PD Editorial: No on Prop 23, a cynical attack on dialysis care

Don’t be fooled by Proposition 23 on the Nov. 3 ballot. This initiative is ostensibly about protecting kidney dialysis patients, but it’s actually a cynical attempt to punish clinic operators for resisting a union organizing campaign.

Sound familiar? It should.

Proposition 23 is a reprise of the 2018 election, when Service Employees International Union-United Health Care Workers West bankrolled Proposition 8, which would have imposed a cap on dialysis clinics’ revenues.

Voters recognized Proposition 8 for what it was and thrashed it on Election Day, with 60% saying no.

The union and its allies are back with Proposition 23, and it deserves the same fate.

This time, instead of capping income, the union is looking to drive up the clinics’ costs.

Dialysis patients and, to a lesser extent, taxpayers stand to be collateral damage.

Under Proposition 23, dialysis clinics would be required to have a physician or nurse practitioner on duty whenever patients are receiving treatment. The initiative also would mandate new quarterly reports to the state health department and require clinics to obtain written state permission before could closing or reducing services.

An on-site doctor or nurse sounds like a good idea, right? Who would oppose that?

Well, doctors and nurses, for starters.

The California Medical Association, the American Nurses Association and about two dozen other medical associations are part of a large coalition opposing Proposition 23. Organizations representing veterans, seniors and dialysis patients also are opposed.

It’s easy to see why.

About 80,000 people are treated for kidney failure in about 600 clinics statewide. The vast majority of these patients have their own physicians and visit clinics three times a week for life-saving dialysis treatments. A physician at the clinic wouldn’t be involved in their care but would add to their costs.

Moreover, with the shortage of renal specialists, it’s likely that dialysis clinics would end up hiring physicians without any expertise in the field just to meet the mandate.

Proposition 23 would allow clinics to apply for permission to have a nurse practitioner or a physician’s assistant on duty if a physician couldn’t be hired. But this, too, would be an added cost with little or no medical benefit for patients.

An independent analysis by the state’s nonpartisan legislative analyst concluded that Proposition 23 could cause dialysis clinics to raise rates for insured patients as well as Medi-Cal managed care programs, with added taxpayer costs “in the low tens of millions of dollars annually.”

Of course, driving up costs is the unstated goal of Proposition 23.

Dialysis clinics spent about $100 million to defeat Proposition 8 two years ago, and they probably will spend a similar amount fighting Proposition 23. If the clinics don’t wave the white flag, the union could very well be back again with yet another initiative in 2022.

We don’t have a position on whether dialysis clinics should be unionize. That’s a matter for the employees and their employers. But targeting clinic owners who resist union organizing efforts is a clear-cut abuse of the initiative process.

Given rising rates of diabetes, which can cause kidney failure, California is going to need more dialysis clinics, not fewer.

Proposition 23 is likely to result in some clinics closing and create disincentives for opening new ones without improving care for people whose lives depend on kidney dialysis. The Press Democrat recommends a no vote on Proposition 23.

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