Medicare for All Helps Unions by Taking Health Care Off the Bargaining Table

On February 11, the Nevada Culinary Workers Union publicly criticized Democratic front-runner Bernie Sanders’s Medicare for All plan ahead of the state’s Democratic presidential caucus. On February 12, Sanders responded, “Many, many unions throughout this country — including some in Unite Here, and the Culinary Union is part of Unite Here — absolutely understand that we’ve got to move to Medicare for All.”

Sanders continued, “When everybody in America has comprehensive health care, and when we join the rest of the industrialized world by guaranteeing health care to all people, unions can then negotiate for higher wages, better working conditions, better pensions. So, I think the future for unions is through Medicare for All.”

After Sanders’s statement, the Culinary Union’s Secretary-Treasurer Geoconda Argüello-Kline denounced Sanders and his supporters, stating, “It’s disappointing Senator Sanders’ supporters have viciously attacked the Culinary Union & working families in NV simply because we provided facts on proposals that might takeaway what we have built over 8 decades.” The Culinary Union was joined in denouncing the Sanders camp by fellow Democratic presidential candidates Elizabeth Warren and Amy Klobuchar. On February 13, Pete Buttigieg joined with Klobuchar, Warren and the Culinary Union in promoting condemnations of the Democratic front-runner and Medicare for All.

Ironically Warren’s campaign staff repeatedly crossed the Culinary Union’s picket line in March 2019.

Flashback to September 17, 2019: General Motors confirmed to the press that it had ceased payment for the health care coverage of striking United Auto Workers (UAW). On the same day, presidential candidate Joe Biden addressed members of the AFL-CIO on his health plan, stating, “I have a significant health care plan. But guess what? Under mine, you can keep your health insurance you’ve bargained for if you like it.” For the striking UAW members, the choice of keeping private health insurance that was bargained for wasn’t an option.

Talking points touting “choice” have frustrated advocates of Medicare for All and sympathetic union members this election cycle. Biden, Warren and Klobuchar aren’t the only candidates this primary season to promote the “choice” argument: Former Democratic presidential candidates Kamala Harris, Tim Ryan and John Delaney have parroted similar statements in promotion of their proposed health plans.

Earlier on February 12, Buttigieg joined Biden and company in echoing familiar “choice”-focused talking points, tweeting, “There are 14 million union workers in America who have fought hard for strong, employer-provided health benefits. Medicare for All Who Want It protects their plans and union members’ freedom to choose the coverage that’s best for them.”

Sara Nelson, president of the Association of Flight Attendants (AFA), fired back, “This is offensive and dangerous. Stop perpetuating this gross myth. Not every union member has union healthcare plans that protect them. Those that do have it, have to fight like hell to keep it. If you believe in Labor then you’d understand an injury to one is an injury to all.”

Nelson later joined the Culinary Union leadership in denouncing “attacks” from Sanders supporters, rather criticisms of union management not directed at the rank and file. But Nelson has been a consistent advocate of Medicare for All and the AFA has stood with Sanders since 2016.

To paraphrase Nelson and her advocacy, Medicare for All is popular among organized workers. The 150,000 members of National Nurses United (NNU), the U.S.’s largest union of registered nurses, have organized the charge on behalf of patients and fellow workers. NNU and AFA aren’t alone: Over 600 locals, 22 national unions, 44 State AFL-CIOs and 158 Central Labor Councils and Area Labor Federations have endorsed the single-payer legislation. Even with strong support from many rank and file members, some union leaders have shied away from Medicare for All in order to adjust their sails to the political winds at a moment’s notice.

Talking points and political triangulation aside, Biden, Buttigieg and others aren’t wrong for stating that unions have fought tooth-and-nail for health benefits. They have certainly done so, and at great expense to wage increases and membership organizing. But Biden and Buttigieg missed a point in their “choice”-centered pitch — the public option plan that they, along with Warren and Klobuchar, are running on will leave health care on the negotiating table for organized workers.

Through a single-payer system and Medicare for All legislation, health care can finally be lifted from the bargaining table. Single-payer will allow more freedom for unions and replaces a system that keeps workers and patients at the mercy of executives and private insurers with one that recognizes the urgency to treat health care as a right, not a bargaining tool for bosses to hold over workers’ heads.

Removing Health Care From Bargaining

The benefits of organized labor backing Medicare for All over the public option are immense. Unions won’t have to waste negotiating capital fighting to merely preserve health benefits. Under a single-payer model, unions can use resources otherwise spent on retention of health benefits to instead organize new workplaces, fight for higher wages, fight for protections and safer working conditions. A single-payer system frees up organized labor to leverage their resources and membership in favor of gaining even more for their members.

If single-payer is realized, then union members will no longer be bound to tedious network-based health plans like Health Maintenance Organizations or Preferred Provider Organizations. Private insurance and the network “innovations” the market has created have significantly complicated the system and also limits choices for patients. With Medicare for All, patients, whether they be unionized or non-union, will be able to choose their provider and no longer be confined to networks, which a public option framework would maintain.

Under the public option, union members are tied to the benefits of their plan, which sometimes doesn’t cover necessary services. In other words, some union plans have coverage gaps where services like mental health care or long-term care aren’t covered. Medicare for All expands these services to everyone and eliminates the coverage gaps imposed by private insurance. Union members will receive more comprehensive benefits under Medicare for All than under their current private health insurance plans.

Single-payer systems also famously have improved outcomes compared to the American model of private employer-sponsored mixed insurance with an underfunded public insurer. Metrics in terms of quality, cost and access in the American health system have historically lagged behind nations with single-payer models. Under Medicare for All, union members can expect to receive health services that exceed or are at the same quality as the plans they fought for with more health services covered.

Unions also will no longer have to worry if an employer wants to change insurers. Under single-payer, union representatives at the bargaining table can be at ease knowing that their members will have guaranteed, comprehensive health coverage through Medicare for All. The single-payer model throws in the added benefit of eliminating the laborious process of switching health insurance carriers for union workers.

For public sector unions, single-payer will eliminate cost sharing, which is how the business-minded Republican and Democrat governments have passed the cost along to public employees. Cost sharing has forced public union workers to increasingly take a larger personal share of the expense for health coverage. With Medicare for All, unionized public employees can be assured that their hard-earned paychecks stay in their pockets and are not increasingly spent on health costs.

Medicare for All is also more than just getting health care off the bargaining table for unions, it’s about harnessing the energy of movement politics to create a new labor movement. Wages have stagnated since the ‘80s, workers are toiling for longer hours, wealth that has been created by workers is becoming increasingly concentrated in the hands of a few individuals. Labor has been under attack by business-friendly lawmakers and judges on all levels of government for decades. In an era of popular political movements, unions finally have the political climate to fight back.

Medicare for All can revitalize and invigorate a labor movement that has largely been on the defensive. In nations where health care is guaranteed as a human right through single-payer, unions are leading the way in combating pension “reforms” and uniting with non-organized labor against undignified working conditions. Countries with single-payer models have proven that when health care is removed from bargaining, unions thrive and are leaders against the features of an economic system designed to benefit the few.

The transition to a single-payer system is an opportunity for unions to join together to secure health care as a right for all workers, benefits that are the same quality or better, and expand choices and services for their members. All while leveraging the energy that could build working-class power and usher in a new dawn for the labor movement.

Union members have built an enormous amount of wealth for all. The people who got all of us the weekend and the eight-hour work day deserve better than a health system that holds their health care second to employers’ bargaining tactics and the profits of private insurers.

The “choice” arguments pushed by the defenders of private insurance are misleading on Medicare for All. Single-payer will save workers money, expand their freedoms and end the absurdity of toying with workers’ health care by executives to pad balance sheets. It’s crucial for labor to keep in mind management’s callous bargaining tactics like the striking auto workers faced: when employers stop paying for workers’ health benefits, there is no “choice.”

Medicare for All is the path forward for unions. The public option model doesn’t deliver in providing organized workers much needed relief in getting health care off the negotiation table. Getting health care away from the grips of employers and adding Medicare for All to the list of political must-dos is a top priority for organized labor.