In a vote on Monday, more than 98 percent of Kaiser Permanente workers represented by SEIU United Healthcare Workers West (SEIU-UHW) voted in favor of strike action against the health care behemoth. The vote is a powerful expression of opposition to decades of attacks on workers by the multi-trillion dollar US health care industry.
More than 37,000 employees voted in favor of a strike, more than two-thirds of the overall SEIU-UHW membership. The remainder of the group, the Coalition of Kaiser Permanente unions, will vote between now and early September, raising the possibility of a strike by more than 80,000 workers throughout the states of California, Oregon, Washington, Colorado, Maryland, Virginia and the District of Columbia.
Issues that motivated the strike vote were the ensuring of adequate and safe staffing levels, protection of jobs and benefits, including the maintenance of a defined pension benefit, and opposition to the practice of hiring unlicensed and unaccredited staff members.
Kaiser Permanente, a supposed non-profit, is the largest managed health organization in the United States with more than 12 million members, posting more than $5 billion in net income during the first two quarters of 2019 alone, more than its net income in the entirety of 2018.
This has largely been the result of the company imposing onerous conditions on its 217,000-employee workforce along with downsizing and the imposition of the so-called “Kaiser Model” of patient care. The model, which has spearheaded various innovations in the health care industry including the consolidation and centralization of health care records and the use of technology to better integrate and streamline care delivery, is being utilized to ration health care and otherwise cut costs.
The company advances the claim that various lifestyle changes can in many cases completely obviate the need for hospital-based treatment and thus save billions of dollars in expenses. According to a 2015 analysis of the model conducted by the Brookings Institution, “The financial incentive [of the Kaiser model] is to provide high quality, affordable care and manage population health rather than generating high volume of compensable services.”
Kaiser has recently launched, in partnership with CVS and Target, the 7th and 8th largest retailers in the US respectively, a series of “minute” clinics meant to provide non-emergency medical services for members outside of the Kaiser service area. It also launched last May a partnership with the Unite US social care coordination platform to “address the social factors that impact the overall health and wellbeing of individuals across the country.” The company has also heavily utilized the practice of virtual medicine, encouraging and in some cases mandating doctor consultations via phone or video conference in place of office visits.
The emergence of such practices along with other now ubiquitous technologies such as fitness trackers and health-related mobile applications have the potential to improve public health. Kaiser and other hospital and insurance chains, however, utilize these methods largely to steer patients away from more expensive yet necessary treatments in order to increase their bottom lines.
While the company as a whole is listed as a non-profit, making it exempt from many federal and tax obligations, many Kaiser doctors are part of what is known as the Permanente Medical Group, or TPMG, which is the for profit arm of the company. TPMG doctors are encouraged to limit patient visits to as short a time period as possible and to recommend the cheapest treatments available.
This cost cutting along with regular employee attrition and the attendant overworking of remaining workers along with the recent consolidation of Kaiser’s extensive real estate holdings across the Western US has made the company’s executives among the highest paid of any health care organization in the US. Thirty-six of its top executives make more than a million dollars a year in salary. Kaiser CEO Bernard Tyson led the pack with $16 million in salary in 2019, an increase of 74 percent over the previous year. In an absurd and cynical statement, a Kaiser press release addressing such astronomically high salaries stated that, “Delivering care that is affordable is critical, which is why a third of Kaiser senior leaders’ total compensation is tied to performance-based incentives.”
Many of the hospital workers who voted in favor of a strike make $44,000 a year or less, meaning they would have to work 363 years to make what Tyson makes in only one single year.
While Kaiser executives rake in millions, workers are forced to endure increasingly harsh conditions of low pay, overwork and severe understaffing. One Kaiser nurse in Southern California spoke to the WSWS about the conditions she faces on a regular basis. The nurse wished to remain anonymous out of fear of retaliation.
“I started with Kaiser 20 years ago and it was one of my first jobs out of school. There were always problems on the job but in the past few years they’ve only gotten worse. A lot of nurses and therapists who have been with Kaiser for a long time are let go all of a sudden with little or no warning.
“I had a coworker who was given a disciplinary review for taking an extra five minutes on his break. The whole review process lasted for about two weeks and then he was gone. Another coworker I know openly complained about being understaffed and she was let go soon after. Both of these incidents took place within the past year alone.
“Neither of the positions have been backfilled,” the nurse said. “This isn’t like a factory or an office building where you can lay off a number of employees all at once. Instead they do it piece by piece. It is extremely hard to work like this where you fear for your job almost every day. It makes me so angry every time I hear [actress and Kaiser spokeswoman] Allison Janney on the radio. It sounds so compassionate and caring, but it’s so at odds with what actually takes place in the hospitals and med centers.
“The patients keep me going though. They’re so appreciative. Them, and their family members too. Even some of the patients I cared for more than a decade ago still try to stay in touch.
“As far as the union goes, they do nothing to fight for us. The female nurse I spoke of was crying when they fired her and the union rep looked out the window with her arms folded the whole time and didn’t say a single thing to her.”
Beginning in the late 1980s, when Kaiser faced increased competition from private HMOs, the company and the unions decided to form the company’s Labor Management Partnership (LMP) entity, which still remains in effect today. The LMP was part of a wave of union-employer collaboration begun in the wake of the 1981 air traffic controllers strike that launched a wave of wage cuts and union-busting by employers in every major industry. The response of the unions was to adapt to the anti-labor onslaught, dropping any pretense of defending workers and adopting the program of unlimited union-management collaboration.
Under the LMP “position-based” bargaining was abandoned in favor of “interest-based” bargaining, in which the ultimate goal is not the meeting of the workers’ needs but the demands of management. Worker demands were abandoned in favor of creating the greatest possible profits for the companies. In exchange the unions were rewarded with perks and exorbitant salaries for the labor bureaucrats. Indeed, most of the SEIU-UHW heads make well into the six figures, with SEIU-UHW president Dave Regan amassing nearly $225,000 in 2016.
In contrast Kaiser employees regularly receive emails notifying them of their performance goals they need to meet to obtain meager yearly bonuses or even to maintain employment. Such goals are actually set by the LMP.
While the LMP itself has over 150,000 members, a recent rift in 2018 split it into two bargaining committees. The first is the Alliance of Health Care Unions, led by the Teamsters, UFCW and the company union Kaiser Permanente Nurses and Anesthesiologists Association (KPNAA), among others. The alliance wrapped up its negotiations with Kaiser last November resulting in the ratification of a contract providing wage increases of between 1 and 3 percent, which were at or below the level of inflation.
The second committee is the Coalition of Kaiser Permanente Unions led by the SEIU-UHW. The split between the two took place after SEIU-UHW attempted to strong arm Kaiser into certifying it as the sole bargaining representative in the LMP in late 2017.
Despite the split, a strike by 80,000 Kaiser workers would be the largest single strike in the US since the 1997 strike of more than 185,000 UPS workers.
While many Kaiser workers are eager to initiate a strike against the chain, the SEIU and other unions are actively working to prevent a strike, fearful that such a large strike could become a catalyst for workers in the US and mindful of the ongoing mass protests in Hong Kong and Puerto Rico.
The SEIU plans to extend the strike vote through September, hoping to divide workers and wear down their militancy. Thus the earliest possible strike would likely not be until October under conditions where the old contract expired in September 2018.
Workers must mobilize to prevent this. Kaiser Permanente workers must take the struggle out of the hands of the corrupt unions and form their own rank-and-file committees of struggle. Such committees would fight to expand the struggle of Kaiser workers, linking their fight with health care workers across the US, the 155,000 US autoworkers whose contracts expire in September, teachers and other sections of the working class.
Only in this way can health care workers meet their just demands for decent pay and benefits. At the same time these committees would insist that the latest developments in technology and organization be used to create a health care system based on the satisfaction of human need rather than private profit. This is the perspective of the Socialist Equality Party and the World Socialist Web Site. We urge all Kaiser and other health workers to contact us to take this struggle forward.