The Strike That Beat Austerity

With a strike, healthcare workers reverse privatization. DSA was with them all the way.


Socialists in the United States find ourselves back on the terrain of fighting against a neoliberal Democratic administration. But that doesn’t mean that working-class victories are off the table. When workers come together to walk off the job, they can force neoliberal politicians to back off from neoliberalism.

That’s what happened when public healthcare workers at Alameda Health System (AHS) in the San Francisco Bay Area went on strike in October. More than 3,000 workers from the AHS chapter of Service Employees (SEIU) Local 1021 — with almost wall-to-wall membership including nurses, food service workers, and clerks at eight campuses — joined with hundreds of nurses represented by the California Nurses Association (CNA) for a groundbreaking strike.

By withholding their labor, these public-sector workers created a political crisis that forced local Democrats to reverse an earlier privatization. They fired the unelected management of the health system and took steps towards a full public takeover. 

Rank-and-file-led organizing and strike support made this breakthrough possible. DSA members can learn from AHS workers how bottom-up workplace organizing can get the goods, despite the elected officials who stand in the way.

The Path to Privatization

In 1998, the Alameda County Board of Supervisors voted to give up democratic control of the county’s public health system, which comprised hospitals, clinics, and outpatient facilities for the poorest of the 1.4 million residents. Under the new model, an unelected Board of Trustees would manage the Alameda Health System separately from the county. The county would loan AHS funding, which would become debt to be repaid. 

According to AHS nurse, DSA member, and union chapter president John Pearson, this structural change had deeply privatizing results: “The AHS Board only has the power to cut,” Pearson said. “They don’t even pretend to be public administrators. They call it ‘the company.’” Veronica Palacios, an eligibility specialist at Highland Hospital and vice president of the chapter, said, “When I started getting involved in the union, I really learned how management sees and treats workers as something disposable. That to me says they don’t care about public health at all.”

The move relinquished public responsibility for public health, and the multiracial working class of the East Bay paid the cost. More than half of all AHS patients live below the poverty line. More than 80% of AHS patients are people of color, disproportionately African-American and Latino. 

Austerity under the new board led to decades of cuts to staffing and patient care. By the time COVID-19 hit, austerity meant some AHS workers were covering their scrubs in trash bags for safety. Instead of responding to these problems with immediate resources, AHS management chose to protect their own backs, firing a whistleblower nurse and blocking county inspectors from entering the hospital. Worse still, the AHS board doubled down this year on cuts to staffing, including laying off the system’s entire sexual assault support team and closing the outpatient psychiatry clinic, while pushing for further cuts in contract negotiations.

Despite these glaring failures, Alameda County Supervisors were still unwilling to back public control of AHS. A prime example is Supervisor Wilma Chan, who voted for the privatizing move in 1998 and now chairs the County’s Health Committee. In the months leading up to the strike, a campaign for restored County control of AHS was launched by the Alameda County Coalition for Healthy Communities, formed by SEIU, CNA, DSA, and Gabriela, a Filipino community organization. Following a coalition rally for County control, Chan promised to convene a committee that would “study the question.” This proved to be a delay tactic, as Chan would not initially offer a single seat on that committee for labor, and the coalition had to fight for representation.

At their meeting just two days before the strike, only one of five county supervisors supported a change of management; the rest stuck to bromides about “listening to all sides.”

Striking against Austerity

A strike of 3,200 healthcare workers forced these public officials to turn their back on privatization, no matter their reluctance. With an overwhelming strike authorization vote in late September, it became clear a strong strike could be on the way, and months of worker and community coalition rallies made clear that reversing privatization would be a key demand. As Palacios explains, “For two years, we were telling the supervisors how bad it was, and finally, with a 98% strike vote, we showed them that the Board of Trustees had to go. When 3,000 workers are walking off the job for their patients and their communities, you have no choice but to listen.”

Workers delivered on that promise with a five-day strike, starting October 7. This was especially impressive given intense management efforts to discourage involvement.. Pearson said, “We had really high participation in the strike, of people not going to work. Management tries to make a big deal about how a strike is a horrible and negative thing. It was such a boon to the strike that we kept the tone so positive and celebratory.” 

Picket lines drew community supporters mobilized by East Bay DSA, the coalition mentioned above, and workers themselves. News cameras were fixed on the action before sunrise on the strike’s first day. Local politicians felt bound to make appearances. 

Management hired scabs at a cost of close to $10 million, according to figures obtained by AHS workers. Exorbitant spending on scabs by an indebted Board of Trustees drove home the workers’ point that management had all the wrong priorities.

With overwhelming strike participation during the spotlight of a pandemic, AHS workers turned the crisis of healthcare austerity into a political crisis for county officials. As Pearson put it, “There’s already a horrible crisis for us and our patients at AHS. We lack basic supplies, staffing, and training we need to take good care of the public. We put the crisis back in the county’s lap where it belongs. At a public meeting we heard Wilma Chan say the strike was an embarrassment to the county, that it got so bad at AHS that the entire workforce went on strike. We made it a public embarrassment that the county and AHS are failing to provide adequate care to our patients, we’re on the news because we’re striking, we’re at their meetings and in their face. Then they probably have other politicians calling them up, saying ‘Are you fixing this?’”

Forced by the political crisis, on the second day of the strike, the Board of Supervisors announced they were demanding the resignation of the entire AHS Board of Trustees. Even better, they would move to restore public oversight of the system. In the aftermath, the supervisors have stuck to their word and begun replacing the trustees on a temporary basis to transition AHS back into county administration. 

The strike not only fired the boss but reversed the underlying structure of privatization in the East Bay’s public health system. Sheleka Carter, a community health outreach worker at Highland Hospital and SEIU 1021 chapter secretary, explains the win: “The privatization is stopped. We don’t need privatization in the public health sector.”

Pearson reflected on the unions’ success in forcing a political crisis with a reference to Farrell Dobbs’ account of the 1934 Minneapolis Teamsters’ strike victory. “It’s like the Teamster Rebellion thing, where liberal politicians don’t want to become an enemy of labor. We put them in a position with no way out. Even the final opponent [to firing the Board of Trustees] among the County Supervisors, Keith Carson, could only abstain on this vote.”

This strike victory against privatization was not won overnight. It took years of deep rank-and-file organizing first.

Revitalization from the Rank and File

Seven years ago, if you asked the rank-and-file organizers who led this strike whether a mass workplace action at AHS was possible, they say their answer would have been a resounding no. Palacios reports that when she first started going around to talk to workers as a member leader, she didn’t receive a warm reception: “Members had lost faith in the union. They thought I was a union rep. I had to tell them I’m a worker and a member like you.” 

Pearson says that back then, “the union was adrift, without anybody really taking leadership. Union staff were filling in some of the cracks, but nobody was taking on the responsibility of organizing our 3,000 members. It was a very bare-bones service model, with everyone thinking the union is like an insurance company that we pay to fix our problems, not an organization of thousands of workers who bargain together for things we all want, like a sane and respectful workplace and jobs that allow us to have a decent life.”

In 2009, while still in nursing school, Pearson learned about Labor Notes. He says he was invited to the organization’s conference by nurses in New York who were doing a rank-and-file takeover of their union. “It was really eye-opening,” Pearson said. “I wasn’t yet a nurse but I was hearing nurses talk about labor struggles and that was really inspiring and cool. Down the line, when I was working as a nurse and dealing with workplace problems, it gave me something to look to. I wasn’t on my own. I knew to look to Labor Notes guides for what to do.

“I got helpful advice and questions answered by Labor Notes board members and staffers on how to do basic things; they helped us network with people who had gone through similar challenges in their union or with similar employers; they published articles about us; they put on a Labor Notes Troublemakers School specifically for our chapter and helped us send members to their conference.”

Armed with this inspiration and training, Pearson identified a lack of work breaks as a widely and deeply felt issue among nurses at AHS. He and his co-workers organized a campaign around the issue and won improved staffing and thousands of dollars in back pay for hundreds of nurses who had been denied legally-required breaks during their twelve-hour shifts. 

But the fight didn’t stop with winning for the nurses. Pearson noticed that “there was this expectation that we’re separate, that the nurses’ unit wants something different than the general unit. I thought that was wrong. We’re all in this together.” 

Fighting layoffs proved to be a unifying campaign. “That helped build connections between different parts of the workforce, and we learned to trust each other through projects,” Pearson said. For example, at the Fairmont nursing home, management “basically told all the workers to come in on a particular day to sign up for your own layoff, but called it something else.”

In protest, AHS members held an all-day action at the facility. Workers marched off the floor, others came in on their day off, and together, they intercepted every co-worker who came to work and convinced them not to. Feeling emboldened, the group went on to confront their management directly. They marched on the boss, interrupting a state inspection and embarrassing the boss in front of the inspector. While in the end there were some layoffs, this rank-and-file activism was able to block the worst. Since then, the union has successfully fought to win back some of those positions. 

Coming off of successful shop floor organizing like this, worker leaders understood that if change was going to come, it was going to be from hospital workers like themselves. Palacios, Pearson, and others ran a successful slate for union office focused on increasing rank-and-file control, standing up to the boss with confidence, and fighting on behalf of patients and the public.

These new leaders took on countless one-on-one meetings with coworkers to bring them into action, learn what issues were most broadly and deeply felt, and support new leadership from the rank and file. Palacios said, “The membership has taken control, taken responsibility, found confidence in themselves.” 

Part of workers’ new confidence came through overcoming divisions in the workplace. AHS workers are overwhelmingly people of color, including many first-generation immigrants. Workers report that management often hired selectively to keep staff siloed in teams by race or national origin. Rank-and-file leaders worked hard to break down these divides by bringing workers into collaboration on campaigns and holding rallies for Black Lives Matter and racial justice as union issues. 

Marina Stankov Hodge, a labor and delivery nurse and member of the Contract Action Team, which helped mobilize the membership during the most recent contract fight, describes the strength she found in organizing from the rank-and-file: “It’s not someone you don’t have a relationship with coming in and telling you to participate. It’s me. It’s your colleague who is affected by the same things every day. The union staff people have good intentions, but they sometimes can’t read the room on the unit. It’s a stressful environment. But for us, we have time between crises where we can talk to each other, and that’s really meaningful.” 

By taking responsibility for their own fight, AHS workers like Palacios and Stankov Hodge were able to transform their co-workers, their union, and their conditions at work. This rank-and-file resurgence is what made an overwhelming strike vote possible, and support from DSA helped it reach even further.

Socialists in Solidarity

Since Pearson has been an active member of East Bay DSA since 2017, DSA activists had been aware of the situation at AHS for years. When he and his co-workers began to gear up for their contract campaign, East Bay DSA hosted town halls featuring AHS workers and pledged to support the campaign however possible. Despite the pandemic’s challenges to in-person organizing, DSA began working with SEIU 1021 activists more than six months before the strike. 

According to Molly Stuart, the core organizer for DSA’s strike support, “We met with rank-and-file organizers weekly to brainstorm tactics and offer skill-sharing in media strategy, graphic design, action planning, fundraising, and other areas of organizing. Some core DSA members also worked one-on-one with these organizers to provide a sounding board and support their initiatives.”

DSA’s support focused on building the ability of rank-and-file organizers to lead. “It’s easy for DSA to fall into a pattern of acting as a volunteer wing of the union,” Stuart said, “but it’s important to avoid this, and to focus instead on developing relationships of trust and collaboration with rank-and-file organizers. That said, it’s also important to have good communication with staffers so that DSA’s role is not understood as incongruous with overall union activity.” 

DSA also helped organize the community and demonstrate the stakes of the campaign for patients and the broader public. This included public town halls with union activists and DSA political candidates, mass email and text campaigns aimed at recalcitrant county supervisors, multiple car caravans, a blockbuster Cardi B–inspired music video, and over a dozen phonebanks to get DSA members out to AHS picket lines. 

Darryl Richardson, a medical records specialist at Highland Hospital and SEIU 1021 officer, expressed the impact of DSA’s support when he spoke on the coalition’s first call after the strike: “You helped get our people pumped up. Everything you said you were going to do, you did it. You’ve been relentless. It’s been almost a year, you’ve been there the whole time.”

According to Pearson, “DSA was the most stable coalition partner that [union activists] had. The DSA role seemed like, ‘We think your fight is an important fight, how can we be helpful?’ A lot of the work was very thankless; at times we couldn’t pay attention or help out. The most important thing was that it was reliable, consistent, and respectful of union members running their own fight.”

Lessons for DSA

What can DSA members interested in building a powerful labor movement learn from this experience? 

First off, the build-up to the AHS strike is a powerful case study of what the rank-and-file strategy looks like in practice. The rank-and-file strategy aims to rebuild the base of trusted shop floor leaders dedicated to building democratic unions and waging class struggle at work. The vision is that this revitalized base of workplace leaders have a unique potential not just to ignite action from their coworkers but to rebuild a broader working class movement, particularly by connecting socialists and militant unionists. 

While Pearson began as a lone socialist in his workplace, his position in the rank and file over the past seven years allowed him to help build class struggle on a much larger scale than at his workplace alone. Ordinary socialist organizers can play this role in workplaces across the country by supporting and growing the leadership of their coworkers. As AHS workers noted, in comparison to union staff, rank-and-file workers were uniquely able to build trusting organizing relationships with their coworkers. 

Scores of DSA members are already taking jobs where they can do strategic workplace organizing from the union rank and file, in sectors like logistics, teaching, healthcare, building trades, and communications. Every DSA member interested in building the labor movement should seriously consider the rank-and-file path. 

Pearson learned this type of bottom-up workplace organizing through Labor Notes workshops and materials, seeking the advice of experienced rank-and-file leaders in other unions, and testing these ideas in practice. Labor Notes provided a unique national network of organized union activists and concrete training. DSA should do all it can to connect workers with Labor Notes and support its growth.

Another element of the rank-and-file strategy was tested in how East Bay DSA took on strike support. By focusing on support for AHS rank-and-file activists, and building strong relationships with them for over six months before the strike, East Bay DSA was able to bolster their enthusiasm, leadership, and community support. This model contrasts sharply with an approach that was common in DSA before its 2016 Bernie-fueled resurgence, which focused largely on coziness with top union officials and staff disconnected from the workplace. 

Stuart, East Bay DSA’s core strike support organizer, is proud of how the chapter facilitated both rank-and-file organizing and a DSA more rooted in the local working class. “Because of the relationships we developed over a six-month period, and the ways we supported rank-and-file leaders in taking more agency and leadership in their union, eight rank-and-file leaders became DSA members,” Stuart said. “There is now a new formation of SEIU 1021 DSA members organizing for increased democracy and member power within their union.”

Whether as coworkers in the workplace, through Labor Notes, or through DSA strike support, focusing our energy on worker activists is the principal way DSA can help rebuild a democratic labor movement ready to fight and win for the multiracial working class.

The Alameda Health System strike breakthrough gives us a guide for reversing decades of privatization across the national terrain. By fighting for structural wins that replace privatized management with democratic public and worker control, we can put future fights on more favorable ground. 

It comes as no surprise that even elected officials who claim to be pro-labor face huge pressures to deliver austerity and to back up bosses. We can rarely count on elected officials to stand with workers. But when we build powerful strikes from the rank and file, we can force government officials to take our side against neoliberalism, no matter how long overdue. 

Keith Brower Brown and Mark Drexler are organizers in East Bay DSA and members of DSA’s Bread & Roses caucus.