Following a Democratic victory in New York state senate elections this November, the Left and advocates for the New York Health Act (NYHA) had new hope for passing the single payer health bill. The bill passed the state assembly every year for the last seven years, only to die in the Republican-controlled senate.
But before the month was over, powerful New York City public sector unions were expressing grave objections to the bill. In particular, the unions, whose members generally enjoy premium-free health insurance, worry that any new tax to pay for NYHA would amount to their members paying more for the same health benefits.
A recent study found that NYHA would require more than $130 billion in new taxes, though the bill’s proponents point out the figure is misleading: While workers and employers would face higher taxes, they would no longer pay insurance premiums, deductibles, or co-pays.
The bill’s sponsors said they would redraft the bill to address these concerns, but the unenthusiastic reaction from some of the state’s largest and most powerful unions does not bode well for passing NYHA. And a few other unions, including the New York State Building & Construction Trades Council and the police sergeants and firefighters unions, have joined a coalition dominated by big industry that seeks to kill the bill.
Nurses’ unions have been among the strongest advocates for Medicare for All and similar state-level initiatives, including NYHA. This comes as no surprise. Their members see the injustices of the current health care system firsthand every day. And the more people who are able to seek medical care, the more demand there will be for nurses, increasing members’ job security and their ability to negotiate better wages and working conditions.
Many other international unions and New York-based locals have formally signed on as NYHA supporters but have done little to concretely advance the issue or organize their members to support it.
The “pure and simple unionism” philosophy most American unions espouse might explain why few of them have made single payer a priority, despite the AFL-CIO officially endorsing it in 2009 and recommitting to that endorsement in 2017. The pure and simple approach views unions as essentially apolitical entities focused on serving their members that hold no broader duty to progressive politics or the advancement of the working class as a whole.
Of course, in reality, most unions are far from apolitical. With important exceptions, at the national level unions typically support the candidates and priorities of the centrist wing of the Democratic Party. While local and state-level unions are somewhat more progressive, they generally promote the same political positions as their respective internationals.
But the imperative to keep things “pure and simple” usually only arises when members try to push their leadership in a more progressive direction. Indeed, as Natalie Shure notes, given the division between the progressive and centrist wings of the Democratic Party on the question of single payer, “advancing the policy demands a confrontation with the party establishment — something most labor leaders so far seem unwilling to do.”
But while a “pure and simple” orientation might explain a lack of enthusiasm, it fails to explain outright opposition to critical reform that would benefit the whole working class.
Unions have a duty to promote their members’ interests, and NYHA advocates should take their concerns about the possibility of higher costs and fewer benefits for members seriously — as the bill’s sponsors do. The Left should work to overcome the public sector unions’ stated objections and ask for their vocal support for NYHA in return.
But in some cases, the interests of high-level union officials are not the same as those of union members. In a situation where union officials might position their organizations against the clear interests of the working class as a whole, it is worth examining their motivations further.
Advocates frequently argue that because single payer would take an expensive benefit off the bargaining table, it would enable unions to bargain more aggressively over other issues like wages, working conditions, time off, and hours. But this presupposes that union officials want to negotiate aggressively on any of these issues. While that might seem self-evident, history has shown it is sadly not always the case.
Take the recent pattern of bargaining between New York City and its largest municipal unions. Collectively, these unions have hundreds of thousands of members and the potential power to shut down the normal functioning of the largest city in the country — something the city government and the millionaires and billionaires who wield power over it know must be avoided at all costs.
Yet union officials show little to no desire to undertake the organizing necessary to turn their numbers into a plausible threat and thus an advantage at the bargaining table.
Recent public sector contract settlements have featured wage increases below the average increase for private sector workers in New York, as well as shifting health care costs from the employer onto workers. (While most public sector union members in New York still pay no premiums for health insurance, co-pay costs have risen for many services and first-year workers are required to enroll in an inferior insurance plan.) What’s more, in the case of the United Federation of Teachers, union officials settled a contract four months before the current one expired — four months in which it could have organized members to press for a better deal.
One of the main selling points union officials have used in promoting these contracts is the continuation of premium-free health insurance. But if workers had the right to premium- and co-pay-free health care by law, rather than collective bargaining agreement, they would naturally raise their expectations on issues like pay and working conditions, as advocates have long argued. These expectations would put pressure on union leaders to both make more aggressive demands and organize members to back them up. Based on public sector unions’ recent history, this seems to be a task many of them would rather not take on.
A further wrinkle comes from unions’ benefits funds. While the city administers workers’ health insurance directly, for vision, dental, and prescription coverage, it instead pays $1.1 billion per year directly to over a hundred separate union-controlled funds that purchase and administer these benefits for members directly.
Some union leaders may view this arrangement as a way to increase member loyalty, but it also gives high-level union officials the ability to dole out patronage and, in some cases, graft. Because NYHA covers vision, dental, and prescription benefits, these funds would become unnecessary, or their funding would be drastically reduced to cover only ancillary benefits like scholarships and group legal insurance.
It is difficult to imagine either NYHA or, at a federal level, Medicare for All passing without active support from a critical mass of the organized labor movement. There is no other working-class entity with the same structural leverage, money, and grassroots power to push through a proposal to completely restructure a major sector of the economy in a way that adversely affects the rich.
In New York, Governor Andrew Cuomo is famously tax-averse, and he has already laid the groundwork to sow divisions between more conservative moderate Democrats from Long Island and a more progressive cohort entering the legislature from New York City.
Historically, Cuomo has been very effective at keeping progressive legislation he does not wish to sign from reaching his desk, preventing the bad publicity of vetoing it. It is entirely plausible that he will play up divisions among high-level union officials and within the Democratic legislative caucus to do exactly the same thing with NYHA. While many people recognize the value of single payer health care, it is unclear what organized constituency has the power to overcome such divisions.
In the short term, there is likely not very much that average union members can do to change this dynamic. With notable exceptions, most of the unions in question are run in an anti-democratic fashion specifically designed to prevent rank-and-file members from affecting the union’s political orientation.
This situation also pulls into sharp focus the limitations of the newly growing left. Without being firmly rooted, in large numbers, in powerful working-class organs, the Left will be stuck on the sidelines of the major battles to come. If it hopes to enact serious reforms like NYHA, let alone a fundamental change to the structure of society, it must sincerely root itself in the organizations where workers have the most potential power.
To do that, leftists will have to fight to make those organizations into democratic bodies willing to fight for the interests of the working class as a whole. If the Left fails to take these steps, it will be leaving power on the table in the fight for meaningful working-class reforms — just as it criticizes many union officials of doing now.