American Dream. We can have it all.

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About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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