This article is published in partnership with the Center for Media and Democracy.

Forty-five thousand workers at Kaiser Permanente—ranging from nurses to therapists to pharmacists—are on strike across the West Coast and Hawaii, in the country’s largest labor action of 2025, and the largest strike in the U.S. since the October 2024 longshore workers strike. The five-day limited-duration strike comes as workers continue to face major short staffing and wage increases that have lagged behind inflation in some of the country’s highest-cost-of-living areas.

Kaiser Permanente is an Oakland, California–headquartered integrated health care giant, with 300,000 employees, and a long track record of heavy union activity. While Kaiser is ostensibly a nonprofit, it in many ways acts like a for-profit—its physicians groups are for-profit entities, the Board of Directors is for the most part composed of people from the private sector, and the system’s executive compensation more resembles the private sector.

Kaiser CEO Greg Adams made nearly $13 million in 2023. Kaiser spent more than $72 million on total compensation for senior executives that year, with 12 executives besides Adams making over $2 million per year, and three besides Adams making over $4 million per year.

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Kaiser’s care model has been celebrated for decades, and indeed, compared to UnitedHealth or the Hospital Corporation of America, Kaiser is a far better framework for health care delivery. Workers are striking not to upend the Kaiser model, they say, but to protect it against an encroaching for-profit orientation in health care and a national political environment that is utterly hostile to an ethos of patients before profits.

Kaiser has claimed that “the additional wage costs of the unions’ demands would mean that more rate increases for Kaiser Permanente members and customers will be unavoidable.” But Kaiser’s own claims about its finances and ability to afford the cost of the strike raise questions—Kaiser concedes that the unions and management are just $300 million annually apart at most in negotiations, and the company is sitting on $67.4 billion in reserves, up from $40 billion just four years ago. Kaiser recorded $5.5 billion in gains from investments, operating income, and other income in 2024, with $569 million of that in operating income.

“We asked Kaiser to increase our pay by 5 percent during COVID,” Liz Hernandez, a cath lab nurse at Kaiser Fontana outside of Los Angeles, told the Center for Media and Democracy (CMD), and Kaiser declined, saying that negotiations would need to wait until the next contract. “Inflation started going up. We stayed stagnant. In 2020, without hesitation, I spent $36,000 on high-quality N95 gel masks, so when Kaiser said no to increasing our pay back then it was like a slap in the face. We have sacrificed so much of our short lives for them on the front lines. It’s time for us as nurses to stand firm and say, ‘We’re the ones providing high-quality care, making you look good. You are what you are because of us.’”

Unions on strike include the United Nurses Associations of California/Union of Health Care Professionals–AFSCME (UNAC/UHCP); the Oregon Federation of Nurses and Health Professionals–AFT; United Steelworkers; and UNITE HERE.

Due to the size of the strike—impacting the care of as many as 12.6 million people—it has garnered extensive media coverage. Yet Kaiser’s claim that it will need to increase prices has gone unchallenged in the media.

A CMD analysis shows:

  • From December 31, 2023, to June 30, 2025, Kaiser pumped an additional $1.1 billion into hedge funds (which it refers to as “absolute return”) and an additional $1.9 billion into private equity from its $67.4 billion investment portfolio. Hedge funds have been panned by the likes of Warren Buffett as failing to deliver promised returns, and private equity suffers from major transparency issues and high fees. The University of California, citing those concerns, divested from hedge funds earlier this year. The new investments raise questions about Kaiser’s commitment to prioritizing care over money, given the problems inherent in hedge funds and private equity.

  • From 2019 to 2023 (the most recent year for which information is available), Kaiser nearly doubled its spending on outside staffing firms, from $600 million to $1.1 billion.

  • Kaiser provides first-class airfare to its senior executives and Board members, despite being a nonprofit exempt from income tax. It also provides airfare in certain cases to “companions” of senior executives and Board members.

The Center for Media and Democracy asked Kaiser for comment on the above, and did not receive a response as of press time.

Steve Bazan, a nurse anesthetist based in Hawaii, said that Kaiser’s executive leadership has adopted a for-profit mentality, but is not being supportive of its workers. Reinvesting its reserves into the labor force will pay dividends, he said. “We are what makes Kaiser successful and we will continue to make Kaiser successful if they come to the table and bargain in good faith.” Bazan also pointed out that wages for health care workers in Hawaii are 20 to 30 percent below levels on the mainland.

“We’ve accepted the status quo for so long, but people are fed up,” he said. “Health care professionals go into the medical field to care for people in their community. The corporate machine has made it very difficult for people to do that. Because of that, it moves the focus away from what really matters, which is the patients. I enjoy working for Kaiser, I believe in the system, but they need to step up their game and invest in their people.”

Jane Carter, the research director at UNAC/UHCP, underscored that Kaiser had practices that on the whole were far better than other health care systems. Kaiser operates on a close labor-management partnership model, and adopts a neutral position toward unions seeking to organize in their system.

“Kaiser is truly the best health care delivery model in the U.S.,” said Carter. “The emphasis has been on partnership, but it has turned much more into a profit-driven model. The health care delivery model of Kaiser—integrated care with a strong social justice orientation and labor-management partnership—is what we should strive for.”

But beyond the economic justice issues in the strike, Carter pointed out, is anti-union animus on the part of current management. “We have organized three new bargaining units, physician assistants, nurse practitioners, nurse midwives, nurse anesthetists—and in their proposals to us in bargaining, Kaiser is trying to take away benefits and wages that workers already have. In effect, they’re punishing workers for joining a union,” she said.

Carter pointed out that Kaiser has reaped enormous profits since the pandemic. “In four years’ time they’ve amassed more than $20 billion in sheer profits. How did they get that profit? It’s because our members were paid so insignificantly to give them these profits.”

Carter ascribed the anti-union attitude to members of the Board, some of whom have repeated anti-union talking points to UNAC members, and an overall Board composition that is weighted towards private business interests. (Board members’ business interests include major venture capital firm Bessemer Venture Partners and private equity firm TowerBrook Capital Partners.)

Carter pointed out that the CEO used to be a nurse, and that as a result, her analysis is that it is unlikely that any anti-union push is coming directly from him: “He’s held the hands of dying patients, and been at the bedside, so I would hope that in his capacity as a nurse he would stand up for people still at the bedside.”

“Kaiser Permanente is a gold standard of health care delivery,” Carter concluded. “The problem is that it’s turned into a for-profit machine instead of [staying true to] its origins.”