Kaiser Permanente is one of the largest Health Maintenance Organizations (HMO) in the US. In COVID time, it’s doing just fine.
Kaiser’s origins are in the Bay Area, and it still is based in Oakland, today it has 39 nine hospitals and some 700 medical facilities. In recent years, it has expanded to Washington State, Oregon, Hawaii, Colorado, Maryland, Virginia and Georgia. Since just before COVID its membership has grown by 600,000 and it now employs some 300,000 workers, including 80,000 nurses and doctors. In 2020, its profits were $6.4 billion. In 2021, its net worth was $43.3 billion, according to the California Department of Managed Health Care. It returned $500 million in pandemic relief funding to the federal government in 2020.
Kaiser management is doing OK as well; the CEOs bring home salaries that favorably compare to its workers: 231-1! Greg Adams, the chief executive in Oakland received $17.3 million in total compensation in 2020. He and the 100 top executives have the benefit of eight separate retirement plans.
So what about the workers? Kaiser’s front line workers, our heroes?
Kaiser was once considered union friendly, a progressive organization which enrolled thousands of trade unionists. No more. This year is surely a case in point – in the expiration of several major contracts. The corporation has come to bargaining with concessions, not rewards, on the table. In the large United Nurses Association of California (UNAC) strike that didn’t happen, Kaiser pressed for an of array of concessions, but above all the installation of a two-tier system; the nurses, frustrated and angry, held Kaiser off on this but the rest of the new contract was either concessions or a wash. Was more possible? Perhaps, but few expected UNAC to strike. No preparations seem to have been made.
The stationary engineers (Operating Stationary Engineers. Local 39) did strike; they’ve been out for nearly three months. In spite of record profits, Kaiser is playing hard ball with the engineers, both on wages and on a proposal to float engineers among facilities, a transparent ploy to reduce staffing.
There have been solidarity strikes for the engineers. On November 18 the big service workers’ local, UHW, “struck” though this seems to have been token at best. The next day, nurses in the California Nurses Association (CNA) picketed every Kaiser facility in Northern California.
The same day, members of the National Union of Healthcare Workers (NUHW) also walked out in sympathy with the engineers – a solidarity strike that commenced at dawn at Northern California facilities and concluded with a march in downtown Oakland and a rally at Kaiser’s headquarters. Hundreds of NUHW mental health workers, therapists, psychiatrists and counselors, themselves in contract negotiations with Kaiser, were joined by nurses and the engineers, community allies, mental health advocates and elected officials.
Kaiser was denounced as a “union buster” at the rally, especially in keeping the engineers on the streets through the holidays. Kaiser called its workers “overpaid,” an appalling tactic in light of the sacrifices of these frontline workers in COVID time, all the more so in contrast to the millions paid out to its executives.
Kaiser seems resistant to the idea that staffing up might be the decent response to COVID conditions, even in the face of state regulations; the core issue for NUHW is also staffing. Kaiser would rather pay fines than follow the rules. It has been fined nearly 500k, more than any other health care provider in California, by CAL/OSHA for its violations regarding patient and staff safety following outbreak of COVID 19 in hospitals across California, though primarily in the Bay Area. A COVID outbreak sickened 92 people at Kaiser San Jose Medical Center on Christmas Day 2020. Kaiser San Leandro was fined 92k for delays in reporting COVID infections and for failure to ration medical equipment according to pandemic regulations.
Staffing, of course, is an issue right across the country, with nurses, medical assistants, doctors and all the others reporting stress, burnout, long shifts, staff shortages in overwhelmed hospitals. It is acute for Kaiser’s mental health workers in its own exceedingly pernicious way; mental health patients require regular, timely treatment. The mental health is in crisis, both in relation to COVID, but also in the far deeper crisis in the US – anxiety, depression suicide, the crisis of youth, of veterans, of the rural population, the urban population. All these place a great and growing burden on health care workers.
In the fight to place Kaiser’s mental health on an equal footing with medical care, Kaiser’s mental health workers have been at war with the HMO for the best part of a decade. In the last settlement, Kaiser begrudgingly agreed to hire providers and work toward a more humane approach to treatment.
Kaiser, however, not only broke its promise, but routinely denies there is even an issue. This time around, Kaiser is not only defying its own providers; it is effectively breaking the law. In this case, Senate bill SB221, state legislation written with the aid of the NUHW that requires all health insurers to provide follow-up mental health appointments within ten days. In practice, this means increasing staffing to provide timely access to care in accordance with the law, improving working conditions to reduce turnover and guaranteeing patients’ access that is culturally and linguistically suited to their needs.
The November 19 strike gave NUHW members an opportunity to reach out, to inform the public that Kaiser is refusing to agree to contract proposals to dramatically increase mental health staffing and make access to care decent and appropriate.
Mickey Fitzpatrick, a psychologist at Kaiser Pleasanton reported his next appointments weren’t until January.
“We’re grossly understaffed and caseloads extend into the hundreds. It’s unethical to force clients to wait one or two months, sometimes three months for therapy appointments.”
Joanna Manqueros explained that “long wait for care can have devastating implications for patients. Depression is a serious mental health condition and just like an untreated diabetic or an untreated person with a severe cardiac condition, serious ramifications can include death. This is true for many of the mental health patients we treat.”
Kerry Levin, a social worker from San Rafael, chronicled the deterioration of Kaiser’s services. “I have worked for Kaiser for 20 years and I have never seen it this bad,” he said. “I work in the emergency room. The overdoses, the suicide attempts, the people I see in crisis, it has multiplied by at least four times. It takes eight weeks for people who are suffering to get care. It’s unconscionable.” Levin added, “In contract negotiations, via zoom, Kaiser has nothing to bring to the table. They turn off their cameras after ten minutes. They offer nothing.” The patients too have spoken out, as have their families. Readers with a strong stomach should go to https://nuhw.org/kaiser-dont-deny/patient-stories/ Here’s one example:
“Our beautiful talented daughter Elizabeth went to college at age 15. When she came home on summer break at 17, she said she thought she needed to see a therapist. We immediately went to Kaiser, and the battle to provide care for her began. We first called Kaiser in late May; the first appointment available was in mid-July. We searched for other caregivers in a huge sea of therapists with no coordination from Kaiser. By Thanksgiving Elizabeth was experiencing terrible suicidal ideation. We lobbied Kaiser for five months along with Elizabeth’s non-Kaiser therapist, to approve her admission to a 60-day program outside Kaiser. Kaiser offered to cover 12 days. Would a Kaiser patient get one-fifth the chemotherapy they needed?
“The last time Elizabeth was home from college, it took a month before she could meet with a psychiatrist to discuss her diagnosis and a change of her medication. The psychiatrist spent 20 minutes with her, and he didn’t modify her medication. On January 10, 2018, she hanged herself. She survived, but she had a traumatic brain injury. On May 18, she died. “
1500 stories have been shared with “Kaiser Don’t Deny,” 230 of these can be accessed (on the website above).
This not the first time NUHWs members have been on strike. On the contrary, the tally of strikes, most one-day, some open-ended is in the scores. Strikes are in the news these days; even the New York Times featured a piece on “Striketober.” The important point here is that for the NUHW members’ strikes are not just defensive, do-or-die events. They are routine. Routine in the sense that the Industrial Workers of the World’s (IWW) iconic leader “Big Bill” Haywood referred to strikes as just one weapon in labor’s arsenal. Sal Rosselli, President of NUWU, says that “in today’s conditions, confronted with a corporatized industry, we have to convince employers that we will strike, that our members are willing to strike.” In every bargaining round in a decade, NHUW mental health members have struck Kaiser, including an open ended strike in the last round.
COVID, in its own murderous way, has exposed the deep crisis in this nation’s health care industry. Years of rationalization and starvation (austerity) have made public health virtually non-existent. What we have instead is a private profit based system which not only was unprepared for the pandemic, but has made no plans to prepare for the next one. Mimicking private industry, “big” heath care has adopted a “just-in-time” strategy – minimal staffing, limited capacity, the bare necessity in medical supplies and equipment on hand, while promoting “individual responsibility”: “wellness.”
This is a broken system: for the “consumer,” the human being in need, it’s robo calls, impossible websites, endless waiting on the phone, deductibles, co-pays, unexpected bills or no insurance at all – appointments so far in the future penciled in on next year’s calendar. For the providers, wages and benefits are under constant threat, along with time and motion studies and the 20 minute visit. The outcome is seen in the 800,000 dead, highest in the world (not to mention the opioid crisis). How many might have been saved in a system that privileged the human life above profit?
Today, health care workers, including the NUHW’s mental health workers, are crying out for help. Some are organizing. Some are marching. Some are striking. More power to them. They work for us, shouldn’t we work for them? Solidarity with the Kaiser workers.
Cal Winslow’s latest book is Radical Seattle, the General Strike of 1919. He is author of Labor’s Civil War in California, the NUHW Healthcare Workers’ Rebellion. He lives with his family near Caspar on the Mendocino Coast.
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