Labor and The Bottom Line of National Health Insurace

Marie Gottschalk, associate professor of political science at the University of Pennsylvania, has a very insightful article on national health insurance in the Spring 2008 Dissent and it’s now available on-line.

As we stand at the brink of another major attempt to overhaul the U.S. health care system, organized labor is divided about how to define the alternatives.

At one pole is Andrew Stern, president of the Service Employees International Union (SEIU), the nation’s largest union, and arguably the best known labor leader today. He stridently contends that health care reform must be pitched primarily as an economic competitiveness issue, not a moral one. Stern also has indicated that the single-payer approach, for all its virtues, is a political nonstarter. At the other pole is the growing number of national unions, locals, labor councils, and rank-and-file members pledged to the single-payer solution. Somewhere in between is the AFL-CIO, the nation’s largest labor federation, which in March 2007 endorsed the idea of “Medicare for All” but carefully avoided mentioning the “s” word, that is, single-payer.

So far, Stern has garnered a disproportionate amount of media and popular attention. His business-friendly stance on health care reform, which stresses how the U.S. health care system is fundamentally hurting the country’s economic competitiveness, helps explain why. But his economic competitiveness argument is not convincing and could undermine efforts to forge a successful coalition or movement on behalf of affordable, high-quality care for all.

The bottom line is that to achieve universal health care, the country needs to have real cost containment and to reallocate its health care resources. If we are truly committed to creating a high-quality, affordable universal health care system, someone will have to give something up, and some will have to give up more than others. The call for health care reform in the name of economic competitiveness holds out the chimera that a bloodless win-win solution is possible for all the stakeholders in the health care system—insurers, medical providers, and the general population.

The economic rationales for national health insurance are considerable. But we need to resist the temptation to reduce this mainly to a question of dollars and cents. As Uwe Reinhardt recently said, the health care debate really boils down to one question: “Should the child of a gas station attendant have the same chance of staying healthy or getting cured, if sick, as the child of a corporate executive?” Reinhardt notes that it would cost about $100 billion in additional government spending to provide health care coverage for every man, woman, and child in the United States—or about what the country spends every nine months to fund the war in Iraq.

Check out the entire article here.


One Response

  1. But WHY is single payer a “political nonstarter”, when majorities of both voters and physicians favor it? That’s the truly disturbing question. Nothing else reveals so starkly the corruption of our politics: forget what the body politic wants, it’s what the “campaign contributors” want that counts—in this case the health insurance companies.

    Providing healthcare for all would indeed increase payroll and income taxes, probably by more than the $100 billion per year cited by Reinhardt. But he fails to mention that premium payments by individuals and employers would decrease by about the same amount that taxes would increase, because we would save the $350 billion costs per year now imposed on the system by insurers—over $1 billion wasted per day, more than the cost of the Iraq war, and greater in loss of American lives, too—18-20,000 per year.

    We are already paying for universal coverage, we just don’t have it.

    For more, see

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