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Tens of thousands of nurses, pharmacists, physician assistants, therapists, and other healthcare professionals across the western United States are preparing to launch a five-day strike Tuesday against Kaiser Permanente. The walkout by 46,000 workers organized in the Alliance of Health Care Unions (AHCU) expresses the explosive anger of healthcare workers confronting intolerable conditions amid soaring corporate profits and social inequality.

The strike encompasses a wide range of essential personnel: registered nurses, nurse practitioners, midwives, anesthetists, pharmacists, rehabilitation and respiratory therapists, speech-language pathologists, dietitians, acupuncturists, surgical and laboratory technicians, and dozens of other specialists indispensable to modern hospital operations.

Their grievances are the same as healthcare workers across the US and the world, including chronic understaffing, unsafe patient-to-staff ratios, crushing workloads and wages that have fallen far behind inflation.

The very professionals hailed as “heroes” during the pandemic now confront layoffs, pay suppression, and burnout in a collapsing healthcare system.

Kaiser Permanente, a multibillion-dollar “nonprofit” giant, is responding with threats and intimidation. In mid-September, it laid off more than 200 workers across California, citing a need to “rebalance resources.” The cuts affected administrative, IT, and food services across 15 hospitals and clinics from Oakland to San Diego.

But the main obstacle to a real fight against Kaiser is not management alone but the union bureaucracy that collaborates with it. The AHCU, including the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP), has long enforced corporate dictates through joint programs such as the so-called “Labor Management Partnership” (LMP), created in 1997 to institutionalize cost-cutting under the guise of “cooperation.”

Facing mounting anger from the rank and file, the union bureaucracy sent a letter last week to Kaiser CEO Greg Adams declaring it was “pausing participation” in certain LMP activities. At the same time, it boasted that “after 28 years, the evidence is clear: Partnership has strengthened Kaiser’s performance in quality, affordability, safety, and patient satisfaction.”

This is an open admission of complicity. The “performance” strengthened was not that of workers or patients, but of exploitation and profit extraction. For decades, the union apparatus has functioned as a junior arm of management, suppressing strikes, policing dissent, and enforcing sellout contracts.

The clearest example came in 2021, when the AHCU abruptly canceled a planned walkout to ram through a rotten deal containing meaningless “staffing ratio” language and inadequate raises. That betrayal, justified as a step toward “labor peace,” only deepened the crisis now confronting 46,000 Kaiser workers.

The struggle by Kaiser workers unfolds amid a rapid escalation of the class struggle and the breakdown of democratic forms of rule in the United States. President Donald Trump is openly preparing to invoke dictatorial powers under the Insurrection Act. Under the guise of restoring “order” and defending “national security,” such measures are directed above all against the working class.

The shutdown of the federal government is already disrupting essential healthcare services, with Medicare and Medicaid telehealth appointments suspended. These interruptions, under conditions of mass poverty and aging, threaten the most vulnerable layers of the population. According to one study, Americans over 60 with low incomes die on average nine years earlier than their wealthier counterparts, a staggering expression of class inequality in life expectancy.

Trump’s fascistic government has launched a frontal assault on nutrition programs such as WIC, while his accomplice Robert F. Kennedy Jr. promotes anti-vax quackery. The deliberate aim of the administration is to lower life expectancy even further, redirected money they deem “wasted” on the sick and elderly towards Wall Street and the military.

California’s deepening nursing shortage underscores the irrationality of the for-profit healthcare system (Kaiser Permanente, officially a non-profit, reported a “net income” of 12.9 billion). The state faces a projected deficit of 60,000 nurses within a decade. They have been driven out of the field by overwork and poverty wages. Hospitals have deliberately understaffed units, closed facilities, and increased patient loads to the breaking point..

These conditions are the product of decades of bipartisan policy: the defunding of public health, privatization of hospitals, and funneling of pandemic relief into corporate hands. During COVID-19, Kaiser and other health giants received billions in government subsidies while workers labored without adequate protective gear, contracted the virus by the tens of thousands, and saw no improvement in wages or staffing.

Now, as inflation erodes living standards, these same corporations are demanding further “cost containment.” Both the Biden and Trump administrations have overseen the dismantling of pandemic-era safety nets, while the unions have ensured that no national mobilization of healthcare workers takes place.

The crisis at Kaiser parallels mounting opposition in the working class as a whole. But the bureaucracy is working might and main to prevent these struggles from expanding and developing into a broader fight against fascism and inequality. As the Kaiser strike begins, 3,200 Boeing defense workers have been on strike for more than 2 months at major plants in the heart of the defense industry. Teachers in cities across the state of California are working on expired contracts and pressing for strike action in the face of sabotage by the California Teachers Association, hypocritically keeping them on the job under a campaign they have named “We Can’t Wait.”

Pharmacy and grocery workers represented by the UFCW are also preparing strike action, but the union is seeking to limit it to a toothless “unfair labor practice.” Over the summer, the UFCW isolated and rammed through contracts for tens of thousands of grocery store workers across America who were pressing for strikes against poverty wages.

Kaiser workers must draw the lessons of these experiences. The fight for safe staffing, decent pay, science-based public health policies, and humane conditions cannot be waged through the corrupt AHCU, UNAC/UHCP, or UFCW apparatuses. It requires independent, rank-and-file organizations controlled by workers themselves. To win, Kaiser workers must take control of their struggle out of the hands of the union officials and into their own—through democratically elected rank-and-file committees in every hospital and clinic that unite all healthcare workers on the basis of their shared class interests.

The Kaiser Workers Rank-and-File Committee, which opposed the 2021 betrayal, must be the example for how to organize to coordinate action across the entire healthcare network. Such committees can link up with autoworkers, teachers, logistics workers, and others confronting the same corporate assault.

The fight at Kaiser is not just about one contract but about the future of healthcare and the defense of the most basic social rights against fascism. The right to high-quality, free medical care for all is incompatible with private profit.

The right to a secure job and decent living standards is incompatible with the domination of Wall Street. To defend these rights, workers must build rank-and-file committees, unite their struggles across industries and borders, and prepare a political fight against both corporate parties and their union accomplices. The power to transform society lies not in appeals to management or the Democrats, but in the collective strength and consciousness of the working class itself.

Fill out the form below for information on forming a rank-and-file committee.