Never Good Enough: Health Care Workers and the False Promise of Job Training

9. Education as a Benefit

9 Education as a Benefit Labor unions have long struck questionable bargains to survive to fight another day, but 1199’s training and education programs are the basis of a strategy that will have lasting consequences and shape future choices about how to respond to the inequities and insecurities that face growing numbers of Americans. Education that is a benefit of employment is a potential obstacle to a public education system that is universal, accessible, and of high quality. At least that is a plausible lesson to draw from the historical record on health insurance in the United States. In the years following World War II, health care was established as a benefit of employment, often collectively bargained, rather than a right, creating a private insurance system that has become an insurmountable obstacle to universal health security. The United States is the only industrialized nation that does not provide universal health insurance to its citizens, and unions played a pivotal role in shaping this reality. Collectively bargained health benefits have reinforced a health care system in which access is stratified, insurers (now largely for-profit companies) “cherry-pick” and cover the Education as a Benefit 209 healthiest populations while government payers cover the most costly and vulnerable groups, and providers of services (including physicians, hospitals , but also pharmaceutical companies) focus on developing products and services for which there is a viable market—for which they will be paid. The question is whether trends in education might point toward a parallel future. The analogy between health care and education developed below may at first seem dubious: education through high school is ostensibly a wellestablished universal right and education at the postsecondary level is readily available through public and community colleges. 1199’s joint labormanagement training programs therefore might be seen as opening access to a level of training and education beyond that which is a basic right, supplementing the security that is provided publicly. Many of the programs to which 1199 members now have access through their employment attempt, however, to make up for the inequities in access to basic kinds of education . Bridge-to-college programs, for instance, provide core competencies in reading and math that should be the responsibility of high schools or, in the case of newcomers, accessible to immigrants no matter their employer. Programs to support union members in college courses—whether toward a general degree or a specific occupational credential—are necessary because college is not readily accessible, even to those who are unquestionably qualified. Students face growing costs, high rates of indebtedness, and other obstacles created by the continual underfunding of public institutions like City University of New York (CUNY). Despite the abstract agreement that education is a universal right, education in the United States is in reality a service made available on discriminatory terms. On-the-job training, such as in-services or job-specific training, has been, traditionallyandlogically,theresponsibilityofemployers(thoughsuchtraining has long been subsidized by the state in various ways, and, as in New York, employers seem to increasingly expect public educational institutions to provide such training). This chapter, however, focuses on the significance of union-organized programs such as individual upgrading, college preparation , and tuition assistance—programs that compensate for deficiencies in what has been the traditional role of public education. Like private health care benefits, such programs receive large amounts of public financing and subsidies, which are channeled through private, even profit-driven organizations charged with the task of designing and administering benefits. 210 Never Good Enough Much can be learned about the possible consequences of these programs— for working Americans and the unions who represent them—from the historical case of health care benefits. In the short term, the training and education industry for allied health care workers in New York City offers access to education to a group of working Americans who have historically been discriminated against in education as in the labor market. Union programs offer tuition assistance, and in some cases even salary replacement, in an era when more and more Americans go into significant debt to acquire even entry-level skills and credentials. In the long term, however, the risk is that the employmentbased training and education industry will become an obstacle to an adequate universal, public education system. It is an industry in which public resources support narrowly...