Members of United Educators, San Francisco, AFT Local 61, join locked-out hotel workers on a picket line in November, 2004. Hotel workers are fighting to maintain affordable health care against the demands of hotel chains, owned by multi-national corporations, that workers must shoulder enormous co-pays and premium increases for health insurance coverage.

Is collective-bargaining based health care a thing of the past?

Nearly every strike over the past few years in the United States has been driven by skyrocketing health insurance costs, including the recent United Food and Commercial Workers strike and lockout of 70,000 grocery clerks in southern California, the four day Communications Workers of America strike in May at the phone giant SBC, and the current dispute between San Francisco hotel workers and the corporations that own most of the city's largest hotels.

The old model of health coverage through collective bargaining -- a cornerstone of negotiated benefits for the past half century -- is breaking down, a victim of converging trends: declining union density in the private sector, with fewer workers covered by collective bargaining agreements, and out-of-control private health insurance cost increases. Corporations are taking a hard line, seeking to get their employees to shoulder more of the costs, and in some cases dumping their health insurance programs entirely.

For teachers and other public sector workers, the picture, while not yet so dire, is heading in the same direction. The health care cost spiral is forcing no-win choices upon the bargaining table: do we negotiate a modest wage increase, but take on employee co-pays that reduce or eliminate the wage increase, or accept flat wages in return for keeping health care cost increases at bay?

Health care costs are being driven by bureaucratic waste (insurance companies raking 20 to 30% off the top of each medical dollar), lack of oversight on provider costs and medical outcomes, and the greed of pharmaceutical corporations. Insurance premiums for family coverage now average $9,950 annually. Since 2001, family premiums have skyrocketed by 59%. No wonder more than six million Californians—and forty seven million Americans—lack health insurance coverage.

Unions are faced with tough choices: cave in to employer demands for takebacks, find mutually acceptable solutions such as switching carriers or employee pools (but these are decreasingly viable options) or, when all else fails, strike. With collective bargaining hitting the skids over health insurance, labor is turning to political and legislative solutions to the health insurance crisis.

In the meantime, it helps to remember that solidarity is a matter of principle, but it is also pragmatic. It may be hotel workers today, and grocery clerks tomorrow, out on the picket lines defending their historic right to decent health care. But it may be CFT members the day after that.