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October 17, 2000


Reflections On An Explosively Important Book

The Shadow Welfare State:
Labor, Business, and the Politics of Health Care in the United States
by Marie Gottschalk, Cornell University Press

by Townsend Walker, Sr.

I had long suspected Mr. John J. Sweeney of engineering, with Mr. Lane Kirkland, the demise within the American labor movement of universal health care as the only rational solution to the problem of health care in the U.S. Two hard facts, when linked together, undergirded that suspicion, and now the necessity of this book.

First, Mr. Sweeney occupied the position of health-care reform advisor to the AFL-CIO and in that position could, and did, influence the health-care reform policies of a labor federation purporting to represent the interests of the nation's unionized working class. And second, he was the only representative from American labor on the National Leadership Commission on Health Care. Not surprisingly, the NLCHC ultimately proposed "providing private health insurance through the workplace" and "without mandating that employers provide such coverage." (It should be noted that this was at a time when Louis Harris and Associates had concluded from one of its polls that "the majority of Americans...would prefer a system like in Canadian health-care system to the one they currently have."

There is nothing in the report, or elsewhere to my knowledge, to indicate that Mr. Sweeney objected to or demurred from the commission's position. However, there is strong suggestive evidence that he knew very well the implications of the report and that its philosophy of the economics of health-care reform comported with both his thinking and that of Mr. Kirkland.

Now comes Marie Gottschalk's marvelous book that relieves us of the need to conjecture and hypothesize in trying to make sense of the little that we really knew of what was going on at the highest level of the AFL-CIO ten years ago. She lifts the veil and at last we can all understand -- and share in -- the anger of those courageous union leaders within the federation who steadfastly stood firm for a universal, single-payer system of health care. One of those unions -- Oil, Chemical and Atomic Workers -- has since led the way in creating the Labor Party whose first priority today is universal health care. (The identity of other unions standing firm with O.C.A.W., both local and international, are always listed in the pages of the Labor Party Press).

What Gottschalk does is to confirm all we suspected. The Shadow Welfare State synthesizes into an intelligible whole the hitherto isolated parts of a wretched story that can only be characterized as a grievous disservice for all working-class Americans. The working rank-and-file will ignore this book at their own peril.

But it is more than that. It is a lens that allows us to see federated labor's ignominious rejection of universal health care in a context broader than the mere present. It allows us to connect the rejection of "single-payer" a decade ago with the philosophy and intentions of the National Civic Federation in the early years of the twentieth century. It underscores (silently, to be sure) the fact that class warfare is a reality of American life, and that the enemy of the working-class side of the struggle is, as often as not, within the working class itself. We cannot think otherwise when we are informed by Marie Gottschalk that --

But as perfidious and disastrous as the AFL-CIO's leadership was for universal health care, there is yet another dimension to the tragedy. Again, in Gottschalk's words: "Organized labor missed an opportunity to use the campaign for universal health care as a platform on which to develop a more encompassing and durable political movement committed to 'reasserting broader social aims in order to challenge the primacy of narrowly defined budget and economic goals.' It may have forfeited the chance to link up its health-care campaign to the inchoate efforts of other groups that challenge corporate America on a number of fronts."

Reading Gottschalk's book and writing a review of her book have been a painful business. The former because it lays a painful truth that screamed to be brought to light. The latter because this reviewer has been preaching for years the absolute essentiality of the American labor movement for a universal health care system -- and is fearful of unjustified negative and unintentioned reactions within that movement. I hope, therefore, that labor's reaction to the book and to this review will be somewhat like the patient seeking relief from some troubling condition. The recognition of truth, however, unpleasant, is a positive force, and indispensable to making us whole. Working brothers and sisters, Salud!


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