Labor's messy health-care bargain
The Net roots is up in arms about the Senate's version of health-care reform, with many rooters demanding it be voted down. The liberal establishmentarians lament the compromises they were compelled to accept but support the bill's passage. In between the two, indignant and stuck, is organized labor.
"There's an excise tax on policies, but there's no public option to hold down the cost of those policies," says Leo Gerard, president of the United Steelworkers. "There's no Medicare buy-in, no pay-or-play mandate for employers. There's no Canadian reimportation to hold down drug costs, on the grounds of 'safety.' No one gets sick from Canadian reimported drugs," adds Gerard, who is Canadian. "I know a guy who got sick from a Chinese-made ingredient in an American drug, but there's no restriction on Chinese drug imports."
Gerard is hardly alone in his criticisms. Labor believes, rightly, that the cost controls in the Senate bill come chiefly from insurance policy holders (among them, labor's members), rather than from insurance and drug companies. Both the AFL-CIO and the Service Employees International Union have condemned these provisions, while hailing the bill's epochal creation of affordable health insurance for 30 million Americans. They're careful, too, to exempt President Obama from their criticisms.
"I'm not blaming the president," says Gerard. "He wants to believe people will do the right thing."
The unions have few illusions that the public option will be restored in the House-Senate conference committee, but they are working to promote the chief funding mechanism in the House bill (a tax hike on individuals with incomes over $500,000 and couples with incomes over $1 million) over that in the Senate bill (a tax that, to start, will fall on health insurance policies that cost more than $23,000 for a family of four). With medical costs unchecked by a public option and drug reimportation, they fear that the value of their members' policies will rise above the threshold by the middle of the next decade.
There's a political problem as well. During the fall of 2008, the unions spent millions persuading older working-class whites to vote their pocketbooks instead of their prejudices in such key swing states as Pennsylvania and Ohio. Just about the only issue that moved these voters from John McCain's column to Barack Obama's, they discovered, was that McCain supported taxing their members' health insurance and Obama didn't. "We negotiate and fight hard for our health-care benefits," said one widely distributed piece of AFL-CIO literature. "Now, Republican John McCain wants to tax them."
"This was our mantra," says Gerard. "Obama was polling better with our active members than with our retirees, which is very unusual, until we focused on McCain's plan to tax benefits. Our retirees are in expensive plans; that kind of tax would be devastating to them."
Politically, in fact, the tax could set in motion the kind of dynamic that undermined many Great Society anti-poverty programs: taxing the working class to provide benefits to the poor (or, in this case, the uninsured). Richard Nixon and Ronald Reagan smashed the Democrats' New Deal coalition by fanning the racial and class tensions endemic to such programs. Does anyone believe that today's Republicans will think better of mounting such attacks?
In theory, the House-Senate conference committee should be able to split the difference on funding by raising the Senate's threshold on taxing insurance policies and combining it with a scaled-back version of the House's millionaire tax. If the conference does that, raises the subsidies for people buying policies on the exchanges and extends Medicaid to more poor families, liberals and labor will likely have gotten all they can plausibly hope for, given the constraints that the Nelsons, Liebermans and Republicans have imposed on the bill.
Labor is boiling mad about those constraints, but unlike some of the Net-rooters, they can't and won't call down curses on the Senate Democrats -- yet. "We've played an inside game," says one of Gerard's fellow union presidents. "We've delivered our criticisms privately." Labor's leaders still hope a scaled-back version of the Employee Free Choice Act (EFCA) -- the bill that would restore unions' ability to organize private-sector workers -- will pass the Senate next year. They've seen the White House and congressional Democrats move their way on jobs legislation, and they welcomed last week's unveiling of a $5 billion tax credit to bolster green manufacturing, a long-overdue step toward rebooting manufacturing in America. But it will take more job creation and the enactment of EFCA to motivate unions to go all out in the 2010 elections. Anything short of that, and their anger will take a toll on the Democrats' electoral prospects.