In Health Care Reform Debate, Single-Payer System is Labor’s Only Clear Choice

Union members have a huge stake in the present debate on health care reform.

At a time when employers routinely slash or eliminate health benefits for workers and their families or force union members on strike to preserve those benefits, when insurance plans routinely restrict workers’ choice of doctors and prescription drugs, and when more working families declare bankruptcy due to medical debt, only one reform can provide the health care security working people need: single-payer.

Under single-payer, you don’t face the loss of health benefits if you lose your job or are forced out on strike. You don’t face employers constantly shifting costs onto your back. You don’t have to worry about retiree health care if you are able to retire before age 65. And you are no longer at the mercy of the insurance industry predators who routinely deny care.


Single-payer is not a dream. It’s legislation—House Resolution 676, introduced by Congressmen John Conyers and Dennis Kucinich, with dozens of co-authors. It also has the backing of 235 labor organizations in 40 states, including 17 AFL-CIO state federations and 60 county/regional central labor councils. Several states, including California and Illinois, also have single-payer bills in the hopper.

Does single-payer work? Every industrialized nation in the world except the U.S. has either a single-payer system, like Medicare, or a national health system, like our veterans health system. That’s why the U.S. stumbles along at 37th in the world in overall health care quality, according to the World Health Organization.

Under single-payer, all health care revenues go into one publicly administered pool of money that pays for all medically necessary services delivered by doctors, hospitals, and other providers.

Its guiding principles are:

• Universality: Everybody in, nobody out.

• Portability: Even if you lose your job or never had one, you still have health coverage, guaranteed.

• Comprehensive, uniform benefits: No Cadillac plans for the wealthy, no tricycle plans—with high deductibles, limited services, and caps on coverage—for everyone else.

• Choice of physician, hospital, clinic, and other caregivers: Most private plans restrict where you can go.

• Cost controls and cost savings: 30 percent of every dollar that currently goes to insurance companies pays for their administrative costs—and their profits. Under single-payer, savings accrue from eliminating this overhead.

• Public oversight: The public sets policies and administers the system, instead of high-priced CEOs meeting in secret and making decisions based on what inflates their compensation packages or company profits.


Single-payer is such an obvious solution that one might wonder why there is not overwhelming accord by labor, liberal, and progressive organizations and politicians to campaign for it.



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One reason is the enormous economic and political clout of the health care industry. The 20 largest HMOs in the U.S., for example, made $10.8 billion in profits in 2005. Drug companies make even more; the world’s 13 biggest reported $62 billion in profits in 2004.

Health care corporations employ that wealth to block real reform in Washington and in state capitols. They promote “solutions” for the health care crisis that throw more money to the private marketers who created the present mess by putting revenues and profits ahead of the health and well-being of patients.

Thus, we’re presented with a series of market-based approaches masquerading as “universal” coverage, along with browbeating campaigns designed to lower public expectations and promote the conventional wisdom that only substandard solutions are feasible.

We’ve heard this before. From abolition of slavery to women’s suffrage to enacting Social Security and Medicare to ending legal segregation, our history is filled with achievements that the political “realists” repeatedly dismissed as unrealistic.


Most of the alternatives offered instead are based on expanding the role of the insurance industry. Among the ideas now being touted by, among others, liberal advocacy groups and a few Presidential candidates, are mandates that everyone be required to buy insurance, tax deductions to encourage people to buy insurance, taxes on employers to pay for more insurance, and expansions to existing federal or state programs to buy insurance for the low income.

No wonder that Stephen Hemsley, chief executive of health care giant UnitedHealth Group, calls one such scheme, by California Governor Arnold Schwarzenegger, “an interesting set of proposals that represent real opportunities for our business.”

Both the Schwarzenegger plan and the Massachusetts law on which it is modeled have as their central premise the requirement that all state residents buy health insurance.

Yet neither places any limits on skyrocketing premiums, and in both states individuals and families will face huge deductibles with even the cut-rate plans the law will force them to buy. The result is that many will end up paying for virtually all their medical expenses or gamble with their health by avoiding most services.

On the other hand, the California and Massachusetts models are welcome news in the corporate boardrooms of the insurance industry. Insurers stand to make hundreds of millions more just in California.

Another favored scheme, especially by some in labor, is employer mandate “pay or play” plans that require businesses to provide health benefits or pay into a state pool to buy insurance for the uninsured.

But in addition to being another windfall for the insurers, a federal court ruling throwing out a Maryland law based on this approach cast doubt as to whether any employer mandate will withstand legal challenge.

The health care industry and conservative ideologues hardly need our help. It’s time for labor activists to unite behind the only health care reform that is universal, comprehensive, and assures one standard of quality care for all.

Rose Ann DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee.