California recently enacted new, tighter rules mandating maximum waiting times for appointments with primary-care docs and specialists in managed-care plans (HMOs), such as Kaiser Permanente.  According to regulators, the problem is so bad it threatens a "feudal situation".

On top of this, the California Nurses Association has produced a bizarre report that claims that health plans reject 22% of all claims, which it has not published but shared with Attorney-General Jerry Brown and, apparently, the Los Angeles Times' Lisa Girion.

Years ago, organized nursing in California enlisted government power to impose one-size-fits all nurse-patient staffing ratios in the state's hospitals, which hospitals credibly assert has caused emergency rooms to close and acute-care services to be cut back, because they simply cannot fill the mandated positions.

Yesterday, the National Right to Work Committee entered the mix (excuse the pun), with a valuable and timely op-ed in the Wall Street Journal by its President, Mark Mix.  At Kaiser Permanente, explains Mr. Mix, union bosses play a "co-equal" role with the HMO's managers in running the operation, and warns us against Detroit-style labor relations in the hospitals.

I expect that this is one explanation for the deteriorating access to care in California's HMOs.

This blog post originally appeared on State Policy Network.