Andy Stern, the President of the SEIU, published a letter to his membership on the union’s website today, saying that they cannot accept the Senate health care bill without fighting to improve it.

In the letter, Stern cites Joe Lieberman (not by name) as the one Senator saying “no we can’t” to an up or down vote on the Senate bill – of course, there were other conservative Democrats with similar concerns. He weighed the pros and cons, and agreed that the coverage expansions and insurance regulations are worthy goals. But he wasn’t blind to the negative aspects of reform in the Senate bill:

And while it is not entirely clear what the Senate bill will look like, it is becoming clearer that:

For many people, care will still be too expensive to afford.

Some of you would face an additional burden because your health insurance benefits would be taxed.

And the best way we saw possible to hold insurance companies accountable was no longer an option.

The first point is really key. Health reform is starting to look like a way to make coverage attractive to those least likely to use it, while making those most likely to use insurance – such as older customers, who would have to pay rates four times what the young pay, with no sense of where that age-banding begins; or those with pre-existing conditions, who would get charged 50% more – unable to afford it. As Jon Walker put it, “This sounds like a recipe to price out the old (nonprofitable) and force only the young (profitable) to buy insurance.”
Mcjoan had a host of other points to make on the weakness of the insurance regulations, including the most important fact, that there’s no regulatory framework created at the national level to actually enforce these rules.

On the excise tax, this is obviously a key concern for unions, and the best practice would be to enact a carve-out for those who arrived at their health benefits through collective bargaining. The White House is trying to defend the excise tax by saying that it only impacts 3% of all health plans, but with health inflation not expected to end with this bill (perhaps slow down if everything goes well), that 3% number will grow. The CBO score tells you the number will grow. That’s why reformers like it, because it raises more revenue than health inflation!

Finally, Stern cites the public option, or any way to hold insurance companies accountable and reverse incentives in the market, as a key element of reform, along with a real employer mandate like what exists in the House bill, as opposed to the atrocious “free rider” policy in the Senate’s.

After laying out the particulars, Stern says that his organization will fight for improvements – and he calls on a certain DC resident to fight as well:

President Obama must remember his own words from the campaign. His call of “Yes We Can” was not just to us, not just to the millions of people who voted for him, but to himself. We all stood shoulder to shoulder with the President during his hard fought campaign. And, we will continue to stand with him but he must fight for the reform we all know is possible. He must fight for Cynthia, Maria, and Gerry – for every American.

Our challenge to you, to the President, to the Senate and to the House of Representatives is to fight. Now, more than ever, all of us must stand up, remember what health insurance reform is all about, and fight like hell to deliver real and meaningful reform to the American people.

This is one of the first times that any union has publicly called on President Obama to actually use his power as President. It’s significant, in that context.

UPDATE: I have confused the 4:1 age banding that was in the Senate Finance Committee bill with the 3:1 age banding in Harry Reid’s current bill. I regret the error.