I. Welcome to the Salem Health Circus

The rising costs, they tell us, are an act of God – like weather, or plagues, or executive greed. But this isn’t divine intervention, and no matter how loud or how often the American healthcare system cries inflation – that word still does not absolve them of sin. 

Yet, Salem Health would have you believe that, while most of the globe deals with rising costs, their situation is unique. It’s personal. And – most importantly – it’s your fault. 

CEO Cheryl Nester Wolfe recently took to the Daily Dose to explain to her loyal workers just how unsustainable their “benefits” have become. “For several years,” she said,  “we’ve shielded employees from inflation-related increases in benefits… Today, Salem Health spends over $150 million per year on all employee benefits. This growing cost increase is no longer sustainable.”

But put on your deerstalker and peer through your magnifying glass at Salem Health’s tax filings – the ones covering June 2023 to June 2024 – and that number collapses like a frat boy’s veins after a Halloween weekend bender. The actual spending on employee benefits, according to their tax filings, was $116.2 million, not $150 million. So, where did that extra $34 million come from?

It came from taxes. Somewhere in the fog of bureaucracy, Salem Health decided to lump in payroll taxes – the Medicare, Social Security, and state taxes that every worker already pays their share of (you pay more, actually, because as a non-profit, the hospital doesn’t pay income tax). The hospital is crying poverty while counting your own money as part of your “benefits.” 

Payroll taxes accounted for about $39 million, close enough to explain the gap – and the only expense in their filing that could account for such a gap. Such a sour twist in their story curdles their rhetoric from corporate divinity to something much spookier: corporate alchemy. Shift a few numbers, blur a few definitions, and suddenly, it’s the workers who are the reason the empire is collapsing.

Does that sound paranoid? Check the trendlines. In 2019, the hospital spent $71 million on benefits, about 10% of which was labeled “management and general expenses.” That’s stuff like overhead. Administrative fees. The money ADP takes for running payroll. Money you don’t see. By 2021, those expenses doubled to $16.4 million – almost 20% of the total. Over the next four years, the pattern solidified: benefits went up 8.3% per year (Cheryl’s math does check out here, for once), while annual overhead ballooned by over 30%.

So, Sherlock: what does Nester Wolfe’s Sermon On The Dose really mean? It means that it isn’t your insurance that’s unsustainable. It’s management. The hospital needs you to tighten your belt and pay 733% more on insurance premiums because they can’t stop lighting money on fire, and you should be grateful they haven’t fired you.

II. The Bug is the Feature

2022 was a banner year for this insanity. Even though revenue for the hospital went up 8.5% (lol), the hospital spent at least $72 million renovating the ER and rebuilding the parking garage, forcing workers to park at the abandoned K-Mart building miles away, adding roughly 30 minutes of unpaid travel time each shift; Indentured Commuters. It also dropped $20 million on traveling nurses and recorded a net loss of $53.6 million. No one saw Cheryl on a shuttle that year, yet executive pay got raised to a record high: $13.2 million, including $1.5 million to her alone.

By 2023, Aya Healthcare, Salem Hospital’s choice travel nurse agency, was being paid $50.6 million. Taking numbers that Nester Wolfe cited that year in an OPB Think Out Loud interview, the highest number of travel nurses Salem had at any time was 320, and they still had 100 on the books. That totals up to $71.1 million for a maximum of 420 nurses, or $170,000 per traveling nurse, annually. A median full-time nurse in Oregon hardly scratches $99,000. A nurse would have to make $140,000 in base salary in order to cost the hospital $170,000 in wages and benefits, and that doesn’t factor in the added indignity of being told your health insurance is “unsustainable.”

It keeps getting better: the hospital lost $52.5 million in 2024, which is roughly the same as the contract they paid Aya Healthcare that year ($51 million). Take that away and you’re left with a measly $1.5 million deficit; less than Cheryl Nester Wolfe’s salary.

There, I fixed it. Give just some of that money to staff instead of traveling agencies, fire the CEO, and voila! The hospital is profitable. 

But that’s too easy. This isn’t a brown spot on the surface of one CEO or one hospital. It’s a festering rot that reaches to the core of the entire machinery of American healthcare – a system built to extract every possible cent from the people to keep it running. Nester Wolfe could be fired tomorrow, and she’d just be replaced by a doppelgänger functionary in a system that’s been perfecting worker exploitation since just before Florence Nightingale was in diapers.

Exploitation isn’t a bug. It’s the backbone of the system. Two centuries of capitalism have perfected this: take as much from workers as possible, reinvest it in control, and condition the workforce to accept it. Meanwhile, executives laugh all the way to their “cabins” in Sunriver.

The executives tell us they’re “listening.” That they “value our feedback.” They take what we say “into consideration” before they cut CN pay, gut benefits, and pay traveling contractors 3x what they’d pay a new hire. Employees are given the illusion of power—“We hear you! You matter!”—but the reality is a perpetual cycle of understaffing, unpaid labor, and benefit cuts.

This isn’t management. It’s theater.

III. The Only Logical Step

We’re not going to defeat capitalism overnight. We’re probably not going to be able to make our premiums drop magically next year. But we can reclaim some leverage.

How? By unionizing.

Unionizing is the only logical step. Unionization gives us workers a seat at the table. Negotiations become enforceable. Benefits are locked in. Premium hikes aren’t sprung on you like a trap. Providence has it. OHSU has it. Samaritan has it. They all have contractual limits on benefit increases; they can plan for any premium increases years in advance. Meanwhile, Salem Hospital workers are told to be grateful for whatever scraps fall from the boardroom buffet.

Management will tell you unions are bad. That they’re unnecessary, expensive, dangerous, and divisive – that they’ll cause layoffs and chaos. The aggressor will certainly play the victim. The executives who spent over $125 million on travel nurses, hundreds of millions on renovations, watched overhead expenses bloat more than a beached whale and gave themselves 18% raises while telling nurses to “tighten their belts” want to warn you that unions will ruin everything? That kind of projection would give Freud pause. 

IV. Start Somewhere

Unionizing isn’t a silver bullet. It won’t instantly reverse years of mismanagement. But it is a first step toward reclaiming power in a system built to keep you powerless. Writing email complaints to your manager or leaving comments of frustration on The Daily Dose guarantees that the next $150 million, the next premium hike, and the next executive bonus will hit your paycheck while you’re forced to shuttle the extra 15 minutes to work, unpaid, from a dark, desolate parking lot.

The truth is simple: doing nothing isn’t working.

It’s time to turn that listening session into a reckoning.

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Salem Nurses! Reach out to an ONA representative to let them know you’re interested in unionizing Salem Hospital. Do not use an email that can personally identify you. Retaliation for organizing is illegal, but it’s hard and expensive to prove it in court, so companies  do it anyways. Plus – do you really think this government will have your back? Be smart and protect yourself. 

OR

Email: organize@oregonrn.org

OR

Call: (503) 293-0011 and ask to speak to an organizer

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Non-nursing staff: Reach out to an AFSCME representative to let them know you’re interested in unionizing Salem Hospital. Do not use an email that can personally identify you (see above). 

Email: Join@OregonAFSCME.org

Call: 503-370-2522

Note: AFSCME represents thousands of hospital workers at OHSU. SEIU also represents hospital workers around Oregon; I do not know who the best fit will be, but they will.

V. Sources