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					Labor Campaign for Single Payer

                  January 2013 - Chicago
                       Cindy Young
  Campaign Coordinator, Campaign for a Healthy California
  Bay Area Labor Committee for Improved Medicare for All
   Preparation for your presentation -
       Think about your audience
• While there are common     • Research and ask
  themes, some unions are      questions –
  dealing with specific      • Develop a couple of slides
  issues:                      that will speak to your
• Part time workers            specific audience
• Retiree H&W                • Tailor your presentation
• Trust Funds                  to the amount of time
• Right now, we have to        you are given
  deal with jobs, or the     • Always ask them how
  election, or, or, or, or     they think we can move
    Some Sources for Information
• Kaiser Family Foundation
• Commonwealth Fund
• California Health Care
• California Nurses
• Physicians for a National
  Health Program (PNHP)
• Labor Campaign for Single
• UCLA Center for Health
  Policy Research
• UC Berkeley Labor Center
Guarantee Healthcare for Every Worker
by Guaranteeing Healthcare for All
What’s the Climate and Future for
      Bargaining Benefits?
Cumulative Increases in Health Insurance Premiums, Workers’ Contributions
        to Premiums, Inflation, and Workers’ Earnings, 1999-2012

 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2012
The Downward Pressure is Tremendous!

              Among Firms Offering Health Benefits,
              Percentage That Offer an HDHP/SO,

Kaiser Family Foundation: 2011 Employer Survey
Brokers and
  “They wanted a 30% increase, but I got
  them down to 20%”
  They throw 20% on the collective
  bargaining table and watch management
  and labor eat each other alive.

  “Your group is old, fat and expensive.
  That’s why rates are going up”
  Why is it every other modern country has
  similar demographics, - pays less, insures
  everyone, and has better quality?

  “We are going to develop a network of
  hospitals and physicians based on cost
  and quality!”
  What happens to hospitals in poorer
  neighborhoods who serve the sick and
  uninsured patients?
  Healthcare money gets moved to wealthy

  “Electronic Medical Records are going to
  improve care.”
  A banking and IT initiative to collect
  our data, and corporatize our health!
                  Insurance Companies
                      What Value?
 30 cents of every dollar spent on
healthcare goes to keep you from
seeing the provider you want to see
and denying you the care you need.

In a recent statement discussing the
rate increases, “Blue Shield said it
expects to have lost $10 million to
$20 million on its individual health
plan business in 2010 and to lose
$20million to $30 million this year.
It’s costs for hospitals, physicians
and prescription drugs have risen an
average of 15 percent annually each
of the past three years.” –
Bargaining for health insurance is a failed
bargaining strategy
1980s – PPOs were going
to control the cost of care

1990s – Consolidation and
Organized health systems
(HMOs) were going to
control the cost of care

2012 – Accountable Care
Organizations and medical
homes are going to control
the cost of care

2012 Kaiser now realizes
getting healthy is good for
us, but is not going to
reduce premiums
More fancy power points
from third party
Some Research for Unions on
       Retiree H&W
        Among All Large Firms (200 or More Workers)
    Percentage of Firms Offering Retiree Health Benefits,

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2012
• Calculating the
  obligation for post-
  retirement benefits is
  not a precise science.
  It’s a SWAG!
• The actuarial report is
  like reading The
Retiree H&W is not a mandatory
      subject of bargaining
PITTSBURGH, Feb. 22 /PRNewswire/ -- LTV Steel
has informed the union that the Voluntary Employee
Beneficiary Association (VEBA) trust -- which has
paid for part or all of retired Steelworkers' healthcare
and life insurance benefits since June 2001 -- will not
be able to assure payment of health-care claims past
March 31, 2002, and all LTV hourly retiree
healthcare and life insurance benefits will end on that
date, the United Steelworkers of America announced
here today.

STOCKTON - Franklin Advisers Inc., a global
investing firm, and Wells Fargo bank ... Bankruptcy
judge: Stockton can stop paying for retiree health
care - 8/6/12 ...
                               City of Stockton

Stockton filed for bankruptcy on June 28 and on July 1
adopted a budget that included unilaterally reducing
retiree health benefits. That illegally impaired the city's
contract with retirees, the plaintiff's claimed.

U.S. Bankruptcy Court Judge Christopher Klein
disagreed. The key sentence in his 40-page opinion on
Aug. 6 fleshed out a shorter ruling for the city he issued
several weeks ago.: "In sum, even if the plaintiffs'
benefits are vested property interests, the shield of
the Contracts Clause crumbles in the bankruptcy
      Kodak to end healthcare benefits,
         solves $1.2 billion liability
   (Reuters) - Bankrupt Eastman Kodak Co said on
  Wednesday it was ending retiree healthcare and
survivor benefits at the end of the year, allowing it
 to resolve a $1.2 billion liability, one of its biggest
   The benefits, which include medical, dental, life
  insurance and survivor income benefits, will end
                    December 31.

 Reuters 10/10/2012 8:13:32 PM ET 2012
        The Affordable Care Act
• Not much help for union negotiated plans:

  – Taxes “Cadillac” plans starting in 2018
  – No cost control
  – Union negotiated plan will compete with high
    deductible plans on the Exchange
  – Employer penalty - $3,000 per year
  – Even the ACA experts project 3 – 4 million
    uninsured by 2019
    Conservatives have captured the
        public with the frame….
                             By building from the bottom,
• I live on a minimum           means we keep for those
  wage, why shouldn’t           that are what’s on top!
• I don’t have a pension,
  why should you?
• I don’t have health
  insurance when I retire.
  Why should you?
  Worse, why should I pay
  taxes for yours?
                AFL-CIO 2009 Convention
                      RESOLUTION 34
    The Social Insurance Model for Health Care Reform
Submitted by Alameda Labor Council (Calif.), California Nurses
  National Nurses Organizing Committee and International
             Longshore and Warehouse Union

“Whatever the outcome of the current debate
over health care reform in the 111th Congress,
the task of establishing health care as a human
right, not a privilege, will still lay before us. We
continue to believe the social insurance model
should be our goal, and we will continue to fight
for reforms that take is in that direction.”
How does our healthcare system
        measure up?
We spend more……..
But we get less……….
Hospital Inpatient Days per 1,000
  Average Annual Number of Physician
        Visits per Capita, 2009

Source: OECD Health Data 2011 (June 2011).
                                                   Overall Ranking
        Country Rankings
                                           AUS         CAN          GER        NETH         NZ          UK          US
  OVERALL RANKING (2010)                    3            6           4           1           5           2           7
  Quality Care                              4            7           5           2           1           3           6
           Effective Care                   2            7           6           3           5           1           4
           Safe Care                        6            5           3           1           4           2           7
           Coordinated Care                 4            5           7           2           1           3           6
           Patient-Centered Care            2            5           3           6           1           7           4
  Access                                    6.5          5           3           1           4           2          6.5
           Cost-Related Problem             6           3.5         3.5          2           5           1           7
           Timeliness of Care               6            7           2           1           3           4           5
  Efficiency                                2            6           5           3           4           1           7
  Equity                                    4            5           3           1           6           2           7
  Long, Healthy, Productive Lives           1            2           3           4           5           6           7
  Health Expenditures/Capita, 2007        $3,357      $3,895       $3,588     $3,837*     $2,454       $2,992      $7,290

Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).
Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International
Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians;
Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for
Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).
“I don't believe there's any
problem in this country, no matter
how tough it is, that Americans,
when they roll up their sleeves,
can't completely ignore.”
George Carlin
                 Is Your Health a Commodity?
Competition: Which
insurance company is
competing for ill patients?

For profit –avoid care
Not for profit (fancy tax
avoidance accounting

Physicians – new payment
arrangements allow them to
keep what they don’t use

No health planning!
Do we build hospitals where
we need them, or where
they can profit, or have      Are we going to allow Wall Street to control our
enough insured lives to       health?
        It’s About Solidarity!

Unions in other
have figured out the
only way they
are going to keep
what they have is by
advocating everyone
get it!
Are We Organizers or Bean Counters?

              Are we going to keep nibbling around the edges
              attempting to fix a system that can’t be repaired?


              “Significant social change comes from the
               bottom up, from an aroused opinion that forces
              our ruling institutions to do the right thing”

              Senator Paul Wellstone
     Framework for Health Care
• Lead with a moral message of
• Health Care is a Human Right
or we need
Guaranteed Health Care for All
 Start with agreeing on a common set
   of values and economic principals
•Everyone should be            •No one should profit
treated by a medical           from people’s suffering
professional if they are ill
                               •Pricing for medical
•Medical care should be        services should not be a
returned to the hands of       secret. We need public
medical professionals,         disclosure
not insurance company
bean counters                  •There should be no
                               barriers to our health –
•Everyone should pay           everyone is covered
their fair share
                  Keep it simple
•Unions can’t deliver    Join Bay Area Labor
healthcare or a wage     Committee and support
increases until we get   Campaign for a Healthy
                         California or other like
everyone under one       minded groups (insert
plan and control costs   your ask)

•Start an education
campaign with your
A Proper Sense of
DC - 1968
“On some positions
cowardice asks the
question, it is safe?
Expediency asks the
question, is it politic?
Vanity asks the question, is
it popular? But conscience
asks the question, it is
right? And there comes a
time when one must take a
position that is neither
safe, nor politic, nor
popular, but must take it
because conscience tells
him it is right.”
Thank You!

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