Seventy-five thousand health care workers at Kaiser Permanente, the largest nonprofit health care provider in the United States, are set to go on strike on Wednesday, October 4, after contract negotiations failed last week. The coalition of Kaiser Permanente Unions have accused Kaiser of negotiating in bad faith and committing unfair labor practices (ULPs). The strike, authorized early in September, will take place for three days at hundreds of Kaiser facilities across California, Colorado, Oregon, Washington, Virginia, and Washington, DC.

This is but one development amid the bustle of what promises to be the biggest year for labor activity in four decades, but its historic importance should still be appreciated. Not only will the Kaiser strike be the largest health care strike in American history, but should this limited ULP strike fail to convince Kaiser to negotiate in good faith, the ensuing open-ended strike would likely be a protracted battle over the future of health care provision in the United States.

The unions’ primary complaint in negotiations has been low staffing levels, which workers believe are hurting patients and employees alike. “We’ve repeatedly raised our concerns with Kaiser executives about the Kaiser short-staffing crisis, but they are bargaining in bad faith and refusing to listen to us,” said Audrey Cardenas Loera, a fees and benefits support specialist at Kaiser Permanente in Hillsboro, Oregon. In a recent survey of thirty-three thousand Kaiser employees, two-thirds of workers said they’d seen care delayed or denied due to short staffing.

“Kaiser executives refuse to acknowledge how much patient care has deteriorated or how much the frontline health care workforce and patients are suffering because of the Kaiser short-staffing crisis,” said Dave Regan, president of Service Employees International Union (SEIU)-United Healthcare Workers West (UHW), the largest union in the coalition.

The coalition is also asking for basic cost-of-living pay increases of 6.5 percent for the first two years of the contract and 5.75 percent for the next two. Kaiser has thus far only offered 4 percent for the first two years and 3 percent for the next two, and only in select regions. The company has also been trying to introduce a two-tiered wage system for some time now — a particularly insulting proposal given how such a system has roiled the auto industry, emerging as a central issue in the current United Auto Workers strike.

Meanwhile, Kaiser is reporting enormous profits recently, despite being a nonprofit, membership-based health care provider. According to the SEIU-UHW, it has reported more than $24 billion in profit over the last five years. In 2021, its CEO was compensated more than $16 million in 2021, and it has investments of $113 billion in industries ranging from fossil fuels to casinos to for-profit prisons. In addition, Kaiser’s nonprofit structure allows it to pay no income taxes on its earnings and extremely limited property taxes.

The strike begins tomorrow in a period of general labor unrest, particularly in the health care industry. Workers across eleven Tenet Healthcare facilities recently authorized an unfair labor practice strike, and they did the same at four Prime Healthcare facilities (the latter is set for October 9 to 13). Similar actions were taken against Fresenius Medical Care, Satellite Healthcare, and other health care corporations this fall.

The COVID-19 pandemic thrust an already embattled health care workforce onto the front lines of a global emergency, causing overwork and burnout from which the industry has not yet recovered. According to Megan Mayes, a patient care representative at a Kaiser facility in Hillsboro, Oregon, “We just saw a mass exodus in the health-care field.” The battle with Kaiser will produce the first large post-pandemic contract for health care workers and will dictate whether hospitals will continue to be dangerously stretched thin or will prioritize patient and employee well-being.