Mark Dudzic Reviews State of Labor Campaign for Single Payer Healthcare
Note: Following is the presentation by Mark Dudzic, national coordinator of the Labor Campaign For Single Payer, at the April 10, 2012, forum in San Francisco hosted by Single Payer Now titled, "Labor and Single Payer Healthcare." The transcription of Brother Dudzic's presentation is by The Organizer newspaper. This presentation was published in the May-June 2012 issue of Unity & Independence, the labor supplement of The Organizer newspaper.
I was at headquarters of the ILWU here in San Francisco with labor folks, trying to figure out where we are in this movement, this fight to make healthcare a right in this country, and what our next steps have to be in order to move this thing forward.
I have maintained that if you put 10 random people in a room with some white sheets of paper that in an hour they could figure out everything that's wrong with the healthcare system and have a good sense what the best solutions are. Everybody knows somebody who doesn't have access to any kind of healthcare. Everybody knows some father or uncle who has to cut their pills in half at the end of the month to make it through the month. Everybody has stories of horrible service and wait times and poor healthcare experiences, so there is no mystery as to what is wrong with the healthcare system in this country. Nor is there a mystery as to what the solution is.
We have to do what everybody else in the world has done, in every industrialized country in the world: Make it our birthright for everyone in America. Get rid of the profiteers at the center of this business that treat healthcare as a commodity and as a profit center, and run it the way we run Medicare and other social insurance programs that provide a basic standard of security for working people in this society. There really is no dispute about any of that.
So really the fight is all about solving that equation that people claim is called "political feasibility" or some other excuse for the reality that we do not have a movement that is powerful enough to confront the organized corporate power that sits on top of our healthcare system and that seeks to continue to control it and continue to profit from people's illnesses and diseases. So that's the reality and we have to change that equation. That's what the Labor Campaign for Single Payer is all about.
We launched this project in 2009 as we were getting ready to inaugurate President Obama and there was a promise that we were going to enter into a new period of some real farsighted and great social reform in response to the worst economic crisis since the Great Depression and healthcare was going to be a part of that project. We felt that labor needed to get ready for that fight and needs to stay in that fight.
The basic premise of the Labor Campaign for Single Payer is that labor has to lead the fight for healthcare for all in America, just like labor has led the fight elsewhere in the world. It's the only institution that has the capacity to really confront corporate power. It's truly independent, or could be truly independent, of corporate power. It needs to move this thing forward.
And, in the process, we believe that labor will begin to transform itself back into the social movement that it needs to be in order to speak on behalf of all working people. So, I think there is a two-way process that occurs. As labor steps up and we move labor from the inside to take this fight up, we're also moving labor a lot closer to where it needs to be to revitalize the labor movement, and make it again part of a vital movement of working people in this country.
So that is really the reality we're trying to operate in and what we're trying to do with this campaign — in alliance and in coalition with other social movements that are also fighting for healthcare justice.
We have been working in a number of different forums over the last few years and have a achieved a number of successes to get labor to address these issues, and to move the AFL-CIO back toward a formal support for single-payer as a long-term solution to the healthcare crisis. That had been the position of the labor movement for a number of years. They moved away from that, particularly during the Clinton years in the 1990s. There were some historic debates that took place in the labor movement during the early 1990s that moved the labor movement in a different direction on this issue.
Our first job, we felt, was to try to begin to turn that giant tanker back at least in the right general direction and then begin to engage in a more direct way. And we achieved a number of successes, but in the process of all of this, they did pass a bill in 2010 called PPACA — Patient Protection Affordable Care Act of 2010 — and that is the bill that has kind of set the terms of where we are today in terms of the healthcare policies in the United States. We need to understand what it does and what it doesn't do and what kind of conditions that creates for the labor movement and for the broader healthcare reform movement.
PPACA does do a number of things, and we have to be very aware of the sort of contradictory aspects of this healthcare bill. It does provide an expansion of access to healthcare for millions of working Americans. It expands access to Medicaid for the working poor in potentially some expansive ways and then promises to expand to subsidize private insurance healthcare to other low-wage and middle-wage Americans.
Now that's where some of the quandary begins because expanding access to healthcare insurance is not always the same thing as gaining access to healthcare. But there is a promise there, which has yet to be met, to move in that direction.
It also provides some direct assistance to clinics in under-served communities, to training programs to try to get more healthcare professionals on the street. There are a number of small programs and incentives in this bill that will make things better for people.
In addition, it purports to try — for the first time on a federal level — to regulate the private healthcare insurance industry in certain ways. In terms of preventing them from denying coverage for pre-existing conditions and withholding coverage from people when they become sick; supposedly limiting the amount of money they can use for administrative and profit-taking expenses, etc.
Again, we'll see. The jury is going to be out on this insurance regulation. I've seen a lot of attempts to regulate healthcare at various levels over the last 25 years. It seems like they are pretty good at finding ways to scam the system and resume their rush to profitability. Those of you who were in the labor movement during the HMO explosion in the 1990s will recall the promise and the disaster of that scheme, so we'll see where that goes.
There are also certain things that are very clear that PPACA doesn't do and will never do. It does not make healthcare a right in this country and it is not intended to make healthcare a right. What you have with PPACA is the right to buy private healthcare insurance. Healthcare insurance is not healthcare in any way. Especially in the kind of insurance many people will be able to afford under PPACA, and, therefore, it does not make healthcare universal in any fashion.
The latest estimates by the CBO — the Congressional Budget Office — indicate that in 2018, which is eight years after the passage of the bill, there will be 27 million uninsured Americans. That's four million more than they had estimated when they passed the bill two years ago, so they are already revising their estimates. And that extra four million are going to be people who used to have employer-based coverage and whose employers have dropped employment-based coverage and chose to pay a penalty under PPACA.
So it's not going to cover everybody. It wasn't intended to. It won't be universal and it doesn't really bend the cost curves because it doesn't attack the fundamental problem of healthcare financing, which is profit-taking and insane administrative costs. It's not going to attack the cost curve. So the costs are going to continue to escalate two, three, four times.
PPACA, moreover, does not remove healthcare from the bargaining table, which is the goal of the labor movement, or should be the goal of the labor movement at this time. It's certainly the goal of the Labor Campaign for Single Payer; we've got to remove healthcare from the bargaining table. PPACA does just the opposite. It puts new pressures on us at the bargaining table.
First of all, in terms of the race-to-the-bottom pressures: PPACA sets certain tiered levels of benefits, starting with platinum and going down to bronze. The platinum plan is supposed to cover 90 percent of your healthcare costs on average. The bronze plan is supposed to cover 60 percent of your healthcare costs on average. Anybody who has ever seen a hospital bill knows how useful a bronze plan is going to be.
Right now, the last I checked, the average union plan covers around 93 percent of costs. So there is going to be downward pressure to move into those lower tiers. I've been around a long time, negotiated a lot of years, and that's going to be the constant reality as we move to collective bargaining, to begin to move these benefits downward through these tiered benefit structures.
In addition, there are all kinds of incentives built into this system for employers to jettison private health insurance altogether, pay the penalty and then throw their workers onto these State Exchanges that are being developed.
There will be particular pressure, I think, in lower-wage workplaces. But there is a whole group of consultants right now who are working with management, and they are running the numbers, figuring out that this is how much we're going to have to pay; this is how many people will be eligible for this subsidy into this plan and we can do this and we can do that. There will be a continual assault on that level.
You know it's also going to put incredible pressures on what we call Taft-Hartley plans, union-sponsored healthcare plans, which are sort of the gold standard right now for a lot of unions in terms of trying to hold the line on healthcare. These plans are going to be under unique stress. This reality is beginning to set in, and it's going to cause a bunch of rifts in the labor movement.
Finally, we have the excise tax, what they have called the Cadillac tax, but is really a Chevy tax on plans that they say are better than the American people deserve. Workers who have fought and died to achieve those benefits are now going to subject to a 40 percent excise tax, starting in 2018 on those type of plans.
Already, that issue is being used as a hammer in collective bargaining to go after medical benefits. It was one of the issues in the unsettled Verizon contract, a strike last summer on the East Coast, and the continued fight in Verizon. It's a little bit disingenuous of the company to say that because something is going to change in 2018 they have to get concessions in 2011, but, nonetheless, they are claiming they have to restructure their healthcare radically in order to avoid an excise tax in 2018. And this is hitting the bargaining table all over the country.
Unions like the ILWU right here in San Francisco and the Mine Workers are telling me that even though they lobbied for and won a higher limit for their members because of the hazardous nature of their occupation, their latest studies show that they are going to hit that tax in 2018 or 2019. So, it's going to be a constant pressure on us as we bargain for these issues.
Those are kind of the stresses that we're facing in the labor movement. Then, if you have read the news, you understand that PPACA is under massive judicial and legislative assault right now. We had the spectacle two weeks ago of the Supreme Court hearings in D.C. I stopped by one day; it was a very interesting circus going on. I didn't go into the court. You had to be really important and cool to get into the court.
But you had this spectacle of a bunch of liberal Democrats going to the barricades for a social program that was devised by the right-wing Heritage Foundation and saying we have to defend this social program. Across the street, you had all these right-wing Tea Party folks denouncing this idea of an individual mandate — which was in fact devised to prevent the expansion of healthcare through a single payer-type program — and claiming that it is a socialist plan.
But every once in a while something funny happens. You can view on You Tube, for example, the attorney general from Louisiana, who was one of the plaintiffs trying to overturn PPACA because it was socialism, but who got way off-message and started saying, well, we don't want the insurance companies doing this because it will be just like when the hurricane came into New Orleans. They will all run away and they won't do their jobs, so really the government ought to be doing this healthcare. I'm sure he got taken to the woodshed afterward. It's on You Tube and it's unbelievable.
What this is all about is the next election. It's not about healthcare. It's about the next election, including the way the justices are going to rule. This is a political court. It's a court that appointed George Bush president. It's a court that determined that corporations are people and money is speech.
The nurses' union says, and they are absolutely right, that whatever happens with the Supreme Court ruling on PPACA, the fight will be there the next day and we have to be ready for that fight. But the danger I see is that the Supreme Court may rule on this issue in ways that undermine the whole social insurance model that working people have fought for, to build and to maintain over the years, and this could move us really backwards on a number of fronts.
In addition, I think the danger for places like California — if they find this unconstitutional — is that you may find a big effort to pass a mini-PPACA — that is, an individual mandate and healthcare "reform" that will just suck the air out of the healthcare justice movement in the state. I think we have to be aware of that and be ready for that kind of so-called solution.
So there is going to be a constant assault on this bill and we're going to have a choice as a movement; as a labor movement and as a broader movement for healthcare justice.
That choice is to circle the wagons and try to defend a flawed bill and defend it by throwing pieces of that bill at the right-wing and hoping that they are going to go away. We have been doing that in a whole bunch of areas for the last 30 or 40 years in the labor movement and it really hasn't worked out too well for us.
Or we can use this opportunity to revive the fight for healthcare justice. That's really the choice we have to make, and that's really the challenge we have to bring to the labor movement and to all of the social movements: We have to look at this time as a time to revive that fight for healthcare justice, for single-payer healthcare.
We've got to move labor into the center of that fight, and we've got to see California as the real place where we can move this thing forward. There have been a number of efforts to build single payer reform at a state level. I happen to think that the final solution has to be a national solution, but I think the dynamics of organizing and the dynamics of change show that right now the options are kind of trying to move forward on a state level.
There have been some breakthroughs in Vermont, where the labor movement was central to the process. They haven't achieved single payer in Vermont. In fact, they have finally awakened the insurance industry to their danger, and there is going to be a big fight brewing in Vermont.
Nonetheless, there has been a real breakthrough there that puts that state on the road. Hawaii may follow; there are some interesting things going on in Hawaii, but the real prize is California. If we can move Single Payer in California, we will win nationally.
For me, the challenge we have as a labor-based organization is to get labor to take this issue of healthcare as seriously as it takes any other issue; that this is a survival issue as sure as the paycheck deception initiatives on the ballot this year is a survival issue for labor.
Labor needs to defeat that paycheck deception initiative, and they will move heaven and earth to defeat it. I was at a Steelworkers' political action meeting in Southern California where they committed $100,000 out of that one organization and releasing a large number of people to walk precincts in the last month for that election. They will mobilize millions of dollars and thousands of organizers to defeat that initiative, as they should.
We have to take that healthcare issue — labor has to take that healthcare issue — as seriously as they take those survival issues. I tell you something, brothers and sisters, when that day comes, when labor puts that kind of resource into this issue, that's the day we're going to achieve Single Payer in this state and in this country.