Kaiser Permanente, AI, and the Workers on Strike, Again

“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 require urgent appointments 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 as being assessed by a licensed therapist.”

 Kaiser Permanente, the nation’s largest health maintenance organization (HMO) is forcing its therapists onto the streets in the ongoing battle to deny mental health parity with medical in its services to 12 million members.

The 2400 striking mental health care workers are members of the National Union of Health Care Workers (NUHW). They walked out on Wednesday, March 18, a “practice” strike, but most likely a taste of what’s to come. In 2022, these workers struck for ten weeks, the longest mental health care workers’ strike recorded. Two issues dominated negotiations from the start: workload for Kaiser therapists and wait time for Kaiser patients. The strikers won on both, forcing concessions until then all but unheard of. The strikers won break-through provisions to retain staff, reduce wait times for patients and a plan to collaborate on transforming Kaiser’s model for providing mental health care.

This time, it’s inevitable the fight will be just as hard fought.  But the NUHW members are battle-tested; each contract fight with Kaiser thus far has included a strike. More, this time the 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 the detriment of patient care. This can hardly be over-estimated. Since the 2009 SEIU trusteeship, Kaiser has faced a workforce has been deeply divided. But not so much this time, though thousands of service workers will still cross picket lines. The registered nurses are represented by the National Nurses Association. Stationary Engineers, represented by IUOE, Local 39, will also hold a sympathy strike with mental health workers, who will walk picket lines outside Kaiser medical centers in Oakland, Sacramento, Fresno, Santa Clara and Santa Rosa.

“We’re proud to strike alongside registered nurses and engineers in the fight for human-centered care at Kaiser,” said Joshua Gibbons, a therapist for Kaiser in Sacramento. “Mental healthcare is about human connection, and Kaiser is recklessly forging ahead with untested artificial intelligence that it sees potentially replacing us and the care we provide our patients.”

Kaiser is determined to rescind past concessions, never mind that in 2023, a $200 million agreement with the California Department of Managed Health Care that it lacks sufficient behavioral health providers.  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, “billions” has replaced “millions.” Kaiser has $67 billion in reserves. Kaiser’s CEO Greg Adams, is reported to receive more than $20 million annually. Kaiser must reimburse patients who had to pay out-of-pocket for mental health treatment they couldn’t get from Kaiser. So, fines, no problem.

“Kaiser has been punished and fined so many times for mental health violations, we can’t let it get away with more,” says Kaiser therapist Emma Olsen. “Our patients need human therapists, who can work seamlessly with their doctors and have enough time to do our jobs right — and it’s clear Kaiser doesn’t want to pay for that level of care.” Yet Kaiser wants to add AI to its array of extreme proposals – it is demanding “flexibility,” meaning all but a free hand in the introduction of AI.

The workers have been without a contract since September. The sides remain far apart, with Kaiser sticking to proposals that would reverse patient care safeguards previously won by therapists and open the door to replacing therapist jobs with artificial intelligence and further outsourcing care. When it comes to AI, Kaiser is setting the stage to not just replace work done by therapists but to replace therapists themselves.

Why is Kaiser doing this?  The behemoth was once known as union-friendly.  Workers supported it and were central in its origins and growth. “It’s a corporation,” says Sal Rosselli, president emeritus of the union. “It’s the bottom line. Profit and competition.”  Kaiser is a competitor, an empire builder, but this costs money. Kaiser, which began in California and stayed there for decades, now has hospitals and clinics in Hawaii, Washington state, Colorado, Maryland, Michigan, Pennsylvania, and Georgia. It’s like General Motors in the fifties or Amazon today.

Healthcare is remaking the US economy.  It’s the nation’s top employer, surpassing manufacturing and service.  In 38 states, the industry is the biggest employer. Manufacturing cities like Cleveland and Pittsburgh have transitioned to healthcare as the driver of their economies. Hospitals are often the largest employers in small towns and rural settings. The industry will continue to grow (it can’t be outsourced, not like manufacturing), despite looming cuts in federal health care spending. Healthcare is an engine of the twenty-first century economy; its workers are our blue-collar millions. 2,400 workers, not so big, then. But it’s 2,400 in a union that fights, and we need fighters. Their example is incalculable.

A note. Seeing daily the rampaging of ICE on our streets and murder of healthcare workers in Minneapolis and in Gaza, Lebanon and Iran as well as the destruction of their hospitals, all the more important that we understand the connections and also support our sanctuaries and the healthcare workers who stand up in the face of repression, especially those healthcare workers who have been discipled or fired for daring to say Genocide.

Thanks to Matthew Artz.

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