No on Prop. 23, which won’t improve care

You’ve probably seen the ads on TV. Many times.

“They’re trying to take away my clinic, again.”

Well, “they” might if voters approve Proposition 23 on the Nov. 3 ballot. It’s a reworking of a measure that voters rejected two years ago that would have limited the profits of kidney dialysis clinics by increasing their overall work force.

Prop 23, if approved, will require kidney dialysis clinics to have at least one physician present during all operating hours, and to report infection data to the state. It also would require that operators get approval from the state’s health department before closing a clinic, and prohibit clinics from discriminating against patients based on insurance type.

As with several measures on the ballot, Prop. 23’s support mainly comes from unions — more specifically from the Service Employees International Union-United Healthcare Workers West, which has targeted the companies that operate dialysis clinics and had vowed to come back with another measure after the 2018 one went down.

The union wants to organize the clinics, which it says could be better run and provide better medical treatment.

Opposition comes from the dialysis industry, which has put out more than $105 million to defeat Prop. 23 — a sum that dwarfs the nearly $7 million the union has contributed to make its case to voters

he union says that the clinics make huge profits and aren’t investing enough back into the clinics.

It’s still a bad case, and we urge voters to reject Proposition 23.

Here’s why.

If you just read the capsule description of the measure, it would seem to affect only the 80,000 kidney dialysis patients who get life-saving care at more than 550 California clinics.

The problems with Prop. 23, however, actually would harm more than just the patients receiving this care, just as the people testifying in the ubiquitous TV ads maintain.

That’s because at a time when there is a shortage of doctors and nurses in much of the state, requiring the clinics to keep a doctor on site at every dialysis clinic all the time, would take an estimated 1,000 doctors and nurse practitioners away from patients who might urgently need them.

Moreover, at most dialysis clinics, charge nurses who are already present at all times are often more skilled at solving dialysis problems than the doctors who supervise them.

In addition, many dialysis clinics are located within or near hospital complexes, which means if physicians would be needed for a crisis , they could get to clinics quickly.

But this measure isn’t really about patient safety. It’s about the $468 million in 2018 profits raked in by dialysis companies — specifically a German company, Fresenius Corp., and Colorado’s DaVita Corp., which combined own about 70% of California’s dialysis clinics. Fresenius also makes profits by selling the dialysis machines that clear toxins from patients’ blood.

These two corporations are the main spenders trying to defeat Prop. 23.

The SEIU is probably correct that the domination of the industry by just two companies keeps clinic staffing down. It’s not a perfect situation by any means.

But this measure, like the one before it, is not the answer. Consider that the nonpartisan analysis of Prop. 23 by the state Legislative Analyst Office shows it would cost each dialysis clinic hundreds of thousands of dollars yearly. These expenses would be paid by Medicare, Medi

Cal and insurance companies – which means in the end, taxpayers and patients would have to pay the bills. Opponents of Prop. 23 also say that clinics that can’t afford the increased costs would be forced to reduce hours or close completely, including nonprofit clinics that aren’t owned by DaVita or Fresenius.

Raising costs and exacerbating the shortage of physicians is not the roadmap to improving kidney patients’ health care.

We urge a no vote on Proposition 23.