Why, in the recent campaigns for universal health care, did
organized labor maintain its support of employer-mandated
insurance? Did labor's weakened condition prevent it from endorsing
national health insurance? Marie Gottschalk demonstrates here that
the unions' surprising stance was a consequence of the peculiarly
private nature of social policy in the United States. Her book
combines a much-needed account of labor's important role in
determining health care policy with a bold and incisive analysis of
the American welfare state.
Gottschalk stresses that, in the United States, the social
welfare system is anchored in the private sector but backed by
government policy. As a result, the private sector is a key
political battlefield where business, labor, the state, and
employees hotly contest matters such as health care. She maintains
that the shadow welfare state of job-based benefits shaped the
manner in which labor defined its policy interests and strategies.
As evidence, Gottschalk examines the influence of the Taft-Hartley
health and welfare funds, the Employee Retirement Income Security
Act (E.R.I.S.A.), and experience-rated health insurance, showing
how they constrained labor from supporting universal health
care.
Labor, Gottschalk asserts, missed an important opportunity to
develop a broader progressive agenda. She challenges the movement
to establish a position on health care that addresses the growing
ranks of Americans without insurance, the restructuring of the U.S.
economy, and the political travails of the unions themselves.
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