The bustling glitz of Las Vegas is sustained by the sweat of the 50,000 waiters and waitresses, bartenders, cooks, maids, janitors and porters who make up the local hotel and restaurant workers’ union (HERE).  Half of these workers are Latino, 10 to 15 percent are Asian—and, thanks in part to Elizabeth Gilbertson MA ’90, all of them have health insurance.

More often than not, hospitality workers go without health insurance, either because their employers do not offer it, the price is unaffordable, or their work at multiple part-time jobs disqualifies them for benefits.  But at unionized hotels and restaurants, HERE’s labor contracts transfer the responsibility for benefits from the employer to the union, ensuring that participants can receive high-quality, affordable health insurance for as long as they work at unionized companies.

Gilbertson is the director of strategic planning for the labor-management trust fund that administers HERE’s health benefits.  Her job is national, but her work is concentrated in Las Vegas, where most hotels are unionized and her trust fund is the second-largest provider of health care in the city.  Gilbertson’s job is to grapple with the same public policy question that faces the entire country: How do you provide comprehensive health care at a reasonable cost? “It’s a hard question, and it’s getting harder all the time,” she laments.  But Gilbertson loves the challenge. In a health-care system riddled with problems, Gilbertson is the rare person who gets to do something about it, applying new ideas about health care to her own organization.   

“Traditionally, insurance systems don’t reward quality. We’re trying to change that.”

One issue Gilbertson has tackled is physician accountability. “Doctors get paid for giving treatment, whether that treatment is effective or not,” she declares. Under the trust fund’s new system, Las Vegas physicians who practice preventive medicine and adhere to national standards of care—such as routine blood tests and eye exams to monitor diabetic patients—are rewarded with cash bonuses and gold stars next to their names in the fund’s directory of doctors. “Traditionally, insurance systems don’t reward quality,” Gilbertson explains. “We’re trying to change that.”

Gilbertson has been working to improve health care for her entire adult life. As the daughter of a doctor, she grew up believing that health care was a right; working as a community organizer in the 1960s, she was appalled to find people dying in the streets right next to Yale Medical School. After a brief stint as a graduate student in public health, Gilbertson went to nursing school “to learn how health care works from the inside.” She then worked as a nurse, organized a nurse’s union, and directed an independent, nonprofit women’s health center. Twenty years after receiving her undergraduate degree, she came to the Health Advocacy program at Sarah Lawrence. “Health care is complicated—you never run out of things to learn,” she explains.

All of these experiences convinced Gilbertson that, in the world of health care, financing drives delivery: The people who pay health-care claims are the ones with the power to change the system. That’s what drew her to the HERE trust fund, and why she has stayed there for thirteen years. “A union trust fund is a unique payor,” she says. “Since we’re sponsored by the union—a nonprofit organization—our only goal is to provide the best health care we can.”  With that august goal and a significant market share, Gilbertson pioneers systems that benefit patients and payors alike.

—Suzanne Walters MA ’04