“Kaiser executives say they’re not using AI to make patient care determinations, but they won’t say what technology is underpinning the online questionnaires that automatically determine whether patients need an urgent appointment and assess whether they may be a threat to themselves,” said Carolyn Staehle, a behavioral therapist in San Francisco. “Whatever Kaiser wants to call it, it’s not a human being making these potentially life-and-death decisions, and it’s not the same level of care that a licensed therapist would assess.”
Kaiser Permanente, the largest health maintenance organization (HMO), forced its therapists to walk the streets in an ongoing battle to win parity for mental health care workers, in relation to traditional medical providers, in its services to twelve million members – also now facing the challenge of artificial intelligence.
The 2,400 striking mental health care workers are members of the National Union of Health Care Workers (NUHW). They went out on Wednesday, March 18, in a “practice” strike that was most likely a taste of what was to come. In 2022, these workers went on strike for ten weeks, the longest mental health worker strike on record. Two issues dominated the negotiations from the start: workload for Kaiser therapists and waiting times for Kaiser patients. The strikers won in both, forcing concessions until then all but unheard of. They won a breakthrough provision to retain staff and reduce patient wait times, with plans to collaborate on changing Kaiser’s model for providing mental health care.
It is inevitable that the current contract battle will be difficult. But NUHW members are battle-tested; every fight contract with the Kaiser so far has included a strike. And this time, NUHW members are joining a sympathy strike by thousands of registered nurses who share their concerns about Kaiser’s expansion of artificial intelligence at the expense of patient care.
The importance of this cross-union solidarity can hardly be overstated. Since 2009, NUHW has been struggling alone in a highly divided workforce. In January of that year, the long-running dispute between SEIU’s national leader, Andy Stern, and the 150,000-strong United Health Workers, based in the Bay Area, came to a head: after several hours of hearings, SEIU’s former labor secretary-designate, Ray Marshall, ruled for the national union. This local is trusted, no votes are taken, the officers are fired, offices are occupied, and assets are confiscated; This is widely seen as a travesty. The core was left to start again as NUHW.
But not this time (although thousands of service workers still cross the picket line). Registered nurses are represented by the National Nurses Union. Stationary Engineers, represented by IUOE Local 39, also held a sympathy strike with mental health workers and walked picket lines outside Kaiser medical centers in Oakland, Sacramento, Fresno, Santa Clara, and Santa Rosa.
“We are proud to strike with registered nurses and engineers in the fight for human-centered care at Kaiser,” said Joshua Gibbons, a therapist for Kaiser in Sacramento. “Mental health care is about human relationships, and Kaiser is recklessly moving forward with untested artificial intelligence that it sees as potentially replacing us and the care we provide our patients.”
The Kaiser was determined to revoke his past concessions; Never mind that, in 2023, it was fined $200 million by the California Department of Managed Health Care for not having enough behavioral health providers. And last month, Kaiser entered into a $31 million settlement with the U.S. Department of Labor over violations of mental health parity laws.
Alas, in our new world, where “billion” has replaced “million,” Kaiser has $67 billion in reserves. Kaiser CEO Greg Adams reportedly receives more than $20 million in annual compensation. Kaiser is forced to reimburse patients who have to pay out of pocket for mental health care they can not get from Kaiser – but, millions, no problem.
“Kaiser has been convicted and fined several times for mental health violations; we can’t let it go any further,” said Kaiser therapist Emma Olsen. “Our patients need human therapists, who can work well with their doctors and have enough time to do our work – and clearly Kaiser doesn’t want to pay for that level of care.” But Kaiser wants to add AI to its extreme proposal — it demands “flexibility,” meaning everything but a free hand in introducing AI.
The workers have not had a contract since September. The sides remain far apart, with Kaiser clinging to a proposal that would roll back patient care protections won by therapists and open the door to replacing therapy jobs with artificial intelligence and further outsourcing care. When it comes to AI, Kaiser is setting the stage to not only replace the work that therapists do but to replace therapy itself.
The behemoth was once known as union-friendly; Kaiser Permanente was originally established, in cooperation with labor unions, to provide medical services in Kaiser’s shipyards, steel plants, and other facilities, due in part to Henry Kaiser’s desire to treat all patients regardless of ability to pay, in the context of the failure of President Harry Truman’s national health plan. Workers support it and are central to its origin and development. But ultimately, “it’s the company,” said Sal Rosselli, president emeritus of the union. “This is the bottom line. Luck and competition.” Kaiser was a competitor, an empire builder, but it cost money. It spends its surplus on expansion. Kaiser, which started in California and lived there for many years, now has hospitals and clinics in Hawaii, Washington state, Colorado, Maryland, Michigan, Pennsylvania, and Georgia. It’s comparable to General Motors in the 1950s or even Amazon today.
Health care is reshaping the US economy. This sector employs the most workers, surpassing manufacturing and services; industry is the largest employer in thirty-eight states. Manufacturing cities like Cleveland and Pittsburgh have turned to health care as a driver of their economy. And hospitals are often the largest employers in small towns and rural settings. Industry will continue to grow (unlike manufacturing, it cannot be offshored), despite cuts in federal health care spending.
Twenty four hundred workers is not so much. But they are 2,400 in a struggling union, and the health care workforce needs fighters. Their example is incalculable.
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