If you liked 2018’s Proposition 8, which put tens of thousands of medically vulnerable Californians in the middle of a multimillion-dollar battle between dialysis clinics and the union that wants to organize them, then you’ll love this year’s Proposition 23. The statewide initiative reprises the same dreary contest in slightly different form, forcing voters to weigh in twice on a matter that shouldn’t have been put to them once.
While the earlier initiative would have capped dialysis clinics’ profits, the key provision of Prop. 23 would require them to have a physician on site during treatment hours. Despite the superficial appeal of the idea, putting voters in charge of specialized medical staffing doesn’t make much more sense than asking them to micromanage the clinics’ finances. But sense is not really the point so much as dollars.
The ballot initiatives amount to a proxy war over the workforces of the for-profit companies that own about three-quarters of the state’s 600 dialysis clinics, DaVita and Fresenius Medical Care, which have been unsuccessfully targeted for organization by Oakland-based Service Employees International Union-United Healthcare Workers West. The latest measure, like its predecessor, will exact a price from the companies even if it doesn’t pass: A coalition led by DaVita and Fresenius spent more than $100 million defeating the 2018 proposition.
The union maintains that requiring the presence of a physician — or, with a waiver, a physician assistant or nurse practitioner — will address care deficiencies. Clinic operators say it will force superfluous spending on doctors who, given the limited supply of nephrologists, aren’t likely to have any particular expertise in dialysis. The clinics are already required to employ a physician medical director and keep a registered nurse on site, while patients must be seen regularly by their doctors during dialysis.
The measure also requires providers to report infection data to the state Department of Public Health, among other auxiliary provisions. Dialysis clinics, which are regulated by the state and federal governments, are already required to report infection data to the latter to receive payment from Medicare, which covers a majority of their patients.
An independent review by the Legislative Analyst’s Office found that the measure would cost clinics “several hundred thousand dollars annually on average.” Providers would likely pass on some of those costs to government and private insurers, the office found; they also could decide to close clinics, an alarming prospect for patients.
The lives of some 80,000 Californians with kidney failure depend on dialysis, which typically entails three treatments a week lasting four hours each. That they are at the center of a battle over financial spoils for the second time in as many years is an unfortunate comment on the nation’s health care system as well as the state’s initiative process. Vote no in the hope of discouraging any further reliance on this tactic.