Cover image for The shadow welfare state : labor, business, and the politics of health care in the United States
The shadow welfare state : labor, business, and the politics of health care in the United States
Gottschalk, Marie.
Personal Author:
Publication Information:
Ithaca, N.Y. : ILR Press, 2000.
Physical Description:
x, 288 pages : illustrations ; 23 cm

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RA412.2 .G68 2000 Adult Non-Fiction Central Closed Stacks

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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.

Reviews 1

Booklist Review

Several solid studies of the failure of the Clinton health reform campaign of the early '90s attempt to assess the role of all the key players. Gottschalk, a University of Pennsylvania political scientist, focuses on the interaction of labor and business in that debate. Her relatively narrow emphasis sheds light on the nature of (what remains of) the nation's hybrid public/private safety net and on how interests, ideas, and institutions interact in forming U.S. social policy. Since the '40s, labor has been part of the key institutions of employment-based health insurance: Taft-Hartley plans, the Employee Retirement Income Security Act of 1974, and experience-rated insurance contracts. These institutions, together with the appealing idea of an "employer mandate" as a moderate approach and labor's (false) hope that business would support reform, pushed labor into a position that ignored the needs of millions of workers yet couldn't gain enough support to pass. A cogent, provocative analysis of a particular battle that also raises larger questions for the future. --Mary Carroll

Table of Contents

Prefacep. vii
Chapter 1 Introduction Labor, Business, and the Shadow Welfare Statep. 1
Chapter 2 The Missing Millions the "exceptional" Politics of Organized Labor and the U.S. Welfare Statep. 16
Chapter 3 The Institutional Straightjacket of the Private Welfare State Taft-Hartley, Erisa, and Experience-Rated Health Insurancep. 39
Chapter 4 Labor Embraces a New Idea the Journey from National Health Insurance to an Employer Mandatep. 65
Chapter 5 Workers and Managers of the World, Unite Wooing an Elusive Allyp. 86
Chapter 6 Taking Care of Business the Political Economy of the Health-Care Cost Burdenp. 114
Chapter 7 Adrift and on the Defensive Labor and the Defeat of Clinton's Health Security Actp. 137
Chapter 8 Conclusion the Peculiar Politics of U.S. Health Policyp. 159
Notesp. 177
Abbreviationsp. 243
Intervieweesp. 245
Bibliographyp. 249
Indexp. 275