Why Won’t Corporate America Support Single Payer Medicare-for-All?

By Mark Dudzic, National Coordinator of the Labor Campaign for Single Payer

On the surface, it appears to be a no-brainer. Healthcare costs in the U. S. are twice as high as any other industrialized country. Most large corporations still pay a big chunk of their employees’ health care insurance premiums. Some are obligated by union contracts to pay an even larger percentage and to provide coverage for retirees. Many operate profitably in countries with national health care systems where they pay far less towards healthcare costs than they do in the U.S..

So, from a straight bottom line business perspective, corporations should be leading the fight to replace our dysfunctional, overpriced, for-profit private insurance system with a single-payer, Medicare-for-All model. Yet more than 20 years after the crisis of escalating health insurance premiums first hit the corporate radar screens, not a single major U. S. corporation has come forward to advocate for replacing employment-based health insurance with a comprehensive national healthcare system. What gives?

Well, I can’t claim any deep psychological insights into the corporate mind-set but I did negotiate with a wide array of corporations in my 20-odd years as a union official. In fact, in 2005, my union negotiated a national agreement with the oil industry that established a joint “Health Care Strategic Committee” meant to address the “undue burden” that the “upward spiral of healthcare costs has placed on employees and employers alike.” The purpose of the committee was to, “[E]xamine, explore and seek means, both internal and external, to address this rapid rise in health care costs. Further, the Committee will endeavor to influence the national debate around health care issues through positive participation in public and governmental forums.”

Now many of us were hopeful that this might produce some results. Lots of these companies were based in countries that had national healthcare (British Petroleum, Royal Dutch Shell, etc.). All of them did business in countries where the right to healthcare is a birthright. But it was all in vain. The union practically had to tie them to their chairs to get them to listen to a presentation on single-payer from highly-credentialed experts. After two sessions, the whole thing dissolved into acrimony. They were only interested in one thing: shifting their healthcare costs onto the backs of their employees.

I think there are a number of factors that contribute to this mindset:

It’s about power. Corporations like having healthcare linked to employment. They like having people held captive in jobs they hate for fear they they’ll lose their health coverage. They like it that, when you go on strike, you generally lose your health insurance. They like to control who they will cover, how much they will pay and what benefits are offered. They like the ability to change anything at any time for any reason whatsoever.

They already have a plan to reduce healthcare costs. Thirty years ago, most employees of large corporations were covered by defined benefit pension plans that paid a guaranteed retirement benefit for as long as the person or their spouse lived. Today, the lucky ones have a 401 (k) plan that they pay into that has no guaranteed pay out. In effect, most large corporations have transferred all of the risks of providing retirement coverage onto their employees. This is their same plan for health insurance. All of the talk about “employee-directed health coverage” is about transferring risk from the corporation to the employee, Ultimately, they would like to replace any guarantee of health coverage with a voucher system where workers purchase their own coverage from an unregulated market.

They don’t like slippery slopes. Large corporations almost always religiously resist any attempt to regulate or control their behavior. These people would probably fight a regulation requiring them to help old people cross the street by claiming that it will create a new entitlement mentality that will undermine the free market. Much of the politics of the last 30 years has been about corporations trying to free themselves from any national or social constraints on their mobility or freedom to do just about anything. They’re not going to easily concede that the time has come to establish a new social right in the heartland of capitalism.

They practice class solidarity. Unlike the poor benighted U. S. working class (was it Jay Gould who boasted, “I can hire one half of the working class to kill the other half.”?), large corporations actually believe in class solidarity. Health industry executives serve on other corporate boards and other executives serve on their boards. The banking and financial sectors establish all kinds of interlocking relationships between various large corporations. They belong to the same country clubs and their kids go to school together. They know that the threat to put the voracious health insurance industry out of business is a threat to profiteers everywhere.

They are their own worst enemies. In the darkest days of the depression, President Roosevelt’s New Deal saved the capitalist system from itself by ushering in a new era of regulation and transparency. Almost without exception, corporate interests fought him every inch of the way. In fact, he had to link up with a vast popular movement against the “malefactors of great wealth” in order to create the conditions that stabilized the economy and then allowed corporations to thrive in one of the most prosperous eras in world history. Once we win single-payer, many large corporations will become big supporters. But we’ll have to drag them kicking and screaming to that moment.

This is not to say that we should stop demanding that corporate America add their voice to the fight for healthcare for all. Nor does it mean that all employers will act with the same obstinate resistance that large corporations do. In particular, small businesses are led by flesh and blood human beings with healthcare needs of their own and relationships to their employees and the communities they do business in. They can be a powerful constituency for single payer and there are some successful organizing models out there that we should embrace.

Likewise, public employers should be a natural supporter of single payer. They don’t have the profit-driven reasons to maintain support for a wasteful system of private insurance. They could save trillions if they were relieved of obligations to provide continuing private insurance coverage for retired and active employees. The entire federal budget deficit would disappear if we paid the same amount in per capita healthcare costs as any other industrialized nation where healthcare is a right. You need only to compare the vicious, “low road”, blame-the-workers approach to budget cutting in states like Wisconsin and Ohio (whose current political leaders are financed, I might add, by some of the most despicable corporate interests) with the “high road”, we’re-all-in-this-together, solve healthcare first approach in places like Vermont to see the potential for our movement to have public employers on our side on this issue.

But, in my opinion, the only thing that will move most large corporations is a powerful grassroots anti-corporate movement that will hold their feet to the fire. We’d be better served spending our time building that movement than clinging to a naive hope that somehow corporations are going to come to our rescue out of their own self-interest.


  1. Vashti Winterburg on May 16, 2011 at 11:54 pm

    Thank you,Mark. This is one of those topics that has driven me crazy since I first became involved with single payer.
    I think an additional problem is that we’ve pretty much let the financiers run things in this country for the last 30, or so, years. These guys don’t give two hoots about managing people, or the best way to run a company. It’s all about how many dollars can we screw out of the process and walk away with. How much debt can be loaded onto a company before we unload it onto the next financial type? It’s not about how many widgets can we build and sell, or how much market share can we capture. It’s all about much money can be squeezed out before it’s unloaded.
    I consider myself a born again capitalist, but honest to God, ultimately, capitalism is its own worst enemy. There’s a reason it needs adult supervision.

  2. Usha A on May 17, 2011 at 9:04 am

    I am a supporter of Single Payer Medicare-for-All and would like to point out a contradiction in your article. You simultaneously state that “Corporations like having healthcare linked to employment. They like having people held captive in jobs they hate for fear they they’ll lose their health coverage” and “they would like to replace any guarantee of health coverage with a voucher system where workers purchase their own coverage from an unregulated market.” This makes it seem like you are grasping at straws to build an argument / article. I think that Corporations understand that until Medicare is reformed and made into a wholly public health care insurance system that will maintain its integrity, the Medicare-for-All plan is only going to increase overall cost for all. Rather than each state introducing new and improved bills and various formats to achieve Single Payer, we ought to keep it simple and coherent – a core plan that each state can attempt to adopt, if that is the way to go.

    • Mark Dudzic on May 19, 2011 at 10:54 am

      Usha A: I don’t think there is a contradiction between corporations wanting to use healthcare linked to employment as a way to enhance their control over their workforce and an assertion that most have a long-term plan to replace “defined benefit” healthcare benefits with a “defined contribution” model where the risk is transferred from the employer to the worker. As I said, they’ve already done it with pensions.

      And I certainly hope it is true, as you assert, that corporations understand the need for Medicare reform to make it a “wholly public health insurance system.” It would certainly be a starting point to begin negotiations with corporations if they were saying that they would condition their support for Medicare-for-All on the establishment of a more efficient and rational delivery system. However, in the past 20 years, I have come across absolutely no evidence that any large for-profit corporation has expressed support for a single-payer, Medicare-for-All model in the U.S. with or without conditions. In fact, in Vermont today, corporations like IBM are leading the employer counterattack to attempts to establish a state single-payer plan (http://vtdigger.org/2011/04/18/davis-ibm-bullies-the-state-of-vermont-again/).

  3. Chris Hagel on May 17, 2011 at 3:28 pm

    There is something else that figures into this.
    America is an extremely class conscious country. How and why we got this way is another story, but it is subtly re-enforced while at the same time projecting the image of solidarity between various economic strata of people.
    The reality is that a lot of the rich and middle/upper middle class people are simply repulsed by the idea of being in the same risk pool as those working “poor people”. They wear their gold plated health insurance plan like a badge of honor. It distinguishes them from the “others”.
    They just want “them” to be over there working at some low wage job with their cruddy health insurance plan.
    Don’t even mention the thought of being in the same risk pool with those unfortunate “medicaid people”.
    This is evil. This is, Oh no! SOCIALISM!!!!
    Similar to African Americans in the south who had to sit in the back of the bus, drink from a different water fountain, use a different bathroom…etc.
    Generally too, it would just infuriate and scare them to no end that the “working poor” and “medicaid people” have equitable access to health care, no longer being separate “working poor” or “medicaid people”.
    How is it that England with its remnants of royalty…kings, queens, etc., and poor as it was after WW ll, was evolved and enlightened enough to see health care as a public necessity/service & human right?
    This is not complicated stuff. For a more civilized, stable, and happier society there are some things that are “off the table” and health care is one of them.
    (We are a society, aren’t we?… United we stand?…Or what are “We The People?”)
    The rest of the industrialized world has figured this out and they are capitalist not socialist nations.

    • Vicki Decker on May 27, 2011 at 1:15 pm

      I agree completely with this writer regarding the class structure tied to insurance programs. Doctors and hospitals clearly understand this thinking with their ability to contrive all kinds of treatment and accommodations for those who have money to pay for things like additional catering, conciere service, home care, etc.
      These people would not be caught dead sitting in an emergency room, going to any type of clinic or what they would consider “demeaning” place. Only high rise medical offices, lots of caterine work for these people. Many middle class attempt to emulate this type of behavior.

    • Rosalind Gnatt on May 27, 2011 at 10:12 pm

      It’s simple: The famed American Capitalist Dream – the supreme prize of the individualism of which so many are proud – the same which brought us the genocide of most of the Native American population and the further genocide of millions upon millions of Africans, is perceived by those who in their lifetimes, or the lifetimes of their forebears, have wrested a lion’s share out of this country on the backs of its workers and its natural resources. These people also own and operate the system that is now our form of government; many economists call what we now live under a Capitalist Oligarchy.
      They own the whole show now. Our elected politicians work for them, not us. Our military works for them, not us. They don’t give a rat’s behind what happens to the “have-little’s” and the “have-not’s”. I’m not sure these avarice-addicts have though about who’s going to mow their lawns and clean their pools when the little folk are killed off. Clearly, a societal infrastructure is the farthest thing from their minds.
      I suggest revolution.Talk is going to get us nowhere.

  4. Clarebro on May 27, 2011 at 12:43 pm

    Mark, I agree, it is a no-brainer! I’m originally from Australia, and we don’t have health benefits tied to employment at all. So we don’t live in fear of loosing benefits if we loose our job. Also, the Health Insurance companies are for profit as well, but are tightly regulated by the government to prevent price gouging. America needs a single payer system that is not linked to employment with tough government regulations and oversight that will protect consumers. The answer is simple:

    1. Put a stop to the corrupt politicians that are backing the Lobbyists by recalling them.
    2. Put into place heavy penalties to cut out the price fixing going on between Insurance companies and hospitals.
    3. Implement tough pricing regulation that restricts pharmaceutical companies e.g. Better negotiate drug pricing for a single payer solution. That is onle large “pool” that should drive down the price significantly.
    4. Set up a single payer system that charges every one that earns under $80K a flat 1.5% of their taxable income. Anyone that earns more than $80K pays an additional 1% on their total income. (Yes, this includes millionaires.) You’ll find that this will balance out the cost across the board for the poor and low income to the wealthy.
    5. Offer additional private insurance for those that want a higher cover e.g. Private room in a hospital, choice of doctor.
    6. Get rid of the this ridiculous insurance scam known as an “Annual deductable”. Which means that unless you have a serious medical condition you end up paying all of the medical bills each year.
    7. Limit Out of Pocket amounts to $30 – $50.

  5. joe marcinkowski on May 28, 2011 at 11:16 am

    Most older people (lower to upper middle class) relate to Mark’s argument, especially when he described how the old corporate retirement programs were turned into 401K’s with employee being fully responsible. The employees felt this when Wall Street collapsed and they lost 30-40% of their retirement funds. But since the market returned so fast, the lesson didn’t take. The fact that some of the big houses were caught selling bad securities and betting against them had some impact, but no one but Michael Moore stormed Goldman Sachs.

    Wall Street knows that as long as we see the Dow Jones return to previous levels, short term declines will not cause problems. However a change in consumer buying patterns could have a long term effect on the market.

    Start with the single payer group, targeting a corporation that is obviously egregious, with a information campaign to reduce the purchase of their products. This is what a revolution in a Consumer economy looks like.

    Also, Change the lexicon, if the taxpayer are paying some part of the bill, lets refer to them as Socialized or Subsidized,e.g. Blackwater, Kellogg Brown & Root, all the oil companies what are getting subsidies, the major energy companies including Enron that received big tax rebates in 2001, Cargill and other food companies that get subsides companies that run prisons and the companies that work in defense or space program, companies running the prisons etc.etc.

  6. Richard Austin on May 29, 2011 at 4:04 pm

    Corporations use continuation of health care coverage as a hammer.

    They use it to suppress wages and they use it to rob workers of jurisdiction. With national health care, corporatists would also lose the excuse that “high U.S. health care costs forced them to move offshore”.

    Using health care as a bargaining chip has proven quite successful for free market capitalists. Their plan is, however,sociopathic in its causes and results.

    Power! Money! Prestige!


    Universal, comprehensive, accessible, quality, affordable health care for all must be the clarion call of an organized labor movement worth its salt!

    If it takes a general strike to achieve health care justice, let’s hit the streets! (Whatever the hell the labor “movement” has been doing for the past 40 yearts hasn’t worked. It’s time to return to the basics…”to help any worker in distress”.

  7. Merry Foxworth on February 9, 2012 at 12:08 am

    This issue takes on yet another meaning with the recent discussion about Catholic institutions not wanting to provide free contraception to their employees, many of whom are non-Catholic. It is perfectly obvious that a single-payer Medicare-for-All system would completely eliminate this problem. Aside from the fact that government should not be getting involved in these matters, not only from the religious standpoint but also because of the power wielded by the sexist white males in Congress and in the Catholic Church over the female half of the population.