Unions and Health Care Reform

With health care the number-two priority of voters-behind jobs but still before terrorism-hopes are riveted on the 2004 election for reform that would extend coverage to forty-five million uninsured and safeguard the care of those lucky enough already to have coverage. Unfortunately, defeating George W. Bush, even if it can be done, won’t correct course. Congress will remain largely unchanged; and it’s not just Republicans who are loath to take on the insurers and pharmaceuticals, or who share a weakness for privatization and deregulation.

In the long run, reform depends less on the results of any election than on the reinvigoration of the organizational resources, numerical strength, and moral force of labor. No industrialized society has successfully mitigated the effects of for-profit health care or won national health insurance without a vibrant labor movement.

The battle will be uphill all the way. In the thirties, forties, and fifties unions raised employment standards by organizing on such a massive scale that they dominated labor markets for union and non-union workers alike. Higher wages and benefits helped tame industries, redirecting them away from deflationary wage competition and toward productivity growth and rising consumer incomes. They also helped rationalize the economy and guarantee unions’ social and political role. U.S. unions failed to win national health care, but they won employer-paid insurance for many and helped safeguard Social Security.

Union density is at less than 13 percent. As more jobs have become part time or temporary, the stability of the system of privately paid, job-based benefits has crumbled. Taming the health care industry today means solving the problem of universal access and skyrocketing costs. And the moral imperative for unions organizing health care workers lies as much in the linkage between safeguarding jobs and winning adequate financing for the uninsured as it does in bargaining. The question is not only whether unions can organize on a massive enough scale to set employment standards again, but whether they can contribute to the far more difficult problem of regulating an industry increasingly beset by the same forces of privatization, globalization, competition, and budget cutting that buffet the economy at large. In larger movement terms, the question is how to forge a more enduring coalition between labor and progressives. For progressives, the challenge is to raise expectations for reform and keep them raised. For unions, it is to deepen the political understanding and commitment of members and build a base that will stick to and demand reform, whether today or ten years from today.

Following the Industry

The challenges of building a coalition between labor and progressives are illustrated by the experience of the Service Employees International Union. SEIU is one of a handful of unions that have seriously focused on the changin...