Trench Warfare at Kaiser Permanente
It’s trench warfare at Kaiser Permanente, the huge HMO. There, five thousand California healthcare workers are holding the line on concessions – fighting off Kaiser’s demands for take-aways that would undermine workers and their families and further erode the quality of care they provide to their patients.
Turusew Gedebu-Wilson is a Kaiser dietician. She says the idea of cuts to employees’ retirement and health benefits is “shocking.” “If Kaiser is making a lot of money, if the executives are making a lot of money, then why do they want to take away so much from the frontline staff? It’s really mind-boggling to me.”
The Kaiser workers are nurses, dieticians, mental health clinicians, social workers and opticians employed in dozens of hospitals and clinics across the state. As members of the new National Union of Healthcare Workers (NUHW), they recently voted by margins as high as 98% to reject Kaiser’s proposed cuts.
Kaiser wants concessions in health care benefits, pensions, and workplace standards – in other words, the usual. The usual in this case, however, is that Kaiser is playing its part in the national drive by employers to roll back benefits that workers have won through decades of struggle. Kaiser wants to increase workers’ out-of-pocket payments for health care, to put a cap on retiree health coverage, and to eliminate defined-benefit pensions for all newly hired workers and instead force them into a risky 401(k). These demands come against a backdrop of Kaiser’s attacks on workplace standards, including staffing levels.
NUHW’s members have steadfastly said “No” to Kaiser’s demands, some for four years. They have been on strike four times in the course of this struggle, twice with support from RNs at the California Nurses Association (CNA-NNU). Each of the latter walk-outs (in September 2011 and January 2012) involved more than 20,000 strikers. NUHW’s members have also taken their fight to government regulators, the courts, consumers, Kaiser’s board room , and the doorsteps of the managers of this behemoth of HMOs – 35 hospitals, hundreds of clinics across the state, 9 million members.
Kaiser’s profits are in the billions –$2.7 billion in 2013 and $11.4 billion in the past five years. And they continue to soar. Its bloated management includes an array of millionaires. George Halverson, its just retired CEO, leaves compensation of $11 million a year. He takes nine pensions with him to his new job at the First Five California Commission, appointed to the post by his friend, the governor, Jerry Brown.
Kaiser’s fifteen Board members receive more than $200,000 each. Board member Dr. Christine Cassel was forced to step down last month, charged with conflict of interest, the result of an NUHW complaint. Cassel is also a top official at two other health firms, Premier Inc. (compensation last year $235,000) and the National Quality Forum (salary as CEO $500,000). National ethics experts told ProPublica that Cassel’s ethical breaches were “absolutely egregious.” She had been on Kaiser’s Board since 2003 – compensation more than $1.5 million.
The “non-profit” is literally awash in profit. Herb Klar, a Kaiser retiree, was with a group of Kaiser workers who visited the most recent meeting of Kaiser’s Board. Phil Marineau, former CEO of Pepsi and Levi-Strauss, makes $225,000 a year for serving on Kaiser’s board of directors and attending just six meetings a year. Kaiser’s most recent board meeting was held at the W Hotel, a swanky place with a spa, a restaurant and two bars and panoramic views of San Francisco. Also in attendance was a delegation from SEIU, including Hal Ruddick, Executive Director of the “Coalition of Kaiser Permanente Unions.”’
Kaiser’s origins are in the crisis of World War II. It promoted itself as worker friendly, patient friendly. No more. Klar and fellow-workers were “accosted by five Kaiser security guards and forcefully ejected from the building. As the board members pretended not to notice, stern men with earpieces took us by the arm and brusquely pushed us toward the door.”
Kaiser has allies inside labor’s ranks, its “partners” in the “Coalition,” led by the Service Employees International Union (SEIU) and its huge United Healthcare Workers-West, the “local” union that represents 45,000 Kaiser service workers. SEIU-UHW, in its 2012 contract with Kaiser, surrendered massive cuts to its members’ health benefits – a concession that Kaiser is now trying to get from NUHW and other unions. SEIU’s collaboration, however, has gone far beyond this; it includes having twice ordered its members to cross the picket lines of striking NUHW and CNA members.
LaNeta Fitzhugh is a Registered Nurse (RN) in the neo-natal intensive care unit at Kaiser’s big Los Angeles Medical Center, where 1,200 RNs are members of NUHW. She, too, is on the NUHW’s Executive Board.
“I’ve been working at Kaiser for thirty-two years. I’ve been in negotiations since 1987. I’ve never seen anything like this. Our contract expired in 2012,” she reports. “Our members voted down Kaiser’s last offer by 98% to 2%.”
“Staffing is a huge problem,” she says. “We often have no one to relieve us, no matter how busy we are. We have nurses working sixteen-hour days, sometimes over twenty. It’s not right.” She insists Kaiser must recognize the staffing crisis.
On pensions, she says, “I’d like to retire. A nurse ought to be able to retire after 30 years of service. Look at George Halvorson and all those pensions. They want to get everyone on a 401(k); I think it’s just part of corporations trying to get rid of the middle class.”
Jim Clifford is a mental health therapist in San Diego and a member of the NUHW Executive Board. He sees the conflict in two categories – first, the economic issues, and then the issues of staffing and patient care. “Kaiser continues to be more profitable than ever, yet they refuse to use those resources to pay for benefits and staffing. This is what we’re objecting to.”
Clifford helped prepare the 2011 NUHW publication “CARE DELAYED, CARE DENIED: Kaiser Permanente’s Failure to Provide Timely and Appropriate Mental Health Services.” This report led California’s Department of Managed Health Care to impose a $4 million fine against Kaiser for understaffing its clinics and “limiting patients’ access to mental health care.” The fine, issued in June of 2013, is the second largest in the agency’s history. The DMHC concluded that Kaiser committed “systemic access deficiencies” by failing to provide its members with timely access to mental health services. Instead, large numbers of Kaiser’s patients were forced to wait weeks and months for appointments in violation of California’s “timely access” regulations.
“The staffing issue in mental health is crucial. Our concern is how understaffing – especially in the availability of care and follow-up treatment – undermines everything that we do. Kaiser is still under review. We’re anticipating another fine, this one probably the biggest ever.”
These NUHW members are holding the line in the war against concessions and the beating down of workers’ standards of living – a war the employers are winning, with the staggering figures on inequality as just one indicator. This is, of course, just one front. We’re all in it. In “Healthcare Costs Go Viral” (CP March 3, 2014), Carl Finamore reports that California health insurance premiums have risen 185% since 2002. NUHW are not the only ones, to be sure. There have been stirrings by teachers, above all in Chicago.
Still, at 5,000 strong at Kaiser, they’re far from insignificant. In contrast, there were fewer than 1500 voters in the widely watched, widely debated UAW debacle at Volkswagen in Chattanooga. And the healthcare industry, led by firms like Kaiser, is huge and expanding. This summer, 18,000 Kaiser nurses in Northern California, represented by the California Nurses Association/National Nurses United (CNA/NNU), will enter the fray. Kaiser has made it clear these same demands – healthcare benefits, pensions, staffing – will be on the table. What happens here will impact the futures of healthcare workers and patients in California and beyond.
The NUHW, curiously, is more often than not ignored in discussions of the “which way for labor” kind and these abound. Yet NUHW represents a vital and indispensable form of organization and activity, one with deep roots in the best traditions of American labor. These include its own history, and its origins in the San Francisco labor earthquake of the 1930s.
More recently, it represents the best that could be salvaged from SEIU’s wrecking job in California. This was SEIU’s 2009 cynical and bloody-minded take-over of UHW, the firing of its elected officers, seizure of its assets and then the dismantling of its basic infrastructure including the firing of 5000 stewards, the result of years of struggle.
SEIU essentially replaced this 150,000 strong militant California union, once called a “model” union by historian Nelson Lichtenstein, with another kind of organization that has handed over billions of dollars of concessions to highly profitable healthcare corporations while using loyalty oaths and trials to target union dissidents. Today it stands on the right of California labor: corporate friendly, wheeling and dealing in smoky corporate boardrooms, and lubricating politicians in the backrooms of the political world.
NUHW lost two elections for Kaiser’s service workers; these were serious setbacks, sadly, evidence that Goliath often wins.
Yet, the NUHW continues, with support inside and outside Kaiser, both as an important example of what “small” organizations (10,000+) can do, and as a rising pole in a declining movement. It remains, in principle and in fact, workplace-oriented, member-driven, bottom-up, democratic.
NUHW organizer, Marilyn Albert, notes that academics observing the Kaiser conflict from afar have described it “as just two unions fighting over already organized workers.” Their assumption is that “thousands of those workers had no agency in this struggle” she says, “but were just being batted around by leaders of SEIU-UHW and NUHW-CNA. In reality, rank-and-file members would not have fought so hard and for so long if they did not think they were defending their very jobs, working conditions, salaries and hard-won benefits.””
Steve Early, journalist and labor activist, in his newest book, Save our Unions Dispatches from a movement in Distress (MR 2014) concludes in part: “The Kaiser union rebels will gain wider solidarity and support only when more advocates of ‘organizing the unorganized’ belatedly realize that the fate of their own troubled project is inextricably tied to the precarious state of workplace organization, contract protection, and rank-and-file morale among the already organized.”
The sooner the better!
Turusew Gedebu-Wilson says, “It’s been three and a half years now; it’s not been an easy fight, but we knew it would be that way.
“We’ve all become very engaged, the membership now knows what a union is, it appreciates what a contract means. It’s like never before.”
LaNeta Fitzhugh, says, “We’re solid. The union? It’s us. We go home and look in the mirror and we see the union.”
The NUHW itself records modest gains; its “reputation is growing.” Its membership is increasing, in the last six weeks of 2013, it won five elections. It won recognition at San Rafael Healthcare and Wellness Center, Sutter Santa Cruz Visiting Nurses Association, Kindred Hospital Westminster, and Corizon Health. And Radiology Associates of Marin General Hospital, a forty-member independent union in operation for three decades, voted unanimously to affiliate with NUHW. They join workers at a long list of workplaces, including California Pacific Medical Center, Keck Medical Center at USC, Salinas Valley Memorial Hospital, Santa Rosa Memorial Hospital, , and Providence Tarzana Medical Center. In October, NUHW conducted its first annual Leadership Conference. Two hundred rank-and-file members gathered at Emeryville’s Hilton Garden Inn to discuss the union’s future and “to recommit ourselves to winning industry-standard contracts, empowering work-site leaders, organizing the unorganized and those trapped in undemocratic unions, and fighting for healthcare for all.”
Cal Winslow is the author of Labor’s Civil War in California, PM Press, 2012 (second edition, revised and expanded), an editor of Rebel Rank and File: Labor Militancy and Revolt From Below during the Long Seventies (Verso, 2010), and a co-editor of West of Eden, Communes and Utopia in Northern California (PM Press, 2012). His latest book is a collection of the writings of Edward Thompson, E.P. Thompson and the Making of the New Left (forthcoming from Monthly Review Press). He is a Fellow at UC Berkeley, Director of the Mendocino Institute and associated with the Bay Area gathering, Retort. He can be reached at firstname.lastname@example.org