As much as anything else, we need to turn the 2004 elections into a referendum on whether all Americans should finally be able to get affordable, high quality health care with their right to choose their own doctor. -- AFL-CIO Executive Council, February 2003. This policy statement by the Executive Council of the AFL-CIO, along with its resolution in opposition to the war drive in Iraq, has sounded a clarion call to everyone that the labor movement is back and ready for action.

The AFL-CIO Executive Council is responding to a growing movement among individual unions and state and local affiliates. State labor councils in Wisconsin, Oregon, California and others are putting forward stopgap state-based plans to stem the growing tide of escalating health care costs and increases in the uninsured. International unions and individual locals are fighting tooth and nail to maintain and possibly improve health benefit packages.

The Executive Council’s resolution pays particular attention to thegrowing right-wing attack on the federal Medicare system, the health program for people over 65 years of age. It also cites the attempt by the Bush administration to convert the Medicaid program from a health service program for people with low or no incomes into a pork-barrel financial gift for state governors.

The new position is the most important statement by labor on health care since 1994.

Since the Clinton health policy was put forward in 1993-94 the Democratic Party and the labor movement had agreed to keep health policy “off agenda.” This was the result of a complete misreading of the failed Clinton efforts. Rather than targeting the Medical Industrial Complex as the enemy of national health legislation, they tacitly agreed with the right wing that the Clinton proposals were too complicated and ill conceived. They were complicated, but the policy debate was a good one, even though it was lost to the power of the insurance carriers, drug companies and right-wingers in Congress led by Newt Gingrich.

The vacuum created after 1994 was rapidly filled by profiteers. Their promises that the marketplace would solve the health crisis utterly failed. But, with each passing congressional and presidential election, the opportunity to respond to the crisis was thwarted by the right-wing agenda within the Democratic Party and unfortunately followed by labor.

Changes in the Democratic Party leadership and the AFL-CIO position open a window of action that everyone has to fill. But in this new period the mistakes of the past must not be made. In US history no piece of socio-economic legislation has been enacted by Congress that was not led by or strongly supported by organized labor. The following principles must guide the mass people’s movement for a national health program that truly encompasses everyone:

• labor must lead the fight and draft the policy; • civil rights groups must be at the table to make sure that Black, Latino and other oppressed people are assured their health rights - racism is pervasive in the health care system; • women activists in the pro-choice movement must be at the table; • public worker unions must be guaranteed a major role; • rural health organizations must be included to guarantee true universality of access to health services; • health care unions must be at the table to prevent employment dislocations; • public health care research must have a priority in funding.

Legislation Drafting Principles The formulation of the legislative drafting process should guarantee that the gains of the past are protected for the future. This is a major bone of contention among advocates of sweeping health legislation. Too many non-labor, non-Medicare activists are ready to discard past gains in favor of future promises.

This all-or-nothing approach is faulty on its face. But more importantly, it has made sure that most labor unions along with Medicare leaders would not be part of the process of new congressional legislation. It was the death knell of all legislative efforts from 1994 to the present.

These organizations should be encouraged to drop their slogans and quick-fix legislation solutions and allow labor and Medicare leaders to flex their muscles. Labor unions and their members must have the opportunity to maintain their own programs regardless of any national program. (This is the way legislation was initially enacted in France, Canada and other countries with national health insurance programs).

Medicare must be maintained (federalized with full benefits, again) so that all recipients can be assured they will not be getting less under a new national program. All civil rights and right-to-choose laws must be strictly enforced.

Over the years, most unions and to some extent the AFL-CIO have worked closely with national and local public health and community-based organizations on major social and economic issues. There is growing trust between many of these groups to draw upon. This is the time to act.

Some anti-labor forces will try to drive a wedge between organized labor and the community over some aspects of this strategy. But labor will make it clear that while they want to maintain the right to keep their own benefit programs, they will fight for a health benefits package for everyone else that is as good or better than most unions have negotiated with their employers. This would be the same for Medicare rights organizations.

Labor-led Coalition for National Health The Executive Council resolution, in addition to signing a new approach, fortunately makes no mention of an ill-conceived coalition with big business insurance carriers and financed by drug company foundations.

State and local labor coalitions have been forming in Wisconsin, Oregon and California. These federations, before the enactment of the new labor position, were pressing for a state solution. But, as the AFL-CIO resolution makes clear, this a national health crisis. It is a crisis that confronts all labor unions and the growing number of unemployed workers who are without insurance. (Insurance policies required following unemployment are simply too expensive to buy.) The crisis is national and does not conform to state lines.

The time for state experiments is past. During the period of retrenchment, state experiments made sense. They not only showed what is possible, but also kept people in motion. Combining these experiences with national movements to get Congress to act is the next strategic step. A good idea is to pressure state and local government to memorialize Congress to begin enacting universal health care coverage.

Special Role for Medicare/Medicaid The Bush administration is aiming its salvoes against two of the most important entitlement programs: Medicare and Social Security.

Privatization, in whole or in part, is their primary goal. But these entitlement programs are the building blocks of a national health care system.

While Medicare was enacted to provide health services for people over 65, it also provides important health services for the disabled. Since enactment, it has unfortunately been administered by insurance carriers. That was the price Congress had to pay. It was a big mistake. In the 1990s Medicare has been privatized, to some extent, into so-called HMOs run by different insurance companies. But, this partial privatization has not been enough for the Bush ideologues. They now demand, as the price for prescription drug, the full program be privatized into for-profit insurance carriers.

This carrot-and-stick approach must be militantly opposed. It is already being opposed by all Medicare activists and the labor movement. As the AFL-CIO resolution correctly notes, these changes in Medicare would mean that “insurance executives rather than Medicare” would decide its future.

Medicaid The most insidious attack is in regard to Medicaid. Medicaid is a life-and-death issue to millions. It has too little political support as its recipients are not powerful enough to protect their own interests. This is a cutthroat effort to stop Medicaid as an entitlement program and turn it into a so-called block grant to state governors. Block grants carry few restrictions for use. This proposal would have fallen mostly on deaf ears, but Bush ideologues are more than aware that governors are in terrible financial shape and are crying to Washington, DC for help.

To sweeten the pie, Bush is offering more Medicaid money to those governors who take it.

Stopping Bush Bush may not care about the people’s will, but all candidates for the House of Representatives, the Senate and Democratic hopefuls for the White House in 2004 must have a different agenda. Even the Republicans’ allegiance to the ultra-right and their bogus think tank ideas are tempered by reelection efforts.

Every candidate for Congress and the Senate must be approached and pressured to save and improve Medicare and Medicaid; and, now, under the leadership of the AFL-CIO Executive Council’s resolution, to fight for a national health program.

Labor put the question squarely: “Now, even more than in the past, the AFL-CIO believes strongly that universal coverage is the best and ultimately only way to achieve the goal of extending affordable, high quality health care to all Americans.”

By making health care a priority and beginning the process of an expedited legislative struggle to enact a national health program, labor and its allies are making it clear to all politicians that our country must join the rest of the human race. In most industrial countries, health care is a human right, not a privilege. This goal is fully achievable, but it will require the broadest peoples’ struggle under the leadership of labor. Advocates from every mass struggle in our country must be included. We can leap frog over traditional national health insurance schemes and achieve the full comprehensive system that is called for in the national health service program (HR-080) introduced each year by heroine Barbara Lee, Congresswoman from California. This makes practical sense since to adequately implement a real national health program there must be more trained health professionals; public facilities for the delivery of health services; and health planning to make sure it all works.

--Phil E. Benjamin is health editor for Political Affairs.