Fail Globally, Act Locally:Hotel Workers, Family Medicine, and the Future of Health Care
Kevin Grumbach, MD
November 11, 2004
Earlier this year, the San Francisco Chronicle quoted me as saying that my motto was, “Fail globally, act locally.” This was in the context of discussing my frustrating legacy as a physician advocate for universal health care, affirmative action, and primary health care. I thought about this motto this week as I pondered a dilemma that brought global issues in health policy home to a personal and local level.
Months ago, I accepted an invitation to be a keynote speaker at a national conference of family doctors and educators in family medicine scheduled for this weekend in San Francisco at the Hyatt Regency Hotel. I was honored to be invited to address the conference. Then, on September 29, 1400 hotel workers at four of the City’s major hotels went on strike—largely over a dispute about proposed increases in employee contributions for health benefits. Two days later, the hotel consortium The San Francisco Multi-Employers Group responded by locking out 2600 union workers at 10 additional San Francisco hotels, including the Hyatt Regency.
As the date of the conference approached, I experienced a sinking feeling. I watched the hotels dig in their heels and continue the lock out despite Mayor Newsom’s call for a cooling off period. I saw TV clips of the housekeepers and banquet waiters and prep cooks out on the picket lines, about to lose their health insurance. I thought about hundreds of conference registrants arriving in San Francisco, expecting to hear me deliver my plenary address on the theme of “Humanizing Care.” I wondered what I should do. Cross the picket line and swallow hard when giving my talk on making health care more humane? Cancel my talk on short notice and leave the conference organizers and my colleagues in the lurch?
I have much sympathy for the hotel workers. It’s not that my family traces its roots back to Mother Jones and had me singing Solidarity Forever in grade school (both my parents are physicians). And as a head of a medical school department, I am a “manager” and sometimes find myself contending with union grievances that seem more senseless than substantive. But the issues at stake in the hotel workers labor dispute are deeply meaningful—both to the workers involved and to the future of our nation’s health care system. At the core of the dispute is whether hotel workers in lower income jobs will be able to earn a living wage and afford health insurance. According to a September 2004 study by the UC Berkeley Labor Center, a full-time hotel room cleaner in San Francisco earns $2,611 per month. The “self-sufficiency” income required to pay for basic necessities for a single parent with a preschool age child living in San Francisco is $4,003. Currently, unionized hotel workers in San Francisco contribute $10 per month towards the purchase of family health insurance coverage. The new contract proposal by the Multi-Employers Group would require employees to contribute $32.53 monthly next year, rising to $273.42 in the contract’s fifth year.
The number of Americans with employment-based private health insurance has plummeted in recent years as employers drop coverage altogether or compel workers to assume a larger share of the cost of premiums—with the result that low wage employees are increasingly unable to afford to participate in their company’s health benefit plan. Between 2001 and 2003, 5 million fewer Americans were covered by employment based health plans, contributing to the surge in the number of the nation’s uninsured that has now reached 45 million. In my own practice as a family physician at the Family Health Center at San Francisco General Hospital, I care for many uninsured and marginally insured San Franciscans. I see first hand the hotel housekeeper with arthritis in her knees from a lifetime of making 40 beds a day, the banquet server with chronic dermatitis of his hands from carrying stacks of hot plates. The hotel concierges may be doing all right and not showing up at San Francisco General. But there are a lot of service workers behind the scenes in our city who are barely making ends meet, experiencing deteriorating health, and struggling to afford health care.
I also feel badly for the organizers of the conference. Conference planning requires booking venues years in advance and getting locked into hotel contracts that leave the organizers financially liable in the event of cancellations. The organizers of the family medicine conference have suffered a string of bad luck lately. The organization’s major annual conference in the spring of 2003 was scheduled to be held in Toronto, Canada. The only problem was that the SARS outbreak hit Toronto a few weeks before the conference date. The conference was cancelled days before the opening session. Who on the conference planning staff could have anticipated that the Hyatt would take the lead in an offensive lock out of its workers in the very city planned for the November 2004 conference? Conference registrants purchase their plane tickets in advance and carefully arrange their work and family lives to be in San Francisco for a 3 day meeting. How should they respond when they find out that hotel workers are picketing their conference hotel?
Conference organizers and participants are in a no-win situation when hotels use these types of tactics. For the courageous organization willing to take on a hotel and demand a rebate of all payments on the grounds that the hotel violated the terms of its conference contract by locking out workers, good luck! You will be spending a lot of time in court battling a multinational corporation in the “hospitality” industry represented by a top-dollar legal firm.
The people I don’t have any sympathy for are the hotel owners. As Mayor Newsom has pointed out, hotels like the Hyatt are no longer local businesses in touch with the local environment. These hotels are operated by huge conglomerates headquartered in distant cities, and have posted handsome profits in recent years. In their view, holding the line on employee pay and benefits is essential for sustaining this financial performance. I believe that this is a narrow view, breeding both resentful employees and disgruntled customers.
I decided not to attend the conference to deliver my keynote address. I had hoped to find some middle ground that would have permitted the conference organizers to use the meeting as an opportunity to educate attendees about the issues at stake in the labor dispute, allowing me to cross the picket line in good conscience and talk about the general topic of humanizing care while also addressing the immediate matter of the human rights of the hotel workers. But conference organizers get skittish about politics intruding on conference plenaries and being perceived as taking sides against the hotel. (The organization has another conference already booked for the Hyatt Regency in 2006.) I was gratified by the support I received from many colleagues about my decision, several of whom have decided to join the picket line at the Hyatt, reaffirming my faith that many health professionals desperately desire a more just system of health care in our nation.
I wish the hotel workers luck in their negotiations with the hotel industry, especially when it comes to preserving affordable health benefits. However, it is difficult to be optimistic about the future of health benefits for our nation’s workers. The US is facing the “perfect storm” of escalating health care costs and decreasing insurance coverage. I am skeptical that workers on the lower end of the wage scale will be able to avert continued deterioration of benefits under our current market-driven health care system. Maybe we should all start picketing together for the national health insurance system that is so long overdue in the United States.
