Editorials

Put patients ahead of union priorities

Dialysis technician Audrey Thomas demonstrates how kidney dialysis is set up on patient DeWayne Cox at a new Southern California clinic. Proposition 8 on the Nov. 6 ballot would limit clinic profits.
Dialysis technician Audrey Thomas demonstrates how kidney dialysis is set up on patient DeWayne Cox at a new Southern California clinic. Proposition 8 on the Nov. 6 ballot would limit clinic profits. Pew Charitable Trusts/TNS

We have no particular affection for the way the business of healthcare is conducted in this state or country. Many of the modest reforms enacted by the Obama administration have been gutted, and we’re seeing more people unable to get or afford insurance coverage. The for-profit model prevalent in so many of the industry’s specialized cul-de-sacs simply does not serve patients well.

But a ballot initiative attacking one segment of the industry is not the way to solve the problem.

Proposition 8 is one union’s attempt to force two specific companies in a single industry segment – kidney dialysis – to hire more workers. It is unnecessarily elaborate, uses scare tactics and is unlikely to deliver what it promises. In fact, it’s more likely Proposition 8 will make matters worse in areas where specialized care can be difficult to obtain.

The union, SEIU-United Healthcare Workers West, is trying to organize workers in 555 dialysis clinics, according to the public-interest journalism website CALmatters. This ballot measure is being used as leverage in negotiations with DaVita and Fresenius Medical Care, the state’s two biggest for-profit dialysis companies. Sixteen places offer dialysis in the greater Modesto area, and DaVita runs six of them. Fresenius is centered in the Bay Area.

Proposition 8 would limit clinic profits to 15 percent more than specified “direct patient care” and “health care improvement” costs. Any excess profits – potentially several hundred million dollars a year – would be returned to insurance companies.

Even with those profits, the union alleges some clinics are roach-infested, use run-down equipment, provide shoddy care and staff is overworked. It has gathered the support of other labor groups, some healthcare groups and the state Democratic Party – apparently captive to the party’s most liberal elements.

Prop 8 would put another complex layer of regulation atop an already enormously complex industry.

Healthcare nationwide is volatile, difficult to understand and is likely to continue changing. But the state of California has been a leader in finding patient-oriented solutions.

This isn’t one of them. The measure is opposed by roughly 100 groups, including the California Medical Association, emergency room doctors, hospitals, the American Nurses Association, Renal Physicians Association and patient-advocate groups such as the Chronic Disease Coalition.

It’s entirely possible the measure could backfire. Depending how the state Department of Public Health implements the new rules, wrote the Legislative Analyst’s Office, some clinics might close and fewer new ones could open.

Foes say under Prop 8, many clinics would recover only around two thirds of their costs. With dialysis facilities already unavailable in many rural communities, clinics in less populated areas would be the most likely to close.

The SEIU is spending about $19 million to pass the measure. DaVita, Fresenius and other dialysis companies are going to spend $47 million to defeat it.

The SEIU has highlighted some valid financial issues, but they should be addressed by state regulators or – better yet – a nationwide policy that provides better ongoing healthcare for everyone.

About 80,000 Californians need dialysis. The last thing we should do is put their health in jeopardy. In any healthcare debate, the well-being of the patients should be uppermost in our minds. Not the well-being of even the most well-meaning of unions. Vote no on Proposition 8.

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