The missing millions: Organized labor, business, and the defeat of Clinton's health security act

During the battle over comprehensive health care reform in the early 1990s, organized labor was not only unable to put together a winning coalition bu t also found itself divided and on the defensive as it struggled to prevent any further erosion of the private-sector safety net of the U.S. welfare s tate. Labor's relative ineffectiveness has deep institutional and political roots and was not merely a consequence of its dwindling membership base. S everal key institutions of the private welfare state, notably the Taft-Hart ley health and welfare funds and the Employment Retirement Income Security Act (ERISA) preemption, brought the interests of organized labor more close ly in line with those of large employers and commercial insurers and aggrav ated divisions within organized labor and between unions and public interes t groups. In addition, several political factors conspired to reinforce lab or's tendency to stick to a policy path on health care issues that was pred icated on an employer-mandate solution and that had been charted primarily by business and leading Democrats. As a result, organized labor did not eme rge from the 1993-1994 struggle with its political base fortified nor with a viable long-term political strategy to achieve universal health care and to shift the political debate over health policy in a more desirable direct ion.