By Jordan Barab, Reprinted from Confined Space
Yesterday was Workers Memorial Day; a day dedicated by the labor movement to “pray for the dead and fight for the living,” in the words of fabled labor organizer Mother Jones. This year we’re hoping that while the praying goes forward as usual, the fight for the living may be making more headway.
The focus of this year’s commemoration is the Sago mine explosion in which 12 West Virginia coal miners died last January, as well as the subsequent Alma Aracoma fire that killed two miners. As traumatized as Americans were by the deaths of these men, the revelations of the Bush administration’s weak enforcement efforts, low fines and withdrawal of proposed regulations that could have saved the lives of the Sago and Alma miners have prompted citizens, labor advocates and politicians to take a serious look at this nation’s waning commitment to ensuring safe workplaces.
Mineworkers President Cecil Roberts, speaking at the AFL-CIO Wednesday evening, reminded us that only one Sago miner was killed in the initial explosion; the other 11 died from lack of oxygen. If they had had enough extra air or a means to communicate, the 11 miners would still be alive today. If the Bush administration hadn’t withdrawn a proposal to make coal belts fireproof, the two Aracoma miners would be alive today. This country created the Mine Safety and Health Administration, Roberts continued, because mine owners were not ensuring the safety of miners. Now, however, the Bush administration has handed MSHA back to the mine owners. And they’re not doing a very good job. Twenty-six coal miners have been killed so far this year, compared with 22 for all of 2005.
But Sago was not an isolated event. Few Americans realize that if the 12 miners who died at Sago were the only American workers to die on the job that day, it would have been a good day in the American workplace. Every day in this country, more than 15 workers are crushed in trench collapses, shot in convenience stores, mangled in machinery, killed in vehicle accidents, or fall to their deaths from scaffolds and cell towers. And the problem is getting worse. The number of workplace fatalities has risen in each of the past two years and the national workplace fatality rate rose in 2004 for the first time since 1994. The rate also rose for manufacturing, construction and Hispanic workers.
But the workplace dead are largely invisible souls. You can find the names, birthdates and hometowns of every American killed in Afghanistan or Iraq with only a few moments of web searching, but no amount of searching will identify more than a fraction of the almost 6,000 Americans killed in the workplace every year. Most die one at a time, noted only by their families, friends, co-workers, and possibly, a small article in the local paper.
Despite the rising workplace death rate, the Bush administration boasts about the falling number and rate of injuries and illnesses. “Only” 4.3 million injuries and illnesses were reported in the private sector in 2004, compared with 4.4 million in 2003. But in fact, no one really knows how many workers are injured or made ill in American workplaces. A recent study published by Michigan State University researchers confirms previous research showing that the federal government may miss up to two thirds of all workplace injuries and illnesses. Does anyone find it curious that the number and rate of workplace deaths is rising while the number of injuries and illnesses is allegedly falling? Could it have something to do with the fact that dead bodies are harder to hide than back injuries, cuts and burns?
Most of these deaths, injuries and illnesses could, of course, have been prevented if employers had simply complied with workplace safety standards issued by MSHA or OSHA. But the message has gone out from the Bush administration that employers don’t have to worry about OSHA or MSHA anymore. The overt hostility and unceasing attacks from the business community and Republican politicians has turned OSHA into a shadow of the tough enforcement agency originally envisioned by Congress. One of the first actions of the newly elected President George W. Bush and the Republican-controlled Congress was the repeal of OSHA’s ergonomics standard in March 2001. That standard, which would have addressed the largest health and safety problem facing American workers, had been ten years in the making. Today, one-third of workplace injuries and illnesses still come from ergonomic problems, and despite the administration’s promises to take ergonomics seriously, the agency has issued only three guidelines and 17 General Duty Citations over the past five years.
In fact, OSHA has issued only one other major standard since Bush took office – covering the cancer-causing chemical hexavalent chromium -- and that was done under court order. The standard was issued with permissible exposure limit (PEL) five times what was originally proposed by the agency; a level exposure which by OSHA’s own admission will leave workers at a significant risk of developing cancer. Only one week before, a study reported that the chromium industry had covered up evidence that the chemical caused cancer at extremely low levels. Meanwhile, standards to protect workers from silica, beryllium, noise and confined spaces in construction, and a requirement that employers pay for employees’ personal protective equipment make little progress at the agency. “New” issues like pandemic flu and other communicable diseases, stress, workplace violence and thousands of unregulated, uncontrolled chemicals are not even on the drawing table.
And OSHA isn’t even doing a very good job enforcing the standards it has on the books. American employers who are well aware that they are far less likely to be inspected by OSHA at work than they are to be pulled over for speeding on the way home from work. The AFL-CIO has found that it would take 117 years for OSHA to visit every worksite in those states covered by federal OSHA. Even if a workplace is inspected and violations are found, the fines levied by OSHA or MSHA are often absurdly small. Although the maximum penalty for a willful violation of an occupational safety and health standard is $70,000, most penalties are far smaller – even when a worker is killed. An exhaustive review of OSHA enforcement actions by Mike Casey of the Kansas City Star last year found that in 80 fatal and injury accidents, half of the fines Kansas City area employers paid were $3,000 or less. Even where fines are large, they are rarely high enough to present an effective deterrent. BP North America was fined $21.3 million for the 2005 Texas City refinery explosion that killed 15 workers and injured 170, but even that record penalty comes to only a few hours of profit for the giant corporation.
But Republican administrations and business hostility toward tough enforcement are only part of the problem. Most experts think that even with the most pro-worker administration, available resources and current penalties are not sufficient to force employers to take workplace safety more seriously. The Republican solution to this problem is to be less confrontational and leverage OSHA’s limited resources by promoting more partnerships, technical assistance, alliances and other voluntary programs under the theory that if you provide employers with relevant health and safety information, they will naturally do the right thing. Instead of an ergonomics standard, OSHA has formed 70 voluntary Alliances with industry associations ranging from he National Chicken Council and National Turkey Federation to the International Society of Canine Cosmetologists. Yet ergonomics remains the biggest problem facing American workers.
OSHA persists in expanding these voluntary programs despite a 2004 Government Accounting Office report that revealed that there is no evidence that these programs are effective in improving the safety of American workplaces. Further, the GAO warned, the growth of these expensive programs threatens to reduce the share of OSHA’s static budget pie dedicated to enforcing the law.
The continuing carnage in our nation’s workplaces proves the bankruptcy of the Republican voluntary approach. Labor unions and workplace safety advocates may have a better idea. Backed by studies that show that holding corporate heads personally liable for workplace crimes can be much more effective than monetary fines, they are arguing for more aggressive criminal prosecutions of employers who knowingly put workers in deadly environments.
Although rarely used, OSHA has the ability to criminally prosecute employers when a willful violation of a standard leads to the death of a worker. (“Willful” means violations in which the employer knew that workers’ lives were being put at risk.)
OSHA was embarrassed in 2003 by a New York Times investigation that revealed that from 1982 to 2002, OSHA declined to seek criminal prosecution in 93 percent of more than 1200 cases where a worker was killed due to a willful violation of an OSHA standard. At least 70 employers willfully violated safety laws again, resulting in scores of additional deaths. Even these repeat violators were rarely prosecuted. Fewer than 20 employers have ever gone to jail despite well over a thousand cases involving work deaths that involve “willful” OSHA violations over the past twenty years.
The problem is that a conviction under the Occupational Safety and Health Act is only a misdemeanor with a maximum penalty of six months in jail. By comparison, the penalty for harassing a burro on federal land is one year in jail. In fact, a chemical release that kills fish and crabs draws a much larger penalty from the Environmental Protection Agency than killing workers. Although the agency has signaled renewed interest in pursuing criminal convictions following the New York Times series, the small penalties make federal prosecutors reluctant to dedicate the energy and resources to prosecuting cases unless the workplace death can be linked to the violation of an environmental law that carries higher penalties. Edwin Foulke, the new head of OSHA, has indicated that the administration has no interest in strengthening the laws criminal penalties, even for the worst violators.
But there is a small glimmer of hope that change may be on the way -- if not in Congress or at OSHA, then at the local level.
Last November, New York prosecutors charged a Staten Island construction company owner, Ken Formica with second degree manslaughter for the 2003 death of his employee, Lorenzo Pavia who was crushed to death under tons of earth when a 15 foot deep unprotected trench collapsed on top of him. Pavia was then decapitated in the rescue attempt. Formica had received a trenching citation nine months before Pavia's death. OSHA fined the company $15,000 for Pavia’s death. But if convicted of manslaughter, Formica faces 15 years in jail.
In Arizona, the Far West Water and Sewer Company was found guilty last year on five felony charges filed against it by the state prosecutors office. The company was found guilty of violating a safety standard causing the death of an employee and two counts of endangerment in the deaths of James Gamble, 26, and Gary Lanser, 62, who were overcome by toxic sewage gases while working on an underground sewer tank. The conviction resulted in a $1.8 million fine. The OSHA citation was only $31,000. Far West president Brent Weidman will be tried for manslaughter, aggravated assault and endangerment at the end of April.
Some prosecutors, like New York State Attorney General Elliot Spitzer, aren’t even waiting for workers to die before jailing employers who put workers at risk. A Bronx jury recently found John Chiapperino and his company, Bronx Auto Venture, guilty of one count of Endangering Public Health, Safety or the Environment in the Second Degree, a felony, and two counts of Endangering Public Health, Safety or the Environment in the Fourth Degree, a misdemeanor, for sending one of its employees, Anselmo Alfaro to clean out pipes in a tank containing thousands of gallons of automotive petroleum waste products released during vehicle dismantling and crushing, without any protective equipment. Alfaro, who had objected to going into the tank, passed out and had to be rescued by the fire department. OSHA had fined the company $750, later reduced to $562.
What Is To Be Done
How can we make employers and the Bush administration take workplace safety and health more seriously. We could (and often do) go on all night coming up with ideas, but in the short term, there are two areas on which we can focus. First, let’s make every workplace fatality a “teachable moment.” Write a letter to the newspaper, or call the local T.V. station if they don’t report about how a workplace death could have been prevented.
Talk to local prosecutors about filing manslaughter charges. Talk to the press about talking to the prosecutors. If you’re not a family member, get in touch when the time is appropriate. Talk to them about how workplace deaths can be prevented, and how they can talk to the medial and local politicians.
Second, get the families who have experienced workplace tragedies involved. As a result of the "Weekly Toll" which lists workers who have died on the job in the previous two weeks, I hear from a lot of people who have lost loved ones to needless, preventable workplace tragedies. They're angry that the death of their son, daughter, husband, wife, mother or father could have been prevented. Their one wish is that somehow the death of their loved one will help to prevent similar tragedies from ever happening again. But, most of all, they're frustrated that nothing is being done, that the news media has glossed it all over with a short article implying that it was just a terrible freak accident, that OSHA has handed down an insignificant fine, that this tragedy that changed their lives forever had no impact, that it teaches no lessons. There's a lot of energy there to be harnessed and channeled into the political process. Let's not lose it.
Third, we’ve got an election coming up. Candidates will be crisscrossing their districts from now until November to talk to potential voters. Well, let’s make sure we talk to them. Workplace safety may never be a major issue in a national election, but it also doesn’t have to be a dead issue. If a politician hears once from an angry worker or family member who has lost a loved one, it’s a fluke. The second time, their ears may perk up. By the third or fourth time, they’re asking their staff for a report on who all these people are and what the hell do they want?!
And the same goes for union members who don’t feel their unions are doing enough about workplace safety and health conditions. Stop muttering to yourself and start nagging and complaining to your elected officials. They'll start nagging and complaining to headquarters.
As flawed as many of our institutions are, we still live in a democracy. Squeaky wheels eventually get greased – if they squeak enough.
Go forth and squeak.
By Jordan Barab, Reprinted from Confined Space
Union mines are safer than non-union mines explains Charles McCollester, Director of the Pennsylvania Center for the Study of Labor Relations at Indiana University of Pennsylvania.he decline of governmental oversight and enforcement under the present administration is a scandal.
The Mine Safety and Health Administration levies fines but rarely collects and fails to go to court to enforce.McCollester alos authored a fascinating article on on the called so-called miraculous rescue of Less Than Miraculous: The Near-Disaster at Quecreek Mine Citing many of the warnings that the company had before that mine was flooded, McCollester wrote:
In a non-union mine, the inspector has no back-up. It's his word against the company. The union has the right to accompany inspectors and provide documentation and testimony. The heart of the union presence, the local Mine Committee, meets monthly, receives additional training, has the right to inspect any part of the mine including its access, and must perform full inspections at least every two months.
Critically, workers in a union mine are not afraid to speak. In a non-union operation, asking questions or challenging company mining practices or safety procedures can lead to termination. The company's fear of knowledgeable, independent inspections was illustrated in their attempt to bar the entry of UMWA representatives at Sago.
Union mines resist efforts to cut corners including the installation of dubious products like foam Omega blocks that the government now allows to replace previously mandated two-foot thick poured concrete or block walls.
Two successive roof fall deaths at the non-union Rosebud mine in Armstrong County were in an area with recognized poor roof conditions, but the company was not test drilling to effectively gauge conditions. It continued to take deep cuts (in excess of 20 feet) using 36- and 42-inch roof bolts when conditions called for longer ones. The failure to drill test bores was a contributing factor in the mine flooding at the non-union Quecreek operation.
Black Wolf owner-operator David Rebuck called the flooding an "act of God" in one local TV interview. As McCollester wrote, "The flood of testimonials to the mercy of God threatens to obscure the very human factors that led to the near-disaster. God may well have had a hand in the rescue, but human avarice and more than a century of fierce corporate manipulation and struggle for profit and control were behind the wall of water that swept into the Quecreek mine."In that near-disaster as well, McCollester writes, a union would have helped:
If Quecreek had been union, workers might have been more candid about company responsibility immediately after the rescue, when some of them supported management's claim of normal mining conditions. If the union had been recognized, the workers could have refused to continue advancing--without fear for their jobs--as they saw conditions worsening.
Imagine if Dick Cheney returned to Halliburton with a nice fat management contract after landing the company lots of lucrative contracts.
That's just about the situation with the Veterans Administration where the former head of the department, Anthony Principi, returned to the company he previously headed, and the company was promptly awarded a $1 billion privatization contract desgined by Principi himself:
Principi’s company, QTC Management, administers medical exams to veterans who need disability assistance. Additionally, the firm also examines soldiers before they are discharged, the results of which play a substantial role in VA disability benefit decisions. Principi was president of QTC before heading the VA from 2001 to 2005. After leaving the VA, Principi returned to the company as chairman of the board.The LA Times has more on how QTC has been bilking the federal government for years, yet Principi just looked the other way while in charge:
The firm began its relationship with the VA in 1998, conducting disability exams under a pilot program. Principi joined the company in 1999.This illustrates how corruption and the privatization of government services go hand in hand.
QTC's initial performance drew some criticism. As mandated by Congress, its work was reviewed by a private consulting firm, which said QTC's fees were much higher than expected.
A QTC hearing exam, for instance, averaged $495.55 compared with $89.80 for an in-house VA exam. Even with an adjustment for possible hidden VA costs, the difference exceeded 400%. For a general medical exam, QTC's average fee was $393.52 compared with the VA's $225.58, the consultants found. They recommended further cost-comparison studies, but such an analysis was not done...
Right after becoming head of the VA, Principi appointed a task force on the backlog of veterans' claims. In its report to Principi, the panel lauded QTC's performance and recommended that the medical exam program continue or expand.
From over at the Progressive States Network (yes the name is changing)
After the botched Massachusetts health care bill, it's nice to see Wisconsin is stepping up with a really bold health care plan. Backed by unions, businesses and municipalities, a bipartisan group of Wisconsin legislators, led by Sen. Russ Decker (D-Schofield) and Rep. Terry Musser (R-Black River Falls), introduced SB 698, one of the most comprehensive health care proposals in the country -- that would cover every employee in the state much like the existing workers compensation and unemployment insurance systems. An actuarial study done in 2003 estimated that employers would have to pay about $300 per month, while employees and dependents would pay a yearly deductible of $300 for a single person or $600 for a family. The Wisconsin AFL-CIO has this analysis which points out that it's the very ambition of the plan that will make the plan affordable for both employers and employees. And why "individual mandates" or other so-called "consumer driven" proposals will fail:
[V]oluntary purchasing pools don’t work, because they are inevitably subject to “adverse selection”: only groups with above average costs want to participate. “Consumer-driven” or “market” reforms simply shift costs to individuals and ration access to health care according to wealth: none of these approaches increases access to quality health care, improves our health care system, or reduces overall costs...
And the Wisconsin plan, by standardizing benefits and administration will accomplish what almost no other proposal on the table will do-- dramatically reduces administrative costs. 20 to 30% of the cost of health care in the United States is currently for administration – often just patients and care givers negotiating with a blizzard of different insurance companies over what will get covered and who will pay. Compare that to administrative costs of just 3% for Medicare and for the single-payer Canadian health care system and you can see the attraction of the new Wisconsin plan's more integrated approach.
The Wisconsin plan will also bargain with pharmaceutical companies to reduce prescription drug prices and establish common quality standards for hospitals and health care providers to control costs. Now, this is a health care vision that takes the debate beyond incremental reforms. Unlike the Massachusetts bill, it holds employers responsible for providing health care, but also offers the carrot to responsible employers of reduced costs and not being undercut by companies that just dump their health care costs on emergency rooms. The bill is being introduced too late to be passed this legislative session, but will no doubt help define the election races this fall for the legislature-- and hopefully those candidates who refuse to sign up won't be coming back for January 2007.
Wisconsin AFL-CIO, The Wisconsin Health Care Plan
SB 698- text of Wisconsin Health Care Plan (WHCP)
Across the country, various states and local governments have created innovative laws and programs to take on wage law violators, as a new analysis at PLAN details, although none have put all the pieces together.
The facts of illegal violations of our wage laws have been clear for years:
Read those sentences again. A MAJORITY of businesses in these industries and other low-wage sectors routinely disregard our wage laws. If we are going to hear about "respect for the law," ending this pervasive illegal conduct by employers should be the focus. And while some sweatshop workers are undocumented, the majority are not; so even if you eliminated every undocumented worker from the economy, the sweatshops would remain.
Conversely, eliminate the sweatshops and most of the incentive for employers to recruit undocumented workers disappears, a point we have made, but also one that the Bush administration endorsed in their recent budget document, which argued, "[L]abor standards enforcement efforts...will help to reduce the economic incentive for such illegal employment practices and will, in turn, help reduce illegal immigration." The problem is that while this rhetoric is nice, the reality is that the federal government has let the minimum wage rate decline to an abysmally low level at $5.15 per hour, provides few enforcement dollars, and applies minor punishments to offenders even if they get caught.
States have begun raising the minimum wage rate across the country, but the next step is for states to pass comprehensive enforcement measures to make sure workers actually get paid. As detailed at PLAN's analysis, a number of states and local governments have created new innovative approaches to enforcing wage standards. Unfortunately, no state has joined them altogether in a comprehensive enforcement package, which is what is needed to make serious inroads against the pervasive violations of wage laws in our states.
But the outline of the key policies needed to shut down the underground economy is clear.
Read the full details of what states have been doing and can do to eliminate wage violations across the economy.
"The most prominent local black organization, the Greater Metropolitan Denver Ministerial Alliance, attended Saturday's rally. On Monday, the Rev. Patrick Demmer, a member of the alliance, donned toy handcuffs with about 100 ministers from around the country during a demonstration in Washington.In Boston
"This is a continuation of the civil rights struggle," Demmer said. "If we can offset some of the mean-spirited ideologies of Tancredo, I'm happy to be here to offset it."
Cardinal O’Malley and Rev. Hurmon Hamilton, executive board member of the Black Ministerial Alliance of Greater Boston joined nearly 8,000 immigrants in their demonstration for amnesty and more benefits at Copley Square yesterday...Rev. Hamilton commented earlier on his role at the rally saying: “Nationally the question has been raised, where is the black church? In Boston, the answer is clear. On Monday evening, we will be standing with our brothers and sisters fighting for responsible immigration reform.”In Florida:
"Everyone here is illegal except the Native Americans," said Floyd Frazier, 65, an African-American who belongs to the Florida Civil Rights Association.There are no doubt lots of tensions as workers at the bottom are pitted against each other by those making more and more money at the top of the pyramid. But it's encouraging that black leaders so far are refusing to take the bait and are encouraging their members to demand broad-based justice for all of the dispossed, not playing the opposition's game of attacking those one step down on the economic rung.
Among liberals calling for a crackdown on immigrants, there is a trope of speaking on behalf of blacks, low-wage workers and others who are supposedly harmed by undocumented immigration. So it's got to be frustrating that organizations representing blacks and unions are refusing to play their parts and scapegoat the immigrants.
Here's the NAACP on immigration reform:
NAACP President & CEO Bruce S. Gordon said: “Our nation’s immigration policy must be consistent with humanitarian values and with the need to treat all individuals with respect and dignity. We must move away from the politics of ostracizing immigrants and instead look at the demographic shifts and needs of our nation in a larger context.
Gordon said that legislation to address genuine immigration reform should include proposals that would allow people to earn the right of citizenship through hard work, the commitment of several years, and meeting several monetary, security and related requirements. He said the NAACP “strongly opposes any efforts to criminalize undocumented immigrants.”As for the unions, the AFL-CIO Executive Committee, a group that only acts with consensus among its unions, came out strongly for a humane defense of immigrant rights:
Immigrant workers, like all workers, should be full social partners. We will continue to support effective, credible and enforceable rights for all workers, regardless of their country of origin or immigration status. At the same time, we will ensure that our member mobilization efforts include our immigrant brothers and sisters, and ultimately place immigration squarely within a progressive and sustainable economic agenda that benefits all working families in our nation...Reforms must provide a path to permanent residency for the currently undocumented workers who have paid taxes and made positive contributions to their communities. Legalization is an important worker protection.And if you think this is just "wimpy" unions, here's the Teamsters on immigration reform:
While our current immigration system is clearly broken, the Senate is heading down a course that will only make the situation worse. Most egregious is Majority Leader Bill Frist's proposal to criminalize millions of immigrants and anyone who assists them – from priests to doctors to union organizers.What is remarkable is how unified religious, labor and civil rights groups are on this issue-- one reason you are seeing rallies on the scale we have seen in recent weeks and today. For those who see immigration as inevitably undermining wages for existing "American workers", that is the logic of segregationists who once feared equal rights for blacks would undermine white working class wages -- yet white-dominated unions overcame those fears to embrace an alliance with the civil rights movement. And the unions at least learned from that lesson that it is better to embrace the excluded to work together to build a better social system. Yes, globalization is threatening to workers, but the more people are pitted against each other, native versus immigrant, US workers versus workers in developing nations, the less likely real changes in the national and global economy can be achieved to reverse those assaults on working standards.
On a positive note, the Teamsters Union does support measures passed by the Senate Judiciary Committee that include smart border security measures, as well as earned legalization for the 12 million undocumented workers in the country who are essential to our economy and communities.
Those who see immigrants "inevitably" lowering wages assume a neoliberal economic system where supply and demand determine the allocation of justice in society. But for this new social movement, the assumption is that in unity, that inequality can be challenged-- from raising the minimum wage, expanding available employment through greater social investments, and through a fairer global trade system.
The resistance to embracing immigrant rights is reactionary in the definitional sense-- reacting to the present reality with no sense of the possibility of a better world and a better system beyond the present where workers are pitted against each other for crumbs at the bottom of the inequality divide. But for those willing to embrace the future-- because they see a reactionary defense of the present as a sure loser -- the unity around immigrant rights is natural.
One of the most important industries in Brazil is ethanol production, an industry based on native sugar cane that supposedly delivers eight times the energy of corn-based versions and could be a major boost to Brazil's foreign trade-- except that US and European trade laws bar it:
Yet heavy import duties on the Brazilian product have limited its entry into the United States and Europe...Brazilian officials and business executives say the ethanol industry would develop even faster if the United States did not levy a tax of 54 cents a gallon on all imports of Brazilian cane-based ethanol.How seriously can you take "free trade" rhetoric by develope countries that engages in massive protectionism against the agriculture-based products that are often the staple of most employment in poor countries?
The reality is that the US ignored intellectual property when we were a developing nation in the 19th century, but now use the sledge hammer of "free trade" rhetoric to demand enforcement of IP rights on behalf of our drug and movie companies. But even as we demand that countries like Brazil pay up to the prescription drug companies in the name of free trade, we keep out Brazil's agricultural products with protectionist borders.
So can we drop the discussion of "free trade" and just discussion how to make trade fairer for everyone, including the poor in developing nations and workers in the US?
Ezra -- and Max -- have eminent logic on their side in arguing for the superiority of a non-employer based health care system in favor of direct government funding of health care. Except for the tiny flaw that it's not going to happen politically, at least any time soon.
Currently, private funds, primarily employer-paid money pays for 54% of all health care in this country. For the non-elderly population, it is an even greater percentage of health care dollars. So over 8% of GDP consists of private health care spending.
Now, for the government to substitute for that private spending, that would require the US to raise a substantially larger percentage of GDP in taxes than it currently does. In 2004, combined state and federal revenue was 27.5% of GDP (Data from this nice XLS sheet courtesy of Carried Away blog). Given Bush's massive deficts, we need to raise revenue by over 4% just to get revenue and spending into balance before we can even begin incorporating a substantial increase in GDP dedicated to substitute for all that private health care spending.
So we would need to raise roughly 40% of GDP as taxes as a country to incorporate a single payer program into our political system, which assumes a truly massive sea change in the political willingness of the population to accept massive tax increases. Yes, single payer advocates argue that a completely government-run system would save money, but even knocking a couple of percentage points off that 40% figure still assumes an increase in taxes that bend credibility in the present political situation.
And of course, the GOP will filibuster any attempt to create such a government-funded health care system; that was made clear back in 1994 and there is no evidence that the GOP is suddenly going to roll over for such a change at the federal level. And at the state level, many states, including some of the largest such as California, Florida, and Texas need a supermajority vote of at least one state house chamber to raise taxes, giving any conservative resistance to government-funded health care a minority veto on such changes. The California Senate has already voted for a single payer system, but it's irrelevant if the state Assembly joins them, since they can't get the two-thirds vote needed to fund the system.
So the blunt political reality is that an employer mandate is more likely to succeed precisely because it is not a tax increase. It can be passed at the state level without needing new taxes raised and without a supermajority in those states giving a veto to the minority on tax issues. Given the costs of health care, I don't see any budgetary math where we can raise the revenue just to cover the currently uninsured without also holding on to the revenue contributions by employers.
Some states could theoretically bypass these supermajority political restrictions by going to the ballot, but that just promises to unleash the full weight of the health care establishment to defeat you. California tried to enact single payer at the ballot in 1994, which I know well since I worked hard on the campaign at the time. I even helped design their Internet site in that almost prehistoric period of the web.
And after the opposition dropped their attack ads onto television and massively outspent our side, the initiative was slaughtered at the polls. The initiative process has not been kind of progressives pushing complicated legislation. Notably, while business was able to narrowly defeat an employer mandate at the polls in 2004, California voters supported the employer mandate by almost double the percentage they supported single payer back in 1994.
Maybe it's because I've been in the middle of the largest single payer campaign in America's history that I am so skeptical of it as a strategy today. I'd vote for any single payer system that came along, but I think putting all of our eggs in eliminating the employer role in health care is dangerous and reckless with the lives of working families who currently depend on the health care funds coming from employers.
That may be a messy political reality that doesn't fit well with the abstract policy attraction of abandoning an employer-based system, but it seems far more politically within reach to preserve and even expand employer contributions to health care than to pass such a massive increase in taxes. And that will leave scarce public funds for actually expanding coverage rather than just making up for lost non-tax employer contributions.
It may leave a messier, less efficient health care system than the ideal-- but we aren't likely to get that political ideal. And it's my firm belief that fighting for an employer mandate, combined with other initiatives like expanding Medicaid and coverage for kids, is the most effective path to providing the most comprehensive health care for working families. And for actually leaving some tax revenue left over for non-health care needs like education, housing and transit.