The origin of the decision to link health care to employment, rather than having universal health insurance through the government, is in specific anti-inflationary policies enacted in World War II. An executive order froze pay, and employers, with the support of unions, used health insurance benefits as a way to increase total compensation and attract workers without running afoul of the law. Unions have bargained for health insurance ever since and have used their success in obtaining high-quality health care for their members as a measure of the overall advantage of union membership and representation.
But the desire to keep health care at the bargaining table is ultimately shortsighted and defensive. If unions are to survive and grow in the long run, they need to emphasize a voice on the job, dignity at work and broad economic gains, not narrow benefits. If workers join or support unions in order to attain one specific benefit, this support is unlikely to be sustainable. Indeed, many employers offer improved health insurance in order to deter their workers from organizing, heading off efforts that could more broadly shake up their workplaces in favor of employees.
An inordinate amount of time and energy is spent bargaining over health insurance. In the recent spate of strikes, from the West Virginia teachers to the grocery workers of Stop & Shop, the rising cost of health insurance has been a key issue, pushing workers to walk off the job to protect their benefits.
Without having to bargain over health care, unions could focus on higher wages, safer workplaces and more secure retirement plans, measuring their success in total compensation, not a single narrow benefit. In recent years, many unions have traded lower retirement contributions and more modest wage gains for their health insurance plans, as health-care costs have steadily risen. With single-payer health care, employers, workers and taxpayers would all ultimately save money, increasing the amount of money available to workers in their wages and retirement benefits.
Health care has become not just a logistical trap for unions but also a political one, encouraging the organizations to focus narrowly on their members’ interests instead of the transformation of the economy at large.
The recent joy among unions at the House’s vote to repeal the Affordable Care Act’s “Cadillac tax” illuminates an entrenched belief, born from fear, both that a “Cadillac plan” is a luxury good and that it has been earned by unionized workers and highly paid professionals, but not by others. But if universal comprehensive, high-quality health care resembled these “Cadillac” plans, with low to nonexistent co-pays and premiums, and broad access to care, workers in all sectors would have much greater latitude to pressure their employers in other areas — or, failing that, to leave for jobs that offered more generous pay and benefits.
That same dynamic emerged in the second Democratic debate this summer, when Rep. Tim Ryan (D-Ohio) and former representative John Delaney (D-Md.) tried to invoke union interests to attack Sen. Bernie Sanders’s health-care proposal. But even as they did so, they acknowledged that bargaining over health care cost workers other victories at the bargaining table: Ryan said that Sanders’s plan “will tell those union members who gave away wages in order to get good health care that they are going to lose their health care because Washington is going to come in and tell them they’ve got a better plan.” Sanders subsequently tweaked his plan to make it possible for unions to negotiate add-on benefits under the supervision of the National Labor Relations Board. And former vice president Joe Biden has joined Ryan and Delaney’s pile-on, intensifying the party’s division over health care.
Unions and working people should support universal health care rather than adopt an “I’ve got mine” approach. Solidarity requires an understanding that all people deserve dignity at work, fair pay and access to high-quality social supports — none of these should be limited only to union members. Working people should have the vision and imagination to understand that improving the lives and health of all workers is a universal good and creates an opportunity to negotiate for other essential improvements at the bargaining table, from higher pay to dignity for workers and their communities.