The finer points of such policy debates are lost on most union members. That's because unions tend to leave healthcare strategy and lobbying in the hands of experts. In contract talks, negotiators desperately seek new cost-containment schemes to sugarcoat medical plan changes. Meanwhile, labor policy wonks organize events like the current series of AFL-CIO Regional Health Care Conferences--open only to union reps and too narrowly focused on "recent best practice given the current climate." This top-down, technocratic approach fails to address the need for massive workplace education and debate about healthcare reform. Because that's been so neglected, most trade unionists still think of universal healthcare as something that would benefit someone else. The term "single payer" often draws blank stares [see David Corn, "Healthcare for All--Now," January 6]. And the concept of a government-run insurance plan strikes many union members as a formula for longer waits, inferior care and higher taxes--rather than real security and relief from out-of-pocket costs.

One group trying to change "the current climate" through rank-and-file education and cross-union activity is Jobs With Justice. On June 5 the group sponsored a statewide Health Care Action Day in Massachusetts, endorsed by more than fifty unions and community groups. Participating organizations distributed more than 65,000 stickers demanding "Health Care for All" and did the mobilization necessary to get workers--from nurses facing staffing cuts and state workers facing benefits givebacks to utility workers facing slashed retirement coverage--to wear them on the job. This workplace activity was accompanied by informational picketing and rallies calling for a healthcare system that "covers everyone, is publicly financed, and saves money...by reducing bureaucratic waste."

The most active participants were workers at GE and Verizon who have been--or may soon be--on strike over cost shifting. If 80,000 members of CWA and the International Brotherhood of Electrical Workers (IBEW) walk out in August at Verizon, this could lead to termination of their benefits coverage--a further lesson on why healthcare shouldn't be controlled by employers. "When a boss cancels everyone's insurance during a work stoppage, it's a teachable moment," says Rand Wilson, a Service Employees International Union staffer in Boston. "It really gets people thinking about what's wrong with having medical coverage tied to their job. The financial risks and penalties of getting laid off, changing jobs, working part time or retiring early--not to mention going on strike--would all be greatly reduced if we had a Canadian-style system."

Other unions, like the United Electrical Workers, are following up Health Care Action Day with bargaining table challenges to management. UE developed an Employer Pledge that offers two choices: Either join the union in lobbying for real healthcare reform or continue to pick up the tab for the present for-profit system, with its increasingly high costs and shabby care. In Canada, where labor is fighting to improve a thirty-year-old Medicare-for-all program, the Canadian Auto Workers won business backing for the single-payer approach. In a recent letter signed jointly with the union, GM, Ford and Daimler/Chrysler demanded that Canada's "publicly funded health care system be preserved and renewed, [based] on the existing principles of universality, accessibility, portability, comprehensiveness, and public administration."

Jobs With Justice didn't attract such corporate support for Health Care Action Day. But the diversity of its labor endorsers shows how widespread conflict over cost shifting has become, in both the private and public sectors. As such disputes intensify, more trade unionists are reaching the conclusion that incremental private-sector solutions aren't the answer. As Colin Gordon concludes in Dead on Arrival: The Politics of Health Care in Twentieth Century America, "employment-based health insurance, floated as an alternative to public insurance in the middle years of the [last] century, is now little more than a leaky life raft for politicians clinging to budget-neutral solutions and workers with nowhere else to swim."

Growing budget deficits, legislative gridlock and huge military expenditures create a daunting context for new healthcare initiatives that would expand public coverage at the state or federal level. Nevertheless, mounting workplace attacks on employee benefits are forcing unions to fight back in a more political way for what workers really need, not just what some leaders think they can get. This represents an important first step toward revitalizing labor involvement in healthcare reform--and projecting unions as a champion of all workers, not just those with a membership card.

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