Current Affairs

Why Would A Union Oppose Medicare For All?

The Culinary Union’s stance on Medicare for All raises serious questions for the immigrant labor movement. It is in Labor’s interest to back M4A.

The Culinary Workers Union of Nevada, UNITE HERE local 226, is the largest union in the state of Nevada. The union is frequently held up as a model of success for unions in right-to-work states, maintaining a dues-paying membership percentage said to be in the high 90s. Back in the 1990s, the Culinary waged a truly moving and inspiring strike against the Frontier Hotel and Casino, earning it the distinction of the longest victorious strike in United States history, at six years, four months, and 10 days. Most union organizers and many union activists on the West Coast have seen the emotional documentary about the strike. The footage of the workers talking about winning the strike makes me cry every time, and not because I’m overly sentimental—it makes me think of my parents and family members who were service workers in non-union casinos in Nevada, and how their lives might have been different if a union organizer had been knocking on our door when I was a kid. And the Culinary didn’t stop fighting in the ’90s—they’ve won many victories, and are currently in the midst of a tough multi-year campaign against the Stations casino chain, one of the last large non-union employers in the Las Vegas hospitality industry. 

Through decades of struggle by its members, the Culinary Union has built real political power in Nevada. The Culinary’s influence is particularly strong in the highly important, third-in-the-nation Nevada Democratic Caucus. The Culinary has even won caucus sites inside major casinos—essentially voting sites just for their members—and this year won even more Culinary-focused voting locations

So what is the union using that political power to fight for? In fact, they’re campaigning against Medicare for All, the signature issue of the U.S. progressive movement, which would make such a difference in the lives of people like my parents. 

A Union Comes Out Against M4A 

In the past three months, the Culinary Union—together with UNITE HERE’s International President (and former head of the Culinary) D. Taylor has been waging an increasingly public campaign against Medicare for All, using union members’ healthcare as the prime reason to oppose guaranteed healthcare for all people in the United States. When NBC News ran a national story on December 21st titled “In Democratic presidential race, labor unions remain cool on ‘Medicare for All’ plan,” it almost entirely focused on the Culinary. It included negative statements on Medicare for All from Taylor and the Culinary’s Secretary-Treasurer. A January 11th headline in the Las Vegas Review Journal read “Culinary Union embraces Pete Buttigieg’s stance on health care.” PBS ran a segment entitled “Nevada’s Culinary Union isn’t Buying Medicare for All.”

 Bernie Sanders was even heckled by the union. When he traveled to Nevada to participate in a Culinary Workers’ town hall, he was interrupted by chants of “Union Healthcare!” by the crowd. (Anyone who is familiar with the internal culture at UNITE HERE! suspected that this was no spontaneous action by the rank-and-file.) The Culinary then had former strike leader Elodia Munoz ask Sanders a very aggressive question: 

“We went on strike to protect our health care, health care I need for my family. We love our culinary health care. We want to keep it. We don’t want to change it. Why would you change it?” 

Soon after the town hall, a waitress and Culinary activist, Marcie Wells, confirmed that it had been a planned ambush in a Medium post “I Saw A Paid Culinary 226 Union Organizer Heckle Bernie Sanders And I Haven’t Stopped Wondering Why.”

According to reporters on the scene, most of the Culinary members themselves actually gave Bernie an “enthusiastic reception.” The Las Vegas Review Journal reported

“The crowd was otherwise firmly behind Sanders, offering standing ovations and chants of ‘Bernie! Bernie’ at various intervals during his remarks. His plans on immigration, criminal justice and climate change were cheered loudly.”

But the union leadership has not been presenting it that way. The official Culinary social media accounts have approvingly shared negative press on Medicare for All that the union itself helped generate. And the union has made opposition to Medicare for All its bottomline issue, tweeting:

 “Backing from Culinary Workers Union, LOCAL 226 could be pivotal in determining who wins Nevada, and union members are intent on ensuring whoever receives the coveted endorsement provides a commitment to leaving the union’s hard-fought health care plan untouched.”

The Culinary’s opposition to single-payer has gotten the attention of all the leading candidates, not just Sanders. Pete Buttigieg now frequently name-drops the Culinary when explaining why we should oppose Medicare for All. Joe Biden promised that Culinary workers would be able to keep their plan (that is, as Biden admitted to the New York Times, so long as their employers don’t choose to take it away—in which case they might find themselves on strike for nine months like Elodia Munoz.) Elizabeth Warren, who has a history of shifting positions on the issue, refused to mention Medicare for All even once in her appearance at the Culinary, and has eliminated any mention of the phrase from her stump speech, her debate answers, and almost from her campaign entirely. She essentially capitulated on passing it, adopting something similar to the Buttigieg plan—claiming that a public option might somehow lead to Medicare for All. Buttigieg said of the Culinary: 

“Now, I said Medicare for all who want it because if you like your private plan — I’m thinking for example about the Culinary workers who have negotiated and fought year after year for a good plan and earned it and it’s part of your compensation — I’m not going to make you give it up.”

This does not hold up. Saying you can guarantee healthcare to all without a single-payer system is like saying you can have lasting workplace improvements without a union. It’s a lie. Expanding healthcare to everyone without implementing a single-payer system would be immensely costly—you’re covering all the poorest and sickest people without any of the benefits of eliminating administrative overhead and cost controls that single-payer provides. Meanwhile, the latest evidence strongly shows that Medicare for All will save the nation money.

Yet unfortunately, the Buttigieg-style rhetorical bait-and-switch is exactly where UNITE HERE’s president has landed. Standing alongside Elizabeth Warren, Taylor told a crowd:

 “Just so we’re clear for all the media. The healthcare system in this country has to change. Health care should be a right and not a privilege and no one should go without it… At the same time, I think if somebody has health care that they really like, I don’t think it’s a very smart idea saying they have to give that up.” 

Whether employed by Biden, Buttigieg, D. Taylor, or other detractors, this rhetorical move masks their actual position: leave millions uncovered, millions more with near-useless coverage, with all of the bankruptcies and avoidable deaths that entails. It’s criminal for union leadership not to think about the lives of working people outside their membership. 

Medicare For All Is Clearly Good For Working People And Their Unions 

The oft-repeated argument against Medicare For All is that unions have fought hard to achieve their existing healthcare plans, and members want to keep them. And it’s true: Unions have often managed to negotiate excellent healthcare after protracted struggles. But it would be far, far better if union workers didn’t have to dedicate so much of their energy just to secure decent health coverage.

In fact, union leaders have long bemoaned the fact that an enormous portion of their bargaining power must be expended on trying to get healthcare costs covered. Those costs have increased more than twice as fast as earnings since 2008. “When we’re able to hang on to the health plan we have, that’s considered a massive win,” Sara Nelson, president of the Association of Flight Attendants, told Politico, explaining why many union leaders support Medicare for All. “But it’s a huge drag on our bargaining. So our message is: Get it off the table.” Healthcare negotiation is a particular burden for service worker unions and other unionized workers in low-wage industries, because the healthcare costs come to represent such a huge portion of their overall compensation package. (In one campaign I worked on, we ran a program of organizing conversations with workers which involved counting out their compensation package per hour using actual cash. Needless to say, workers were shocked at how much their healthcare cost.) 

Service workers, like UNITE HERE’s members, come from exactly the communities where the bulk of the nation’s uninsured live. That’s part of why fighting for healthcare has been such an important part of the struggle to organize service workers—if you’re a hotel housekeeper, chances are that your husband or partner might not have a job that provides healthcare either. When union workers speak emotionally about their desire to keep their existing health insurance, it’s almost always because their family depends on their plan, and that a child or spouse has ongoing medical needs. 

But even good union healthcare plans don’t get coverage for all of your family, and it sure doesn’t cover your community. Once your kids turn 26, they’re uncovered. A unionized worker can still go bankrupt trying to cover healthcare costs of an adult child. You can have “great” coverage for yourself and watch your sick sister’s health decline. Your plan might be decent, but she won’t get proper medical attention, and there’s little you can do about it. Your neighbors, if they’re lucky enough to have owned their home, may lose it once they are saddled with tens of thousands in debt because they did go to the hospital without insurance. In Marcie Wells’ Medium post about the Sanders ambush, she also writes movingly about how even high quality private coverage fails people with serious health problems due to out-of-network providers and out of pocket costs, and contrasting it with Medicare for All:

“If I had Medicare For All, I would probably be able to afford Christmas gifts for my kids this year instead of being the gift. If I had Medicare For All, I wouldn’t have to travel to seek medical treatment or start a GoFundMe to expedite my treatment to avoid losing my job because I can’t hold onto it much longer in this condition.”

And, of course, no matter how good your union coverage, you can always lose it. If you’re too sick to work, you’ll not only be without income but it may be much harder to get the treatment that could return you to health. NPR interviewed Culinary member Francis Garcia, who was thinking through the obvious downsides to torpedoing Medicare for All, like losing her healthcare the moment she was no longer in the union:

“FRANCIS GARCIA: Right now, my kids depend on my insurance, but I don’t want to think what is going to happen if one day I stop working for culinary. So myself and my kids are going to be out of health insurance because I don’t—I’m not a union member?”

Medicare for All would be an immense boon to nearly every person in the country. Guaranteed health coverage would mean that Americans would be free to pursue their careers, education, take care of their families, start a business, create art, write a book, travel, retire early, or work fewer days a week without fearing that they would lose their healthcare coverage. Workers would be freer to stand up to their abusive boss—or organize a union—without fearing that getting fired would mean losing their medical coverage. It would mean that women could take more time off to have a child, or stand up to sexual harassment in the workplace, without worrying about losing healthcare on top of the loss of income if they lost their job. It would save as many as a half a million people from going bankrupt each year, and prevent countless thousands of people from seeing their loved ones fall sick or die because they didn’t have health coverage (or delaying treatment due to cost). 

Under Medicare For All, many large employers of unionized low-wage workers would actually save on healthcare costs, because higher payroll employers would contribute proportionally more. And Bernie Sanders has proposed requiring employers to pass the savings from Medicare For All onto their workers. (Incredibly, UNITE HERE’s D. Taylor completely dismissed that idea. “Nobody believes that, come on” told the New York Times. Taylor seems to think a President Sanders could marshall a movement powerful enough to pass Medicare for All, but somehow not be able to include a relatively minor requirement for unionized employers to pass on the savings).

Because the stresses and deprivation of poverty and physical labor cause illness and injury, low-wage workers and their families are much more likely to be sick and require medical care in the first place. Low wage workers are the closest to the pain and horror of lack of medical coverage, and would be the biggest beneficiaries of Medicare for All. This moral atrocity could be ended. But it will only be ended with the unions’ help.

Medicare For All Is Good For The Labor Movement As A Whole 

Medicare for All can help the labor movement in other ways. In fact, Bernie’s Medicare for All could mean the rapid unionization of the entire healthcare industry, which employs some 16 million people, nearly one in eight working Americans, with the share of total jobs only expected to grow. Medicare For All gives the government enormous negotiating power. Healthcare unions are already some of the strongest in the country, meaning they would be especially well-positioned to take advantage of that leverage. Pressure from the Franklin Roosevelt administration on businesses who wanted government contracts—and most large employers do—was a crucial element in the explosion of unionization under his tenure (the only period of mass union expansion in the nation’s history). Senator Sanders has explicitly committed to apply this strategy as president, and Medicare for All would provide a powerful tool for doing so. 

Unions have long had a strategy of legislating higher standards across an entire industry. This reduces both non-union employers’ opposition to union drives and unionized employers’ resistance to contract improvements. It’s part of why unions fight for state and national legislation on higher minimum wages, overtime, and other workplace protections. If an employer is already required by law to do many of the things in the union contract, the prospect of unionization doesn’t present as big of a threat to their bottom line, and currently unionized employers will be less resentful of the union, and at less of a market disadvantage for accommodating union demands.

UNITE HERE has employed this exact approach when legislating health care requirements for particular sectors (although the union has the dubious distinction of working to include union loopholes in their legislation). When the California Nurses Association successfully pushed through legislation implementing mandatory nurse-to-patient ratios, it saved patients’ lives, reduced stress on overworked nurses, and boosted the union’s efforts to organize new hospitals and win better contracts in existing facilities. Perhaps that understanding is part of why the Nurses support Medicare for All.

 Having guaranteed healthcare independent of your employment frees up workers to strike longer and with fewer repercussions. Militant French workers who have been on strike for as many as 55 days have to worry about losing pay for the days on strike, but they don’t have to worry about their healthcare, unlike UAW employees who were threatened by GM with losing their healthcare while on strike. In Canada and Western Europe, nations with universal healthcare systems, union density is often much higher and labor is much more powerful.  

Unions should want healthcare taken care of, so they can focus on other issues. “Wouldn’t it be great if we had a single, universal access point for health care and we could instead spend our time bargaining for lower class sizes and wrap around services and increases to people’s pay?” mused Randi Weingarten, President of the 1.7 million-member American Federation of Teachers, who is typically an unreliable ally of progressive movements. “Wouldn’t it be great it if it wasn’t always dominated by health care fights?” 

Exactly. What could union workers win if they didn’t have to spend so much of their time, energy, and bargaining power just keeping up with increasing healthcare costs? Would it mean time to focus on wages and retirement benefits which have been sacrificed to keep healthcare coverage? Would it free up space for unions to challenge short-staffing and rampant sub-contracting of what were once decent full-time positions? Could taking healthcare off the bargaining table open up space for fighting for reduced hours, or greater control over working conditions, even fights for self-management? And getting Medicare for All done would open up more space for labor to use its political power to advocate for immigration reform and a wide range of other burning issues affecting workers. 

In fact, we don’t have to rely on our political imagination to envision what Medicare for All could mean to workers’ struggles. The moving and powerful general strike in France—the longest series of rolling strikes in the country since May 1968—has already defeated an attempt to raise the retirement age from 62 to 64. They are now looking to defeat the pension cuts entirely. The French pension system has achieved one of the lowest old-age poverty rates in the world, which puts the U.S. to shame (3.4 percent of French people age 66 and older are income poor, compared with 23.1 percent of Americans in that age range). A large sector of German workers won the right to work 28-hour work weeks after a series of short strikes in 2018. Not having to constantly fight just to get healthcare coverage has meant that unions in other countries have often been able to go on to fight for bigger and better things.

In fact, unions need the Sanders agenda, and they need it now. The U.S. labor movement is reeling from a disastrous Supreme Court ruling, Janus v AFSCME, which will hamstring the power of public sector unions (the last major sector where union density had remained high). Private sector unionization is at more than a 100-year low, following six decades of decline. Unions have suffered a series of humiliating political defeats on the state level, including the passage of right to work legislation in former union strongholds such as Wisconsin, Michigan, Indiana, and West Virginia. And despite some hopeful signs and inspiring victories, the labor movement in the U.S. is on track to continue its decline. 

We need a president who can be pressured to overhaul labor law. Candidates need to be asked: What is their plan to strengthen unions and protect workers who take enormous risks to organize? Bernie Sanders has set a goal to double union membership in just four years. What does Joe Biden say? Sanders’ Democracy at Work Act would make widespread strikes more likely by banning the replacement of striking workers, eliminating the prohibition on secondary boycotts, and giving federal employees the right to strike. It would make it much easier for non-union workers to form a union, would enable sectoral bargaining where workers can win gains across entire industries, as well as eliminating right-to-work laws. 

Sanders is the clear candidate of working people in other ways, too. He rallied to labor’s demand of $15 an hour almost immediately, and placed it on the national agenda with his 2016 campaign. Sanders has a much, much stronger record of supporting labor organizing from supporting union struggles in Vermont, to lending crucial support to striking Verizon Workers in 2016. In the past years he has joined many picket lines, including UNITE HERE’s own. He helped pressure Amazon to adopt a $15 million minimum wage, has joined Wal-Mart workers to demand the same and even is using his campaign supporters list to turn supporters out to strike lines. Senator Sanders provided crucial support to UNITE HERE’s contract campaign with Disney, resulting in an important victory of the union. Sanders traveled down to Florida to fight for mostly undocumented immigrant tomato pickers back in 2008, helping to explose horrendous conditions including outright slavery, something he highlighted in his 2016 campaign. And the rest of Bernie’s agenda is focused on delivering for working people: guaranteeing tuition-free public college, university, and trade schools would mean the world to many working people and their children. Rebuilding dilapidated infrastructure would mean lots of good union jobs. And as we’ve seen in natural disasters like Hurricane Katrina, taking insufficient action on climate change will hurt poor and working people the most.

We should remember the stakes here. Every year that unions languish is another year that non-union workers get injured unnecessarily or even die on the job. It is another year where vulnerable housekeepers are raped on the night shift without a union to back them up. Rebuilding the labor movement is an urgent task.

Why In God’s Name Is the Culinary Opposing Medicare For All? 

It’s extraordinary, then, that a fighting union of immigrant workers would choose to purposely undercut Medicare for All and fail to support a viable, pro-labor progressive candidate. How could a union side with a candidate of the corporate elite over a candidate of the working class? Trying to make sense of this requires acknowledging some ugly ways that unions have narrowed their sense of possibility and been influenced by corporate ideology and professionalized political thinking.

This is hardly the first time that UNITE HERE has ended up on the wrong side of corporate versus grassroots political battle. UNITE HERE Local 1 in Chicago earned national attention by backing notorious corporatist—and sworn enemy of the Chicago Teachers Union—Rahm Emanuel for re-election for Mayor of Chicago, in his surprisingly close race against the more progressive Chuy Garcia. The union even ran a revolting “Rahm Love” campaign that encouraged housekeepers to wear “Rahm Love” t-shirts in advertisements and at rallies. More recently, UNITE HERE’s powerful New York City Local backed Mayor Bill de Blasio’s vanity run for President, spending who-knows-how-much in dues money on the race, apparently in exchange for pushing card-check agreements on new developments. 

UNITE HERE is not alone in these types of political moves, and is probably far from the worst actor. The SEIU is notorious for making dirty deals with both employers and politicians, including negotiating a Nursing Home Care organizing agreement which required the union to win millions in state subsidies for the industry but secured very weak contract standards. Usually, these agreements are the result of quid-pro-quo thinking in which labor’s support is traded for specific promises, but they’re often transparently bad deals. And it’s hard to build real support when a political endorsement may be about some dubious trade rather than a genuine belief that a candidate supports working people.

There is an element of self-interest. While Medicare for All would free up casino and hotel workers in Las Vegas to leave their jobs without fear of losing their healthcare, it would do another thing: It would also free them up to be much less likely to pay their dues. But unions should focus on the real problem: anti-union “right to work” laws rather than Medicare for All. (Sanders is pushing for a ban on “right to work” laws.)    

There’s also a real chance that the Culinary’s opposition to Medicare for All is instead simply a rhetorical strategy that gives the union the excuse to back Joe Biden. Biden lacks a compelling appeal to their membership, but the union may expect that he will win the nomination. Opposing Medicare for All also allows the union to draw attention to its real priorities: eliminating the Obamacare “cadillac tax” on their health fund and promoting their brand as a model of success. Biden’s persistent weakness may have contributed to UNITE HERE’s announcement on Tuesday that they will stay neutral in the race, and the Culinary may follow suit.

Yet none of the plausible explanations excuse what the union is doing. 

Moving Forward

I hesitated to write about this. In the labor movement, publicly criticizing other people’s unions is something you just don’t do, for good reason. We have so many enemies to call out, so much injustice in the world to focus on, we can’t spend all our time criticizing our brothers and sisters in the struggle.

Recently, though, my father died after many years of failing to receive adequate treatment for a neurological disorder and other ailments. He worked for years without health insurance, in Nevada casinos that the Culinary may one day organize, and in small restaurants that almost certainly will never unionize. I joined the labor movement to fight to organize unorganized workers because I know what happens when we face employers alone. Solidarity doesn’t mean condemning fellow workers to death to protect the special advantages that you have.

The path for the Culinary is obvious: The union can celebrate Sanders’ public commitment that his Medicare for All program would force employers to pass on any cost savings to workers and ensure that immigrant workers actually receive much better health coverage than they currently do. If the union leadership announces their confidence in Medicare for All, it’s doubtless that the bulk of their membership will support the move, given Sanders’ popularity among Latinos and working-class Nevadans, his history of work for the union, and the members’ positive reaction to Sanders’ visit. And a rejection by UNITE HERE of labor’s inclusion in anti-single-payer attacks would go a long way to unify the labor and progressive movements and strengthen the fight for Medicare For All.

Fortunately, other major Nevada unions and progressive organizations are lining up behind Sanders. Sanders has recently earned the backing of the Clark County Education Association, Nevada’s largest teachers union, the Clark County Black Caucus, (Clark County includes Las Vegas, and is home to 72 percent of Nevada’s population) and the widely-admired base-building immigration organization Make the Road. The Culinary Union is beginning to stand out in Nevada’s progressive community for its opposition to Medicare for All and Sanders. And while the Biden-supporting firefighters union and AFL-CIO Richard Trumka have expressed opposition to Medicare for All, unions representing a majority of workers in the labor movement have endorsed the plan. Recently, another prominent hotel union local, UNITE HERE local 11 in Los Angeles, announced its endorsement of Bernie Sanders (together with Warren) and has backed Medicare for All.

The struggles of Las Vegas hospitality workers and their supporters have lifted tens of thousands of families out of poverty and into lives of dignity and stability. UNITE HERE’s national campaign against Hyatt, with its clear declaration “One Job Should be Enough,” and the dedication of striking Hyatt workers, was an inspiration to workers everywhere. It’s that spirit of solidarity, of ¡Sí, se puede!, that we need fighting unions to bring in support of Medicare for All and the growing progressive movement in this country. As Amber, a Las Vegas hotel worker, said in explaining her support for Medicare for All

“Here’s the thing. The union fought for their rights for years so why not get all of us to unify so everyone has the same health benefits we have?” 

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