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Then pay them all a salary of 1 million dollars, health care or otherwise. Blow up the system that results in CEOs getting paid 100s-1000s times more than the average worker.
CNN Article - Psychologists to Strike
- Thread starter AbnormalPsych
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In the case of Kaiser, CEO compensation is around 35-40 million. That is WAY more than any one person needs to live an amazingly comfortable life. Kaiser is basically paying for multiple generations of the CEOs family to live amazingly comfortable lives.
I have Tufts Insurance. It does what it needs to- good coverage network; typical copays/deductible for a group plan. Top executive salary (if the internet is correct) is 700K. I know its not as big a venture as Kaiser, but is it 50 times less of a job than the Kaiser CEO postion?
I have Tufts Insurance. It does what it needs to- good coverage network; typical copays/deductible for a group plan. Top executive salary (if the internet is correct) is 700K. I know its not as big a venture as Kaiser, but is it 50 times less of a job than the Kaiser CEO postion?
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You'd say the same for any other profession?
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Yep- I'd say a million is enough salary for one person.
Sanman
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While there is a general rule that we should pay for competence, I do wonder if the numbers here make that rule useless. There are plenty of MDs, psychologists, MBAs, and very competent people that make less than a million dollars. You are telling me not one of them could competently do the job for a million dollars if given the chance? Same idea if we put a pay cap on professional sports. What else are those guys doing to earn a million bucks? Even if you lose a few, the guys who did not make the cut would still be entertaining. Very few people are so irreplaceable that someone else could not do the job adequately. CEOs included. The issue is that we only give select few people a chance to even try and run things.
The issue you have here though is a question of what is actual the job of the CEO? To provide the best healthcare or the cheapest healthcare that can do the job with minimal adequacy? If providing the cheapest care comes with more money for the CEO, then what you have is a fundamental misalignment of interests.
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Then you live in the wrong country.
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"CEO skills", i.e. being a smart Psychopath, are not all that rare. What happens is that successful candidates con their way into outrageous pay.
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That is completely impossible as the law stands for private corporations. Even if it were possible, my bet would be that people that have extremely high earning potential would cluster to a new country and relocate management operations along with themselves.
It isn't about one job being a multiple of another. People work for what they can get, and increasingly complex operations require more than 1:1 scaling of skills, as even a small margin of error can cost billions. Kaiser has 10.5 times the operating expenses and generated over 8 billion dollars of net revenue, compared with Tufts which lost 11.7 million. That's good management, if evil, and good management costs money, because it can easily jump ship and make billions for someone else.
Finally, yes, it is a comfortable life for several generations of a family. I would argue keeping 217,000 peoples' jobs and lives in order is worth a guy and his kids and their kids being taken care of.
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Or the country I live in has a bit of an endemic issue with income disparity, but that’s a topic for another thread.
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"When most of us think of mental health care, we think of seeing a therapist once per week. But at Kaiser Permanente facilities in California and Hawaii, clinicians — including psychologists, clinical social workers, marriage and family therapists, and addiction medicine counselors — say their patients routinely wait months between appointments. Not only that: There’s no limit to the number of patients that can be assigned to one therapist.
“You’re expected to follow anybody you have seen in the last two years. At times, the number of people I have seen in the last two years has been up to 600,” Sabrina Chaumette, a Kaiser therapist in Oakland, said.
Since July 2021, Kaiser mental health clinicians in California, who are members of the National Union of Healthcare Workers (NUHW), have attempted to use contract negotiations to demand the resources they need to provide better care for their patients. But workers say management has been unwilling to budge on changes necessary to reduce their unmanageable workloads and reverse understaffing, so on August 15 — nearly 14 months after their first bargaining session — over 2,000 Kaiser therapists in California went on strike. Nearing two months, it is the longest mental health strike in history. And on August 29, 57 of their colleagues in Hawaii, also NUHW members, joined them.
Kaiser is the largest nonprofit HMO in the United States, operating in eight states and the District of Columbia. It’s the largest health insurance plan in California, with more than half the market share, and the second-largest in Hawaii. However, despite reporting an $8.1 billion profit in 2021, Kaiser staffs only one full-time-equivalent mental health clinician for every 2,600 members in Northern California and just one therapist for every 5,500 patients in Hawaii, according to NUHW. Union members say this flies in the face of Kaiser’s key marketing promise: That by offering health insurance plans and operating hospitals and other facilities under one umbrella, patients receive better and more integrated care.
“I call it the glitter cloud,” Rachel Kaya, a Kaiser therapist in Hawaii, told Truthout. “They put out into the world how they promote mental health care, how they help people thrive, and how they do fair labor bargaining. But in my field, we talk a lot about the difference between talking the talk and walking the walk.” Unlike their colleagues in California, whose contract expired, Kaiser therapists in Hawaii are still without a first contract four years after joining NUHW.
Kaiser staffs only one full-time-equivalent mental health clinician for every 2,600 members in Northern California and just one therapist for every 5,500 patients in Hawaii.
“A strike is an absolute last resort. We have made numerous efforts to compel our employer to shift our model of care to reduce dangerous delays in terms of wait times that our patients face,” Ilana Marcucci-Morris, a Kaiser therapist in California and bargaining committee member said. According to Marcucci-Morris, the union’s last contract cycle nearly ended in a strike over the same issues, but members ultimately accepted an offer from Kaiser when it agreed to form a committee, with equal participation between union members and management, that would make recommendations on how Kaiser could improve its model of care. After that committee met for over a year and made its final presentation, “Kaiser cherry-picked one or two pieces that they liked and then dumped the rest,” said Marcucci-Morris. Before walking out, NUHW members in Northern California accepted Kaiser’s financial terms. They’re not striking over their own compensation or benefits.
“Our patients are waiting three months in between appointments and flooding the emergency room because they’re in crisis or paying out of pocket to go outside Kaiser. That extreme moral injury is the crux of our strike,” said Marcucci-Morris. We want our patients to get better and we need the resources to help them do that.” Kaya agrees. “I just want to be really clear that the reason why we are on strike is not a financial issue,” she said. “It is absolutely a social justice issue. Kaiser being a multibillion-dollar company, yet choosing to underfund mental health care in these communities, is wrong. The entire community pays the price when we underfund mental health care.”
Marcucci-Morris likens the Kaiser model, where there is no limit on the number of patients a therapist can be expected to take on, to “a house where you have a front door that’s wide open but no windows, no side door, or back door.” In addition to forcing clinicians to work many hours of overtime on non-patient-facing work like completing and reviewing notes and connecting with other members of a patient’s care team, union members say this approach actually compels them to break the law. In addition to recently strengthened federal law, California has some of the strongest mental health parity laws in the nation. SB 221, enacted in 2021, requires that mental health and substance use patients be offered return appointments within 10 business days, unless the treating therapist determines that a longer wait time is appropriate. If an appointment with an in-network provider is not available, insurers and HMOs are obligated to arrange for outside care at no additional cost to the patient. NUHW members say state regulatory bodies have been slow to enforce the new law, and that Kaiser was non-compliant even before their strike.
“Our current contract compels therapists to break mental health parity laws on the state and federal level,” said Marcucci-Morris. When she went on strike on August 15, said Chaumette, her next available intake appointment was in mid-November.
Barbara McDonald is a single parent to two daughters with mental health challenges. McDonald told Truthout that getting her younger daughter an appropriate diagnosis within the Kaiser system took so long that she was forced to pay out of pocket to go outside Kaiser. Once her daughter did have a diagnosis of borderline personality disorder, the only treatment she was offered within Kaiser was a series of classes — which were then canceled. After her daughter was hospitalized multiple times for self-harm, McDonald paid out of pocket again to get her the treatment she needed outside of Kaiser. All told, she has spent around $50,000. “I don’t think my daughter would be alive if I hadn’t been able to provide outside care for her,” she said. “And I’m still digging myself out of a financial hole because of that.”
“My older daughter said, ‘Do I have to cut my throat to get a therapy appointment?’ She sees her sister only getting care if she escalates and hurts herself. That must feel really scary, that nobody cares unless you’re hurting yourself or threatening yourself,” said McDonald.
Chaumette said that in her experience, it’s often patients with less severe symptoms who do manage to get a referral for covered care outside the Kaiser system. “If I’m seeing somebody with depression and they’re having a difficult time getting out of bed, dressing, bathing, eating, they’re not going to have the energy to be on the phone with Kaiser fighting for an outside referral. This system disproportionately hurts the people with more severe symptoms,” she said. Kaiser also encourages therapists to keep more severe cases in-house, purportedly to better manage care for those patients, and because they might be rejected by therapists in private practice. But Kaiser’s mental health providers are so overwhelmed that McDonald questions the safety of that approach. “Even though Kaiser is dispensing my daughter’s medication, they don’t have anybody following up with her. She can go six months between meetings with her psychiatrist,” McDonald said. “That’s just dangerous.”
Between June 2021 and May 2022, 668 California clinicians left Kaiser — nearly double the 335 clinicians who left the previous year.
In California, Kaiser contracts with Medi-Cal, the state’s Medicaid program, and its failures to deliver timely care disproportionately affect people who can’t afford to go outside the system. “Any marginalized community that has been unused to advocating for itself is not going to fight the system to give them a referral to an outside provider,” said Chaumette.
These untenable conditions have therapists leaving Kaiser in droves, according to NUHW. Between June 2021 and May 2022, said the union, 668 California clinicians left Kaiser — nearly double the 335 clinicians who left the previous year. In a survey conducted by NUHW, 85 percent of those clinicians said they had an unsustainable workload, and 76 percent said their inability to “treat patients in line with standards of care and medical necessity” influenced their decision to leave.
In California, NUHW members are asking for several key changes: Up to an additional 30 minutes per day to perform indirect patient care tasks such as returning phone calls and emails from patients and communicating with other members of a patient’s care team; the ability for clinicians to stop taking new patients when they have no available appointments for new patients within two weeks; a ratio of one appointment for a new patient to every six appointments with current patients; and a requirement that Kaiser hire enough staff to comply with federal and state law. The only concession Kaiser management has offered, according to Marcucci-Morris, is an increase in indirect patient care time of just 12 minutes per day, applying to generalist therapists only, which would exclude a majority of the union. Representatives for Kaiser Permanente did not return a request for comment.
In May, the National Committee for Quality Assurance, an independent nonprofit organization that accredits health plans, placed Kaiser under “corrective action” because of its violations of national mental health standards. Two California state agencies are also investigating Kaiser’s failures to follow state mental health parity law, though those investigations are not expected to conclude until next year. “I’d like to see them hit them with fines big enough to get their attention and to make it worth it for them to turn this around because clearly, they’re only interested in the money they make,” said McDonald. “Or if they’re not going to provide mental health care, then they should just say that rather than pretending they do.”
In Hawaii, NUHW filed a complaint in November 2021 with the Department of Commerce and Consumer Affairs regarding Kaiser’s failure to address serious patient care problems. In its formal response in December, Kaiser pledged to hire 44 additional therapists. According to NUHW, the number of full-time Kaiser clinicians in Hawaii has actually decreased from 51 to 48 since then.
Chaumette says that, because of its poor practices, Kaiser faces a reputational crisis among therapists. “They are never going to be able to hire enough therapists to treat all these patients because nobody wants to work for Kaiser,” she said. “Our reputation in the community among therapists is bad. When I tell people I work for Kaiser, their first response is, ‘You don’t do therapy.’ I think this strike has increased my reputation within our community of therapists. We’re doing advocacy in ways I’ve never done before as a therapist.”
Kaiser is still booking appointments for patients with therapists who are out on strike, then canceling and rescheduling them.
Though roughly half of the clinicians who went on strike in California have returned to work out of financial necessity, Marcucci-Morris said support for the strike remains high — in a recent vote, 85.9 percent of union members still supported the strike. “It’s important to note what a union is. We are a collection of workers. This is not one or two people telling us what to do,” she said.
According to Marcucci-Morris, therapists who have gone back to work informed the union that Kaiser is still booking appointments for patients with therapists who are out on strike, then canceling and rescheduling them. “If Kaiser felt following the law was a priority, they’d follow our proposal,” she said. “We’re ready to negotiate around the clock to get an agreement.”
“You’re expected to follow anybody you have seen in the last two years. At times, the number of people I have seen in the last two years has been up to 600,” Sabrina Chaumette, a Kaiser therapist in Oakland, said.
Since July 2021, Kaiser mental health clinicians in California, who are members of the National Union of Healthcare Workers (NUHW), have attempted to use contract negotiations to demand the resources they need to provide better care for their patients. But workers say management has been unwilling to budge on changes necessary to reduce their unmanageable workloads and reverse understaffing, so on August 15 — nearly 14 months after their first bargaining session — over 2,000 Kaiser therapists in California went on strike. Nearing two months, it is the longest mental health strike in history. And on August 29, 57 of their colleagues in Hawaii, also NUHW members, joined them.
Kaiser is the largest nonprofit HMO in the United States, operating in eight states and the District of Columbia. It’s the largest health insurance plan in California, with more than half the market share, and the second-largest in Hawaii. However, despite reporting an $8.1 billion profit in 2021, Kaiser staffs only one full-time-equivalent mental health clinician for every 2,600 members in Northern California and just one therapist for every 5,500 patients in Hawaii, according to NUHW. Union members say this flies in the face of Kaiser’s key marketing promise: That by offering health insurance plans and operating hospitals and other facilities under one umbrella, patients receive better and more integrated care.
“I call it the glitter cloud,” Rachel Kaya, a Kaiser therapist in Hawaii, told Truthout. “They put out into the world how they promote mental health care, how they help people thrive, and how they do fair labor bargaining. But in my field, we talk a lot about the difference between talking the talk and walking the walk.” Unlike their colleagues in California, whose contract expired, Kaiser therapists in Hawaii are still without a first contract four years after joining NUHW.
Kaiser staffs only one full-time-equivalent mental health clinician for every 2,600 members in Northern California and just one therapist for every 5,500 patients in Hawaii.
“A strike is an absolute last resort. We have made numerous efforts to compel our employer to shift our model of care to reduce dangerous delays in terms of wait times that our patients face,” Ilana Marcucci-Morris, a Kaiser therapist in California and bargaining committee member said. According to Marcucci-Morris, the union’s last contract cycle nearly ended in a strike over the same issues, but members ultimately accepted an offer from Kaiser when it agreed to form a committee, with equal participation between union members and management, that would make recommendations on how Kaiser could improve its model of care. After that committee met for over a year and made its final presentation, “Kaiser cherry-picked one or two pieces that they liked and then dumped the rest,” said Marcucci-Morris. Before walking out, NUHW members in Northern California accepted Kaiser’s financial terms. They’re not striking over their own compensation or benefits.
“Our patients are waiting three months in between appointments and flooding the emergency room because they’re in crisis or paying out of pocket to go outside Kaiser. That extreme moral injury is the crux of our strike,” said Marcucci-Morris. We want our patients to get better and we need the resources to help them do that.” Kaya agrees. “I just want to be really clear that the reason why we are on strike is not a financial issue,” she said. “It is absolutely a social justice issue. Kaiser being a multibillion-dollar company, yet choosing to underfund mental health care in these communities, is wrong. The entire community pays the price when we underfund mental health care.”
Marcucci-Morris likens the Kaiser model, where there is no limit on the number of patients a therapist can be expected to take on, to “a house where you have a front door that’s wide open but no windows, no side door, or back door.” In addition to forcing clinicians to work many hours of overtime on non-patient-facing work like completing and reviewing notes and connecting with other members of a patient’s care team, union members say this approach actually compels them to break the law. In addition to recently strengthened federal law, California has some of the strongest mental health parity laws in the nation. SB 221, enacted in 2021, requires that mental health and substance use patients be offered return appointments within 10 business days, unless the treating therapist determines that a longer wait time is appropriate. If an appointment with an in-network provider is not available, insurers and HMOs are obligated to arrange for outside care at no additional cost to the patient. NUHW members say state regulatory bodies have been slow to enforce the new law, and that Kaiser was non-compliant even before their strike.
“Our current contract compels therapists to break mental health parity laws on the state and federal level,” said Marcucci-Morris. When she went on strike on August 15, said Chaumette, her next available intake appointment was in mid-November.
Barbara McDonald is a single parent to two daughters with mental health challenges. McDonald told Truthout that getting her younger daughter an appropriate diagnosis within the Kaiser system took so long that she was forced to pay out of pocket to go outside Kaiser. Once her daughter did have a diagnosis of borderline personality disorder, the only treatment she was offered within Kaiser was a series of classes — which were then canceled. After her daughter was hospitalized multiple times for self-harm, McDonald paid out of pocket again to get her the treatment she needed outside of Kaiser. All told, she has spent around $50,000. “I don’t think my daughter would be alive if I hadn’t been able to provide outside care for her,” she said. “And I’m still digging myself out of a financial hole because of that.”
“My older daughter said, ‘Do I have to cut my throat to get a therapy appointment?’ She sees her sister only getting care if she escalates and hurts herself. That must feel really scary, that nobody cares unless you’re hurting yourself or threatening yourself,” said McDonald.
Chaumette said that in her experience, it’s often patients with less severe symptoms who do manage to get a referral for covered care outside the Kaiser system. “If I’m seeing somebody with depression and they’re having a difficult time getting out of bed, dressing, bathing, eating, they’re not going to have the energy to be on the phone with Kaiser fighting for an outside referral. This system disproportionately hurts the people with more severe symptoms,” she said. Kaiser also encourages therapists to keep more severe cases in-house, purportedly to better manage care for those patients, and because they might be rejected by therapists in private practice. But Kaiser’s mental health providers are so overwhelmed that McDonald questions the safety of that approach. “Even though Kaiser is dispensing my daughter’s medication, they don’t have anybody following up with her. She can go six months between meetings with her psychiatrist,” McDonald said. “That’s just dangerous.”
Between June 2021 and May 2022, 668 California clinicians left Kaiser — nearly double the 335 clinicians who left the previous year.
In California, Kaiser contracts with Medi-Cal, the state’s Medicaid program, and its failures to deliver timely care disproportionately affect people who can’t afford to go outside the system. “Any marginalized community that has been unused to advocating for itself is not going to fight the system to give them a referral to an outside provider,” said Chaumette.
These untenable conditions have therapists leaving Kaiser in droves, according to NUHW. Between June 2021 and May 2022, said the union, 668 California clinicians left Kaiser — nearly double the 335 clinicians who left the previous year. In a survey conducted by NUHW, 85 percent of those clinicians said they had an unsustainable workload, and 76 percent said their inability to “treat patients in line with standards of care and medical necessity” influenced their decision to leave.
In California, NUHW members are asking for several key changes: Up to an additional 30 minutes per day to perform indirect patient care tasks such as returning phone calls and emails from patients and communicating with other members of a patient’s care team; the ability for clinicians to stop taking new patients when they have no available appointments for new patients within two weeks; a ratio of one appointment for a new patient to every six appointments with current patients; and a requirement that Kaiser hire enough staff to comply with federal and state law. The only concession Kaiser management has offered, according to Marcucci-Morris, is an increase in indirect patient care time of just 12 minutes per day, applying to generalist therapists only, which would exclude a majority of the union. Representatives for Kaiser Permanente did not return a request for comment.
In May, the National Committee for Quality Assurance, an independent nonprofit organization that accredits health plans, placed Kaiser under “corrective action” because of its violations of national mental health standards. Two California state agencies are also investigating Kaiser’s failures to follow state mental health parity law, though those investigations are not expected to conclude until next year. “I’d like to see them hit them with fines big enough to get their attention and to make it worth it for them to turn this around because clearly, they’re only interested in the money they make,” said McDonald. “Or if they’re not going to provide mental health care, then they should just say that rather than pretending they do.”
In Hawaii, NUHW filed a complaint in November 2021 with the Department of Commerce and Consumer Affairs regarding Kaiser’s failure to address serious patient care problems. In its formal response in December, Kaiser pledged to hire 44 additional therapists. According to NUHW, the number of full-time Kaiser clinicians in Hawaii has actually decreased from 51 to 48 since then.
Chaumette says that, because of its poor practices, Kaiser faces a reputational crisis among therapists. “They are never going to be able to hire enough therapists to treat all these patients because nobody wants to work for Kaiser,” she said. “Our reputation in the community among therapists is bad. When I tell people I work for Kaiser, their first response is, ‘You don’t do therapy.’ I think this strike has increased my reputation within our community of therapists. We’re doing advocacy in ways I’ve never done before as a therapist.”
Kaiser is still booking appointments for patients with therapists who are out on strike, then canceling and rescheduling them.
Though roughly half of the clinicians who went on strike in California have returned to work out of financial necessity, Marcucci-Morris said support for the strike remains high — in a recent vote, 85.9 percent of union members still supported the strike. “It’s important to note what a union is. We are a collection of workers. This is not one or two people telling us what to do,” she said.
According to Marcucci-Morris, therapists who have gone back to work informed the union that Kaiser is still booking appointments for patients with therapists who are out on strike, then canceling and rescheduling them. “If Kaiser felt following the law was a priority, they’d follow our proposal,” she said. “We’re ready to negotiate around the clock to get an agreement.”
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Kaiser has attempted to recruit me (since the strike began) at a very high rate of compensation. I turned them down for many reasons but ALSO because my understanding of professional ethics includes the fact that you cannot practice unethically because your employer tells you that you have to.
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Ah, that's the rub. We're not going to agree on this issue, but I appreciate the dialogue.
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That's fine. I guess I'm view myself as more pragmatic- if a guy can make you more than his salary, he has earned his salary. Money is nonsense, at the end of the day, so I just don't see anything wrong with paying anyone any particular amount, so long as they can afford food, basic necessities, and housing.
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Quality of life is often related to the availability of money, unfortunately, at least in the US.
Sanman
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There is nothing wrong with paying anyone anything until there is. Money is just a means to buy stuff. The question becomes what we allow someone to do to acquire that stuff. The law says I can't kill you to take your stuff (pretty easy way to get more money or stuff). How about letting someone die so you can keep their stuff (like their health insurance premiums)? How about letting them suffer so that you can keep their stuff? You're right that money is nonsense, but so are rules and law. Murdering and stealing from Native Americans was not a problem. Murdering and stealing to get the things the settlers murdered and stole? Problem.
We as a society decide what is out of bounds. No one else. This a segment saying something is out of bounds.
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If all the CEOs demanding salaries above one million dollars decide to leave for friendlier places, wouldn't new CEOs eventually show up? They might have less experience, but they might still be completely competent and do a good job. Isn't that kind of what Kaiser is hoping for by trying to recruit new providers and waiting out the current ones? Ignoring the difficulty of implementing something like that within the US, it seems reasonable to use similar strategies if it works.
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"CEO skills", i.e. being a smart Psychopath, are not all that rare. What happens is that successful candidates con their way into outrageous pay.
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Oh I'm a strong advocate for a public option because I think private insurance is unethical. But like, somebody's gotta run it while it exists 🤷♂️ hopefully we get some form of public option or universal coverage so there is less of a role for people to be doing this in the future, but a guy making a million is more likely to screw everything up for everyone, from himself down to the patients, than a guy making more. I've watched enough executive transitions at hospitals to be fearful of what they mean for providers and patients
Sanman
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Public or private, you are correct that someone has to run it. The question then becomes what are ethics of the person running it? What says that the guy making a million is more likely to screw it up? Is a more ethical operation with a lower profit margin screwing it up or better? The underlying assumption here is that maximum profit margins are the measure of success.
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Society is asking the question, it seems: ‘Who is going to hold Kaiser accountable?’ Patients detail mental health care failings
"San Francisco Board of Supervisors hearing Tuesday as politicians sought to understand why Kaiser delivers what patients, families
and employees called deeply inadequate mental health care, even as the city spends nearly $500 million a year with the health care giant."
“I’m literally sitting here trying to contain my rage after everything I’ve just heard,” Supervisor Catherine Stefani said.
“We have never seen such an egregious case of delayed access for follow-up appointments,” Ronen said, quoting a 2020 letter about Kaiser from the American Psychological Association to the California Department of Managed Health Care.
“If Kaiser were here, I’d be asking them what the hell is going on,” said Supervisor Dean Preston, who asked if Lewis thought the company’s business model was to intentionally “drive people to go outside the Kaiser system for their mental health.”
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It's to get people to give up on mental health care but keep paying premiums to belong to Kaiser.
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35 MILLION. Wow. I mean, if--as a psychologist--I could demonstrate a 95% cure rate in two sessions (including in a group format over telehealth) for any/all conditions in the DSM-5-TR...I wouldn't expect to be compensated at that rate.
Sanman
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You are undervaluing your imaginary skills then, clearly. That's the problem we have here in the first place. 35 million and he can't cure anyone of anything but a fat wallet.
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That CEO has the skills of a very accomplished and intelligent psychopath who is rewarded with 35 Million dollars a year for his illness that harms thousands of people. If you see nothing wrong with this, there is something wrong with you.
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"As SEIU-UHW Kaiser union leaders, we are calling on our SEIU-UHW Kaiser members - all 36,000 strong in northern California and 22,000 strong in the south - to participate in a 24-hour sympathy strike on Nov. 18, 2021 to help our union co-workers win fair contracts, the Local 39 Operating Engineers in the north and the UNAC/UHCP RNs in the south. Kaiser used to embrace the labor movement and try to be the provider of choice for union members. But now, Kaiser is on a different path, engaging in union-busting by allowing the engineer strike to continue for more than eight weeks and by driving a dangerous, anti-worker “two-tier” wage proposal with the RNs that will lower wages and benefits for all workers. Kaiser’s position that frontline workers are “overpaid” is demeaning, especially as it continues to rake in billions of dollars in profits during the pandemic and pays dozens of executives million-dollar salaries. We cannot allow Kaiser to continue to engage in this anti-worker bullying or else we will face the same when we go back to negotiations in less than two years. Not only are Kaiser Permanente executives failing to confront the crisis in care brought on by the COVID-19 pandemic, but their drive for profits over people is also making things even worse for patients and workers. Our patients are being charged more for care but getting worse results with less hands-on attention and longer delays. Kaiser’s focus on cutting pay rates and reducing benefits for workers instead of recognizing our sacrifices during this extraordinary time is so demoralizing that many of us are considering leaving our jobs. We can relate to how disrespected the engineers and nurses feel by Kaiser’s unfair labor practices. We see it every day – not enough staff to care for patients safely, mandated overtime and vacation denials even though we’ve put in tons of extra hours, bonuses slashed because we didn’t improve attendance in the midst of a deadly virus surge, work outsourced, COVID leave stopped before COVID is brought under control, and on and on and on. We reject what Kaiser is becoming. Enough is enough."
In Unity, SEIU-UHW Kaiser Executive Board Members
In Unity, SEIU-UHW Kaiser Executive Board Members
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Hyperbolic much? Or have you been treating him? Got an MMPI profile to share?
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What you see and what you can infer is what you get.
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Is there a non paywall version of that article?
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If you use Chrome, open it in an incognito window (Push Ctrl-Shift-n simultaneously) OR install the TOR browser from The Tor Project | Privacy & Freedom Online and use that to open it. Tell me if none of this works, please.
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Source: Voices from the Picket Lines - Beyond Chron
The Strike at Kaiser Continues - Voices from the Picket line:
The strike of 2000 Kaiser Permanente mental health care providers, which began on August 15, is now in its eighth week.
Why? Here’s Jane Kostka, a steward with the National Union of Healthcare Workers (NUHW). She’s part of the bargaining team; NUHW members choose their team; bargaining sessions are open.
“We’re out here on the picket line today because of professional ethics denied. The strike is not about money. In fact, over the weekend on Saturday Kaiser made us a conditional offer to raise our pay if we would accept pretty much leaving the working conditions and the patient care at status quo. And that is not acceptable to us. We are striking because it’s one last resort to get Kaiser to understand that we need to see our patients at a frequency that helps the patients actually get better. And we need to have enough time in the day to take care of the patients we already have. We need Kaiser to hire more therapists and to give them a workload that is sustainable so that those therapists stay on the job and do not leave because they are burned out
“We have many, many patients who have suffered trauma or abuse. What they need is someone on their side They need someone who is accessible, someone who they can talk with regularly to help them deal with the fear and with the feeling that their life could just close in on them. When we’re working eight, nine, ten weeks between appointments, they don’t have that backup and they wind up getting more depressed, more anxious, calling us, emailing and we don’t have enough time in our daily schedule. I and many of my fellow therapists work late every day just to call back those of our patients who are the most distressed because we just can’t leave them hanging there with no answer between one day and the next.”
This is from Kostka’s speech at the NUHW’s rally in Sacramento. NUHW members have been picketing Kaiser medical centers and clinics throughout Northern California. They’ve held rallies in Santa Rosa and Sacramento, as well as a Labor Day rally at Kaiser’s flagship medical center in Oakland.
It’s a cliché to say there is a mental healthcare crisis in this country; everyone from the President down has joined the chorus – depression, anxiety, addiction, suicide, something has to be done.
The difference here is that these strikers are doing something about it, and to their credit, virtually every mental health care advocate in California has come out in support of the strike, as has the San Francisco Central Labor Council and an array of unions. The Massachusetts Nurses Association sent $25,000.
The San Francisco Board of Supervisors, meeting Tuesday, September 27, held a hearing on the strike. Kaiser stayed away, leaving NUHW members Kaiser parents, family members and others to turn the hearing into the next best thing to a strike support rally.
“I am, literally sitting here trying to contain my rage after everything I’ve just heard,” said Supervisor Catherine Stephani. It is way past time that mental health care must be treated the same as physical health care.”
Supervisor Hilary Ronen, who called the hearing, scolded the absent Kaiser. “If you had showed up, you would have heard that your employees spend a significant amount of time apologizing to their patients for you. (Chronicle 9/27)
Supervisors were also dismayed to learn that Kaiser continues to defy regulations of all kinds, including, the State Senates law SB221, sponsored by NUHW, which requires HMOs like Kaiser to provide follow-up mental health care appointments within 10 business days if recommended by a therapist. Its purpose was to put some teeth into existing legislation.
Speaking on the picket line, Sabrina Chaumette, a steward at Kaiser’s flagship Oakland medical center, spoke in support of the patients:
“If this were a war, which I feel it is, this is what is considered collateral damage, they can afford to lose the ones with mental illness.”
“During the pandemic, we have had losses on a number of different fronts. People suffered all at once. Consider this like the great depression, people suffered illness, death, job loss, learning that millions of people had died from COVID or long Covid. They suffered isolation, loss of community, loss of purpose, loss of meaningful work, loss of housing. Substance abuse use went up, as people tried to survive and cope. Rates of suicide went up; rates of depression went up, anxiety went up, especially social anxiety. Imagine being home for three years and somebody tells you gotta get out of the house. So social anxiety went up and so did suicide.”
Readers here will know that Kaiser Permanente is a behemoth amongst this country’s corporate, “not for profit” health care providers, with 39 hospitals and 700 medical facilities, and 9.4 million “members” who pay for Kaiser’s services. It’s net worth in 2021 was $43.3 billion Its CEO Greg Adams received $17.3 million in total compensation in 2020. He and the top 100 executives have the benefit of eight separate retirement plans.
The NUHW represents 2000 Northern California mental health technicians, and clinicians (psychologists, social workers, psychiatric nurses and chemical dependency counselors). They have been bargaining with Kaiser since July.
So, in the face of all this, Kaiser is defiant; it denies its obligations to its patients, to its workers, to the public and the law. It attends bargaining sessions (most of the time) but rarely offers anything for discussion. It will talk money, but it insists that SB 221 (which it is out of compliance) and anything related to staffing and work load is off limits. Management rights. It says it will talk about money but nothing else. To make the position clear, the strikers responded to the offer of a raise. On Saturday, September 18, their opposition was overwhelming. The no vote was 1349 to 222 to continue the strike.
I might add here, Kaiser has consistently played hard ball (and worse) with NUHW – clearly apparent in comparison with any of the other half dozen unions that represent Kaiser workers. This is a fight going on now for the best part of ten years.
First, certainly, NUHW is a union that is present on the “shop [hospital] floor,” that fights for its members, that doesn’t do concessions.
Second, NUHW’s Kaiser’s workers have steadfastly refused to give up their watchdog role – their responsibility to their patients and to the community; they consistently rejected Kaiser’s insistence on “gag rules” imposed in contracts and elsewhere. Why? The union and its members have from the beginning joined other mental health campaigners in advocating for patients and in exposing Kaiser’s negligence, while calling for parity with medical health care and supporting the rights of mental health care patients.
Still, all that said, here in California, as elsewhere, there’s the bottom line. And while Kaiser is a pacesetter, it’s far from alone. In denying its members mental health care services that they’ve paid for, it’s just a leader of the pack. See for example, a New York Times feature, “Profits over Patients,” a report focused on the Washington State giant, Providence Health Care, about how on the medical side, patients are denied entitlements, billed in defiance of existing regulations, then, when these bills are not paid, sends them into collection, well knowing what this means to working class people and their credit scores. They Were Entitled to Free Care. Hospitals Hounded Them to Pay.
Kaiser’s workforce is represented by half a dozen unions, service workers, nurses, engineers, northern, southern, separate negotiations for each. There’s no doubt Kaiser likes it this way. So, in the long run here may lie the key. Here’s the voice of an Emergency Department nurse from Kaiser’s Santa Rosa medical center. He and the nurses in his department took their lunch break on the Santa Rosa picket line.
“I’ve worked here in the Emergency Department for five years. I’d just like to say that I think this strike is a righteous strike and what you guys are doing is fantastic and I can’t wait to join you guys out here soon. We continuously see patients come in with the same triage note. ‘I had an appointment made for me in three weeks and I’m in crisis right now and I need to see a therapist’ and instead of getting that opportunity people are making attempts on their lives and then coming to the emergency room and then sit in a box. It’s not therapeutic and it’s disgusting and Kaiser needs to do better and so I really appreciate the sacrifice you’re making here today and again can’t wait to join you out here when we get on strike as well when we can combine and put the hurt on them.”
And that’s the point, isn’t it? “Combine.” Or, solidarity. If, indeed, we are experiencing a new awakening of labor, if this is to be a “striketober,” then let’s hope that Kaiser’s other workers are awakened from their slumber, there’s much to be gained, not so much to lose. “I’d rather leave Kaiser altogether than go back to work with a contract that forces us to break the law,” said Ilana Marcucci-Morris, a therapist for Kaiser in Oakland. “It’s time for Kaiser to get serious about mental health care so we can get back to work serving our community and providing patients with the care they need.”
In the meantime, NUHW doesn’t plan on losing. I spoke to Sophia Mendoza, NUHW’s Secretary-Treasurer, on the picket line in Santa Rose. She put the strike into the big picture, the COVID catastrophe, a broken healthcare system, big pharma, the insurance racket, the hospital chains, the bottom line, profits, first., “It’s all got to go.” NUHW, it goes without saying, supports a single-payer system, it has from the beginning.
“We’ve been fighting Kaiser for ten years. We know what to expect. We’re part of a movement whose time has come, they’d better figure this out. If they won’t collaborate with us, everything will just get worse. Clinicians are already leaving. That’s the future. No one’s going to want to work at Kaiser.”
How you can help
A note from the union: We know Kaiser’s playbook: Cancel thousands of appointments, make patients suffer, blame the therapists, and reject every proposal therapists make to improve care.
Here’s how you can make Kaiser finally prioritize mental health care:
The Strike at Kaiser Continues - Voices from the Picket line:
The strike of 2000 Kaiser Permanente mental health care providers, which began on August 15, is now in its eighth week.
Why? Here’s Jane Kostka, a steward with the National Union of Healthcare Workers (NUHW). She’s part of the bargaining team; NUHW members choose their team; bargaining sessions are open.
“We’re out here on the picket line today because of professional ethics denied. The strike is not about money. In fact, over the weekend on Saturday Kaiser made us a conditional offer to raise our pay if we would accept pretty much leaving the working conditions and the patient care at status quo. And that is not acceptable to us. We are striking because it’s one last resort to get Kaiser to understand that we need to see our patients at a frequency that helps the patients actually get better. And we need to have enough time in the day to take care of the patients we already have. We need Kaiser to hire more therapists and to give them a workload that is sustainable so that those therapists stay on the job and do not leave because they are burned out
“We have many, many patients who have suffered trauma or abuse. What they need is someone on their side They need someone who is accessible, someone who they can talk with regularly to help them deal with the fear and with the feeling that their life could just close in on them. When we’re working eight, nine, ten weeks between appointments, they don’t have that backup and they wind up getting more depressed, more anxious, calling us, emailing and we don’t have enough time in our daily schedule. I and many of my fellow therapists work late every day just to call back those of our patients who are the most distressed because we just can’t leave them hanging there with no answer between one day and the next.”
This is from Kostka’s speech at the NUHW’s rally in Sacramento. NUHW members have been picketing Kaiser medical centers and clinics throughout Northern California. They’ve held rallies in Santa Rosa and Sacramento, as well as a Labor Day rally at Kaiser’s flagship medical center in Oakland.
It’s a cliché to say there is a mental healthcare crisis in this country; everyone from the President down has joined the chorus – depression, anxiety, addiction, suicide, something has to be done.
The difference here is that these strikers are doing something about it, and to their credit, virtually every mental health care advocate in California has come out in support of the strike, as has the San Francisco Central Labor Council and an array of unions. The Massachusetts Nurses Association sent $25,000.
The San Francisco Board of Supervisors, meeting Tuesday, September 27, held a hearing on the strike. Kaiser stayed away, leaving NUHW members Kaiser parents, family members and others to turn the hearing into the next best thing to a strike support rally.
“I am, literally sitting here trying to contain my rage after everything I’ve just heard,” said Supervisor Catherine Stephani. It is way past time that mental health care must be treated the same as physical health care.”
Supervisor Hilary Ronen, who called the hearing, scolded the absent Kaiser. “If you had showed up, you would have heard that your employees spend a significant amount of time apologizing to their patients for you. (Chronicle 9/27)
Supervisors were also dismayed to learn that Kaiser continues to defy regulations of all kinds, including, the State Senates law SB221, sponsored by NUHW, which requires HMOs like Kaiser to provide follow-up mental health care appointments within 10 business days if recommended by a therapist. Its purpose was to put some teeth into existing legislation.
Speaking on the picket line, Sabrina Chaumette, a steward at Kaiser’s flagship Oakland medical center, spoke in support of the patients:
“If this were a war, which I feel it is, this is what is considered collateral damage, they can afford to lose the ones with mental illness.”
“During the pandemic, we have had losses on a number of different fronts. People suffered all at once. Consider this like the great depression, people suffered illness, death, job loss, learning that millions of people had died from COVID or long Covid. They suffered isolation, loss of community, loss of purpose, loss of meaningful work, loss of housing. Substance abuse use went up, as people tried to survive and cope. Rates of suicide went up; rates of depression went up, anxiety went up, especially social anxiety. Imagine being home for three years and somebody tells you gotta get out of the house. So social anxiety went up and so did suicide.”
Readers here will know that Kaiser Permanente is a behemoth amongst this country’s corporate, “not for profit” health care providers, with 39 hospitals and 700 medical facilities, and 9.4 million “members” who pay for Kaiser’s services. It’s net worth in 2021 was $43.3 billion Its CEO Greg Adams received $17.3 million in total compensation in 2020. He and the top 100 executives have the benefit of eight separate retirement plans.
The NUHW represents 2000 Northern California mental health technicians, and clinicians (psychologists, social workers, psychiatric nurses and chemical dependency counselors). They have been bargaining with Kaiser since July.
So, in the face of all this, Kaiser is defiant; it denies its obligations to its patients, to its workers, to the public and the law. It attends bargaining sessions (most of the time) but rarely offers anything for discussion. It will talk money, but it insists that SB 221 (which it is out of compliance) and anything related to staffing and work load is off limits. Management rights. It says it will talk about money but nothing else. To make the position clear, the strikers responded to the offer of a raise. On Saturday, September 18, their opposition was overwhelming. The no vote was 1349 to 222 to continue the strike.
I might add here, Kaiser has consistently played hard ball (and worse) with NUHW – clearly apparent in comparison with any of the other half dozen unions that represent Kaiser workers. This is a fight going on now for the best part of ten years.
First, certainly, NUHW is a union that is present on the “shop [hospital] floor,” that fights for its members, that doesn’t do concessions.
Second, NUHW’s Kaiser’s workers have steadfastly refused to give up their watchdog role – their responsibility to their patients and to the community; they consistently rejected Kaiser’s insistence on “gag rules” imposed in contracts and elsewhere. Why? The union and its members have from the beginning joined other mental health campaigners in advocating for patients and in exposing Kaiser’s negligence, while calling for parity with medical health care and supporting the rights of mental health care patients.
Still, all that said, here in California, as elsewhere, there’s the bottom line. And while Kaiser is a pacesetter, it’s far from alone. In denying its members mental health care services that they’ve paid for, it’s just a leader of the pack. See for example, a New York Times feature, “Profits over Patients,” a report focused on the Washington State giant, Providence Health Care, about how on the medical side, patients are denied entitlements, billed in defiance of existing regulations, then, when these bills are not paid, sends them into collection, well knowing what this means to working class people and their credit scores. They Were Entitled to Free Care. Hospitals Hounded Them to Pay.
Kaiser’s workforce is represented by half a dozen unions, service workers, nurses, engineers, northern, southern, separate negotiations for each. There’s no doubt Kaiser likes it this way. So, in the long run here may lie the key. Here’s the voice of an Emergency Department nurse from Kaiser’s Santa Rosa medical center. He and the nurses in his department took their lunch break on the Santa Rosa picket line.
“I’ve worked here in the Emergency Department for five years. I’d just like to say that I think this strike is a righteous strike and what you guys are doing is fantastic and I can’t wait to join you guys out here soon. We continuously see patients come in with the same triage note. ‘I had an appointment made for me in three weeks and I’m in crisis right now and I need to see a therapist’ and instead of getting that opportunity people are making attempts on their lives and then coming to the emergency room and then sit in a box. It’s not therapeutic and it’s disgusting and Kaiser needs to do better and so I really appreciate the sacrifice you’re making here today and again can’t wait to join you out here when we get on strike as well when we can combine and put the hurt on them.”
And that’s the point, isn’t it? “Combine.” Or, solidarity. If, indeed, we are experiencing a new awakening of labor, if this is to be a “striketober,” then let’s hope that Kaiser’s other workers are awakened from their slumber, there’s much to be gained, not so much to lose. “I’d rather leave Kaiser altogether than go back to work with a contract that forces us to break the law,” said Ilana Marcucci-Morris, a therapist for Kaiser in Oakland. “It’s time for Kaiser to get serious about mental health care so we can get back to work serving our community and providing patients with the care they need.”
In the meantime, NUHW doesn’t plan on losing. I spoke to Sophia Mendoza, NUHW’s Secretary-Treasurer, on the picket line in Santa Rose. She put the strike into the big picture, the COVID catastrophe, a broken healthcare system, big pharma, the insurance racket, the hospital chains, the bottom line, profits, first., “It’s all got to go.” NUHW, it goes without saying, supports a single-payer system, it has from the beginning.
“We’ve been fighting Kaiser for ten years. We know what to expect. We’re part of a movement whose time has come, they’d better figure this out. If they won’t collaborate with us, everything will just get worse. Clinicians are already leaving. That’s the future. No one’s going to want to work at Kaiser.”
How you can help
A note from the union: We know Kaiser’s playbook: Cancel thousands of appointments, make patients suffer, blame the therapists, and reject every proposal therapists make to improve care.
Here’s how you can make Kaiser finally prioritize mental health care:
- Follow and share our fight on Twitter, Facebook and Instagram.
- Join therapists on the picket line:
- Don’t let Kaiser get away with canceling appointments. Kaiser is required by law to provide the same level of care during a strike no matter how much it costs them.
- Donate to the strike fund. Donate to the NUHW Strike Fund - National Union of Healthcare Workers
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There's no actual consequences to sb221. That's an impossible standard to meet anywhere.
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Where are you seeing that? From what I am reading the consequences are $25,000 per violation.
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If it is so impossible to meet, then Kaiser should be arguing that in court, not just violating it as they are doing now.
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Considering the general failure of federal and state parity laws, they will argue this in court, and I suspect that they will win, or at worst settle for an amount that they consider as a normal part of doing business.
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The fines are not stated in SB221 language. The fine was $2500 max per violation. SB858, signed into on 9/30/22 increases the maximum penalty to $25000 per violation. It goes into effect 1/1/2024. However, no one has audited KP yet. So, I imagine it will take several years before the changes come.
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Sanman
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It is not impossible to meet. It is simply a question of how much money it would take.
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Ironically, it may be tough for Kaiser to meet since they have fouled the waters with their bad behavior so much that almost no mental health providers want to work for them.
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That is their problem, though money can repair a lot relationships. It can also bring in therapists from out of state if there is a significant income disparity due to the law. It may also lead KP to shut down MH services altogether. You can bet that they will run the numbers and do what is cheapest for them.
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If anything, it will likely be a viable legal defense if they can make a case for undue burden.
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Perhaps. There is a loophole in SB221 as well that the standard of care can be greater than 10 days if agreed to by the patient's provider. I imagine some providers can be incentivized to do this.
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Agreed. There are probably lots of ways around it. Offer group therapy, offer case management, make external referrals for everyone and eliminate non-medical internal psychosocial services altogether, etc... To be honest, this may be a situation where mid-level hiring explodes comparatively to psychologists. Since it all comes down to $.
For those in the VA, wondering how similar this is to the VA choice situation when that was developed.
For those in the VA, wondering how similar this is to the VA choice situation when that was developed.
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Yeah, that worked out great. Now veterans can choose how they wait months for care. 3 months for VA care, 6+ months for community care, or 6+months for community care then give up and wait 3 months for VA care.
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Considering the past hassles community providers had in eventually getting paid in the Choice program, I wouldn't sign up for it as a provider unless they streamlines the process and upped the compensation. But yeah, community waitlist times for neuropsych have always WAY longer outside of the VA then internally where I've been.
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Eh, my dad spent his career working for two absolutely massive international conglomerates, and he said the sheer amount of executive BS from the highest reaches could be mind blowing. One moved all the company-level upper leadership around to different companies every 3-5 years to avoid having to hold any of them accountable, for example. And the CEO salaries were over $10 million, so it’s not like they were coming cheap.
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But how could they ever survive on such merger wages? /s
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Or get referred to a community provider that doesn't actually offer the service the VA is requesting (we get that all of the time with full model DBT; patients often end up seeing someone who claims to be trained in DBT but doesn't actually offer full model).
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I used to see that pretty frequently for neuropsych as well, at least until they made the neuropsych community care consults separate and more obvious. The patient would be referred for therapy (often to a masters-level provider) despite the consult stating, in all caps, NEUROPSYCHOLOGICAL EVALUATION. I'd try to catch the consults and check in with the admin person handling the case to point out the error, but I know there were many that slipped through. Often the patient would be sent to the community provider, would be told that said provider doesn't do neuropsych, and would then have to come back to VA and reschedule in the community...meaning they'd end up back on the waitlist for the new provider.
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I once referred out for specialty therapy/CBT for erectile dysfunction (I think there was some contraindication or maybe it was patient reluctance to use meds for the issue) such as sensate focus or some specific behavioral treatment by a mental health professional specializing in treating sexual performance issues. What the veteran actually got was a referral to a very poorly and generically trained non-doctoral therapist who was--unsurprisingly--self-described as a specialist in essentially everything, including--of course--treating sexual disorders. She encouraged him to talk about his feelings and meditate. I mean...not necessarily BAD advice, but not what I was looking for either.
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Side note, but this is my experience with the extent of training rigor and practice of most mid-levels I am around in my clinical work and it frustrates me to no end.
Edit: But I will 100% take this over the one's who treat patient's based on their personal n=1 experience of having themselves the said disorders they are also treating patients for and using that to guide care.
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