Solidarity Forever: a Labor History of Medicare for All

Mark Dudzic, National Coordinator for the Labor Campaign for Single Payer, joins us again to take a deep dive into the recent history of Medicare for All organizing within the labor movement, including the political calculations made during the failed Clinton health reform push, the changing landscape for unions through the Affordable Care Act, labor’s role in the creation of the center-left Healthcare for America Now (HCAN), and the direction labor is moving in the Sanders/Biden era.

Show Notes

Ben kicks things off on a rant. Recently diagnosed with gout, which leads to extremely painful inflammation in the joints Ben was warned by his doctor that the miracle drug that treats gout inflammation – colchicine – could come with massive copayments of hundreds of dollars. How? Colchicine is one of the oldest medicines in recorded history – described in Egyptian medical texts from 1,500BC, and used by the ancient Greeks to treat joint pain!

Colchicine has been widely available and prescribed by doctors at low prices for generations now, but in 2009 the FDA decided to give the patent rights for colchicine to one pharmaceutical company, which drove all the generic manufacturers out of the industry, and prices rose by more than 2,000 percent. Ben now has trouble accessing a drug that was readily available to Aristotle and Christ. Good job American healthcare!

With that rant over, we bring back our guest Mark Dudzic, national coordinator for the Labor Campaign for Single Payer to do a deep dive on the history of the Medicare for All movement, and labor’s role.

Mark starts by pointing out that in the U.S., the linking of healthcare to our employment was an accident of history coming out of WWII. When wages were frozen during the war effort, the labor movement effectively pushed for and massively non-wage benefits – including healthcare coverage – for workers in the U.S.

However, the promise that Roosevelt made to implement an economic bill of rights following the war, including establishing healthcare as a public right, was never realized. Instead, a serious attempt by Truman to pass national healthcare in the late 1940s was defeated by Southern Democrats to protect structural racism in the healthcare system, and that was followed by a decade of red-baiting and anti-worker legislation.

During the entire postwar period, the official policy of the labor movement was to fight for a national health plan, until the 1990s. However, the late 1980s and early 90s marked a huge health crisis – huge losses in healthcare coverage, and surging prices. Bill Clinton ran on healthcare in 1992, and tasked Hillary Clinton with implementing health reform. However, the Clintons early on ruled out a single-payer system, taking the approach that Democrats need to coopt market-oriented policy from Republicans, and they promised to develop a universal healthcare plan with all the benefits of Medicare for All without taking on the healthcare industry.

Mark describes the Clinton reform as a classic example of bargaining against yourself, and predictably the healthcare industry took all of the concessions that were offered to them, demanded more, and then ultimately opposed and defeated the bill in the end anyway. The bill was dead on arrival, and it wasted a couple years of the Clinton administration’s political capital.

The Clinton reform was also a turning point for the labor movement. The official policy of the labor movement had been supporting national health insurance for decades. Entering 1992, though, the AFL-CIO very narrowly – by a vote of 5-4 – decided to endorse the Clinton healthcare plan and retreat from Medicare for All organizing.

This led to a period of very little activity around Medicare for All: the 1990s rise of HMOs and managed care being forced upon workers, which dramatically restricted choice and access to care, did temporarily stabilize premium costs. The labor movement was also side-tracked in fights over NAFTA and the impact of globalization on workers.

By the time Obama was first elected in 2008, a significant social movement had grown for Medicare for All – with M4A grassroots groups springing up around the country, and the Improved & Expanded Medicare for All Act being introduced to Congress in 2003.

By this time, the healthcare crisis had returned in full – insurance coverage was dropping, prices were exploding. Right before Obama’s inauguration, Mark launched the Labor Campaign for Single Payer Healthcare in 2008 with a broad range of national unions, specifically to fight for Medicare for All during the 2009 national debate over health reform. That year Mark was arrested for civil disobedience in Congress when Senator Max Baucus refused to include a single speaker on behalf of Medicare for All in Senate hearings over the ACA. Democrats pushed for a public option, but after a year of bargaining against themselves to gain Republican votes – which they never succeeded at – not even a public option was included in the final bill.

A number of large unions also launched “Health Care for America Now” to fight for the Affordable Care Act and a public option – which was a suspiciously similar name to our organization, Healthcare-NOW! Some of the reason labor driven by a hope that if the ACA could succeed, Obama would be able to continue on to pass many of labor’s other priorities (spoiler alert: that didn’t happen). Lining up behind the ACA definitely cost many unions credibility with their own members, though, primarily because the “cadillac tax” on workers’ benefits included in the bill – something Obama had specifically campaigned against McCain on the year before.

Which brings us to the past decade of the 2010s, characterized by the Clinton and Biden runs for the Democratic Party. Mark characterizes the Democratic Party’s philosophy during this period as “wanting progress without struggle,” or wanting universal healthcare without taking on the healthcare industry. However, this has been the position of neoliberal Democrats since the 1990s, a position that is at odds with the growing crisis of our healthcare system – insane price increases, massive loss of access, growing racial disparities. If something must change, it will change.

At the same time, we’re in a period of incredible potential change. For the first time in 2019, unions representing a majority of unionized workers in the country endorsed the Medicare for All Act of 2019 – something we’ve never seen in the history of the labor movement. This was a watershed moment, and we now also have what feels like an unbreakable majority of support from the American public – a majority that holds up even in the face of public attacks and lies.

People are not going to forget the pain and failure of healthcare that they’re experiencing during the current coronavirus pandemic either. Ben, Stephanie and Mark close on a hopeful note that we have really reached a tipping point at the grassroots level, and the last step is for the massive public support to move even more decisively the political system.

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