Few progressive leaders have proven as committed to health care reform as Andy Stern, head of the Service Employees International Union (SEIU). Last week, he sat down with TAP's Ezra Klein to talk about the disunity in the labor movement, the skittishness of business, and the unsung heroes of health reform. (Transcript has been condensed and edited for clarity.)
How does Labor's approach differ from 1994? What's changed for them?
There's a level of desperation on the part of the Labor movement. Nothing more can demonstrate it than the problems United Auto Workers (UAW) is having, that's kind of a stunning example of institutions that provided benefits for a long time and now find themselves at risk.
But I'd say besides our union, I'm not sure a lot of people have spent a lot of time in the last couple years really working on this. You don't see the big industrial unions engaged in the national level. I'd say most unions have been trying to deal with this acute problem within their own framework, with collective bargaining rather than national solutions. There is no serious attempt to create a united Labor position. Some unions individually are out there on their own, like the California Nurses Association and some others for single payer. SEIU kind of has the "we gotta get this done, can't let the perfect be the enemy of the good" approach. I know the AFL has done some work, but I don't think there's a lot of coherence yet. It's not a divided labor movement, just not yet a united labor movement.
A few years ago the labor movement was more divided than it was in 1994 and as of two days ago, or this week, there's fissures within the fissures. How will that affect the overall ability to push on this issue?
I'd say the bigger issue is that most local union leaders are dealing with layoffs, furloughs, and budget cuts. It's hard to get people's attention on a national issue when their members are screaming and hurting locally. The good news for healthcare -- I don't think it would be true for energy or national service -- is that people appreciate the answer to part of their problem is universal health care. So if you're a health care worker, or if you're some of these workers with not enough health care, we're able to tie health care to the recovery, because people say "oh, if we get health care maybe my hospital will have more money and not lay me off or maybe Governor Paterson will get more money so the cuts won't be so severe."
I was talking to someone who works a lot with business on health care, and he said to me "I finally have this insight after years of working with these people. They're stupid. Not on everything. But they just don't know much about this issue."
Maybe, but it's just too universal. These are companies that operate around the world, which is also fundamentally different than 1993. So they've seen a Swiss system, a German system, the UK system, the French system. So I appreciate a CEO's not a genius on health care anymore than I'm a genius on Walmart's logistics. But I do think they have to be knowledgeable enough to say, "why do we want to provide this? Will it cost us more or less?" As a CEO you have to ask yourself these questions all the time. Is it worth greening your company or doing an environmental impact report. What's the return on investment on this? Is it better than letting someone else provide it and cap the money employers pay and let them stop managing risk, why wouldn't they want that? I don't know.
Do you have a theory on why they want to be involved?
I think people have a tremendous fear of letting go and not knowing what the consequences will be in the long run. Right now, in some ways they get to control their costs: They can cut the benefits, they can create co-pays and deductibles. So part of it is they don't want to be in a position where five years from now they're not in control of their own fate. I just think it's a basic "I don't trust that the situation, the system, the government, won't stick me with something I don't want." So they want some semblance of control.
How much money is SEIU putting into this?
We have this Change That Works campaign. We have 350 people out full time in the field right now. We're part of a series of coalitions that we've invested money in advertising. We have a war room that's been rolling mostly on Employee Free Choice but is getting much more involved in health care cause it's up first. But I think the biggest contribution we will make is not the people we take off the job. With over 2 million workers, it's the staff and the shop stewards on the job that offer us the greatest base of operations. We have the infrastructure now in the field, we're in places like Arkansas, North Dakota, Maine, Pennsylvania, and Montana, where important senators are going to make decisions, so we've actually done our targeting.
Surveying the landscape, you've mentioned the many coalitions that have emerged. Which ones do you think are the most important?
Divided We Fail has had a very concrete public role and a very concrete private role. Health Care for America Now has been enormously important because they've hooked in all the progressive forces, and it will be incredibly important to hold the line on things like the public plan and low wage subsidies. There are lots of other coalitions that serve good niches, the one with American Cancer Association and PHARMA, and the We Can't Wait coalition. Then there's a series of private groups, meeting with legislators.
Who has surprised you with their position or openness in things you didn't expect?
NFIB has surprised me up to now, we'll see as we try to land the plan, but they've had a totally positive attitude. They're worried about is cost, cost, cost, and cost. And they don't like paying 18 percent more for insurance than larger business. That makes no sense to them. When people focus on cost that's not an ideological question. Someone can count that. So they've surprised me.
The insurance industry has surprised me. Maybe one of the untold stories here since we don't know the end of the play is that it's rather fortunate that George Halverson, CEO of Kaiser, happens to be the chair of the American Health Insurance Plans. He's not your classic insurance guy. He's written quite a terrific book on health care himself, about changing the delivery of care and getting better outcomes, which is not what most insurance executives write about or think about.
Max Baucus has surprised me. I didn't think he would be as bold and aggressive as he's been.
It doesn't really surprise me, but Obama doing this right now is a pretty gutsy move, given that half the world is telling him that this is not the right time to reform health care. He is totally repositioning the conversation, arguing that you can't fix the economy without fixing health care, which just makes this a different discussion. Everybody wants to fix the economy. If they can get that in people's head, it makes it much harder for congressmen who talk about socialized medicine.
