October 17th, 2020

Change Point

HEALTHCARE & UNIONS

Explanations for the absence of a universal healthcare program in the United States tend to focus on the obstructive role of the American Medical Association, which, via an extensive lobbying campaign, prevented the passage of a national health insurance plan in 1945. Much less attention has been paid to the diverging and often contradictory interests of organized labor during this period.

In her 2006 book, JILL QUADAGNO considers the relationship between industrial policy and healthcare reform, analyzing how the labor movement came to unify behind private insurance providers by the late 1940s.

From the text:

"Although Taft-Hartley outlawed independent, union-run welfare funds through a provision that employers had to share equally in the administration of any pension or health plan, it had left unresolved the issue of whether employers had to bargain over fringe benefits. In 1948 the National Labor Relations Board ruled that fringe benefits were subject to collective bargaining, a decision that was upheld by the Supreme Court. Then in 1949 the Wage Stabilization Board, whose job was to keep inflation from wage increases under control, determined that fringe benefits were not inflationary. With many options for increasing membership closed off, union leaders made bargaining for fringe benefits a top priority. Fringe benefits became organized labor’s key strategy for recruiting and retaining members. Over half of strikes in 1949 and 70 percent in 1950 were over this issue.

Between 1946 and 1957 the number of workers covered by negotiated health insurance plans rose from 1 million to 12 million, plus an additional 20 million dependents. Close to 95 percent of industrial workers represented by the CIO were covered, compared to only 20 percent of skilled craft workers affiliated with the AFL. As for national health insurance, most industrial unionists now 'gave [it] only lip service.' Private health insurance 'had taken the heat off.' The expansion of private health benefits divided the working class into those who had health insurance and those who did not, and it transformed the way organized labor mobilized politically. Instead of requiring leaders who could inspire the troops to stand by the barricades, the labor movement needed leaders who could master complex financial instruments. The next battle would be won by policy experts with calculators, not charismatic militants who could issue a call to arms."

Link to the book.

  • "Labor unions, senior citizens, socialists, and other groups have certainly participated in campaigns to redesign the health care system, but the campaigns themselves have most often been initiated and run by elite organizations and individuals with little connection to a popular base of support." Beatrix Hoffman on "Health Care Reform and Social Movements in the United States." Link.
  • Maryaline Catillon, David M. Cutler, and Thomas E. Getzen analyze US healthcare provision since 1800. [Link'(https://voxeu.org/article/two-hundred-years-health-and-medical-care).
  • "By the early 20th century, Britain had a strong civil service and competing, programmatically oriented political parties. However, the contemporary United States lacked an established civil bureaucracy and was embroiled in the efforts of Progressive reformers to create regulatory agencies and policies free of the 'political corruption' of 19th century patronage democracy." Ann Shola Orloff and Theda Skocpol compare healthcare provision in the US and UK. Link. And a 2011 article by Howard Glennerster and Robert C. Lieberman argues that "there are more parallels and points of tangency between the two systems than are readily apparent." Link.
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