Does single payer work for workers? Yes ... Will it work in the United States? Yes


November 2017 - In 1979, I had been in America almost a year. I finally spoke to my mother in Ireland and I told her I was in Los Angeles and found work and would soon have health care insurance. She went quiet for a moment. Then she asked me, “What do insurance companies have to do with health care?”


I’ve never been able to answer that question.

You know it and I know it: in the Building Trades over the past 20 years, pretty much all of the compensation increases we have negotiated for our members have been sucked away into the growing cost of health care.

At some locals, the benefit package includes as much as $17 an hour for health care alone. That is money that should be going into workers’ pockets, to pay for better housing and higher education for their children, to take care of their parents. Instead, it is going to pay for health insurance, and not just for themselves, but for 27.3 million people in our country who don’t have any coverage. Now we’re finding that the more we pay to cover health care, the bigger the bills we get in return.

At the State Building Trades, we’ve tried to work with the hospitals and others to come up with solutions to fix our national healthcare system, if it can be called a system at all. What we really have is a disaster in progress that is getting worse by the day.

The way it is designed, most people are supposed to get coverage through their employer. These days in the United States, barely half of them do, if that, and in our industry, the pathetic reality is that not even 20 percent of them do. Take a look at the survey the city of Los Angeles’ Department of Public Works did on Project Labor Agreements a few years ago: all 125 union contractors on 13 jobs worth $166.5 million paid their workers’ health care. Of the 74 nonunion contractors, the number was only 10. This means that our union contractors who provide workers with a coverage plan are forced to bid against others who do not, and that the workers they employ wind up getting socked with higher premiums to cover higher hospital costs to pay for the uninsured who come in off the street.

It is a system that is eating up our pay raise and dragging down our employers, making them less competitive.

The solution to this problem is obvious. It’s been around the industrialized world for nearly 70 years, and the time has come for lawmakers in Sacramento and in Washington, D.C., to begin the process to enact the fix whose time has come:

Single payer.

It started in England after World War II as part of a union/Labor Party movement to give the ordinary working man and woman a better chance at a decent life. The British had seen what a motivated nation could do to wage and win a war against the Nazis. When the victory had been achieved, the country turned its focus inward to develop its wealth and industry for the benefit of the masses instead of for the blue-blooded few who had been running the country.

Of all the notions of social insurance that came out of the post-war progressive impulse, it was the idea of single-payer health care that caught hold in the United Kingdom and spread throughout the industrialized and industrializing world, to Scandinavia and Western Europe, to Japan, Australia and New Zealand, to Canada. From country to country, the concept of single payer has taken different forms, but with a few resolute precepts: total medical coverage, paid for by nominal fees and a central health care tax paid by every worker in the nation – no exceptions – and available to all. Everyone pays, everyone receives. Everyone benefits. Everything is covered for every citizen – primary care, specialized care, hospitalizations, surgery, dental, and mental health. Indeed, they even have extended the same concept to college education.

Now the time is right to bring a single-payer health care system to the United States and to California.

Take a look the next time you stop at a red light at a busy intersection and you see gas stations on every corner. Think about the clerk who is standing behind the counter or sitting on a stool late at night inside the bullet-proof glass. Think about people just like them working three shifts around the clock at the all-night station.


Think about whether their employer is paying for their health care. You know they’re not. Think about what they’d do if they have a medical emergency or their small child gets an ear ache. Think about where they would go to get treated. If it’s a hospital, think about how much of that cost gets passed on, and how it gets passed on to you, the Building Trades workers who are paying for medical coverage, and think about that $17 an hour that has been negotiated into some of our members’ benefit package in lieu of salary.

Then, think about how a single-payer system might work.

For starters, that $17 an hour for a construction worker’s health care would likely get cut down to around $4, with our members having a choice of plans that would include preferred providers such as Kaiser Permanente.

All employers, union and nonunion, would pay into the system, meaning the owner of the gas station who now gets away with shirking his workers on their health care would now probably get nicked for a couple of bucks. In our industry, the nonunion contractors who provide no medical benefit would now be forced to pay – leveling the playing field for union contractors and thereby helping to rectify the massive deficit of uninsured workers and families in America. Meanwhile, hospitals would be reimbursed from a nationwide health coverage pool, administered locally, to take care of anybody who walks in through the emergency room door.

This would be a system that works for everybody – for hospitals that would no longer be left holding the bag for providing care for the uninsured, for doctors and pharmaceutical companies who would be paid a fair rate for their services and products, for employers who would all enjoy a fair and equitable system that provides them with a healthy workforce, and for ordinary people who would no longer cringe at paying ever-increasing premiums and deductibles while facing the possibility of economic ruin if they are not covered and somebody in their family gets struck by a catastrophic illness.

Right now, the system doesn’t work for anybody, most of all the working people of the United States who can’t get a decent pay raise and who are forced to worry about retirement security – the sorry result of a health care system that for union negotiators acts as an anchor wrapped around our necks.

One party, of course, loves the system as it is, and that is a party that doesn’t belong in the system at all: insurance companies. They act as a middle man who consumes around 40 percent of the premium even though they play no role in providing health coverage. They are simply a broker who has inserted themselves between workers and the health delivery system. You have a doctor. You have a patient. Why in the world do they need an insurance company to bring them together? The fact is that we don’t. There are plenty of plans out there on how a single-payer system can help current insurance industry employees transition into the new model. One thing we don’t need is the existing intermediary system that only adds one thing to the delivery of health care in America, and that is cost.

Building a single-payer system for California is going to take some time. The idea is there, and the idea is good. Now, we need to create a strategy that brings together hospitals, unions, employers, drug companies, and politicians. In organized labor, we need to build allies and develop a specific, detailed plan. We need more than just a statement of purpose. The fine points of how it will be financed must be worked out and they must be explained, and they must gain the acceptance of the public, to defeat what we all know will be a massive campaign waged against it by the insurance combine.

This is a process that can be done in a relatively short period. The nations of the world have shown us that it works.

We already have a model. It exists across the rest of the progressive, industrialized world, where the ideal of social insurance with room and incentive for individual initiative has been woven into the fabric of their societies.

They have created systems that are equitable, efficient, functional, and available to everybody, to cover everything from the common cold to cancer. They have simplified accessibility. They have endured through the decades.

It’s all possible. You can keep your chosen provider, your doctor, and you can provide for your family’s financial well being. The nation can end a worker’s nightmare that something could go wrong and they could lose their health care.

We need a system of our own. Our workers cannot bear the weight of supporting an unmanageable system any longer. It is time for a better deal.



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