For anyone who has attended health-care panels in Canada, it was a familiar argument about the need to shift away from traditional delivery models.
"Hospitals are Blockbusters in a Netflix world," the panelist at a Bloomberg forum at the Democratic National Convention said, referring to the possibility of new technologies and new choices making much of what they do redundant.
What was remarkable was who said it.
Andy Stern is seen to have had a huge influence on U.S. health-care policy, including the overhaul of the system introduced by President Barack Obama. He also happens to be the former president of the Service Employees International Union, and one of the most powerful organized-labour figures of recent decades.
If you're accustomed to union leaders highly resistant to institutional change – people who would be inclined to paint any shift away from funding hospitals as a cut to health services, and an affront to hardworking nurses and other employees – Mr. Stern's words were enough to nearly cause a double take.
It goes without saying that the health systems in Canada and the U.S. are vastly different, and that unions have somewhat less of an interest in the status quo in the latter.
But in a conversation after the panel was done, Mr. Stern indicated a broader aversion to turf-protecting, and a belief that unions that fail to adapt will make easy targets for cost-cutting governments looking to score points with electorates that believe the public sector has been sheltered from tough economic times – Wisconsin being the most prominent example under union-busting Governor Scott Walker, though it's far from the only one.
Beyond that, he suggested, unions should embrace the job opportunities created by new health-care strategies – even if it means letting go of the some of the old jobs in places like hospitals – when services are shifted toward more specialized clinics or other delivery mechanisms, such as virtual care.
He even went so far as to lament the inclination of politicians to buckle to pressure in their constituencies to preserve every existing public institution – exactly the sort of pressure that Canadian unions typically help exert.
It's important to note that Mr. Stern is no longer running the SEIU, and that even when he was at the helm he was seen as unusually reform-minded – more so than the rest of organized labour here.
Still, his call for unions to take a leadership role in advancing reforms to core services, rather than just resist them, is a provocative one. And if he'd delivered it in Canada – particularly in Ontario, where the opposition Progressive Conservatives are flirting with running on a Wisconsin-style union-busting agenda – it would have turned more than a few heads.