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October 10, 2005

Why No National Health Care

Kevin Drum asks: Why no national health care?

My answer is it's the fault of the unions. Because of the labor movement in the 1930s and 1940s, we won just enough against corporations to create a pretty decent health care system for most workers and their families. And then Medicaid covered a lot of the poor folks at the bottom.

Which meant that most of the population were left with a stake in the present system and fears about change. So a fully comprehensive national health care system would get strong approval in theory but opposition could be easily whipped up by playing to the fears, since most people had little to gain. The dirty secret is that most unions were lukewarm about national health care for years (including during 1993 and 1994) because the system did well by their members and unions often strengthened their position by managing the health care funds.

But take hope-- to site one of my favorite bad graphs:

The trends have continued and, in addition, copays and other costs mean that even employees with health care coverage are paying more out of pocket.

Which means that fewer and fewer people have a stake in the present system of health care coverage. And unions increasingly see negotiations for health care sucking up all their time and efforts during negotiations, so they are redoubling their efforts to pass serious health care reform. And as large employers providing health care see their profits eroding due to having to compete with countries with national health care systems -- and without the costs they face -- even some employers can be cajoled around to support.

Most employers will probably stay opposed but even a minority joining with the uninsured and increasingly partly insured can change the politics around universal coverage. It's tricky but there are models out there-- and polls show that as the politics line up, basic public support for a government program is solid.

Posted by Nathan at October 10, 2005 09:45 PM