Kaiser Permanente, which just narrowly averted one massive strike, is facing another one Monday.
The ongoing labor battles have undermined the health giant's once-golden reputation as a model of cost-effective care that caters to satisfied patients -- which it calls "members" -- and is exposing it to new scrutiny from politicians and health policy analysts.
As the labor disputes have played out loudly, ricocheting off the bargaining table and into the public realm, some critics believe that the nonprofit health system is becoming more like its for-profit counterparts and is no longer living up to its foundational ideals.
Compensation for Chief Executive Bernard Tyson topped $16 million in 2017, making him the highest-paid nonprofit health system executive in the nation. The organization also is building a $900-million flagship headquarters in Oakland. And it bid up to $295 million to become the Golden State Warriors' official healthcare provider, the San Francisco Chronicle reported. The deal gave the health system naming rights for the shopping and restaurant complex surrounding the team's new arena in San Francisco, which it has dubbed "Thrive City."
The organization reported $2.5 billion in net income in 2018, and its health plan sits on about $37.6 billion in reserves, which represent the value of its hospitals and hundreds of medical offices in California, plus the information technology they rely on.
Against that backdrop of wealth, more than 80,000 employees were poised to strike last month over salaries, retirement benefits and concerns over outsourcing and subcontracting. Nearly 4,000 members of its mental health staff in California are threatening to walk out Monday over the long wait times their patients face for appointments.
"Kaiser's primary mission, based on their nonprofit status, is to serve a charitable mission," said Ge Bai, associate professor of accounting and health policy at Johns Hopkins University. "The question is, do they need such an excessive, fancy flagship space? Or should they save money to help the poor and increase employee salaries?"
Lawmakers in California, Kaiser Permanente's home state, recently targeted it with a new financial transparency law aimed at determining why its premiums continue to increase.
There's a growing suspicion "that these nonprofit hospitals are not here purely for charitable missions, but instead are working to expand market share," Bai said.
The scrutiny marks a disorienting role reversal for Kaiser, an integrated system that acts as both health insurer and medical provider, serving 12.3 million patients and operating 39 hospitals across eight states and the District of Columbia. The bulk of its presence is in California. (Kaiser Health News is not affiliated with Kaiser Permanente.)