When 3,000 General Electric factory workers and supporters held a contract rally outside GE's Lynn, Massachusetts, plant on June 7, one question preoccupied the crowd: Would there be another strike over healthcare?

Back in January, these workers--members of Local 201 of the International Union of Electronic Workers-Communications Workers of America (IUE-CWA)--walked out as part of a companywide protest against higher medical co-payments. GE, they found out, had made $15 billion in 2002, while its healthcare expenses had increased less than the national average. Yet management insisted that all employees pay a bigger share of the cost of their doctor visits, hospital stays, emergency-room care and prescription drugs.

In a tentative agreement on a new four-year contract, announced June 15, GE unions were able to blunt the company's drive for further givebacks, averting a second work stoppage.

But in other workplaces across the nation, healthcare cost shifting continues unabated. Where workers have no union--and 87 percent do not--the burden of medical cost inflation is shifted from management to labor with little fuss for the former, regardless of the financial pain inflicted on the latter. In the unionized sector, industrial strife about health insurance is spreading. Since 2001, state employees in Minnesota, teachers in New Jersey, janitors in Massachusetts, candy makers in Pennsylvania, food processors in Wisconsin, uranium-plant workers in Kentucky, truck builders in Tennessee and aerospace workers in Texas have all experienced healthcare-related strikes or lockouts--and several are still going on. Later this summer, major contracts in the telephone and auto industries will be renegotiated. If management tries to reduce health coverage for the hundreds of thousands of workers and pensioners at General Motors, Chrysler, Ford or Verizon, even greater confrontations lie ahead.

How US unions respond to this challenge has important implications for the future of healthcare reform. The actions of organized labor--at the negotiating table or on the picket line--can become a rallying point for all Americans ill served by our current system of private, job-based medical benefits. When unionized workers resist benefit cuts in a way that projects the broader demand for healthcare for all, they help generate pressure for a political solution to the larger problem: how, as a nation, to create affordable health coverage. If, however, organized labor chooses piecemeal change and refuses to challenge the link between medical insurance and employment, it will miss the chance to connect with millions of poorly insured and uninsured workers who have no union.

"We need a universal, comprehensive single-payer healthcare program to cover every man, woman and child in the United States," says new United Auto Workers president Ron Gettelfinger, who is pushing Detroit auto makers to support such a plan. "You can't fix the healthcare crisis in America at any one bargaining table, with any one employer, or within any one industry."

The last time labor had a similar historic opportunity to shape the healthcare reform debate, it made a promising start--and then blew it. In the late 1980s and early '90s, medical cost inflation was reaching double digits, just like today. Healthcare disputes were causing four out of every five strikes. In monumental battles like the Mine Workers' yearlong walkout at Pittston, unions that successfully resisted concessions did so by forming alliances with community groups and other unions seeking healthcare reform. Some AFL-CIO affiliates began to do systematic member education about why a tax-supported universal health system like Canada's would be better for workers than the current patchwork quilt of Medicare, Medicaid and myriad private plans. A number of big unions endorsed single-payer legislation, and through grassroots coalitions like Jobs With Justice, they demonstrated for fundamental change.

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