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Commentary :: Labor : Organizing : Social Welfare
Educating Members About Health Care Reform
09 Dec 2004
This article is excerpted from Labor Notes, December 2004
Steward's Corner
Educating Members About Health Care Reform

I recently did a series of one-hour workshops about the health care crisis for the United Food and Commercial Workers Local 227’s stewards in Lexington and Louisville, Kentucky. The objective was to educate members about health care reform and give participants confidence to explain the issue to their co-workers, neighbors, and friends.

Local 227 (which has about 18,000 members in grocery, meatpacking, dairy, poultry processing, apparel manufacturing, and other retail and manufacturing operations) had just been through bruising contract negotiations with Kroger and other grocery employers over contributions to the members’ health and welfare fund. Local President Gary Best wanted to make sure that the members’ recent experience was linked to a broader political reform movement.

He told members that “unless there is a political solution to the health care crisis before the next round of contract negotiations, there is no way that the union can preserve members’ benefits.”

The key to bringing people to a better understanding of the health care crisis is relating their own experiences as union activists and patients to the trinity of cost, access, and quality. The goal is that everyone understand that cost, access, and quality are all essential to understanding the health care crisis, and that reform proposals must be evaluated on how well they addresses all three factors.

To help focus the discussion, I provided members with a few fact sheets about rising costs, the dramatic drop in employer-based coverage, and the poor quality of health care in the United States, despite spending almost twice as much per capita as any other country. These fact sheets reinforced the gut knowledge that members already had.

The second part of the workshop discussion focused on why we are paying more for health care, but actually getting less care. I asked members to compare how supply and demand set the prices for housing, cars, and other goods--when you pay more, you usually get more. Health care is different because of the unique problems of consumer choice and decision making in health care. This led to a good discussion about how no one can wait for a sale on appendectomies or casually shop for a low-priced emergency room.

The key point was that there is no “free market” in health care, and there never will be. And since there is no free market, both liberal and conservative reforms designed to achieve better performance by treating health care like a consumer good will fail.

People enjoyed the next section of the workshop the most: naming the special interests in health care. We made a list of insurance companies, drug companies, doctors, and hospitals and then analyzed their stake in the existing system and how each seeks shape any emerging reform proposals.

The objective was to get everyone to understand that powerful special interests are trying to shape reform solutions to their own benefit, but because these interests are in conflict with one another, reform is politically paralyzed.

Finally, I asked the stewards to talk about reforms that would work for working families. Reminding everyone about the "holy trinity," we talked about how well Medicare performs relative to cost, access, and quality:
· It provides insurance at about one tenth the administrative cost of private insurance companies, and has the bulk purchasing power to hold down costs by negotiating prices with doctors, hospitals, and, potentially, with drug companies.
· It covers almost everyone over 65 and long-term disabled. Most patients actually have more choice, not less.
· It is able to benchmark quality, track doctor and hospital performance, and promote prevention, wellness, and public health.

It’s not too big a leap after this discussion to see that what already works for large numbers of people in the United States–Medicare–could be improved and expanded to cover everyone.

We concluded the workshop talking about how cost, access, and quality can be used as a road map to building a powerful movement for reform. I asked the stewards to identify constituencies most affected in each area: workers (especially union members) and many employers; the uninsured and the underinsured, as well as communities that have lost access to health care services or facilities; caregivers concerned about short staffing and patients worried about health care quality.

The health care crisis offers a strategic opportunity for the labor movement to connect its struggle to stop employer cost-shifting with the vast majority of workers who have no say in their benefits at all. But just resisting benefit reductions when so many workers are uninsured or underinsured isn't enough.

It will take a reform movement that unites union members, the uninsured, and caregivers to capture the imagination of millions of workers while creating enough power to force politicians to stand up to the special interests. Making these connections – like Local 227 has done – needs to begin with shop stewards in every union.

[Rand Wilson is a national organizer for Jobs with Justice. Labor Notes readers who are interested in getting an outline and educational fact sheets for giving this workshop should contact him at rand (at)]
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