Lost in the scrum surrounding the Supreme Court's review of the health coverage mandate in the Affordable Health Care Act (a mandate which, it should be noted, was first proposed by conservatives as an alternative to anything that might resemble government-provided universal coverage) is a discussion of how we got into this position in the first place.
Although we are proud to be the most prosperous nation in history, tens of millions of Americans cannot afford health care. Children and their mothers do not get preventive care. People whose bodies wear out with age and work cannot pay their hospital bills.
Our political culture, it seems, recoils at the thought of a government-sponsored, single-payer system, ostensibly because the free market thinks like a really good doctor... or something. So instead, we have relied on employers to provide health coverage for everyone who is still in the labor market, and on chronically underfunded Medicare and Medicaid programs for the rest.
How did employers wind up paying for health insurance? This was a historical accident: In the middle of the last century, unions were strong enough to wrest wage increases from employers. When the pressures of World War II precluded increases in take-home pay, the alternative was to require employers to provide health coverage instead. Companies purchased insurance, or they paid into employee benefit plans administered jointly by the employers and the unions.
Remember that in this period, unions represented well over one-third of American workers and set the standards for the entire workforce. Now, unions represent less than 7 percent of employees in the private sector, and employers simply do not feel the pressure to offer health benefits -- or, to be more precise, coverage that their employees can actually afford.
The Writers Guild of America, East, AFL-CIO, is an organizing union.
We talk with hundreds and hundreds of unrepresented writers and others in the television, radio, movie and digital-media businesses. By far, the number one issue people complain about is the lack of health benefits. Some companies provide health insurance only to their executives and a handful of other employees. Some companies say they make coverage available to everyone, yet the premiums are so costly that very few people actually participate.
Other companies offer no benefits to anyone. The nonunion writers and others ask the Guild to represent them and to negotiate, above everything else, affordable health benefits, and that is what we are doing. The vast majority of American workers, however, finds it extremely difficult to organize and to bargain collectively, and has no leverage to ensure that employers will provide health coverage.
In my view, the best way for Americans to get the health coverage they need is to exercise the collective strength of union representation, which offers a lot more than just the opportunity to bargain for benefits. With a weakened labor movement, however, the next best alternative is federal mandates.