“Kaiser executives say they don’t use AI to make patient care decisions, but they won’t say what technology powers the online surveys that automatically determine whether a patient needs an emergency appointment or assess whether a patient is a potential threat to themselves,” said Carolyn Stahl, a behavioral therapist in San Francisco. “Whatever Kaiser wants to call it, it’s not a human being making potentially life-or-death decisions, nor is it the same level of care that a qualified therapist would appreciate.”
Kaiser Permanente, the nation’s largest health maintenance organization (HMO), is forcing its therapists onto the streets in its ongoing fight to gain parity with mental health workers compared to traditional health care providers in serving its 12 million members, but now also faces challenges from artificial intelligence.
The 2,400 mental health workers on strike are members of the National Union of Health Workers (NUHW). They departed on Wednesday, March 18, in a “practice” strike that foreshadowed what was to come. In 2022, these workers went on strike for 10 weeks, making it the longest mental health worker strike in history. Two issues were at the center of negotiations from the beginning: workload for Kaiser therapists and wait times for Kaiser patients. The strikers won both and were forced to make previously unheard of concessions. They secured a landmark provision to retain staff, reduce patient wait times, and plan to help transform Kaiser’s mental health care delivery model.
It is inevitable that the current contract battle will be just as tough. However, the members of NUHW are veterans of the war. Previous contract disputes with Kaiser included a strike. And now, NUHW members joined a sympathy strike by thousands of registered nurses who shared concerns that Kaiser is increasing its use of artificial intelligence to the detriment of patient care.
The importance of this cross-union solidarity cannot be overestimated. Since 2009, NUHW has struggled alone in a deeply fragmented workforce. In January of that year, a long-running dispute between SEIU national leader Andy Stern and the 150,000 Bay Area-based unified healthcare workers came to a head. After a lengthy hearing, former Labor Secretary Ray Marshall, an SEIU appointee, ruled in favor of the national union. Local residents were trusted, no votes were held, officers were fired, offices were occupied, and assets were seized. It was widely seen as a farce. Its core parts were left behind to make a fresh start as NUHW.
But this time it was less so (although thousands of service workers still crossed the picket lines). Registered nurses are represented by National Nurses United. Stationary Engineers, represented by IUOE Local 39, also joined mental health workers in a sympathy strike, walking picket lines outside Kaiser Medical Centers in Oakland, Sacramento, Fresno, Santa Clara, and Santa Rosa.
“We are proud to join registered nurses and technicians in the fight for human-centered care at Kaiser,” said Joshua Gibbons, a therapist at Kaiser in Sacramento. “Mental health care is about human connection, and Kaiser is recklessly pursuing the development of untested artificial intelligence that it believes has the potential to replace us and the care we provide to our patients.”
Kaiser is determined to reverse past concessions. Never mind that in 2023, it was fined $200 million by the California Department of Managed Care for not having enough behavioral health providers. And last month, Kaiser reached a $31 million settlement with the U.S. Department of Labor over violations of the Mental Health Parity Act.
Sadly, in our new world where “billions” have replaced “millions,” Kaiser has $67 billion in reserves. Kaiser CEO Greg Adams reportedly receives more than $20 million a year in compensation. Kaiser was forced to reimburse patients who had to pay out of pocket for mental health treatment they didn’t receive from Kaiser, but millions of people did not have a problem.
Kaiser’s therapist, Emma Olsen, said: “Kaiser has been punished and fined numerous times for mental health violations and we cannot allow this to continue.” “Our patients need human therapists who can work seamlessly with their doctors and have enough time to do our jobs properly, and it’s clear that Kaiser doesn’t want to pay for that level of care.” But Kaiser wants to add AI to the set of extreme proposals. The company calls for “flexibility,” or anything but a free hand in AI deployment.
The workers have not had a contract since September. The divide between the two camps remains wide, with Mr. Kaiser clinging to proposals that would upend the patient care safeguards that therapists have had, replace therapists’ jobs with artificial intelligence, and open up the possibility of further outsourcing care. When it comes to AI, Kaiser is poised to not only replace therapists’ jobs, but to replace therapists themselves.
The giant corporation was once known for being union-friendly. Kaiser Permanente was originally founded in the context of President Harry Truman’s failed National Health Care Plan, in part due to Henry Kaiser’s desire to treat all patients regardless of their ability to pay, and in collaboration with labor unions to provide medical services at Kaiser’s shipyards, steel mills, and other facilities. Workers supported it and were central to its origin and growth. But ultimately, “it’s a business,” said Sal Roselli, the union’s president emeritus. “That’s the bottom line: profit and competition.” Kaiser is a competitor and an empire builder, but it costs money. The surplus will be used for business expansion. Kaiser started in California and has remained there for decades, now with hospitals and clinics in Hawaii, Washington state, Colorado, Maryland, Michigan, Pennsylvania and Georgia. This is comparable to General Motors in the 1950s or Amazon today.
Health care is reshaping the U.S. economy. This is the sector that employs the most workers, surpassing manufacturing and services. The industry is the largest employer in 38 states. Manufacturing cities like Cleveland and Pittsburgh are shifting to health care as an economic driver. And in small towns and rural areas, hospitals are often the largest employers. The industry will continue to grow (unlike manufacturing, it cannot be offshored) despite reductions in federal health spending.
In that case, 2,400 workers is not that many. But they belong to a fighting union, and health care workers need fighters. Their example is invaluable.
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