[ A defensive posture and incremental demands have not worked.
Let’s play offense instead.] [https://portside.org/] 



 Michael Lighty 
 March 15, 2018
Common Dreams

	* [https://portside.org/node/16773/printable/print]

 _ A defensive posture and incremental demands have not worked.
Let’s play offense instead. _ 

 National Nurses Union activists for single-payer at a rally with
Bernie Sanders in 2015. , Rick Reinhard / NNU 


Healthcare is the crossroads where the assault on workers meets the
juggernaut of “crony capitalism.” That’s the term used by the
mainstream neo-classical and Nobel prize-winning economist Angus
Deaton to describe the coziness between the healthcare industry and
its government “regulators.” In fact, Deaton argues, how
healthcare is financed and delivered is a driver of inequality.

Registered Nurses see that inequity everyday in hospitals and clinics,
where the standard of care patients receive depends on the quality
(and cost) of the health plan they buy. Not only the benefits but
access to treatments, prescription drugs, certain facilities, the
latest technologies, all depend on what you can pay. And guess who has
the money to buy the best: the wealthy. So for the first time, after
the Great Recession two unprecedented trends occurred: the 1%
increased their share of income spent on healthcare, and the average
life expectancy people in the US declined.

Historically, the labor movement has stepped into this breach of
injustice and inequality. Yet today only 7% of all workers belong to a
union (12% in the public sector). Unions established the system of
job-based health benefits after World War II, in part to provide
better coverage to encourage new memberships, and now employers run it
for the benefit of the insurance industry’s bottom line.

“Controlling” healthcare costs for businesses has meant a huge
cost shift to workers. Rather than pay the annual double-digit
insurance premium increases out of their profits – soon to go up
under the tax bill – companies raise the workers’ share, increase
deductibles and co-pays, and promote employee-funded health savings
accounts. Though it expanded coverage for low-wage workers, the ACA
also lessened the “union advantage” in health benefits,
established new taxes on union plans and created incentives via an
excise tax to lessen benefits.

The decades of incremental erosion of health benefits, escalating
costs, deferring wages in favor of funding benefits, and the thousands
of strikes over just keeping the health plans workers have fought to
win, has taken a huge toll on the quality of those plans and on
attitude toward unions. In short, “unions have become the bearers of
bad news,” unable to stem the tide of concessions. And the
incremental progress – expansions of insurance for kids, limits on
the worst abuses by HMO’s, expanded private coverage under Medicare
for prescription drugs, the ACA itself – none has slowed the
increasing costs or the decreasing numbers of employers providing
benefits, or the decline in membership of unions.

A defensive posture and incremental demands have not worked. Let’s
play offense instead. In the face of existential threats to unions’
ability to fund their operations, and the continuing assault on health
benefits, let’s unite with the growing public demand for Medicare
for All. We don’t need insurance, we need healthcare.  This is the
strategy that can turn the tide:  building a broad movement of
workers to demand economic and health justice. That’s not an
alliance with insurers and employers to “fix” the system in order
to stabilize the healthcare industry. Rather, based on the economic
interests of workers, we need to make healthcare a public good. Only
if it is not compromised by high premiums, deductibles, and co-pays,
without narrow networks and “gatekeeping” that restrict access,
can we guarantee healthcare as a human right. Parsing out healthcare
through insurance based on ability to pay simply means we’ll only
get the healthcare we can afford.

The labor movement exists to stop money from being the metric of value
and power. Healthcare is exhibit A for money as the metric (see
Elizabeth Rosenthal’s book, “American Sickness”). Unions derive
power from members, engaged in fights to win a better life at work,
home and in society. Medicare for All enjoys strong majority support
among the general public, and overwhelming support among union members
and Democrats (70-80% in recent polls). Medicare works and is popular.
A movement led by labor, inspired like the Fight for 15 by a broad,
popular demand for fairness and security, can build the solidarity we
need. A movement positioned as the 99%, can assert that all workers
are part of the labor movement.

Let’s understand this movement moment: the uprising in Wisconsin,
Occupy Wall Street, Black Lives Matter and now #MeToo have created
social movements and a political/ideological context  that infused
the Sanders campaign for President, and provides the well-spring for a
broader health justice demand, linked to and reinforcing the demands
for social and economic justice. Medicare for All can be the health
wing of the broader justice movements.

In the most personal area of public policy – whether we will get the
healthcare we need – Registered Nurses, who are predominantly women,
bring the values of caring, compassion and community to work and to
their advocacy. Let that inspire others to join this movement for
guaranteed healthcare based on our shared humanity. Promoting these
values combined with organizing workers for health and economic
security can overcome the deep pockets of the healthcare industry; it
is only through mobilizing public opinion that people have overcome
politically powerful economic forces.

In demanding guaranteed healthcare through Medicare for All, we are
demanding a more just and humane society. Socio-economic status is the
major factor in determining health status, and disparities based on
race are rampant in healthcare access and outcomes. Here we see the
confluence of addressing race-specific barriers to equality in
healthcare and in society and the need for economic and health
justice.  Addressing the causes of poverty, overcoming structural
racism, establishing $15/hour as the minimum wage, building more
affordable housing and winning guaranteed healthcare are necessarily
linked – we cannot achieve them individually  in isolation.  A
fighting labor movement – that encompasses the broadly defined
working class - is in the best position to make those connections and
organize on a multi-racial basis to win. Medicare for All not only
motivates millions to organize for justice, but winning it would help
win justice for all.

	* [https://portside.org/node/16773/printable/print]







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