Health Care for All

L'assenza di un sistema sanitario pubbico universale lascia 41 milioni di cittadini americani senza assistenza. Ma una parte dei sindacati non appoggia la richiesta di un sistema sanitario come diritto universale

Negli Stati Uniti non esiste un servizio sanitario pubblico universale. L'accesso alle cure dipende dalla disponibilità di un'assicurazioone privata. La metà dei lavoratori sindacalizzati (che negli Usa sono il 13 per cento della forza-lavoro) fruisce di un'assicurazione pagata col contributo delle imprese. Il sistema pubblico interviene garantendo l'assistenza ai poveri (Medicaid) e agli anziani (Medicare). Il risutato è che 41 milioni di cittadini americani sono privi di assistenza sanitaria. Gli autori di questo articolo - due sindacalisti, dirigenti dell'associazionei Jobs with Justice - sostengono la necessità di una mobilitazione generale con l'obiettivo di una riforma che garantisca un sistema sanitario aperto a tutti, come diritto di cittadinanza. Essi sostengono anche che una parte dei sindacati non si mobilita, implicitamente difendendo il sistema assicurativo basato sul negoziato con le imprese. Sistema che esclude un numero crescente di lavoratori. Il tema è di particolare interesse in relazione alle ricorrenti proposte di privatizzazione progressiva del sistema sanitario nel nostro paese. With premium costs rising by an average of 12%, bargaining over health care costs has become as difficult as it was during the late 1980s and early 1990s, when insurance premiums skyrocketed by similar amounts. Nearly all employees and retirees in the United States are being asked to pay more for their health care benefits. Over the last year, almost every union has been involved in major health care-related disputes. The most high-profile clash was when 18,000 General Electric employees walked out for two days last January over GE’s decision to unilaterally raise premiums. An even bigger confrontation lies ahead when, later this summer, contracts covering nearly 80,000 Verizon workers are up for re-negotiation. DAY OF ACTION Jobs with Justice supporters in Massachusetts held a statewide Health Care Action Day on June 5, endorsed by more than 50 unions and community groups. Participating organizations distributed 60,000 stickers demanding “Health Care for All--No Cuts in Benefits or Services” and committed themselves to doing the membership mobilization necessary to get workers to wear them on the job. This unprecedented coordinated workplace activity was accompanied by informational picketing and several rallies. At the rallies and press conferences, activists called for a health care plan that “covers everyone, is publicly financed and saves money by eliminating bureaucratic waste and inefficiency.” “The JWJ campaign helped link the anger that workers and retirees feel about losing benefits and paying more for basic services with a movement to improve the way that health care is paid for and provided,” said Gary Sullivan, President of Utility Workers Local 369. “Let’s face it, there is no solution to this problem at the bargaining table.” How U.S. unions respond to these mounting attacks and the bargaining challenge has important implications for their future and the prospects for real health care reform. The political challenge facing unions today is how to broaden their defense of negotiated benefits, when a record number of Americans have no coverage at all. If struggles against cost shifting are framed narrowly, they will, in effect, be just another special interest fight against give-backs by workers who already enjoy better-than-average coverage. However, if resistance is framed in larger political terms by demanding fundamental reforms so that everyone is covered, these fights could attract much broader labor and community support. UAW President Ron Gettelfinger provided a good example when he told Detroit auto makers, "We need a universal, comprehensive single- payer health care program to cover every man, woman and child in the United States. You can't fix the health-care crisis in America at any one bargaining table or within any one industry." UNIONS AS INSURERS But not everyone in the labor movement agrees. Many union officials don't want to forsake job-based medical coverage -- no matter how tattered--because they're in the benefits business themselves. As Marie Gottschalk notes in “The Shadow Welfare State: Labor Business and the Politics of Health Care,” over half of all union members are still insured through union-administered Taft-Hartley funds (see Labor Notes, September 2000). Such arrangements have long been defended as a way to promote union loyalty and as a result labor conservatives have impeded past efforts at comprehensive health care reform. Unfortunately, Gottschalk argues, by aligning the interests of labor leaders and insurers, the Taft-Hartley funds have given one wing of organized labor, "a vested interest in maintaining the status quo." It also leads to occasional AFL-CIO pronouncements on health care reform that appear to be a balancing act between single payer advocates at the grass roots and AFL affiliates more inclined to partnerships with employers that preserve - and extend - job-based coverage. Too often unions, whether at the bargaining table or in lobbying campaigns, have left health care reform in the hands of experts. So the finer points of such policy debates are lost on most union members. In contract talks, union negotiators struggle to identify new “cost-containment” schemes to sugar-coat medical plan changes. This top-down, technocratic approach fails to address the need for massive workplace education and debate about health care reform options. Because such efforts have been neglected, many trade unionists still view “universal health care” as something that would mainly benefit someone else. The term "single payer" often draws blank stares. And the concept of a publicly-funded, government-run insurance plan strikes many union members as a formula for longer waits, inferior care, higher taxes and rationing--rather than cradle-to-grave security and relief from out-of-pocket costs. That’s why labor activists involved with mobilizations, such as the Health Care Day of Action, favor rank-and-file education and cross- union activity to change such membership views, get workers involved, and build bottom-up pressure to change the status quo in health care. Steve Early is a representative of Communications Workers of America; Rand Wilson works for SEIU Local 285 in Boston. The authors have both been involved in strikes over cost shifting and building movements for health care reform.

Mercoledì, 23. Luglio 2003