Ten years ago, the National Union of Healthcare Workers (NUHW) held its founding convention in San Francisco. Seven hundred workers met the morning of April 25, 2009, gathering in the magnificent Everett Middle School in the Mission District. Angela Glasper, a Kaiser Permanente steward, opened the meeting and set the tone, insisting that “workers must make all the important decisions” in an organization in which power must flow “from the bottom up.” Mike Casey, President of UNITE HERE, the nation’s hospitality workers’ union, local 2, San Francisco, called on workers to “stand up” and asserted that “this is our generation’s chance to make labor relevant – or be consigned to the dust bin.” Sal Rosselli, interim President of the new union, outlined a two-year perspective, a “foundation” for growth based on organizing committees in the workplace.
The enthusiasm that morning was evident to all. What was not so clear was the immediate future. The new union, with little more than an inspired membership, faced not just the challenges of any new organization, but ongoing “war” declared by the nation’s largest union, the Service Employees International Union (SEIU). In late 2009, the SEIU, led by current president Mary Kay Henry and her Ivy League accomplice, Dave Regan, trusteed California’s 150,000 strong healthcare workers union, United Healthcare Workers – West (UHW). Citing an array of alleged misbehaviors. SEIU fired UHW officers, seized the union’s assets, and launched a legal assault on its leaders. It did this with the implicit support of Kaiser Permanente, the nation’s largest not-for-profit healthcare provider. UHW was then SEIU’s California flagship affiliate, representing 50,000 Kaiser technical and service workers – in addition to tens of thousands of others: hospital workers, nursing home staff and home healthcare workers. The consequences of this tragic intervention were deep; tragically, they remain with us.
Still it is not often that it can be truthfully reported that Goliath has been slain, but here indeed it has. This week NUHW celebrates its tenth year as a vibrant, growing, democratic, fighting organization, a model union for the twenty-first century. UHW has faded into near obscurity. The fight with Kaiser, however, continues; here NUHW members find themselves not just fighting for a new contract, but on the front lines of the movement for health care reform in California. This battle today is about timely access to mental health treatment. NUHW is joined in it by the “the community;” NUHW is fusing the interests of its members with those of thousands of Kaiser “members” – above all those seeking timely mental health care. They are joined by advocates of mental healthcare reform, as well as leaders in an impatient movement for real healthcare reform.
Bargaining, begun in July 2018, is now stalled. In response, therapists at Kaiser’s Pasadena clinic stuck on April 25 – a one-day strike protesting delays of up to four month’s-time for initial treatment (following “intake” sessions). At the same time, NUHW is preparing for an open-ended strike at all Kaiser mental health facilities. NUHW professionals – councilors, therapists, social workers, etc., intend to force Kaiser live up to its promises – mental health care parity – and to staff its hospitals and clinics appropriately. This will not be the first NUHW strike at Kaiser. In 2015, these workers walked picket lines five times; among their slogans, “No More Suicides!” They pushed Kaiser back and won their first contract. Importantly, they elicited from Kaiser its now broken promises for mental health care reforms, including appropriate staffing and access. Kaiser, flush with cash – $28 billion in reserves – refuses to do this. The result, according to NUHW President Sal Rosselli, is that “access to care has actually gotten worse.” He cites cases where Kaiser refuses to provide timely diagnostic assessment for new patients with conditions that include depression, bi-polar disorder and schizophrenia. Kaiser’s mental health failures lead to real life tragedies, says Rosselli. On April 17, Kaiser patients, including those who have lost loved ones to suicide, joined Kaiser workers, gathering in protest outside the corporate headquarters in Oakland.
NUHW today represents healthcare workers from Eureka to San Diego. Its members have won contracts in a long list of hospitals and clinics and nursing homes, including: California Pacific Medical Center in San Francisco, Oakland Children’s Hospital, Salinas Valley Memorial, San Francisco Nursing homes, St Joseph’s Tarzana, Kaiser Psych-Social, University of Southern California Keck, Dominican Hospital of Santa Cruz, Fountain Grove Hospital of Fountain Valley, Kindred Bay Area, Kindred San Diego, Kindred Orange County, Richmond Area Multi-services, Kaiser Optical, Elk Grove Unified School District, in Elk Grove, Mission Neighborhood Health Center in San Francisco. These results have been achieved in sharp contrast to the union’s competitors. More, they have been achieved in the face of hostile managements. NUHW members have received and withstood threats, false promises, transfers, retaliation, terminations. The healthcare system in the US today is far from union friendly. NUHW members’ employers include many of this country’s richest corporations, profit and non-profit, virtually all deeply anti-union. They workers have opposed them with rallies, picket lines, strikes and solidarity, and they have won. Moreover, they win good contracts, with improvements in wages and benefits, standing up as well to the industry’s never-ending demands for concessions, cut-backs and giveaways of all kinds.
The NUHW at Kaiser is central in this story, but it started out badly. The newborn NUHW lost representation elections for service and tech workers at the giant provider. SEIU defeated NUHW in the 2010 election, only to have the results thrown out. In July 2011, NLRB Judge Lana H. Parke ruled that SEIU had “interfered with unit employee’s free and uncoerced choice in the election” and ordered another one. SEIU, with its enormous resources – financial, full-time staff, house lawyers – responded with legal maneuvering and long delays, as well as smears, lies, and thuggery. Andy Stern, then President of SEIU, now a consultant of corporations, branded NUHW as “strike happy”, even, incredibly, as “terrorists.” Randy Shaw, writing in BeyondChron, estimated that SEIU may have spent as much as $40 million on the election, one of the costliest (per voter) in US history. Moreover, in this, it became clear, Kaiser colluded with SEIU – for example, it withheld negotiated pay raises for NUHW members in Southern California, allowing UHW to claim, “Vote NUHW and lose your wages.” In many ways, the election was lost before the voting began. Still, NUHW received tens of thousands of votes in these elections. This was impressive indeed for a new union denigrated as strike happy, but not good news, alas, for Kaiser’s workers, today still captive in SEIU’s company union.
The story, however, does not end there. In 2010, Kaiser’s 4000 professionals, defying these odds, voted to join NUHW and stand up to Kaiser. The therapists and social workers, dieticians and counselors, expecting a decent contract, instead received collective punishment. There followed years of fruitless negotiations, with Kaiser demanding concessions in health benefits, pensions, and staffing. These were demands Kaiser knew would be rejected, which they steadfastly were. One central issue in this dispute involved staffing and access. Clem Papazian, a therapist at Kaiser’s Oakland Medical Center, explained that Kaiser “systematically” refused to bring mental health care up to parity with medical provision. “There just aren’t enough of us to do the work. There is a cascading effect. If a struggling patient can see a therapist clinician regularly, he/she might not become so desperate. When routine issues go untreated, they become more acute. When more and more people are prevented from receiving timely routine care, the system gets overwhelmed. One result is suicides.”
There were the suicides. “We don’t have a system that allows the patient to connect with the caregiver, face-to-face, “ says Elizabeth White, a Licensed Clinical Social Worker at Kaiser’s West Los Angeles Medical. “Our work is often about life and death, mental suffering that is stigmatized and marginalized in our society. At a time of ever-increasing need to address mental health issues. It doesn’t have to be this way.”
NUHW initiated a campaign exposing the shocking shortcomings in mental health care delivery at Kaiser, welding their demands for staffing with the increasingly loud voices of Kaiser patients and mental health practitioners and others, advocates of parity in mental health care. This included publishing the path-breaking NUHW study, “Care Delayed, Care Denied.” Kaiser, unprepared, retreated, but stonewalled the therapists’ demands on every front, above all on decent staffing ratios, retaliating against critics and whistleblowers alike. The workers week long strike by 2,600 therapists in January 2015 was—at that point – the largest mental health workers strike in national history. This wasn’t NUMW’s first strike at Kaiser; for NUHW, the strike is just one weapon in its arsenal, to be used whenever necessary – not that is a one-off affair, or an act of desperation.
Kaiser blinked; stung by bad press, unable to replace the strikers, they surrendered. The therapists and social workers won. For Barry Kamil, a psychologist with 34 years’ experience at Kaiser in Richmond, California, “It [was] an historic victory. It puts our union in the forefront of the movement for getting mental health care on a par with medical care. Kaiser’s resistance has been unbelievable; they wanted to eliminate us as a union.” The Kaiser workers won on economic demands as well; 6 percent the first year, 4.5 percent plus bonuses in the second and third years of a three-year contract. They protected their pension benefits; as Kaiser—what’s new—had proposed erasing their defined benefit plan. That contract, their first contract, was the culmination of a five-year fight. The Kaiser victory stabilized the NUHW, strengthened its financial base, and set the stage for the battles to come. It maintained the union’s foothold at Kaiser; more importantly, it revealed for all to see that healthcare workers can win. “ I believe workers want unions,” says Rosselli. “The primary reason? They want representation. So, they call us. But, we ask, why us? there are lots of bigger unions around. The answer is almost always the same. They want a union where they make the decisions, a union that helps them help themselves, a union where they decide what they want. We get more calls than we can handle.”
Workers in the US today face powerful adversaries. The health care industry in California is no exception. It is dominated by giant corporations, bottom-line driven even when branded “not- for- profit.” Kaiser leads the way with 200,000 employees, and $80 billion in reserves in 2018. It’s CEO, Bernard Tyson, received $10 million in salary, plus multiple pensions. Sutter Health, the Northern California chain, has 24 hospitals, with 76,000 employees. St. Josephs of Southern California, now part of Seattle-based Providence-St. Joseph’s (the third largest US HMO), has 27 hospitals and 125,000 employees. Kindred, based in of Louisville, Ky, has 40,000 employees. Oakland Children’s is part of the University of California system. Keck is part of the University of Southern California. Nursing homes are not different. Seventy-five percent are in for-profit chains. One, the Brius chain, owned by the high-flying Zionist, Republican billionaire and philanthropist Shlomo Rechnitz, owns 80 facilities, that is, one in fourteen beds in California nursing homes. His homes have tripled state averages in deficiencies, though these are not uncommon in this industry.
NUHW represents workers in all these sites – overwhelmingly service and technical workers and nursing assistants, but also nurses and other professionals. They have won these members in an industry where SEIU is still the largest union– but where the American Federation of State County and Municipal Employees (AFSME) and the United Food and Commercial workers (UCFW) as well as Teamsters and local, independent unions also represent healthcare workers. In the past five years NUHW has doubled its size, now representing more than 15,000 workers statewide in about forty bargaining units, independent of any national labor union. It is the only healthcare union showing such growth; it is the only such organization continuously in the headlines here in California. The union is widely known for its militant contract campaigns, and its involvement in progressive causes like Bernie Sanders’ 2016 presidential campaign, the on-going fight for single-payer healthcare, for migrant rights on the border, and for making the case for mental health parity.
The basis for this is found in its perspective. In 2014, at its leadership conference in Oakland, the NUHW, the members passed this resolution: “WHEREAS, The National Union of Healthcare Workers (NUHW) was founded to ensure that workers are empowered in a member-led, democratic union that stands up both for workers and patients.”
This was expanded to include in detail the unions perspectives for both workers and patients. The union would “rededicate ourselves to democratic values”; in fact, there are regular elections at every level, shop steward to President. It emphasizes “transparency” in all our actions; bargaining is open, agreements need membership approval. The union “will develop leaders through training, mentorship and outreach”; win strong contracts with “high standards” for workers and patients; continuing to strategically organize non-union healthcare workers and other workers trapped in ineffective, undemocratic unions.
At the same time, the members pledged to “expose healthcare corporations for putting profits ahead of providing appropriate care for their patients; “dedicate ourselves to a watchdog role”, this at a time when employers increasingly demand loyalty oaths; work to improve patient care, benefitting workers and patients alike in increased staffing, improved access and higher quality patient care; expanding our influence by developing our political action program, educating our members on the role of politics in our work and on issues and candidates, and engaging our members in the political process; “supporting workers with any issues” that are widely and deeply felt within the membership.
“The 2014 NUHW Leadership Conference will strive to build the model union.” It might be noted here, that the NUHW has not invented the model union. Rather it builds upon the best in a long tradition of trade unionism in the San Francisco Bay Area; one that goes right back to the nation’s very first hospital union. San Francisco General was organized in the thirties in the heyday of the industrial union movement. NUHW’s long-term perspectives continue to include a national, industrial union of healthcare workers – a hospital today, with half a dozen unions, makes no more sense than an automobile plant with the same did in 1936.
The perspectives of NUHW, then, represent a bold challenge to both its members and their employers. It is not unusual, of course, to find fine sentiments in the constitutions and press releases of various unions. It is also not unusual, sad to say, to find unions that fail to live up to promises. Worse, there remain strong bastions of inertia, even corruption within the labor movement. These include the “business unions,” built upon hierarchy and secrecy, sweetheart and backdoor deals, class collaboration. It seems to me that the evidence suggests that since its birth, NUHW has become steadily more democratic, with more participation, winning better contracts, and committing itself ever more strongly to the needs of rank-and-file workers and patients alike.
Here are three examples:
“Outsourcing” today is a plague, undermining workers wherever it is found. Sodexo outsources. It provides services for employers and institutions, in this case hospitals, that are designed first and foremost to reduce costs. Sodexo is a giant, multinational corporation, with headquarters in France. It employs 420,000 workers in eighty countries – in the United States, 160,000 workers at 13,000 sites. They provide various services in California hospitals and nursing homes: cleaning, food services, security. Universally, they pay starvation wages, tenaciously resist unionization and undermine existing unions. Few companies have been so successful as Sodexo.
In early 2017, NUHW announced a campaign to “Lift Poverty Wages,” targeting Sodexo in Southern California and its employees at Orange County’s, scandal -ridden Tenet hospitals, a for-profit multinational chain based in Texas. The campaign included meetings, pickets and threatened strikes, but its January 2018 video shocked many in Orange County, raising the temperature considerably and attracting the press. Both the Orange County Register and the LA Times plus television news outlets contributed sympathetic reports. The video featured full-time Sodexo workers, all Latinas, collecting cans for recycling. “I collect cans because of the low wages Sodexo pays us,” says one worker. “I do it to make ends meet.” Another says, “I collect cans before and after work…all my co-workers do the same.” Sodexo workers at Tenet hired on at minimum wage, $10.50 in California; some worked up to $12. Many were forced to work sixteen-hour shifts. The movement quickly spread, with increasing militancy. Sodexo found itself confronting united workers – NUHW’s union workers at Tenet included – plus widespread support from the public; it capitulated. The result was raises of up to 40 percent by 2020, dramatic improvements in medical benefits and a three-year contract. NUHW now represents Sodexo workers in Orange County at Fountain Valley Region Hospital, Los Alamitos Medical Center and Lakewood Medical Center. And that’s not the end of the story. At the University of Southern California’s Keck Medical Center, Sodexo workers also signed up with the NUHW and won. It was, in fact, an astonishing win – wages increase of $3 an hour, free family healthcare coverage, plus a retirement package, and a free ride at USC for worker’s children accepted by the University. Then – “insourcing” – the workers are now employed by USC; Sodexo is gone, and the workers have a NUHW contract .
Children’s Hospital in Oakland is now part of the University of California San Francisco (UCSF). NUHW election victories, including finally the decertification of SEIU, mean that NUHW is all but wall-to-wall – the exception being nurses organized by the California Nurses Association (CNA). These victories include three hundred office and administrative workers, also technical workers -medical interpreters, respiratory therapists, radiologist technicians nursing assistants and maintenance workers. Finally, the hospital’s “professionals” have joined as well, psych and social workers, physical therapists and others. This totals 800 new NUHW members in two years. Children’s is now one of NUHW’s largest locals, its membership 1200 – it is also an important step forward in the face of UCSF’s threats to cut back services in the East Bay. It also expands NUHW’s base in mental health, one now going well-beyond Kaiser.
Beverly Griffith is the NUHW organizer at Children’s. She was a founder of the union. In 2009 she was working at Sutter Health in Oakland. As an activist there, she became a worker organizer for the new union and was fired for this – refusing to abide by management’s gag rules. Griffith’s sees the drive at Children’s to decertify SEIU and win NUHW recognition as the basis for today’s progress. “We fought SEIU in five decertification elections. It took six years to win . The elections were all close, we never gave up, but SEIU always had the lawyers and the law and the hospital on its side. But now we control the union. We have job security throughout, and it means we can do a lot more. I see my job as teaching, we want the new members to learn how to take care of themselves. We want them to become stewards, activists, and officers – it’s what we mean by empowerment.”
Psych-social at Kaiser continues to be a battle ground; past contracts are just that, past, never the last word. The issue, according to Jim Clifford, a psychiatric therapist at Kaiser San Diego (where he can “look out the window and see the border”) is that Kaiser refuses to keep up with the increase in patient rolls. “We’ve been bargaining since last July. We’ve made some progress, but patient access remains the sticking point. We struck statewide for five days in December. 4,000 of us. We had very high participation. Kaiser failed to replace us, even by bringing in non-licensed (illegal) replacements from out-of-state. We’ll see if Kaiser is really committed to working with us.” In the meantime, a super-majority of Kaiser members have signed onto a petition supporting an open-ended strike in May.
Ten years! April 25 was work-as-usual at NUHW, no champagne in the office, as far as I know. – but its achievements here have not gone unnoticed. Just this month, the Humboldt Del Norte Central Labor Council named NUHW, “Union of the Year” – “for its rallies protesting layoffs… and its town hall convening residents and civic leaders to consider the effects of Providence St, Josephs layoffs.” The Council “recognized the activity over the past year in fighting for patient safety We appreciate NUHW’s steadfast commitment to the community…and recognize the work NUHW has done in organizing non-union workers into the unionized workforces.” These sentiments come from California’s far north, but they can be found in healthcare workers and healthcare reform advocates throughout the state. In the far south, San Diego – the union’s members can be found helping migrants, papers or not. NUHW is a Sanctuary Union.
“It’s all a testament to our members,” says Dan Martin, the union’s Secretary Treasurer, “also of our staff and officers. They fought against truly great odds, not just to survive. They fought to flourish. They fought to be on the cutting edge of labor. They created a vision to do this – just look at our ranks in psych-social and their battle for access to mental health.” Martin was fired by SEIU ten years ago, but like the others SEIU sought to silence, firing them, forcing them out of the union – all good union women and men – he’s back. He and scores of others continue to work in the trenches of labor, in NUHW, in trade unions and in progressive organizations right across the country. They bring with them a deep tradition of struggle, and education in the real world, and a commitment to winning – a model worth celebrating and fighting for. Also, more Goliaths to slay.
Cal Winslow is Director of the Mendocino Institute. He is author of The Seattle General Strike, forthcoming (Monthly Review) and editor of a co- author of Albion’s Fatal Tree, editor of EP Thompson and the Making of the New Left, and, co- editor of Rebel Rank and File, Labor Militancy and the Revolt from Below during the Long 1970s. He lives with his family near Caspar on the Mendocino Coast. He can be reached at email@example.com