California Prop. 23 question (state regulation of dialysis clinics)

Anyone who lives in California has probably seen the (very effective) TV commercials opposing this proposition. I have read the voter’s pamphlet as well, and the opposing arguments claim that a special interest group is funding this proposition. The TV commercials say the same.

But they don’t identify the special interest group, nor do they say in what way passage of this measure would benefit that special interest group. The pro arguments in the voters pamphlet are sponsored by a dialysis RN, a dialysis patient, and a pastor – not any obvious interest groups there. The anti arguments are sponsored by the Executive Director of the state Nurses Association, a dialysis patient, and president of the California Medical Assoc.

Does anyone know what the truth is about this alleged special interest group that is supposedly behind this measure?

Fundamentally this is a fight between labor unions and management.

The labor union SEIU has been trying for years to unionize workers at the major dialysis clinics, such as DaVita and Fresenius. The union sponsored this initiative, the goal is to put pressure on the companies.

The initiative would require a physician on duty at all times when the clinic is open.

The major donors are exactly what you’d expect: The union on the yes side, DaVita and Fresenius on the no side.

So these measures (this is the second one they’ve tried) are just a cynical ploy on the part of the union to force unionization on a workforce that has presumably rejected it in elections? And that they were too ashamed of this tactic to put their name on the For arguments in the voters pamphlet? That sounds like a good reason to vote against the measure. Thanks for the info.

I would not disagree with your characterization.

I’m not there with disagreeing with the characterization, but I don’t get the leap from “requiring a physician on duty at all times when the clinic is open” and forcing unionization on the workforce.

I believe the theory is that implementation of the requirements from this measure would cost the clinic owners, of which there are two major companies and a lot of small ones and even some non-profits, a lot of money. Also note that this is the second time that a measure like this has been on the ballot, sponsored by that union; the first one failed to pass. And it is costing those same companies a not insignificant amount of money to advertise against the measure, while the backers appear to be spending almost nothing, at least so far.

So the calculation may be something like this, assuming that this one fails as well: if the clinic owners will roll over on the unionization issue, the union will stop putting measures like this forward. The provisions of the measure are not particularly important, they are solutions in search of a problem that doesn’t seem to exist, the main point is that if any of these measures ever passes the clinic owners will have to pay more money out and will have very limited means of recovering those funds from their sources (government and insurance companies).

It seems a bit roundabout to me, but very much the sort of thing the SEIU would do if their reputation is anything to go by.

Yeah, that does sound a bit wheels-within-wheels. A better argument would be the one I tend to use when voting “No” on a ballot initiative: if this law is needed, it’s the legislature’s job to enact it, and I would prefer it if they did. With a Democratic Party supermajority in the Assembly, it ought to be something that parties with an actual interest in patient safety could swing.

I DO like unionization wherever it can be achieved, though. OTOH, if this passes, it won’t be a bargaining chip for union organizers, and I just don’t see it as a keystone that would result in unionization.

On the OTHER other hand, those commercials with all the if this passes, my dialysis clinic will close, and I’ll DIE message just piss me off to no end.

And a big fat lie too, because the measure, if passed, would prevent existing clinics from closing without getting permission from the state department of public health.

I don’t think either side has much to be proud of here. And I agree that if this law were needed, there would be no shortage of votes for it in the legislature.

If passing this measure means that some smaller clinics can no longer afford to operate, who will subsidize them to keep them open?

To be clear, I am opposed to the measure.

However, the commercials specifically say “Prop 23 would shut down many dialysis clinics.” That’s “would” not “could” and “many” not “some.” I don’t know on what basis the state’s DPH would allow or not allow a clinic to close due to increased costs, and neither do the clinic owners. The threat is clearly being overblown, at the same time as the bill itself is unnecessary and intrusive.

Here’s one of the commercials:

How does the state prevent a clinic from closing? Presumably these are either corporations or not-for-profit organizations. No person can be held responsible. You’d just dissolve it or failing that walk away. I suppose they could prevent you from selling the equipment.

I was all set to vote NO on Prop 23 until I saw John Oliver’s segment on dialysis.


Good grief what a mess. Fresenius and DaVita are truly awful, but I really don’t like being a pawn in this grudge match between them and SEIU. The legislature should get off their butts and regulate this shameful, runaway industry more. This is really a national problem and ultimately should be dealt with at the federal level.