By Jonathan Michels and Will Cox
Jacobin, March 31, 2024
UAW president Shawn Fain’s call to utilize labor power — four hundred thousand working members and six hundred thousand retirees make up the UAW alone — for the “good of the entire working class” is a major departure from business-as-usual unionism and represents a potential game changer for social movements to secure public goods, including Medicare for All, that extend beyond the shop floor.
The struggle for single-payer health care is part of a larger conflict between the working class and the billionaire class. Incremental reforms have gotten the single-payer movement nowhere, while legislative lobbying has proved insufficient. Nothing short of a nationwide campaign of rank-and-file workers — union and nonunion alike — willing to confront capital will be strong enough to secure transformative health reform.
In order to win, single-payer activists must embrace this once-in-a-generation opportunity and join in solidarity with workers in ways many never have before.
A New Opening for Militancy
Roderick Jaynes hurriedly inspects his welding work as another massive slab of steel shuttles toward him on the production line. Jaynes grips the welding gun to secure pieces of galvanized metal underneath the slab.
A shower of welding sparks lights up around the autoworker, only to dissipate against his heavy leather jacket. Jaynes sucks in a mouthful of purified air circulating inside his helmet, which prevents him from breathing in toxic weld smoke.
The voltage on the welding guns is turned up high so that they burn hot and fast, allowing him to keep pace with the quick tempo of the production line. The goal is to do the job right but also quickly, so you don’t cause the rest of your team to fall behind.
The kind of solidarity displayed on the assembly line must be replicated at the bargaining table as UAW workers at Daimler Truck North America (DTNA) gear up for a contract battle, which includes the possibility of a strike. With a looming contract expiration on April 26, contentious negotiations are already underway, pitting Daimler Truck against seven thousand plant workers throughout Georgia, North Carolina, and Tennessee. On March 8, 96 percent of UAW workers across DTNA voted to give their leadership the ability to call a strike when the contract expires, if necessary.
Daimler Truck posted record-high revenues of $60.3 billion in 2023, an increase of 10 percent compared to the previous year. UAW members who work at DTNA, meanwhile, say they are beaten down by stagnant wages, increased cost-of-living expenses, and a demoralizing work environment.
Jaynes hopes union negotiators will align their contract to enable them to participate in the unified May Day contract expiration in 2028 outlined by Fain. Calling for a strike is not to be taken lightly. Strikes are won when they have overwhelming support from the workers who have the most at stake. The ability to move hugely profitable products — in this case, cars, trucks, and buses — along with the power to stop production and shut down assembly and parts plants, into which corporations like Daimler Truck invest massive amounts of money, puts autoworkers in a unique position to make demands from capital.
“Workers in heavy industry have tremendous power to twist capitalists’ arms,” Jaynes told Jacobin.
“Auto, steel, rubber, aerospace, military defense production, oil have always played a really key role in the labor movement, and that remains true today, despite changes in the global economy,” he said. “I think that that was really hammered home for a lot of people after the [2023] UAW strike, when people said, ‘Holy shit, autoworkers really have power!’”
From Rights on Paper to Rights in Action
Most of the credit for turning the union around has been heaped upon Fain, but his ascent to the UAW presidency represented a decisive victory for rank-and-file members who have been fighting for years for a more democratic, more militant approach within the union. In the wake of a protracted federal corruption probe that sent two UAW presidents to jail, UAW members voted in 2021 by an overwhelming margin to adopt a “one member, one vote” method for selecting their leadership — a development that paved the way for the election of a new reform leadership, headed by Fain, in late 2022 and early 2023.
These victories were made possible, in part, by the efforts of a newly formed reform caucus within the union, Unite All Workers for Democracy (UAWD). One problematic aspect of this process, it’s worth adding, is that it involved the direct involvement of the state into the affairs of the UAW; it was a federal consent decree stemming from the government’s probe into corruption within the union that led to the referendum vote for “one member, one vote.”
The shakeup in the UAW set the stage for the UAW’s militant “stand-up” strike in 2023 against the Big Three (Ford, General Motors, and Stellantis) and fueled the union’s subsequent campaign to organize autoworkers at nonunion workplaces. That effort is already paying off. The UAW recently announced that ten thousand autoworkers signed union cards at thirteen worksites, including a majority of workers at two plants in the heart of the anti-union South.
The stand-up strike showed that labor still has the power to force concessions from management. More importantly, the labor campaign provided an example of a rank-and-file movement that can link its struggle to the larger political economy.
“This new union leadership has created a new opening to building a labor movement that is more militant but also, taking that a step further, that can bring up political demands,” Jaynes said. “The significance of Fain’s call to align contracts is that they are thinking along these lines.”
There is a lot at stake for workers on the line in an actual strike. Strike threats that arise from within the labor movement are often made to achieve strategic goals. For example, Sara Nelson, international president of the Association of Flight Attendants–CWA, called for workers to discuss the possibility of a general strike to end the government shutdown in 2019.
Outside the labor movement, there are periodically well-meaning calls for a general strike. However, as Joe Burns points out, the recent “dizzying number” of calls for a general strike mostly emanate from social media and are primarily issued by activists disconnected from unions and workers.
But Fain and the UAW, riding a wave of goodwill from the 2023 strike, appear poised to revive a fighting spirit among workers not seen since its early days as a militant union. Just a little over a year after the UAW’s founding, autoworkers in Flint, Michigan, staged a sit-down strike in late 1936 and early 1937. Known as the “strike heard ‘round the world,” the action grew the UAW membership rolls from 88,000 members to 400,000 within a year and helped transform labor in America into a fighting force capable of bringing capital to its knees.
“That is far different from the usual just sort of posting up on some telephone poles and . . . issuing some call on Twitter for a general strike and expecting people to do that,” Eidlin said.
In numerous speeches, Fain frames workers as warriors locked in struggle against the billionaire class, with economic equality and security for the working class hanging in the balance. This kind of class rhetoric shows an understanding among UAW leadership that there are some issues, such as the financing of high-quality health care, that are too burdensome for any one union to reasonably carry alone. Though it is still too early to tell, we could be witnessing union officials taking the first steps away from maintaining private welfare states for members and toward securing social goods for the benefit of all.
“We have the right to strike,” Fain told UAW delegates in 2023. “We have the right to arbitration, to collective bargaining. But we have not yet won the rights that will fundamentally change this union and change this country.”
“We’ve not yet won racial and economic justice in the workplace for all of our members,” he said. “We’ve not yet won retirement security and health care and pensions for all.”
Labor movements coalesce around common interests. Likewise, public goods like Medicare for All are capable of uniting the public across the political spectrum. Of all the social reforms before the American public today, single payer is not only the most popular — a 2020 Fox News exit poll showed a staggering 72 percent of Americans want publicly funded health care — it also has the potential to be the most transformative.
Authors Beatrice Adler-Bolton and Artie Vierkant point out that health is one of the pillars underlying the entire structure of our political economy, and yet there is a contradictory relationship between health and labor under capitalism. “Capitalism has defined ‘health’ itself as a capacity to submit oneself to labor,” note Adler-Bolton and Vierkant in their book Health Communism.
To directly confront the health economy is to take on capitalism itself. On the one hand, a national health program is merely a needed social reform that is commonplace in other wealthy countries. On the other hand, conservative forces in the United States correctly understand single payer’s revolutionary potential, as evidenced by their decades-long opposition against its passage.
Fain is already connecting autoworkers to the larger class struggle, because he understands the accumulation of wealth in our economy rests on the shoulders of American labor.
Meanwhile, the only effective path to winning a transformative national health program is through our collective labor power. Any movement of workers willing to connect their struggle to a larger class struggle, and especially the struggle for single payer, is imperative.
The UAW’s clarion call for class struggle should resonate with single-payer supporters, who face tremendous opposition from entrenched, well-financed private interests that stand in the way of transformational change. Instead of the Big Three automakers, the single-payer movement must slay the hydra of American capital, including private health insurers, Big Pharma, hospitals, private equity firms, and interest groups such as the American Medical Association.
Even if a general strike fails to materialize in 2028, connecting the autoworkers’ struggle to broader social movements is a roadmap for the single-payer movement if it wants to build the kind of power that can help it win. All of the traditional avenues — relying on electoral politics, reasoning with the boss, lobbying legislators — have proven to be dead ends because they fail to confront the imbalance of power head on.
Medicare for All Is Freedom
Backaches. Knee pain. Burnt flesh from hot metal slag. UAW workers know all too well that assembly work is dangerous and wreaks havoc on the body.
“It’s part of the nature of the work of being an industrial worker,” Jaynes offered. “If you’re not looking out for yourself, if you’re not wearing the proper PPE [personal protective equipment], knee pads, you’re gonna fuck up your body.”
Jaynes regularly engages in physical conditioning at home to avoid greater injury on the job. Nevertheless, he shrugged off the idea that risk to life and limb was out of the ordinary.
“There’s an understanding that we deserve to be fairly compensated for that work and for the hazards to our health,” he said, “and conditions need to be improved where they can be improved, and yeah, we need good health care.”
Few issues have as much potential as health care to unite the American working class in a common struggle. The reason public goods appeal to working people is that they are based around meeting human needs and not profits. Medicare for All, for instance, would guarantee workers health care no matter what happens to their jobs.
Health care costs are a drain on workers’ take-home pay, even for those fortunate enough to have employer-provided insurance. In 2023, workers paid an average premium of $8,435 for individual coverage through their employer and a whopping $23,968 just to cover their family, according to a survey conducted by the Kaiser Family Foundation. While workers’ wages fail to keep up with inflation, health care corporations continue to rake in billions.
Nonunionized workers are particularly vulnerable to layoffs and poor working conditions, but health care is precarious even among organized workers. When your health care depends on your job, your employer literally has the coercive power of life and death. Apart from a paycheck, the tie that binds most workers to their jobs today is their health benefits.
Medicare for All would cut the cord.
Under a single-payer system, health care would be free at the point of service. Premiums, deductibles, and copayments would be eliminated. Everyone would have the same health coverage, including the foreman, the CEO, the person working next to them on the assembly line, and even their recently retired coworker.
With health care no longer tied to employment, workers would be emboldened to leave their jobs or stay and agitate for a union. Self-employed workers such as writers and artists could focus on their craft and less on scraping together part-time gigs to pay for their medical bills.
In Canada and other Western countries with universal health programs, the public is at least protected from the threat of losing their medical benefits. For Canadian workers, single payer is like the ultimate strike fund.
“The basics are all covered in terms of hospital care, physician care, specialty care, all that stuff is covered,” said Eidlin, who is based in Canada. “So for [Canadian] unions, that stuff is not stuff that they have to bargain about at the negotiating table. They can bargain for other things.”
With health care off the table under a single-payer system, unions are free to devote more energy to bargaining for things like increased staffing, worker safety, and better wages.
Consequently, health and safety have been catalysts for the overwhelming majority of American labor struggles. Among the many issues that touched off the Flint sit-down strike of 1936–37 was the horrific wave of autoworker deaths from heat exposure just months earlier. This concern for health and safety was reiterated following the strike at the first national convention of the Congress of Industrial Organizations (CIO) in 1938, when UAW president Walter Reuther, along with other leaders in the CIO, called for a national health insurance program.
We can look to the West Virginia teachers’ strike over health insurance or the widespread labor uprisings fueled by the COVID-19 pandemic as recent examples. Even large unions like the UAW, Teamsters, and the United Mine Workers of America have historically been forced to include private health plans as just another bargaining chip in lieu of competing demands, including national health insurance.
When employees depend on the employer to absorb the cost of medical care, they are playing a rigged game.
History shows that transformative social change will not be won without significant upheaval in workplaces, said Ed Bruno, former director of the United Electrical Radio and Machine Workers of America, and past Southern director for National Nurses United.
“Just think back again about the civil rights movement or the rise of industrial unions or the rise of public sector unions in the states that have collective bargaining,” Bruno said in 2019 amid the Southern Workers Assembly’s campaign to use Medicare for All as a vehicle to organize workers at nonunionized workplaces.
“You’re talking about strikes, sit-downs, sit-down strikes, mass picketing — all of which were illegal. When we think about winning Medicare for All, to think about that divorced from a significant level of action in the workplaces and in communities . . . it’s crazy.”
Labor Is the Missing Piece
Despite national health insurance enjoying broad popular support for almost a century in the United States, a mass movement of millions willing to join together in struggle has so far failed to materialize. Though the connections between labor and national health insurance are plentiful, the single-payer movement is rife with missed opportunities stemming, in part, from an insufficient level of coordination among advocates and workers strong enough to beat back the private forces bent on destroying the so-called lost reform.
The current strategy is primarily focused on legislative efforts, which the history of the single-payer movement shows are unable to match the ability of a powerful grassroots rank-and-file movement to not only mediate conditions on the shop floor but also transform social relations outside the workplace. Parts of a winning coalition operate today, but the critical missing piece to win social reforms is collective power with rank-and-file leadership.
Class struggle is broader than the workplace. It was workers’ “self-emancipation” that won child labor laws, the eight-hour workday, unemployment compensation, Medicare/Medicaid, and workplace health and safety standards. Unlike the majority of wealthy countries, the United States doesn’t have a national health program — a deadly exceptionalism that correlates to American unions’ failure to mobilize workers.
Fain’s call for a militant, national strike in 2028 that connects the UAW’s demands to a broader class perspective represents a clear opportunity to reorient the single-payer movement.
Workplace injuries and deaths in the early twentieth century were endemic and often catalysts for labor uprisings. Protections against worker illness and financial ruin and, later, compulsory health insurance netted support from a cross section of the public, including women suffragists and socialists, along with academics advocating for social welfare reforms.
The movement for national health insurance really picked up steam after World War II, as the UAW and other unions carried forward a sense of renewed concern about social welfare that grew out of the Great Depression. Following labor’s lead and two-thirds of the public, President Harry Truman felt compelled to make “health security for all” a top priority.
Legislation to secure universal health care ultimately stalled in Congress, succumbing to a neoliberal onslaught led by the American Medical Association (AMA). The AMA weaponized respectability by enlisting physicians in a multimillion-dollar smear campaign.
Simultaneously, the conservative bureaucratization of the nation’s large unions severed them from the type of rank-and-file struggles that secured broad social programs prior to the late 1940s. As a result, the weakening of the Left’s ability to mobilize grassroots support for national health insurance quickened the demise of Truman’s proposed legislation by 1950.
Around the time that Ohio senator Robert A. Taft proclaimed Truman’s health proposal “the most socialistic measure that this Congress has ever had before it,” the lawmaker was putting the finishing touches on a bill that would become the Taft-Hartley Act. The legislation used anti-communist hysteria and witch hunts to gut the unions of many of their progressive rank-and-file leaders, stem the labor tide, and empower private industry to claw back some of the social and economic gains that workers fought for and won during the 1930s and 1940s.
Due to myriad factors, including red-baiting and anti-union legislation that purged the most radical elements of the labor movement, unions shifted their focus away from winning universal social goods. Labor’s pivot toward creating private welfare states for a shrinking portion of the working class hobbled the fight for a national health program in the decades to come.
As labor historian Alan Derickson has noted, “Health security for some thus precluded the possibility of health security for all.”
The fight to secure medical coverage for the elderly during the 1960s presented opportunities for unions to focus renewed attention on social concerns. Under pressure to contain the ballooning costs of retiree health benefits, workers under the UAW and other unions linked arms with civil rights and anti-poverty activists and seniors to secure the passage of Medicare and Medicaid in 1965 over the virulent opposition of the AMA and hospitals.
For most of the last fifty years, the weakness of US labor could be characterized as a narrowing of vision at best and, at worst, collaborationism. By the 1980s, the UAW conceded previous contract wins and settled for labor gains limited to its members rather than connecting their struggle to the broader concerns of the working class.
The inspiring yet short-lived Labor Party of the 1990s challenged the calcified labor movement to leverage its power in the class struggle. The Labor Party platform explicitly called for a national health program and expanded workplace rights. Visionary cofounder Tony Mazzocchi, referring to the universality of single payer, is sometimes credited within the single-payer movement for coining the oft-repeated slogan “everybody in, nobody out.”
Unfortunately, the US struggle for transformative social programs has been marked by means-tested poverty programs that contribute to the abandonment of public goods such as a national health program. Big business, desperate to avoid the overwhelmingly popular Medicare for All, colluded with corporate foot soldiers within the Democratic Party in 2010 to ram through the Affordable Care Act (ACA), a divisive, multitiered poverty program, and portray it as a victory for workers.
Any health care is better than none, but the ACA is analogous to a labor concession contract written by the boss. The limited poverty program further entrenches private insurance, and by linking Medicaid eligibility to state-administered means testing, the ACA deepens class divisions among the public — all while extracting profits from taxpayers.
Barring a few notable exceptions like National Nurses United and the United Electrical, Radio, and Machine Workers of America (UE), support for Medicare for All among the leadership of the country’s largest unions today is mostly relegated to endorsements instead of organizing a supermajority of members to join the cause.
“[Single payer] hasn’t been on the table in fifteen years now,” cautioned Eidlin. “You’re not going to get any kind of groundswell of support for Medicare for All or any other broader social vision unless and until you start putting it back on the table as an item for political debate.”
“Stand Up” for Single Payer
Despite Fain’s class-war rhetoric clearly invigorating both unionized and nonunionized workers, no other unions to date have publicly answered the call to join the UAW on the picket line on May Day, 2028. External threats against organized labor loom over the next four years, from the possibility of a second Donald Trump administration to legal attempts by corporate America to gut the National Labor Relations Act (NLRA).
There doesn’t need to be a general strike in 2028 to build the kind of worker-led movements in the United States that shook the halls of power even before unions were officially made legal. One-off events often fail to build collective power. Rather, it is the process of organizing and building solidarity that is much more important than the turnout for a single event, march, or rally.
The questions at hand are: Will UAW workers see their struggle as part of a wider working-class conflict and reconnect with movements for broad social programs like Medicare for All? And will single-payer supporters link their struggle to them?
Organized labor is the strongest engine of a movement, but there are also inherent contradictions among union leadership who, against workers’ interests, pay fealty to the political oligarchy.
President Joe Biden ran in 2020 on an anti-single-payer platform. He even pledged to veto any Medicare for All legislation that crossed his desk. The UAW’s recent endorsement of Biden makes it clear there is a need for continued class struggle inside and outside the union.
The outcome of the union contract battle at DTNA in North Carolina could be a bellwether for how widespread the call for militant class struggle extends among rank-and-file UAW workers. This, in turn, might help determine whether the auto union is willing to step to the front of social movements, be it on the shop floor or in the community.
It will take more than inspiring rhetoric from labor officials to convince the public that the UAW and other unions are serious about linking their struggles to broader social concerns, and to motivate people to join workers in the fight.
“It is not enough [for the UAW to] sign their names to support Medicare for All,” Jaynes said. “There’s a tendency a lot of times in unions for the leadership to, you know, have lofty political ideas and . . . they’ll pass some resolutions at conventions, but there’s in many cases not enough efforts to mobilize the rank and file, organize the rank and file, and provide political education for people.”
“In order to win public goods, the union movement will have to become a mass movement,” he said.
The Medicare for All movement will need union and nonunion workers to build class-conscious organizing committees that draw strength and inspiration from unions, and that carry their fight into the community.
The starting point is when workers become aware that their interests are opposed to their bosses’ interests — and this should also frame how people organize for a universal national health program. Likewise, single-payer activists need to frame their fight as a class-conscious struggle. It’s going to affect all of us, so it’s going to take workers from every sector — from the factory worker to the academic, from physicians to food service workers.
Health policy alone does not hold the answer for how to win transformative social change. It is only an indicator of what a movement is able to leverage to win these programs.
“It’s not like we don’t know how to do these policies,” said Eidlin. “It’s really a matter of generating the political force necessary to get these policies in action. You need a broad social coalition and labor needs to be out front.”
Single-payer supporters should link up with rank-and-file campaigns even when they are not specifically focused around Medicare for All. This is not a call for single-payer supporters to show up uninvited, but instead to look to rank-and-file leadership and to actively join their campaigns.
Solidarity is not reading the news and telling your friend, “I hope the workers win.” It’s putting yourself on the line. The defining feature of the working class is that they must sell their labor in order to survive. That describes almost all of us.
Whether on a picket line or at a rally, it is imperative that single-payer advocates plug into rank-and-file organizing campaigns and make themselves available. We should see clinicians in white coats and nurses and health care workers in scrubs standing shoulder-to-shoulder with sanitation workers, autoworkers, and teachers. Anywhere workers are standing up, single-payer supporters should be there, too.
Only then will it become clear that we are part of the same struggle.
Jonathan Michels is an independent journalist and heath care worker based in Atlanta, Georgia, and a national board member of Physicians for a National Health Program.
Will Cox is a current member of the Southern Workers Assembly and former staff organizer with the National Nurses Organizing Committee.
