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The Good, The Perfect and the Wisconsin Compromise

I attended an interesting conference on “Health Care for All,” sponsored by Citizen Action at Rutgers University today, with a lot of breathless anticipation about how the 2008 elections were going to provide a mandate to finally get a national health plan. That is, if our policy-thinkers and policy-makers don’t compromise it to death. Dr. Oliver Fein, of Physicians for a National Health Plan, provided a spirited advocacy for universal single payer health care – “Medicare for All” – with a direct challenge to the for-profit insurance lobby and the compromisers. Too bad he’s not running for President. Representatives for Obama’s and Clinton’s campaigns were in attendance and said a whole lot about nothing, which does not bode well for voters’ supposed mandate for meaningful reform.

In the face of federal inaction, many states are putting together piecemeal, stop-gap programs. New Jersey’s slow move in this direction was the ostensible purpose for the conference. The state of Wisconsin is apparently close to enacting (or at least voting on) a pretty good plan that, nevertheless, demonstrates the pitfalls of statewide solutions. What Wisconsin would do, according to Dr. Robert Kraig of Citizen Action, is what most states do to insure their own employees. They spell out the terms of coverage – what procedures would be fully reimbursed, how much hospitalization, whether there would be co-pays or deductibles, that no one be denied coverage because of age, location or pre-existing condition, that no more than 15% of the costs go towards advertising and administration, etc. – and then contract out with various companies to provide the coverage. The Wisconsin plan would replace private insurance with a payroll tax to fund a statewide system and throw everyone into the same statewide pool, but allow individuals to choose between different insurance companies – Blue Cross, GHI and the like – or a state-run, non-profit plan. This idea of creating a state plan to compete with the private companies is apparently coming up often in these compromise plans. The thinking is that it’s a backdoor to single-payer health insurance, since a non-profit state-run plan would be cheaper and more efficient and would inevitably drive the private companies out of the market. At the very least, it is reasoned, they will keep the private companies competitive and “honest.” Call me a cynical socialist, but I assume the public plans will be sabotaged in some way so that the “superiority” of private plans will be proved.

Nevertheless, from an operational standpoint, the Wisconsin plan would work. It would provide good, comprehensive health care for everyone. However, I’m afraid it wouldn’t retain enough public support to survive the gauntlet of opposition it will receive from business and the insurance lobby. The problem is the funding formula. The plan calls for a ten percent payroll tax on employers, which is a good, suitable level (California’s Super Hero Governor is proposing a meager 6% payroll tax for his less-than-universal plan). A ten percent tax is less than employers pay for good health insurance, but more than employers pay for lousy or no insurance, helping even the playing field for companies than have been competing over health care costs (like Wal-Mart and the unionized supermarkets).

However, the plan also calls for a four percent payroll tax on employees, which, simply put, represents a pay cut for many workers for something they already have. Workers who have formed unions and bargained to gain and maintain good health insurance have already forgone higher wages in lieu of that insurance. To propose that they take a cut now, essentially to bail out employers who have shirked their responsibilities, is not only unfair, it is politically untenable. No matter what proposals come out for universal health care, the insurance lobby is going to spend tons of money on television and radio advertising to scare voters out of supporting the plan. Why give them a good, scary issue? Perhaps I see this more clearly as a union organizer. During a union recognition vote, an employer campaigns to convince his employees to vote against forming a union. The employer never campaigns on his issues – his need to maintain “flexibility” and the ability to freeze or cut wages, increase hours and lay off employees as he sees fit – because these issues are obviously not in the interest of his workers. So, the employer instead campaigns on an issue that is in the interest of the workers: their paychecks. Every employer-run anti-union campaign makes union dues a main focus. The insurance lobby is not going to campaign on its need to maintain profits at the expense of people’s health, but they will campaign on issues of costs and taxes.

Wisconsin, like any other state, is limited in terms of its options for new revenue, so a payroll tax (the burden of which falls inordinately on working people) is one of its few options. The federal government, which ultimately should take up the responsibility of a universal plan, has many more equitable options. To fund a “Medicare for All” plan, Congress could and should implement a payroll tax on employers. But Congress could also repeal the Bush tax cut, which mostly went to the wealthy, or increase the capital gains tax, which is how the wealthy get obscenely wealthy. Congress could probably find enough money to fund the program in the billions that are currently being blown to smithereens in Iraq.

As Dr. Fein, of PNHP, remarked at the conference, a long-held saying in the movement for national health, has been “don’t let the perfect be the enemy of the good.” Meaning, don’t let our pipe dream of single payer health insurance stand in the way of a compromise that we can get now. Now, with health care reform definitely on the agenda, it’s all the more important to hold firm to our convictions that single payer health care is not a pipe dream. It is not merely a wonky distinction between a bunch of “equally good” compromise plans put forth by the candidates. It is the only plan that can coalesce and maintain a coalition of unions, community and advocacy groups, healthcare professionals and taxpayers that can survive the barrage of attacks that any plan – good, perfect or terrible – will inevitably face from the merchants of death in the insurance lobby.

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Debs and Bolshevism

In his famous 1918 anti-war speech in Canton, Ohio, in which he martyred himself for a prison term that would last beyond the World War and shave years off his life, Eugene V. Debs declared, “From the top of my head to the tip of my toes, I am a Bolshevik, and proud of it.” This quote is often taken out of context by some to argue that in his later years Debs was turning towards Lenin’s doctrine and perhaps would have joined the Communist Party had he lived long enough. Too many socialists attempt to freeze Debs in a particular moment and argue that because the pioneering leader of American socialism took a certain position, say, forming new industrial unions to compete with and replace the American Federation of Labor in 1907, that that is the correct position for socialists in 2007, even if Debs himself contradicted that position at another point in his life.

That’s why it’s fascinating to read in Edward Johanningsmeier’s excellent biography of William Z. Foster, “Forging American Communism,” is Debs’ response to Foster’s entreaties to join the Communist Party. In a meeting shortly after he was released from prison in 1922, Debs declared, “Some groups propose to take orders from men in Moscow who know absolutely nothing about American conditions. I know more about American psychology and conditions than all the leaders in Russia know in five years, and I will not accept my orders from a maniac like Zinoviev. Since when, I want to know, has socialism become synonymous with Communism? I am not a Communist and I don’t want to be one, and I do not believe in minority rule.”

Debs did, however, publicly endorse Foster’s Trade Union Education League and its program of encouraging radicals to bore from within AFL craft unions to promote an agenda of organizing the unskilled masses and challenging the conservative business union leaders. Debs also served as the Socialist Party’s National Chairman in his twilight years, the only time he held office in the party, or indeed even attended a convention. And he came to the conclusion that the SP should direct its electoral efforts on uniting with the AFL and other progressive groups to form a national labor party. If we are going to let WWEVDD guide us, let’s look at where he stood politically at the end of his life, in a political era that is closer to our own.

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Another Fake Ally for Health Care

Andy Stern continues to invite more strange fellows into his bed. The President of the Service Employees Union has drifted far astray from the rest of the labor movement and most sensible healthcare reformers by partnering with Wal-Mart, the Business Roundtable and other pro-business groups whose agenda is in direct opposition to ours. Their wet dream is to dump their insurance obligations on the public ledger, not to ensure that everyone can receive good medical treatment at “no cost” through public funds, funded in large part by a payroll tax on employers. “Medicare for all” must be our goal, and any proposal that leaves private insurance companies free to exploit and profit, or that places most of the burden for funding the program on the backs of taxpayers and workers who have already won health insurance from their employers through their unions is bound to fail.

Stern recently welcomed into his “unlikely alliance” the National Federation of Independent Business, the small business lobbying group that killed the last effort at achieving universal health care. This group’s number one objective is to fight any new payroll tax. They are an enemy of “Medicare for all.” Aside from the perversely exploitative profit motive of private insurance companies, which leads to medical inflation that prices too many people out of the system, the second biggest problem with our fractured health care system in the U.S. is the unfair competitive advantage that companies that shirk their responsibility to insure their employees gain over responsible companies that do. It’s Wal-Mart vs. Pathmark. Small businesses are the worst offenders in this regard. More than 60% of the 47 million people who have no health insurance in this country work for small businesses.

If all employers paid into the same insurance – Medicare – then companies like GM and Pathmark would benefit from the enlarged group plan and pay new payroll taxes that would be lower than their old premiums. Small businesses and companies like Wal-Mart would face a tax hike that would bring their total payroll closer to that of their competitors. Any proposal for a national health insurance plan that calls for a substantial income tax hike in lieu of a tax hike on employers is asking, in effect, for unionized employees and others who bargained for good health insurance in lieu of greater pay to take a pay cut in order to subsidize irresponsible businesses. This is not a matter of standing on principle and refusing to make pragmatic compromises. It’s a matter of being pragmatic in building the coalition we will need to win health care for all. Inviting the National Federation of Independent Business and the Business Roundtable – who have been and always will be opposed to a single payer health care system like “Medicare for all” – to take part in the “grand alliance” will cost any reform effort the support of regular taxpayers whose political pressure for such reform is essential. Whatever proposal comes from Stern’s coalition will be a political non-starter.

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Is It Treason to Strike Against the Government?

Is it treasonous to go on strike against your employer? Most reasonable people would say no. But, given the opportunity, most Bosses would make it illegal for their employees to strike for better wages and conditions. The government, as employer of many thousands of public sector employees, is the only employer that has the ability to outlaw strikes by its employees. Al Shanker, who led New York City’s school teachers on a number of strikes between the early 1960s and the late 1970s, grumbled that the illegality of strikes and the steep fines and penalties incurred by city unions that strike anyway were a holdover from monarchistic thinking, and that there isn’t even the slimmest pretext of arguing for public safety or welfare in making them illegal. Shanker would point out that teachers at private schools would face no penalty if they chose to strike, even though such a strike would create the same kind of disruptions for parents as a public school strike.

Shanker’s point should be made again in the case of the Transport Workers Union, who are in court trying to get their dues checkoff reinstated, after it was canceled as a part of the hefty fines and penalties that were levied against the union after its 2005 strike. Even though the MTA, the technical employer of New York’s bus and subway workers, supports the union’s efforts to return to regular operations (apparently, the union’s inability to handle a backlog of grievances is harming the Authority’s ability to run the system), the Bloomberg administration is opposing it, demanding that union leaders “once and for all time declare unequivocally that they may not, and will not, ever again engage in a strike.”

What gall! TWU was actually the first union to be recognized and sign a contract with the city of New York. That’s because the union was first organized in the 1930’s when the city’s bus and subway lines were owned and operated by private corporations. The union struck for and won greater wages and benefits back then, and the strikes were 100% legal. The New York City Transit Authority took over in the 1950’s, and the transit workers became public sector employees and lost their “right” to strike. Same workers, same job, same union, same contract. First legal, then illegal, but not because the idea of a transit strike became “unsafe” or more of a disruption, but simply because the new Boss had the ability to set the laws that made the strike illegal. Good for TWU President Roger Toussaint for refusing to submit to Mayor Bloomberg’s monarchistic thinking.