Prop 23 – Do we really need a doctor in the house?

Prop 23 – Do we really need a doctor in the house?

Back in the November 2018 election, California voters were forced to pretend to be health care executives when they were asked to decide whether to require dialysis clinics to give refunds to patients (or patients’ insurers) if profits were above 115 percent of the costs of patient care and healthcare improvements. Californians sensibly voted down Prop. 8.  Right by the Bay wrote about it here.

But now the special interests are back with another idea to hound dialysis patients and their providers — Prop. 23.  But instead of pretending to be health care execs, this time Californians are asked to masquerade as medical professionals.  Prop. 23 wants voters to decide whether to require that a doctor be present at the dialysis clinic while patients are being treated. Since a doctor in the house would add to the cost of care, the key question is are they really necessary?

In California, dialysis patients are already required to have a physician oversee their care, as well as a kidney specialist or an affiliated professional to monitor their health weekly while patients are being treated. If a patient starts to have complications while at the clinic, they are transferred to a hospital where he or she will receive comprehensive care.

According to research by the Los Angeles Times, the average clinic in the state had 11 patient deaths in 2018.  While no one should take this number lightly, it is nevertheless lower than the national average both in number and in percentage, based on federal statistics. Indeed, neither the federal government nor any other state requires clinics to keep a doctor on duty.

An idle doctor hanging around at a clinic will inevitably add to patients’ bills.  In particular, Medicare patients have to cover 20 percent of the copay because Medigap policies don’t cover dialysis.

The Ballotpedia Prop. 23 page lists several health care and patient advocate groups opposing the measure, including doctors themselves (the California Medical Association), AMVETS, the American Legion, and the NAACP.  The only group listed in support is SEIU-United Healthcare West.

The SEIU-UHW has been trying for years to unionize dialysis clinic workers through ballot measures and legislation. Prop. 23 is simply another attempt by the union to punish dialysis providers by raising their costs by requiring them to pay for expensive doctors. The Orange County Register editorial board recently wrote that the SEIU-UHW’s “electoral plan is apparently to make the two companies that own most of the state’s clinics spend so much money fighting ballot initiatives every two years that they have a hard time staying in business. That kind of chicanery makes a mockery of California’s initiative system….”

In 2018 it was Prop. 8, in 2020, it’s Prop. 23.  We’ll likely be writing about dialysis clinics again in 2022.

Rowena Itchon is senior vice president of the Pacific Research Institute.

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Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.