“We can’t survive doing the work that we’re asked to do, the way that we’re being asked to do it with the lack of support we’re being asked to do it with,” says health care worker Nicole Brun-Cottan. Tens of thousands of nurses in the Kaiser Permanente health care system are poised to go on strike. In this episode of “Movement Memos,” Kelly Hayes talks with three health care workers who voted to authorize a strike about what’s at stake in their struggle, and how the pandemic has affected frontline labor.
Music by Son Monarcas and Mattias Tell
Note: This a rush transcript and has been lightly edited for clarity. Copy may not be in its final form.
Kelly Hayes: Welcome to “Movement Memos,” a Truthout podcast about things you should know, if you want to change the world. I’m your host, writer and organizer Kelly Hayes. On this show, we talk a lot about building the relationships and analysis that we need to create movements that can win. Well, it’s Striketober, so this week, we are talking about labor. Health care professionals have been applauded, literally and figuratively, during the pandemic, for their commitment to patient care, despite PPE shortages, traumatic working conditions, and the loss of loved ones and coworkers. But nurses at Kaiser Permanente are not feeling that love at the negotiating table.
I recently spoke with three health care workers who are part of Oregon Federation of Nurses and Health Professionals, AFT, AFL-CIO, who are currently squaring off with Kaiser, which is the largest managed care organization in the U.S. The company calls itself “an integrated managed care consortium” — which means that Kaiser members are insured by the same company that provides their medical care. It’s a profitable model that netted the company $6.4 billion last year. Operating in eight states and Washington, D.C. Kaiser boasts over 12 million members and operates 39 hospitals, with more than 700 medical offices, and over 300,000 employees.
For Kaiser, business is good, but the company claims that to make health care more affordable for consumers, it needs to pay its workers less. While most people would agree that health care is too expensive in the U.S., it seems especially egregious, amid a global pandemic, to claim that nurses and other health care workers are being paid too much. I personally believe we owe health care workers in this country a debt we can’t possibly repay: these people have provided care to the sick and dying, risking their own lives and the lives of their families, and, at times, losing their colleagues to the virus, so that we might have care. According to the World Health Organization, between 80,000 and 180,000 health and care workers may have died, globally, from COVID-19, between January of 2020 and May of 2021. In the United States, nurses have taken the brunt of those losses.
Throughout this crisis, billionaires have lined their pockets while everyday people have struggled and died. We have seen mass death and skyrocketing levels of inequality, and now, workers, including nurses, are fighting back against companies that would devalue their lives even further.
Kaiser is currently proposing a two-tier payment system that workers say would devastate the quality of care in their facilities and compound an existing nursing shortage. Steelworkers Local 7600 Vice President Norberto Gomez, who has transported patients for Kaiser as a mobility technician for 23 years, told Labor Notes that Kaiser’s proposal would put some of the company’s new hires “behind the starting rates at McDonald’s or Amazon warehouses.” As Gomez put it, “If given a choice between flipping burgers or moving Covid patients to the morgue for the same money, it’s a no-brainer.” Current Kaiser employees would receive a meager 1 percent raise per year.
On October 11, nearly 3,400 workers from Kaiser Permanente in Oregon voted to authorize a strike. With a 90 percent participation rate, 96 percent of those who cast a ballot voted to authorize a strike. The workers are part of a 21-union Alliance of Health Care Unions representing 52,000 workers. 35,000 of them have now authorized strikes. I recently spoke with three health care workers who work for Kaiser Permanente in Portland about why they voted to authorize a strike, and what they believe is at stake in this fight.
Hannah Winchester: My name is Hannah Winchester. I am a home health physical therapist. I am also our labor partner. I’m part of the professional bargaining team. I’ve worked for Kaiser for the last four years, and I voted to authorize a strike because I want to make sure that our contract protects the future of health care for those that provide it and those that receive it.
Nicole Brun-Cottan: My name is Nicole Brun-Cottan. I’m an acute care and critical care physical therapist in a high acuity hospital and a member of the professional bargaining unit bargaining team. And I voted to authorize a strike to protect patient care and access to services for our patients.
Dylan Olson: My name is Dylan Olson, and I have worked at Kaiser for 14 years now as a mental health therapist in the emergency department doing crisis evaluations. And, I voted to authorize the strike as part of the bargaining team, because our patients need better staffing. They need better turnaround times. It is not ethical for it to take six to eight weeks to get back into a therapy appointment.
HW: While it seems like in our current climate, COVID is the reason for a lot of conversation, it’s definitely a reason for our employer to make the decisions that they’ve been making…. But I think that we actually got here far before that. I think that trying to make health care an affordable entity and associating it more with an economic ask versus a quality of health care ask has really gotten us here over the course of many, many years, and now, we are just kind of at this breaking point. We’re at this cusp, and it simultaneously lined up with our contract ending, that all of these things have really come to a head, but I think it’s really been happening for quite some time.
NBC: I think that there’s been a narrative about the affordability of health care specifically that Kaiser Permanente is pushing. And the implications of that narrative are [that] health care is very expensive, we need to make it more affordable so that more people have access to it, and what’s implied is, and the way that we’re going to make it more affordable is by paying labor less. For me, the lens that I look through this contract negotiation with is what is it that’s going to get me help as a frontline health care worker so that I can provide the care to patients that they deserve and that is part of what I signed up for when I agreed to do this work, and went through the training to do this work?
DO: I’ve been with Kaiser for 14 years and we’ve definitely had bumpy patches in the past but this past couple of years, it seems like [it] has been more contentious. And, I wasn’t that surprised to see their proposal this year.
KH: Kaiser employees say understaffing has reached crisis levels. To bridge the gap, nurses say the company is offering steep signing bonuses and paying travel nurses as much as $10,000 a week to help keep care systems up and running. So amid an ongoing nursing shortage, how can pay cuts for new employees make sense?
NBC: We do not have the staff that we need to do the work that we’re being asked to do. As far as the nurses go, and it’s true broadly across health care, there is a staffing shortage. That staffing shortage has been predicted since the early 2000s. So when we see the employer using COVID and the pandemic as a license to make changes in our contract and the way that they run operationally, it’s really disingenuous because not only did we have a pandemic that changed the game, but we also had a problem that was predicted, that we understood was coming based on a bunch of aging baby boomers who, both needed care and were retiring from the health force in droves. So what they’re offering is especially stark when you compare it to the context that they’re offering it in. If we know we’re in a staffing shortage and we’ve known that was coming for a long time, and we know that it’s been worsened by social conditions and the pandemic, how is it possible that they would imagine that they would offer to pay less for the labor that we provide?
HW: I think that staffing is absolutely our number one ask, but really looking at not just how do we get people into the door, but how do we stop this staffing crisis from getting worse and worse? How do we start to fix it? Where are the problems? What is the root cause of how we got to where we are right now? Why aren’t people walking out of health care at an overwhelming rate? Why are people leaving this company? Why are people abandoning what their career is and figuring out what those actual problems are and what we can do in our scope of influence to stop it and start fixing it so that our patients continue to have access to care? Because that’s a really scary future if things keep continuing the way that they’re going right now, not just for us as healthcare workers, but for us as patients… for our communities, for our families, for our friends.
It starts with the things that we’re asking for with this contract… to not accept these really dangerous proposals that they’re giving to us to further affect that. This will only make things worse. At this point in time, the proposals that Kaiser’s offered are really focused on economics. Again, they want to… they’ve always said they want to stay affordable, and it sounds like to stay affordable, they just mean that they want their costs to be affordable. What they’re offering is a 1 percent raise, and then for some regions, a 1 percent bonus, although in some other regions, not everywhere, like Hawaii and Georgia, they would only get a 0.5 percent bonus. There are inequities as well in what they’re offering depending on what region you’re in.
The other thing is they’re actually wanting to decrease the wages. They’re wanting to create this two-tiered wage system for new employees starting in 2023. So somehow, the work that we’re doing now will not be worth the same in a year and a couple of months, despite the fact that for the past 20 months, we’ve been breaking our backs, social security has gone up now, they got a 5.9 percent COLA, CEO wages have obviously gone up, managerial wages have obviously gone up, minimum wage is going up. Somehow, health care workers are not going to be worth as much in 2023 according to what they believe would be fair.
KH: I find Kaiser’s arguments about making health care more affordable especially disturbing because they play on the fears and bitterness of people who have been victimized by the profit-based healthcare system, or who are simply terrified of getting sick because they don’t want to bankrupt their families. Even those of us who are lucky enough to be insured know that we’re probably one pricy diagnosis away from financial catastrophe, and a lot of people are already there. Patients who cannot afford the cost of health care deserve relief, but who, under this profit-based system, is responsible for their suffering? It reminded me of the vilification of public school teachers, who are blamed for the flaws of a system that has been gutted by austerity. In Chicago, when our neoliberal mayor wants a scapegoat, she points to the benefits and pay teachers have secured through collective bargaining, and claims that they need to make sacrifices. Because if she can direct our anger at the teachers, she can avoid questions, like, why is our public school system so underfunded, and why aren’t we all getting the same benefits the teachers are getting? Kaiser’s arguments similarly vilify its nurses, who it claims are paid “above market rate.”
According to Axios, “the median pay of a health care CEO in 2020 was more than $9 million, up from 2018 and 2019. Thirty CEOs made more than $30 million each.” In recent years Kaiser’s CEO compensation has ballooned to $16 million — that’s a 166 percent increase since 2015 and double the salary of Blue Cross Blue Shield’s CEO. Some might call that “above market rate.” At Kaiser, over 36 executives make over $1 million dollars, and somehow, these are the people who are arguing that nurses and technicians are overpaid.
HW: We’ve been backed into this corner where, as Nicole said, it’s our responsibility to make health care affordable. That’s not the case. It’s not our responsibility. Our responsibility is to provide the patient care that we are qualified to do.
We cannot cut corners. We cannot sacrifice the quality of the care that we are wanting to and we’re tasked with providing just to stay affordable. I think that it’s really difficult to look through that other side of the lens… that sometimes these demands might seem like they’re high. They might seem like they’re costly, but what’s the benefit of them and what’s the risk if we don’t get them? I think what we’re asking for and what the teachers were asking for, and in a lot of other labor struggles, what they’re asking for, is completely appropriate. It’s not their responsibility to fulfill this affordability ask.
NBC: The way that Kaiser Permanente works is a little bit different than other models of care delivery, in the sense that Kaiser is both the insurer and the provider. So other health care organizations do best when their beds are full, because they’re billing out for their services to other providers. Whereas with Kaiser, it’s a giant kind of pool of money. And I think it’s really important to note that we are Kaiser Permanente members, the vast majority of people who work for Kaiser also get their care at Kaiser.
So when you look at a movement that’s involving eight different regions where Kaiser provides care and you see that 24,000 members of UNAC [United Nurses Association of California], almost 7,000 members of United Steelworkers, 3,400 members of OFNHP are voting to walk out, part of what that is, or should be, is a real signal that the people who are in the building providing the care are concerned about the level of care that they or their families will get if the plans that are being proposed move forward.
KH: On October 12, the U.S. Bureau of Labor Statistics announced that 4.3 million Americans, or 2.9 percent of the entire workforce, quit their jobs in August. A survey by the American Association of Critical-Care Nurses found that 66 percent of respondents said their pandemic experiences have led them to consider leaving nursing. 92 percent of respondents said they believe “the pandemic has depleted nurses at their hospitals, and because of this, their careers will be shorter than they planned.” A survey of Kaiser’s nurses found that 42 percent of the company’s nurses are considering leaving the field, and over 60 percent say they are considering leaving Kaiser. And yet, these nurses have chosen to fight, not only for the pay they deserve, but for the wages of future employees, and they’re fighting at a time when labor power in the U.S. is rising. I wanted to hear more about what had changed for these workers, in the last year and half, and in recent months, as coal miners, factory workers, film crews and many others have withheld their labor or authorized strikes.
HW: I personally am seeing people that previously, maybe a couple of years ago, the last time we were bargaining, would have been uncomfortable standing up for what we’re fighting for right now. The prior mentality of “keep your head down, go to work, do your job, go home, and everything will be fine” is a little bit out the window, I think, at this point. I think it’s with this large movement, with this understanding and this momentum of standing up for what you need and what is important in your workplace has really, in my experience, brought people out of the woodwork to feel comfortable enough to use their voice and use their power, use their union, use their resources, to stand up for what they believe is right and what they believe they really need to do their job. Very happy to be part of Striketober. Definitely love the name, and I think it’s exciting. It’s exciting to see these people feel comfortable enough to hear their own voice and to use it.
Throughout our conversations, throughout our bargaining, our group has asked ourselves, “What do we want to stand for? What do we want our work to show?” We want our work to be safe, sustainable, and ethical. Just like Nicole mentioned, the path that we’re on right now with… I think this is a little bit larger than just us here in this conversation… but the path that we’re on right now with our healthcare system is not sustainable. There’s become this giant divide of those that do the work and those that direct the work. Unfortunately, the people that are directing the work are now no longer necessarily nurses, they’re no longer healthcare workers, they’re no longer therapists or even physicians.
They’re MBAs [people with a Master of Business Administration degree]. They’re people that know numbers and they know graphs and they know charts, but they don’t know people. They don’t know our patients. If we continue on this path, I think that divide is going to continue to get bigger and bigger and bigger and bigger. There’s just such a giant misunderstanding, as we’ve seen in these conversations during our bargaining so far, where it’s shocking. It’s so unfortunate to see what they think our workplace is like, what they think our work is worth, and what they think our troubles are… are our own, are self-created. We’ve also had conversations before about burnout versus moral injury. Burnout is, and what we get forced down our throats, is this understanding that we don’t know how to manage our own stress. We don’t know… just go get a pedicure, go get a massage, take some deep breaths, and everything will be fine.
But what we’re seeing in our workplaces so greatly right now is moral injury… that you can’t just walk away from it. You can’t just box breath it away. This is unsustainable. What we’re doing right now in the conversations that we’re having isn’t just for us right now. This isn’t just about a 1 percent versus a 4 percent raise. This is about stopping something that could really, really damage the health care system and recognizing that people providing that work and people providing this care have to have a larger voice in that and have to have more control over it. This can’t continue to be whittled away. We’ve got to keep the patient at the focus. We’ve got to keep the patient at the center, not a dollar sign.
NBC: The pandemic isn’t over and I have concern that if we continue on the path that has been laid out in front of us, that we really compromise the ability of our systems to take care of our communities. And it’s been evident for a while that the social fabric was wearing pretty thin, right? When we look at the kind of markers of health in the major institutions, public service, health care, teachers across the board are really struggling to get the work done. And we’ve been hearing that reported for almost a generation now pretty consistently. But I do feel that we’re at a tipping point and I think that we’ve reached a point where people have been pushed so hard, that kind of like Hannah said, they’re coming out of the woodwork, they’re coming out of their holes because the conditions are so unsustainable that they can’t survive. We can’t survive doing the work that we’re asked to do, the way that we’re being asked to do it with the lack of support we’re being asked to do it with.
And I think there’s a level of exhaustion and personal strife that pushes people into action and that makes you…. When I talk to our members, we talk a little bit about solidarity and about coming to a problem that you cannot solve yourself and I think that in our really individualistic society, we have reached [a] critical mass of a number of problems that individuals cannot solve themselves. And this is part of that. I think that’s part of what the groundswell of Striketober is about. I too am excited to be part of that. I too am encouraged to see people feel called to act. And I hope that that call to action makes them feel brave because we’re going to need it.
And I think that it’s important to think about how traumatized the people that we’re talking about are. I heard a friend, he was talking about a conversation that he was having with some nurses and some other people at a party and he referred to the people that weren’t nurses as civilians. And I thought about that for a minute. And I thought about my own experiences this summer as we sort of started up social interaction again, and I was talking with my family and friends of my family and my experience of the last two years is really different than theirs. And I think that I’ve really resisted any metaphors that have compared the pandemic to a war, because I think that so much of the time in conditions of war things are so much more stark and untenable than they have been for us.
But there are aspects of what happened that really do, and is still happening, that really do feel like having survived a war. I really do feel different than a lot of the people that I interact with casually after what I’ve seen in the last two years. And some of that has to do with just the stark trauma of watching so many people die and so many of them alone because they were not able to have visitors. And some of that has to do with being really, truly, and completely having the illusion removed that I was in any way essential or valuable to my community beyond lip service. Because it’s nice to be called a hero, but actually the way that you know that people care is by how they treat you. So I just would like to say that feeling like that, and understanding how many of my colleagues feel like that, and then being pushed to the point by an employer that we feel that we need to walk out as exhausted as we are, as torn up as our communities are.
I just want to reinforce, we don’t want to walk out of the job in October or November in the pouring rain several weeks before the holidays come, because we’ve been spoiled and we’re not going to continue to get the benefits that we’ve had. The things that it takes to push a workforce to do that at this level, I’m not sure that people broadly realize what’s been going on behind the veil. So I feel especially resentful of the employer for trying to frame this in the way that it has. It’s just like an extra slap in the face.
DO: In my conversations with people like the Nabisco baker strike and my sister is a part of IATSE [The International Alliance of Theatrical Stage Employees] and in conversations with people in other areas that are also in unions that are also striking or voting to strike, it’s that divide that the pandemic made even sharper. So, these executives who are making these decisions were so far removed from the horrors that a lot of us have experienced in the last year and a half and they’re making these decisions with a background as an MBA. Not as a health care worker. Not as a therapist. Not as a frontline baker. It’s unfortunate what we all had to go through to get to this level of solidarity. But, it’s really exciting to see everybody stand up for themselves. Nurses and healthcare professionals and engineers and housekeeping and baking and John Deere and IATSE. It’s amazing to see everybody finally taking a stand and seeing that solidarity it’s amazing. It just makes me feel so good. And I hope that we continue it.
KH: I think the sense of moral injury Hannah was talking about runs deep for a lot of U.S. workers right now. People aren’t simply burnt out, because we’ve all had a rough year and a half. They’re fed up, because they’ve experienced new levels of dehumanization and disposability. This is a crucial time for labor, and a crucial time for our health care system. Personally, I believe that we won’t have justice for patients or providers until we have universal health care, but while we are living under this system, we have to support nurses and other health care workers who are squaring off with wealthy executives. And we have to insist that if anyone is going to take a financial hit, in the name of making health care more affordable, it should be the pharmaceutical companies and healthcare executives and monopolistic hospitals that are bleeding us dry. We can also support nurses and health care workers by uplifting their stories and demands. This is a moment of great potential for U.S. workers. If we want to see all of these sparks turn into something more drastic, that could help propel the kind of change we need, we need to support striking workers and amplify their demands. Join them on the picket lines. During the 2012 teachers strike in Chicago, some friends and I read to children on the picket lines so their parents could engage more with the public. There are a lot of ways to show up and a lot of ways to show support. What’s important is paying attention to the needs of the workers you are looking to support. Amplify their messaging, and pay attention to their asks. And I also just want to remind everyone that one of the most important ways we can support the larger fight for worker power is by unionizing our own workplaces. I am very lucky that people put that work in at Truthout before I came along, because without their efforts, we simply wouldn’t be the publication that we are.
I want to thank Hannah, Nicole and Dylan for talking with me about their experiences and the fight they’re waging. I also want to thank our listeners for joining us today, and remember, our best defense against cynicism is to do good, and to remember that the good we do matters. Until next time, I’ll see you in the streets.
- If you need help keeping track of who’s on strike, or potentially going on strike, Jonah Furman’s substack, Who Gets the Bird? is worth checking out.
- If you want to learn more about ongoing labor struggles, I recommend checking out Dissent Magazine’s Belabored podcast with Sarah Jaffe and Michelle Chen.
- Did you know South Korean workers recently staged a one day general strike? You can learn more about that here.
- Looking to support a strike fund? United Left recently put together a Twitter thread featuring links to multiple strike funds.
- Kaiser’s Outrageous Two-Tier Wage Proposal May Provoke a Massive Strike by Jonah Furman, Sarah Hughes
- Health care executive pay soars during pandemic by Bob Herman
- Up to 180,000 health workers may have died from COVID-19 (UN News)
- Nurses account for most known US healthcare worker COVID-19 deaths by Gabrielle Masson
- 66 percent of nurses say pandemic has made them consider leaving profession by Kelly Gooch
- White Paper: Kaiser Executive Salary