As most American progressives know, nearly every industrialized country in the world has a government-funded health care program—except the US. Not as many of us know, however, that in nearly all of those countries, organized labor was a central player in fighting for and defending those systems.

The unionists gathered over the weekend at the Labor Campaign for Single-Payer conference in Chicago argue that if universal health care is ever to be achieved in the US, labor must play a key role in pushing for it—which many have plans to do, particularly on the state level, in the near future.

The LCSP was founded in 2009 by a broad group of union activists, including Mark Dudzic, a former union local president, and longtime labor organizer and rabble-rouser Jerry Tucker. Tucker, who died late last year and was commemorated Friday by the campaign, was a stalwart organizer at the rank-and-file level, having little interest in the shifts of power in labor’s upper echelons. That spirit clearly still animates the campaign; attendees seemed to see the hopes for single-payer to come not from on high, but through organizing at labor’s grassroots.

Campaign activists, like many on the left, acknowledged the Affordable Care Act’s positive outcomes like some expanded coverage and the expansion of Medicaid while arguing it does not go nearly far enough in its reforms. Dudzic, the national coordinator of the campaign, says that labor and the progressive movement face a pivotal choice after the ACA has been cemented as the law of the land.

“We’re in a new strategic position,” Dudzic says. “We can either circle the wagons around what’s already been accomplished—which anybody who’s been around for the last 30 years would know is a strategy destined for failure—or we can continue to move forward to real health care justice.

“We want to challenge labor to keep moving.”

Many activists are looking to Vermont as an example to follow. The Green Mountain State saw a successful campaign for single-payer that began in 2008. The fight was led by labor—not by a traditional union, but by the Vermont Workers Center, a community-based worker rights organization, who assembled a broad coalition including many unions that successfully pushed single-payer legislation around a “health care is a human right” framework.

Leslie Matthews, a member of the VWC, says that while full implementation of single-payer is several years away in the state, the laws have already had significant impact. When the University of Vermont’s Fletcher Allen hospital decided their dialysis services were no longer profitable, they looked to a $26 million bid to a for-profit company to privatize them. Alongside the Vermont Federation of Nurses and Health Professionals, the VWC mobilized against this move, saying it was incompatible with the state’s single-payer legislation like H. 202 and Act 48 and demanded the state’s Department of Banking, Insurance, Securities and Health Care Administration reject the offer. They did.

“Our activists pointed to the law and said, ‘Health care is a public good. Privatizing these services is in conflict with this concept,’” Matthews says. “That was influential in convincing them to disallow the sale.”

Vermont is a small state, but the example of its success could be huge. VWC staff and activists have traveled the country talking to other activists about their campaign.

“We’re hopeful that we can lead the way,” Matthews says. “The chances of our success are greatly improved by other states following our lead.”

Activists from other states at the conference are looking to do just that. Unionists from Maine, Oregon, and California mentioned the possibility of launching similar campaigns.

Matt Schlobohm, executive director of the Maine AFL-CIO, says a single-payer push will soon begin in his state, taking cues from Vermont. The Maine AFL-CIO has hosted Vermont activists several times to hear lessons from that campaign, and plans to frame their campaign in similar terms.

“A human rights framework reframes the debate,” he says. “It connects with people, and poses the entire conversation as a values conversation.”

Schlobohm wants to see a campaign based on deep education and mobilization of union members and other single-payer supporters, rather than centering solely around a piece of legislation.

“Vermont has built a successful model of organizing based on one on one conversations, collecting people’s stories and using them to put a broken healthcare system on trial,” he says. By running a similar campaign, Maine can “build sufficient power to change the parameters of what’s possible.”

Chicago Teachers Union President Karen Lewis, who led her union out on strike in September with a broad community-labor coalition at its back, spoke Friday night, saying labor has an “absolute moral obligation” to push for single-payer.

Lewis recalled the organizing with parents, community groups, clergy, and other unions, including the CTU and Lewis’s Caucus of Rank-and-File Educators, did in the years leading up to the strike that helped lead to a contract that included both gains for teachers and steps towards educational justice for students. It is not difficult to imagine health care workers unions pushing for similar coalitions to advance single-payer, as some nurses unions have done.

“They have their coalitions,” Lewis said of the forces allied against public health care. “We need to build ours.”

While most hopes remain at the state level, there will likely be some national legislative rumblings around single-payer in 2013. Rep. John Conyers, Jr. (D-MI), who spoke at the conference, first proposed HB 676, “Medicare for All,” in 2003 to the House of Representatives, and plans on holding hearings on it this year. The bill has served as an important organizing tool around single-payer for unions. Single-payer activists have used the bill to begin conversations with their fellow union members and local leadership; nearly 600 national unions and union locals have endorsed it.

Unions’ interest in single-payer does not spring solely from altruistic principles; it’s in their self-interest. Unions are facing crises in bargaining as they try to convince employers to cover health care costs that are continuing to rise and showing no signs of slowing. Because health plans are provided by employers rather than the government, employers bear the cost of them—meaning negotiated gains in workers’ health care are necessarily coming at the expense of other contract items like wages. A single-payer system could potentially produce a big wage increase for workers: as companies are freed from astronomically expensive health plans and no longer able to claim poverty as a result of providing insurance, workers could demand their employers pay them the difference.

Most public health care programs in the industrialized world were passed at the height of the Keynesian consensus, when such services were expected and demanded of governments. Making the case for such programs today, at a time of voracious austerity and rabid right-wing pushback, like the “death panels” talk during the debates over the ACA, will prove difficult, but Dudzic and others think the example of states like Vermont show it can be done—with the help of labor and others.

“In the US, health care is not a right, it’s a business—the biggest, most profitable business in the history of capitalism,” Dudzic says. “Those are the kinds of entrenched interests you’re up against. That’s why we are building a powerful social movement to take them on.”