Above: National Improved Medicare for All Advocates marching. By Molly Adams from Flickr.
There’s no way to sugarcoat it. As we celebrate labor‘s achievements this Labor Day, the situation of the actually existing labor movement couldn’t be more desperate. And one of labor‘s greatest achievements–the provision of decent, employer-paid health insurance coverage for working-class families–has become an anchor around our necks.
An Accident of History
More than 150 million Americans are covered by employment-based health insurance. This linkage of health care to employment is an accident of history. The 1946 defeat of the Wagner-Murray-Dingell National Health Act and the 1947 passage of the Taft-Hartley Act and other anti-worker legislation was a watershed moment for a resurgent labor movement that had come to represent nearly one-third of all workers and to set the terms of debate on economic and social policy.
After these defeats, unions began to accept “second best solutions” to the problem of ensuring access to health care for workers and their families. While unions throughout the industrialized world led the fight to make health care a right for all, unions in the United States began to negotiate private insurance coverage paid by employers. Healthcare became a benefit rather than a right.
Simply Unsustainable
Unions have fought long and hard to maintain these benefits and a strong union contract continues to be the best guarantee of decent health care coverage for working-class Americans. However, whatever the advantages that negotiated health benefits might have produced for unionized workers in the past, the fact is that employment-based health insurance has simply become unsustainable.
The 2018 Milliman Medical Index reports that total health care costs for a family of four covered by a decent employer-sponsored healthcare plan now total $28,166 per year. The employer contributes $15,788 per year leaving $12,378 to be paid by the family through various combinations of employee contributions, co-pays, deductibles and direct payments to providers. The amount paid by the employer increased by 3.5% from the previous year while the employee contribution increased by 5.9%. The percentage of total health care costs paid by the worker has gone up every year since 1986.
What used to be a union advantage has now become a race to the bottom as employers constantly seek to shift costs onto the backs of workers and union employers face competitive pressures from non-union employers with vastly lower healthcare costs. The Kaiser Family Fund reports that most small firms offer no health insurance coverage whatsoever and that retiree health coverage is rapidly becoming an artifact of the past. 47% of covered employees are now enrolled in high deductible plans, many without even a supplemental health savings account to offset some of the expenses. Narrow networks and other gimmicks to restrict access to healthcare are on the rise.
Not only is decent employment-based coverage economically unsustainable, it is also becoming politically unsustainable as anti-worker politicians and their supporters utilize the politics of resentment to undermine public support for decent benefits for public employees. Unions everywhere find it increasingly difficult to maintain their health coverages when everyone else’s are being cut.
When we bargain for healthcare, we bargain against ourselves.
This crisis has created vast insecurity among working-class Americans. Workers rank health care as the most critical issue in the United States with 60% reporting that maintaining their health insurance is extremely important. Employers know that workers will sacrifice almost anything to hold on to their coverage. And the loss of health insurance during a strike or lockout becomes a horrible weapon in the bosses’ arsenal.
It doesn’t take a math genius to figure out that wage increases are often offset by increased healthcare contributions. For workers earning $15 per hour, nearly all of the average 2.7% union wage hike in 2017 will have to go to pay for higher 2018 family healthcare costs. Even workers earning $30 per hour will, on average, see half of their wage increase go towards higher health care payments.
Every time unions open up a contract for negotiation, they are at a disadvantage as employers know that they can play the healthcare card. There must be a better way!
The Solution: Take health care off the bargaining table by making it a right for everyone in America!
Improving Medicare and expanding it to everyone in America is the single most important thing we can do to improve the security and the living standards for all Americans while restoring worker power at the bargaining table. Supermajorities of Americans now support Medicare for All and single-payer bills in Congress and the Senate have a substantial and growing list of cosponsors.
This Labor Day, let us rededicate ourselves to winning labor‘s historic fight to make health care a right for everyone in America. Contact your representatives and demand that they make Medicare for All a priority. Encourage your local, regional and national union to support the work of the Labor Campaign. Sign up for training sponsored by the National Nurses United to be a volunteer canvass host.
The labor movement continues to be the greatest hope for all working people. Let us celebrate our accomplishments this weekend and work to build our future. Onward to Medicare for All!