Can Medicare for All Be the Next $15 an Hour? It’s Up To the Labor Movement.

Michael Lighty March 19, 2018

This is the strategy that can turn the tide: building a broad movement of workers to demand economic and health justice. (Photo By Bill Clark/CQ Roll Call)

Health­care is the cross­roads where the assault on work­ers meets the jug­ger­naut of crony cap­i­tal­ism.” That’s the term used by the main­stream neo-clas­si­cal and Nobel prize-win­ning econ­o­mist Angus Deaton to describe the cozi­ness between the health­care indus­try and its gov­ern­ment reg­u­la­tors.” In fact, Deaton argues, how health­care is financed and deliv­ered is a dri­ver of inequality. 

Reg­is­tered Nurs­es see that inequity every day in hos­pi­tals and clin­ics, where the stan­dard of care patients receive depends on the qual­i­ty (and cost) of the health plan they buy. Not only the ben­e­fits but access to treat­ments, pre­scrip­tion drugs, cer­tain facil­i­ties and the lat­est tech­nolo­gies all depend on what you can pay. And guess who has the mon­ey to buy the best: the wealthy. So for the first time, after the Great Reces­sion, two unprece­dent­ed trends occurred: the 1% increased their share of income spent on health­care, and the aver­age life expectan­cy peo­ple in the Unit­ed States declined.

His­tor­i­cal­ly, the labor move­ment has stepped into this breach of injus­tice and inequal­i­ty. Yet in 2017, the union mem­ber­ship rate over­all in the US was just 10.7%. In the pri­vate sec­tor it was 6.5% and in the pub­lic sec­tor it was 34.4%. Unions estab­lished the sys­tem of job-based health ben­e­fits after World War II, in part to pro­vide bet­ter cov­er­age to encour­age new mem­ber­ships, and now employ­ers run it for the ben­e­fit of the insur­ance industry’s bot­tom line.

Con­trol­ling” health­care costs for busi­ness­es has meant a huge cost shift to work­ers. Rather than pay the annu­al dou­ble-dig­it insur­ance pre­mi­um increas­es out of their prof­its — soon to go up under the tax bill — com­pa­nies raise the work­ers’ share, increase deductibles and co-pays, and pro­mote employ­ee-fund­ed health sav­ings accounts. Though it expand­ed cov­er­age for low-wage work­ers, the ACA also less­ened the union advan­tage” in health ben­e­fits, estab­lished new tax­es on union plans and cre­at­ed incen­tives via an excise tax to lessen benefits. 

The decades of incre­men­tal ero­sion of health ben­e­fits, esca­lat­ing costs, defer­ring wages in favor of fund­ing ben­e­fits, and the thou­sands of strikes over just keep­ing the health plans work­ers have fought to win, has tak­en a huge toll on the qual­i­ty of those plans and on atti­tude toward unions. In short, unions have become the bear­ers of bad news,” unable to stem the tide of con­ces­sions. And the incre­men­tal progress — expan­sions of insur­ance for kids, lim­its on the worst abus­es by HMO’s, expand­ed pri­vate cov­er­age under Medicare for pre­scrip­tion drugs, the ACA itself — none has slowed the increas­ing costs or the decreas­ing num­bers of employ­ers pro­vid­ing ben­e­fits, or the decline in mem­ber­ship of unions.

A defen­sive pos­ture and incre­men­tal demands have not worked. Let’s play offense instead. In the face of exis­ten­tial threats to unions’ abil­i­ty to fund their oper­a­tions, and the con­tin­u­ing assault on health ben­e­fits, let’s unite with the grow­ing pub­lic demand for Medicare for All. We don’t need insur­ance, we need health­care. This is the strat­e­gy that can turn the tide: build­ing a broad move­ment of work­ers to demand eco­nom­ic and health jus­tice. That’s not an alliance with insur­ers and employ­ers to fix” the sys­tem in order to sta­bi­lize the health­care indus­try. Rather, based on the eco­nom­ic inter­ests of work­ers, we need to make health­care a pub­lic good. Only if it is not com­pro­mised by high pre­mi­ums, deductibles, and co-pays, with­out nar­row net­works and gate­keep­ing” that restrict access, can we guar­an­tee health­care as a human right. Pars­ing out health­care through insur­ance based on abil­i­ty to pay sim­ply means we’ll only get the health­care we can afford.

The labor move­ment exists to stop mon­ey from being the met­ric of val­ue and pow­er. Health­care is exhib­it A for mon­ey as the met­ric (see Eliz­a­beth Rosenthal’s book, Amer­i­can Sick­ness”). Unions derive pow­er from mem­bers, engaged in fights to win a bet­ter life at work, home and in soci­ety. Medicare for All enjoys strong major­i­ty sup­port among the gen­er­al pub­lic, and over­whelm­ing sup­port among union mem­bers and Democ­rats. Medicare works and is pop­u­lar. A move­ment led by labor, inspired like the Fight for 15 by a broad, pop­u­lar demand for fair­ness and secu­ri­ty, can build the sol­i­dar­i­ty we need. A move­ment posi­tioned as the 99%, can assert that all work­ers are part of the labor movement.

Let’s under­stand this move­ment moment: the upris­ing in Wis­con­sin, Occu­py Wall Street, Black Lives Mat­ter and now #MeToo have cre­at­ed social move­ments and a political/​ideological con­text that infused the Bernie Sanders cam­paign for pres­i­dent, and pro­vides the well-spring for a broad­er health jus­tice demand, linked to and rein­forc­ing the demands for social and eco­nom­ic jus­tice. Medicare for All can be the health wing of the broad­er jus­tice movements.

In the most per­son­al area of pub­lic pol­i­cy — whether we will get the health­care we need — Reg­is­tered Nurs­es, who are pre­dom­i­nant­ly women, bring the val­ues of car­ing, com­pas­sion and com­mu­ni­ty to work and to their advo­ca­cy. Let that inspire oth­ers to join this move­ment for guar­an­teed health­care based on our shared human­i­ty. Pro­mot­ing these val­ues com­bined with orga­niz­ing work­ers for health and eco­nom­ic secu­ri­ty can over­come the deep pock­ets of the health­care indus­try; it is only through mobi­liz­ing pub­lic opin­ion that peo­ple have over­come polit­i­cal­ly pow­er­ful eco­nom­ic forces.

In demand­ing guar­an­teed health­care through Medicare for All, we are demand­ing a more just and humane soci­ety. Socio-eco­nom­ic sta­tus is the major fac­tor in deter­min­ing health sta­tus, and dis­par­i­ties based on race are ram­pant in health­care access and out­comes. Here we see the con­flu­ence of address­ing race-spe­cif­ic bar­ri­ers to equal­i­ty in health­care and in soci­ety and the need for eco­nom­ic and health jus­tice. Address­ing the caus­es of pover­ty, over­com­ing struc­tur­al racism, estab­lish­ing $15/​hour as the min­i­mum wage, build­ing more afford­able hous­ing and win­ning guar­an­teed health­care are nec­es­sar­i­ly linked — we can­not achieve them indi­vid­u­al­ly in iso­la­tion. A fight­ing labor move­ment — that encom­pass­es the broad­ly defined work­ing class — is in the best posi­tion to make those con­nec­tions and orga­nize on a mul­ti-racial basis to win. Medicare for All not only moti­vates mil­lions to orga­nize for jus­tice, but win­ning it would help win jus­tice for all.

This piece first appeared at the Sanders Insti­tute.

Michael Lighty is the Direc­tor of Pub­lic Pol­i­cy for Nation­al Nurs­es Unit­ed, where he has worked since its found­ing in 2009, and for the Cal­i­for­nia Nurs­es Asso­ci­a­tion since 1994. He is also a fel­low for the Sanders Insti­tute.  Fol­low him on Twit­ter: @mlighty60
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