Organized labor and health reform: union interests and the Clinton plan

The fringe benefits on which most Americans have come to rely for health insurance constitute a critical foundation of both the postwar regime of labor relations and the distinctive American welfare state. One legacy of these complementary regimes was a wide variety of institutional commitments and organizational arrangements in the area of health benefits. That diversity of experiences created a range of political incentives for unions when it came to health reform. Thus, when President Clinton proposed a "managed competition" approach to health reform in 1993, divisions within the labor movement contributed to the ineffectiveness of the campaign mounted by supporters of the effort. This article reviews the development of a "private-sector welfare state" in the United States, documents the range of accompanying institutional arrangements, and suggests how they may have shaped the political calculations of certain unions when faced with the Clinton White House's reform proposal.