PD Editorial: An abuse of the initiative system

Proposition 8 is nothing short of an abuse of California's initiative process, which allows anyone with enough money to put a proposed law on the ballot.

This initiative is designed to punish dialysis clinic operators who have resisted union efforts to organize their employees. Voters shouldn't play along.

We don't have a position on whether clinic employees should unionize. However, we're absolutely certain that voters shouldn't be asked to judge a regulatory scheme for a specialty medical procedure that literally is a matter of life and death for tens of thousands of California residents suffering from serious kidney disease. That's a job for the Legislature and the state Department of Public Health Services.

Proposition 8, sponsored by the Service Employees International Union-United Healthcare Workers West, supposedly is about improving conditions at the 588 licensed dialysis clinics around the state. Yet there is nothing in this initiative about standards of patient care.

Instead it targets clinic owners by imposing a 15 percent cap on profits and mandating rebates of any excess revenue to private health insurance companies (but, for unexplained reasons, not to Medicare or other public programs that cover expenses for many dialysis patients).

The list of authorized expenses is arbitrary. Employee salaries, benefits and training, drugs and medical supplies are allowed, but administrative overhead is not. That presumably includes a medical director and nursing (both positions are required by Medicare) and, perhaps, a payroll manager. The initiative doesn't specify.

This slanted approach may violate U.S. and state constitutional prohibitions on government takings of private property without due process or fair compensation, according to the state's nonpartisan legislative analyst. SEIU appears to have anticipated as much, as the initiative includes a provision allows courts to reduce the mandatory rebates to, as the analyst puts it, “just enough” that they would meet constitutional muster. That's likely to produce a flood of litigation.

Meanwhile, the potential impact of Proposition 8 on dialysis patients is too unpredictable for the legislative analyst to do much more than venture a guess. Clinics might raise wages, the analyst said, or they could cut costs, or maybe even close.

The number of people undergoing dialysis increased 26 percent to 139,000 between 2011 and 2016, according to state figures, meaning closures would be a hardship for seriously ill patients, who would be left to travel farther, wait longer or seek treatment in hospitals.

This is likely to be one of the costlier fights on the November ballot. SEIU-UHW has raised more than $17 million to support Proposition 8, according to a report in the Sacramento Bee, and clinic owners have chipped in about $27 million to fight it.

This isn't the first time these unions have used ballot initiatives to try to gain leverage at the bargaining table. But this fight doesn't belong on the ballot, as voters are in no position to write accounting rules for dialysis clinics. The Press Democrat recommends a no vote on Proposition 8.

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