The largest health care strike in U.S. history is underway, with more than 75,000 health care workers striking across the Kaiser Permanente (KP) system and spanning five states—California, Oregon, Washington, Colorado, Virginia, and Washington, D.C. KP is the largest nonprofit health system in the country and this strike includes a wide range of health care workers—such as emergency medical technicians, nursing assistants, pharmacists, sanitation workers, and others. It does not include managers, nurses or physicians.

KP workers are striking primarily because of claims of unfair labor practices and unsustainable staffing shortages that they argue are bad for patient care. The COVID-19 pandemic contributed to a mass exodus of staff from KP and the unions are asking for better wages to attract workers to replace those that have left. Workers argue that wages remain unfairly low, and that the workloads for those employees who have stayed in the KP system have also grown unsustainable. Workers are feeling overwhelmed and burned out by the higher volume of patients, which generates concern among workers about patient access and outcomes as well.

While this specific strike is historic, and KP is in many ways unique because of its history and integrated insurer/delivery system payment model, the labor issues that KP is facing are not isolated and relate to the broader pain points in our health care system that are contributing to health care worker burnout and worker turnover. The Cornell labor action tracker shows that the number of strikes in the health care sector has increased over the last few years. There were thirty-nine strikes in 2022, an increase from thirty-three in 2021, and as of October 1, thirty-one strikes had already occurred in 2023; and now, KP’s immense strike makes that thirty-two.

The concerns uplifted by unions as the reason for this KP strike cannot be viewed in a vacuum. Instead, they must be understood as symptoms of a larger issue: the incentives underlying the U.S. health care system are designed to produce exactly the current situation—workers and patients taking a back seat to corporate financial profits and power. Health outcomes and health equity are suffering as a result. On the other hand, if the health care workers’ demands on staffing are achieved, they will directly benefit patients.

Financial incentives put profits ahead of workers and patients

Increased consolidation and corporatization among health care providers is creating the financial incentives that are contributing to many of the challenges in the health care system today. A growing number of hospitals and provider practices are owned by a decreasing number of larger systems. In the 1980s, only 12 percent of hospitals were owned by national chains. Today, a majority of hospitals are owned by a few major systems, including nonprofit systems but also corporate conglomerates such as HCA and Tenet. In such an environment, owners of health care systems are motivated by an interest in spreading financial risk across a larger network, increasing negotiating power with payers and influence over regulators, and also gaining leverage as their competitors also increase in size and market share.

The current squeeze and stress on health care workers was not caused by the COVID-19 pandemic, but the pandemic certainly didn’t help. It increased financial strain on systems, especially in the early days, when more lucrative procedures such as elective surgery were stopped to shift all resources to the public health emergency. COVID-19 also added additional stress to health care workers because of safety concerns and a feeling that their health and well-being was unimportant to their employer. This was especially felt by lower-wage frontline health care workers, many of whom are women and people of color. Studies show that lower-wage health care workers, such as nursing assistants, are leaving the profession at higher rates than before the pandemic, causing labor shortages and heavy workloads for the remaining staff, consequently impacting the quality of care and clinicians’ ability to build meaningful and trusting relationships with patients. Meanwhile, the chasm between hospital CEO and worker pay is growing ever-larger, especially for the largest health care systems.

This consolidated, corporatized environment has contributed to increased health care costs, poorer access to care, worse patient experiences and safety, and worse overall outcomes. Health care systems right now are incentivized to grow their power and market share by increasing revenue and decreasing costs, all of which has negative impacts on patients and workers. Part of how system owners reduce costs is by squeezing labor—lowering wages for workers, and reducing worker/patient ratios, which contributes to workforce burnout, stress, turnover, and staffing shortages. The U.S. Surgeon General has called attention to this issue saying that when health care workers are burned out, the result can be patients getting less time with their providers, delays in care and diagnosis, lower quality of care, an increase in medical errors, and increased care disparities.

KP is unique in many ways, but not in their burned-out workforce

While KP prides itself on its unique model, the system is not immune from the currents underlying our health care system that have contributed to worker burnout, stress, turnover, and shortages. In fact, KP acquired Geisinger—a non-unionized health system—earlier this year to form a new organization, and there is some speculation that this move greatly damaged the management/labor partnership that had long led to stable worker/management relations at KP. Another challenge to the recent stability has been the change in leadership since KP CEO Bernard Tyson died in 2019. Since that time, KP has developed more of a traditional corporate focus. And with that focus, union officials say, KP has become less dedicated to ensuring a successful partnership with its unions and workers, less generous on raises, and more concerned about increasing its operating margins.

Patients will suffer during a health care strike and it will be important to reach resolution, but they are also suffering because of the trends that have led us to these labor disputes. Resolving these issues requires more than a contractual agreement between management and workers in one system. It requires bigger changes to address the pain points underlying the financial incentives of the system overall.