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The Elusive Goal of Universal Health Care in the U.S.: Organized Labor and the Institutional Straightjacket of the Private Welfare State

Published online by Cambridge University Press:  14 October 2011

Marie Gottschalk
Marie Gottschalk
Affiliation:
University of Pennsylvania
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Extract

In the late 1980s and early 1990s, national health insurance returned briefly to the political limelight with renewed calls for a single-payer health-care system that would eliminate any significant role for commercial insurers in the provision of health care. Organized labor, however, which had been a longtime proponent of national health insurance, did not warmly embrace the single-payer solution. Instead, much of the national leadership of organized labor supported some kind of employer-mandate solution that would require employers to pay a portion of their employees' health insurance premiums, thus leaving the private welfare state of job-based medical benefits largely intact.

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Articles
Information
Journal of Policy History , Volume 11 , Issue 4 , October 1999 , pp. 367 - 398
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Copyright © The Pennsylvania State University, University Park, PA. 1999

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References

Notes

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40. Bert Seidman, former director of the department of social security, AFL-CIO, Interview, Washington, D.C., 13 June 1996; and Bert Seidman, memo to Al Barkan et al., 21 May 1970, re: Health and Welfare Trusts and National Health Insurance, attachment, p. 2, AFLCIO Department of Legislation Collection, Box 25, Folder 24, “Health Insurance.”

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52. After Bill Clinton was elected president in 1992, the ILGWU did begin to qualify its support of national health insurance and to indicate its willingness to support health-care proposals based on the employer mandate and the preservation of the Taft-Hartley arrangements. See Gottschalk, Marie, The Shadow Welfare State: Business and U.S. Health-Care Policy (Ithica, N.Y.: forthcoming), chap. 7Google Scholar.

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57. The “Health Insurance Portability and Accountability Act of 1996,” commonly known as the Kennedy-Kassebaum bill, does subject self-insured plans, which were protected from state oversight due to ERISA, to some new broad federal regulations regarding medical underwriting practices. It also forbids self-insured and nonself-insured group health plans from limiting the health coverage they offer to new employees with preexisting conditions. The HIPAA did not significantly alter the ERISA preemption, however. Reforming States Group, “Balanced Federalism and Health System Reform,” Health Affairs (May-June 1998): 181–91Google Scholar.

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66. For example, employers have used the ERISA preemption to mount successful challenges to prevailing wage laws, state standards for the certification or training of apprentices, and state mandates in the area of workers' compensation coverage.

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89. David Abernethy, former majority staff director, Subcommittee on Health of the Committee on Ways and Means, U.S. House of Representatives, Interview, Washington, D.C., 14 June 1996.

90. His remarks were not for attribution.

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98. G. Lawrence Atkins, coordinator, Corporate Health Care Coalition, Interview, Washington, D.C., 6 June 1996; and Karrh, Bruce, vice-president of DuPont Co., “Health Care Reform Act,” Part 6,Google Scholar Subcommittee on Health and the Environment of the Committee on Energy and Commerce, U.S. House, 103d Cong., 1st sess., November-December 1993, 66-79 and 707.

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102. Alan Reuther, legislative director, UAW, Interview, Washington, D.C., 7 June 1996.

103. See, for example, Sweeney, John J., editorial, Industrial and Allied Update (Spring-Summer 1991).Google Scholar In 1991, Sweeney tried to get the Ohio AFL-CIO to rescind its support of legislation that would create a single-payer system in Ohio.

104. Gerald M. Shea, assistant to the president for governmental affairs, AFL-CIO, Interview, Washington, D.C., 13 June 1996.

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111. Or what North eloquently calls the “fumbling efforts” political actors make in “deciphering their environment.” North, Douglass C., Institutions, Institutional Change and, Economic Performance (Cambridge, 1990), 23CrossRefGoogle Scholar and 22, respectively.

112. Weir, Margaret, “American Politics and the Future of Social Policy,” in The Social Divide: Political Parties and the Future of Activist Government, ed. Weir, Margaret (Washington, D.C., 1998), 525.Google Scholar

113. For more on the Canadian case, see Taylor, Malcolm G., Health Insurance and Canadian Public Policy: The Seven Decisions That Created the Canadian Health Insurance System (Montreal, 1978);Google ScholarMaioni, Antonia, “Explaining Differences in Welfare State Development: A Comparative Study of Health Insurance in Canada and the United States” (Ph.D. diss., Northwestern University, 1992);Google ScholarChandler, William M., “Canadian Socialism and Policy Impact: Contagion from the Left?” Canadian Journal of Political Science 10 (December 1977): 755–80; andCrossRefGoogle Scholar Marie Gottschalk, The Shadoiv Welfare State, chap. 2.

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