One Medical Workers Launch Trailblazing Campaign to Organize “Concierge” Medicine
by McKenna Schueler
Downtown Seattle location. (One Medical)
After what one administrative assistant described to Strikewave as a “confusing” year, with internal communications resembling something like “a terrible game of Telephone,” hourly employees of One Medical, a primary care service based in Silicon Valley, announced their intent last month to form a union with Workers United, a Service Employees International Union (SEIU) affiliate that represents roughly 80,000 workers across various industries in the United States and Canada.
According to Richard Minter, Director of Organizing with Workers United, One Medical’s organizing could shape up to be a trailblazing campaign for health tech workers in the concierge service sector—a fairly new field of healthcare that offers a bundle of health services in exchange for paying an upfront monthly or annual fee.
More than 500 One Medical workers, including administrative assistants, shift leads, and phlebotomists, across all U.S. markets the company serves would be covered by the One Medical staff union. Nurses and doctors, who are salaried employees with One Medical, would not be included in the bargaining unit.
Like workers of Big Tech companies such as Google and Amazon, One Medical employees are calling on their “human-centered” employer to live up to its mission of transforming the United States’ increasingly fragmented and inequitable primary care system into one that’s “accessible and affordable for all people,” according to a letter written anonymously by workers to One Medical leadership.
“We, the members of the Organizing Committee, stand by One Medical’s original mission and vision to transform healthcare through technology, innovation, and a human-centered approach—all while making said healthcare accessible and affordable to all people,” the union organizing committee wrote.
“Transforming healthcare for all,” they say, “is only possible with a unionized One Medical.”
Starbucks of Primary Care
Described by one of its investors as a potential “Starbucks of primary care,” One Medical is a hybrid in-person and telemedicine service that offers streamlined access to a doctor, and on-demand virtual care through a digital app, in exchange for paying an upfront annual membership fee.
Building upon an alternative to traditional care practice known as membership medicine, One Medical is a tech-enabled service that offers benefits like same-day booking, mobile prescription renewals, and 24/7 access to a virtual medical team for $199 a year.
With nearly 600,000 members across metro areas like Los Angeles, Chicago, and Boston, One Medical sells memberships directly to individuals, and to more than 8,000 employers—including Big Tech companies such as Google, Lyft, and SpaceX—to whom One Medical markets itself as a tool to reduce total cost of care, attract new employees, and “instill a culture of health.”
One Medical is financially backed by investors like Google’s parent company, Alphabet, and the Carlyle Group, one of the world’s largest private equity firms. The Carlyle Group has a history of bankrupting private companies it buys out and leaving behind a trail of jobless workers in its quest to build value for investors.
While One Medical touts a mission of transforming the United States’ $260 billion primary care market, fraught with inefficiencies, into one that’s more easily accessible and affordable, an organizing committee of One Medical staff—who represent all 13 of One Medical’s current markets—say their employer could be doing more to live up to its stated values.
While the entire organizing committee has chosen to remain anonymous at this time due to fear of retaliation, *Sam, an administrative assistant, agreed to speak with Strikewave about the One Medical’s staff union, on the condition that they be referred to by a pseudonym.
According to Sam, the One Medical staff union is about one year in the making, driven in part by grievances that have commonly undergirded union campaigns over the course of the COVID-19 pandemic: insufficient wages, poor communication from management, denied hazard pay, and—unique to this campaign—a lack of responsibility taken by One Medical leadership for its COVID-19 vaccine rollout, which was the subject of a congressional investigation earlier this year for alleged mismanagement.
But at the forefront of the One Medical staff union’s organizing, Sam says, is fair wages. Starting pay for administrative assistants at One Medical offices varies by region, ranging from $16 an hour in Phoenix and Raleigh offices, up to $21 an hour in places like San Francisco—with the opportunity for a $2 raise after the first year.
And while these wages are “decently competitive” on their face, said Sam, the actual expectations for these hourly positions and the complexity they entail is “way beyond” what employees are led to believe during the hiring process.
Workers United organizer Richard Minter told Strikewave that One Medical employees have reported being “severely underpaid” for their work, are pressured to work past the limits of their own wellbeing, and often earn below the living wage in the cities in which they work. In Los Angeles, for instance, starting pay for an administrative assistant with One Medical is an advertised $18 an hour—below the estimated living wage of $19.35 for a single adult with no children, and less than half that for a single adult household with one child.
Last fall, One Medical employees also requested and were denied hazard pay by company leadership. In a statement to Fierce Healthcare, One Medical said this was a decision made by “many of its peers.” The company says they provided ample personal protective equipment (PPE) for staff to mitigate the risk of infection—which Sam confirmed—and that they provided a one-time $500 bonus for administrative employees late last year.
Sam, who received this bonus, says the money wasn’t sold by management as something to serve in lieu of hazard pay, but rather as a token of appreciation—just in time for the holidays. On the phone, they sounded audibly frustrated with this. “It was just like, ‘Oh, everyone's done such a good job, and you're really appreciated.’”
But to Sam, that one-time bonus alone was no reparation for the lack of hazard pay. “We’re seeing people who literally have COVID, like, sharing the same space as them,” they said. “Then, no hazard pay. At any point.”
Frustration continued with employees’ mounting workloads, poor communication from management, and—in what Workers United organizer Richard Minter described as “the straw that broke the camel’s back”—signals from One Medical that the job security of One Medical’s Virtual Medical Team may be at risk.
According to Minter, One Medical has signaled “with a long series of veiled discussions” that the company’s Virtual Medical Team is going to be dismantled. He says employees have been presented with options of either relocating to One Medical’s Phoenix offices, taking a front desk position in their local markets, or finding employment elsewhere. “Leadership seems to intentionally make the details vague so that no time line exists, just the threat that at any time choices will have to be made,” he said.
And Minter says that’s a relatively new development. But in the fall of last year, before the rest began piling up, it was that initial denial of hazard pay that Sam described as their real wake-up call. “They view us as disposable,” they recalled thinking. “Like cogs being moved in a machine.”
Disrupting Healthcare
Workers have become disillusioned by One Medical’s stated mission to “radically transform” the healthcare system. Once blasted as “yuppie care for the well,” One Medical’s member-based care model isn’t all-inclusive.
First, as a primary care practice, its health services are limited to what you can expect through any other family or internal medicine practitioner.
You can check in with a One Medical doctor, get a referral for a specialist, request prescriptions, and have access to your typical array of preventative and wellness services. “Everyday care,” the company calls it.
Like other concierge care practices, One Medical membership caters largely to healthy, affluent clientele with limited care needs: people who can afford to pay an annual retainer for membership benefits on top of insurance premiums, deductibles, and the actual cost of medical services from One Medical providers.
Hidden between the lines is that membership with One Medical is not a form of health insurance, doesn’t cover the cost of medical services, and isn’t covered as a benefit within most health plans. Like any other traditional doctor’s office, health services through One Medical—with the exception of brief video chats and COVID-19 screenings through their digital app—are billed to a person’s health insurance. That leaves out millions of uninsured.
According to Sam, this frequently causes confusion, frustration, and anger among patients, particularly those who receive One Medical benefits through their employer. Unlike the company’s top executives, administrative and virtual care staff like Sam are ultimately the ones who bear the brunt of this.
Although One Medical does accept most health insurance, Medicaid, which provides coverage for some of the country’s most vulnerable populations, is not. When broached in staff meetings with One Medical leadership, Sam says the justification shared for this ultimately boils down to the conclusion that it would make “too little financial sense” for a company that’s yet to turn a profit. One Medical was valued at $1 billion when it went public last year, and reported $121.5 million in net revenue over the first quarter of 2021.
This doesn’t sit well with workers. Some, like Sam, were initially drawn to One Medical because of its purported mission to address the inflexibility and inequity of the existing U.S. primary care system. They still believe in their ability to help advance that mission—as a union.
More upsetting to Sam is that the weak justification for refusing Medicaid plans allegedly comes directly from One Medical CEO Amir Dan Rubin himself, a former Optum executive who the New York Times reported as the second-highest paid CEO in the United States last year, receiving over $199 million in compensation.
Sam, who says they just happened across Rubin’s total compensation while scrolling through Twitter earlier this year, was shaken by this. “I just burst into tears, I was so enraged,” they said.
“I’ve been on Zoom meetings with that guy, and that was his pay for 2020,” they told Strikewave. “I just want people to know that, that [Rubin] is the man who harps on transforming healthcare constantly,” said Sam, recalling Rubin’s dismissal of Medicaid recipients as an unprofitable market for his bottom line. “You’re not transforming shit if it’s not accessible to everyone.”
Strikewave reached out to One Medical for a response to the claim about Rubin’s comments, as well as other grievances aired by One Medical staff on the union organizing committee. As of publication, One Medical has not provided a response.
Old Wine in New Bottles
Author and organizer Jane McAlevey, in her latest book, A Collective Bargain, explains how big tech’s ambitious rhetoric about changing the world—demonstrated by One Medical’s claimed mission—is the new face of an old dynamic.
“The big-tech elite cleverly disguises their right-wing, anti-worker politics with Democratic-backed social positions,” McAlevey wrote, referring to Big Tech’s superficial support for liberal positions on issues like immigration, ethnic diversity, and equal rights for the LGBTQ+ population.
McAlevey’s observation tracks with, for example, One Medical’s offering of LGBTQ+ services—which, on its face, signals inclusivity for a population that frequently encounters discrimination in clinical settings. However, One Medical’s business model—which is targeted toward an affluent market—fails to address underlying inequalities in healthcare access, many of which are experienced acutely by LGBTQ+ adults.
Services like hormone replacement therapy and gender confirmation surgery are largely accessible only to those who can afford treatment, have Medicare, or who are fortunate enough to have these services covered by their insurance plan. One in five transgender adults are uninsured, and face higher rates of poverty and unemployment.
Notable, too, are the implications of One Medical’s relationships with gig economy giants like Lyft and Uber, which work with One Medical to provide employees with member benefits through One Medical’s digital app.
As Uber and Lyft trample on drivers’ efforts to organize for legal rights and unionization by pouring millions of dollars into campaigns like California’s “Yes on Prop 22,” they’re paying to provide One Medical memberships—which don't cover the cost of primary care visits, nor the treatment a worker might need if they’re injured or mentally scarred on the job.
Despite their stated commitment to inclusivity, One Medical is, like many anti-union employers, relying heavily on standard “union avoidance” tactics. In statements to the press, One Medical has said they’ll recognize their staff union only if the majority of the bargaining unit vote in favor of unionization through a secret-ballot National Labor Relations Board (NLRB) election process.
“We aim to support all One Medical employees by creating a safe, inclusive and fulfilling work environment so that every employee can perform to the best of their abilities,” the company told Becker's Hospital Review. “One Medical leadership remains dedicated to improving by listening and learning from our team members.”
One Medical CEO Dan Rubin firmly declined to voluntarily recognize, according to an email sent to the staff organizing committee, shared with Strikewave in the form of a screenshot.
“We hold our team members in the highest regard and believe our success results from direct collaboration, without an intermediary third party,” Rubin wrote. “For that reason, we do not believe it would be appropriate to recognize a union without everyone affected having the opportunity to participate in an election conducted by the National Labor Relations Board (NLRB).”
Even without voluntary recognition, however, staff aren’t deterred. Sam told Strikewave that getting involved with organizing efforts has been reinvigorating—and they’re ready to see this through.
“I had really started to become checked out,” they admitted, saying that they’d started keeping track of how many days or weeks they’d go without crying in their office. “[To] see that so many people were, like, experiencing what I've been experiencing, and care and want to fight for each other—that has been really heartening and exciting.”
“It feels like I could really shape One Medical into a place that I could stay at for a long time,” they said. “We could actually have people stay and grow here.”
Advocating for a better future for One Medical employees and their patients, the staff union says, is at the heart of their organizing campaign. Minter, the staff organizer with Workers United, told Strikewave the organizing campaign will be gaining greater steam in the coming weeks.
“One Medical’s future is our future,” the union organizing committee wrote, in their initial letter to One Medical leadership. “We should have a say in the decisions that affect our lives and livelihoods.”
*Sam is a pseudonym chosen by the administrative employee who spoke to Strikewave, and who was granted anonymity, by request, in exchange for an honest interview.
McKenna Schueler is a freelance journalist and behavioral health writer based in Tampa, Florida. You can find her on Twitter @SheCarriesOn.