DON GONYEA, HOST:
Tens of thousands of health care workers from one of the nation's largest medical providers wrapped up a scheduled five-day strike this morning. Kaiser Permanente employees in California, Hawaii and Oregon walked out in protest over what they say are staffing shortages, as well as over pay and benefits. The company said it had been negotiating in good faith with the union since May and offered to increase wages by more than 20% over four years.
Joining us now to talk about the significance of this strike is John August. He's the director of health care and partner programs at Cornell University's School of Industrial and Labor Relations. Thanks for being here.
JOHN AUGUST: Oh, it's a pleasure. Thank you.
GONYEA: We should note that in a previous life, you were director of the Coalition of Labor Unions at Kaiser Permanente. That was from 2006 to 2013. So with all that as background, how do you view this strike?
AUGUST: Well, I see it as a part of a trend in the country. What we've seen is that in health care in the last three years, we've seen more strikes than there were in the last 20. And many people tend to attribute that to the effects of the pandemic, which took a tremendous toll on health care workers, and, of course, the kind of unprecedented inflation that people of this generation experienced, you know, right after the pandemic.
GONYEA: We should note here that this strike was always scheduled to end this morning, deal or no deal. Can you just explain how that works?
AUGUST: Sure. My experience has been, frankly, over the last couple of decades, that most of the strikes begin as limited actions as a way of showing unity, showing strength, but at the same time not having it be overly elongated to, you know, really jeopardize patient care.
GONYEA: OK. And you said we are seeing more health care workers striking.
AUGUST: Definitely. As I said, you know, the post-pandemic stressors and reality of many people leaving health care as a result of the pandemic, on top of inflation, you know, has created, I think, a tremendous amount of anxiety among health care workers. But I also want to share that I think there are some very significant systemic problems that are really at the root causes that go beyond those two things that are rather obvious.
There's been a tremendous consolidation of power in the industry, meaning less and less community hospitals, less and less rural hospitals, more and more consolidation, which has led to a centralization of decision-making, often seen as very far away from the realities of the front line. We've seen tremendous and ongoing workforce shortages so that staffing becomes an issue even, I think, when management are doing the best they can to provide staffing. In many professions, there just are not enough people to go around.
GONYEA: In terms of staffing levels, California, for example, does set minimum legal requirements for care-to-patient ratios. And Kaiser Permanente says they're following or even going beyond those guidelines. How do you respond to that?
AUGUST: Well, I think that the staffing ratio law in California, which has now been in effect for a couple of decades, has actually worked pretty well. I think that the problem is that you have a continuous aging out of the nursing workforce. This was something that was predicted 20 years ago, that by this time, we were going to see an aging out. And it's taking a long time to replace the registered nurses, you know, who have been in the system for a long time. From my observation, I do not think that Kaiser Permanente, you know, consciously understaffs. I don't think that's the issue. I think it's more a problem of really being able to recruit people in this time of substantial vacancies.
GONYEA: I live in Detroit, which is, you know, a center of old-school union activity - autoworkers, teamsters, electricians, you name it. But what you're describing feels more like the modern face of labor unions and union organizing in this country. Would you agree?
AUGUST: Certainly. I think there's tremendous similarity, and I think it's this - that we saw the auto industry, for example, lose its market share. General Motors went from 50% market share in 1950, you know, to 20% 30, 40 years later. How is that possible? A lot of it has to do, I think, with a inability on the part of our manufacturing sector during that period to innovate and look ahead to technology, competition, work systems and so on. I think we're facing a similar problem in health care, so that while the times may be different and the workforce may be very different, what I'm very concerned about is that rising costs, workforce shortages, increased technology and, in many ways, broken reimbursement and financial systems - I think that we may be headed for a similar crisis.
GONYEA: That's John August, director of health care and partner programs at Cornell University's School of Industrial and Labor Relations. John, thanks for being here.
AUGUST: Thank you very much.
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