“Kaiser executives say they don’t use AI to make patient care decisions, but they won’t say what technology is behind the online questionnaires that automatically determine whether patients need urgent appointments and assess whether they might be a threat to themselves,” said Carolyn Steele, a behavioral therapist in San Francisco. “Whatever Kaiser wants to say, this is not a human being making these potentially life-and-death decisions, and this is not the same level of care as being evaluated by a licensed physician.”
The nation’s largest health maintenance organization (HMO), Kaiser Permanente, is taking its therapists to 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 — right now facing the challenge of artificial intelligence.
2,400 striking mental health care workers are members of the National Union of Health Care Workers (NUHW). They went on a “practical” strike on Wednesday, March 18, which is likely a taste of what’s to come. In 2022, these workers went on strike for ten weeks, the longest mental health care worker strike on record. Two issues dominated the conversation from the beginning: the workload for Caesar’s physicians and the wait times for Caesar’s patients. The strikers won in both, forcing concessions until then but all were heard. They secured significant terms to retain staff and reduce wait times for patients, along with a collaborative plan to change the Kaiser model for providing mental health care.
It is inevitable that the current contract battle will be just as tough. But NUHW members are battle-tested. So far every treaty battle with Caesar has included a strike. And this time, NUHW members were joined in a sympathy strike by thousands of registered nurses who shared their concerns about Kaiser’s increasing use of artificial intelligence to harm patient care.
The importance of this cross-union connection can hardly be overestimated. Since 2009, NUHW has fought alone in a deeply divided workforce. In January of that year, a long-running dispute between SEIU’s national leader, Andy Stern, and the 150,000-strong United Health Care Workers in the Bay Area, came to a head: After several hours of hearings, SEIU-appointed former labor secretary Ray Marshall ruled for the national union. Local authority was held, no votes were taken, officers were dismissed, offices seized, and property confiscated; This was widely seen as a betrayal. Its core remained to be relaunched as NUHW.
But not so much this time (although thousands of service workers still crossed picket lines). Registered nurses are represented by the National Nurses Union. Stationary Engineers, represented by IUOE Local 39, also staged a strike in sympathy 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 be striking alongside registered nurses and engineers in the fight for person-centered care at Kaiser,” said Joshua Gibbons, a physician for Kaiser in Sacramento. “Mental health care is about the human connection, and Kaiser is recklessly moving forward with untested artificial intelligence that could potentially replace us and the care we provide to our patients.”
Caesar is determined to take back the old concessions. Note 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 equality laws.
Alas, in our new world, where “billions” replace “millions,” Caesars has $67 billion in reserves. Kaiser CEO Greg Adams reports receiving more than $20 million in annual compensation. Kaiser was forced to reimburse patients who paid out-of-pocket for mental health treatment they couldn’t get from Kaiser — but, millions, no problem.
“Kaiser has been punished and fined multiple times for mental health violations; we can’t afford to lose that anymore,” says Kaiser’s therapist Emma Olsen. “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.” Yet Kaiser wants to add AI to its array of extreme offerings — calling it “flexible,” meaning all but a free hand in introducing AI.
The workers have been without a contract since September. The parties remain far apart, sticking to Kaiser’s proposals that would roll back patient care protections previously won by physicians and open the door to replacing physician jobs with artificial intelligence and other outsourced care. When it comes to AI, Kaiser is setting the stage to replace not only the work done by therapists but the therapists themselves.
Behemoth was once known as union friendly. Kaiser Permanente was initially formed in cooperation with unions to provide medical services at Kaiser’s shipyards, steel mills, and other facilities, due in part to Henry Kaiser’s commitment to treating all patients, regardless of ability to pay, in the context of President Harry Truman’s failed National Health Care Plan. Labor supported it and was central to its origin and growth. But ultimately, “it’s a corporation,” says the association’s president, Sal Rosselli. “That’s the bottom line. Profit and competition.” Caesar is a competitor, an empire builder, but it costs money. It spends its surplus on expansion. Kaiser, which started in California and has been there for decades, 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 rebuilding the US economy. It is the sector that employs the most workers, more than manufacturing and services; The industry is the largest employer in thirty states. Manufacturing cities like Cleveland and Pittsburgh have shifted to health care as the 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 outsourced), despite federal health care spending cuts.
Then four hundred workers are not enough. But they’re 2,400 in a union that’s fighting, and the health care workforce needs fighters. Their example is incalculable.
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