2022 CA Proposition 29: Regulating Dialysis Clinics and the Definition of Insanity

I’m never sympathetic to ye olde “we’ll take our marbles and go home” argument

Proposition 29 aims to bring some regulation to the wild west era of clinical treatment centers. At issue here are dialysis centers, which are extremely profitable, thanks to ever-increasing demand brought on through diabetes 2 linked to the “norms” of America’s dietary and exercise choices.

Legislative language: Requires on-site Licensed Medical Professional at Kidney Dialysis Clinics and Establishes Other State Requirements. Initiative Statute

Californians for Kidney Dialysis Patient Protection
Website / Facebook/ Twitter
Media: Yes on California Proposition 29: This measure would protect dialysis patients’ lives

No on Prop 29 - Stop Yet Another Dangerous Dialysis Proposition
Website / Facebook/ Twitter
Media: No on California Proposition 29: This measure would put dialysis patients at risk

Diabetes commonly causes kidney failure, making either dialysis or a transplant necessary to sustain the blood chemistry needed to prevent death. 

There is a subset of the legal industry specializing in either defending or suing dialysis treatment centers, which is, I think, a good indication that problems with the procedure are more common than most people might think.

Here’s a typical pro-litigation pitch found on the internet.   

• About 90% of patients receiving dialysis receive it as hemodialysis. According to a recent study, Americans who have dialysis performed at private, for-profit centers, face an 8% higher risk of death than those who seek the treatment at private non-profit clinics. The research suggests that at least 2,500 deaths a year could possibly be prevented by switching kidney patients to non-profit dialysis centers.

• For-profit dialysis centers typically have smaller staffs and nurses and technicians who are not as well trained. Patients generally attend for-profit clinics for shorter periods, which has been associated with higher mortality rates.

There are about 650 dialysis clinics in California serving about 80,000 patients, who visit three times a week for about four hours.. Two private, for-profit companies — DaVita Inc. and Fresenius Medical Care — own or operate three-fourths of the clinics. State analysts estimate these clinics bring in about $3.5 billion annually.

According to Prop 29 supporters, “the average profit margin for DaVita and Fresenius clinics in the United States is 16% and 15.8% respectively — nearly six times as high as the average profit margin for US hospitals.”

Proposition 29 was brought to the ballot through the efforts of Service Employees International Union-United Healthcare Workers West. They paid  Kimball Petition Management  $13,374,336.75  to collect the 623,212 valid signatures required to put this measure before voters. The initiative campaign submitted 1,018,730 raw signatures to the Secretary of State.

The union obviously would like to organize the workers in all these clinics, but says its larger point is to bring reform and increase transparency in a booming industry.

The measure would require dialysis clinics to have at least one physician, nurse practitioner, or physician assistant while patients are being treated; report data on dialysis-related infections; and not discriminate against patients based on the source of payment for care.

Opponents of Prop 29 claim that it would make the procedure more expensive and force some clinics to close. I’m never sympathetic to ye olde “we’ll take our marbles and go home” argument, especially in an industry with such healthy profit margins. 

Ballot measures, or the threat thereof, are a core part of SEIU-UHWW’s overall strategy. The union can claim some credit for pushing former Gov. Jerry Brown to back increases to the minimum wage via its promise to put the question to the voters.

The fact that Prop 29 is the third consecutive general election attempt at impacting the privately-run dialysis clinic business is a sticking point for newspaper editorialists throughout the state.  Version one (2018) garnered support from 40.1% of the electorate. Version two (2020) performed even worse with 36.6% voting in favor.

Huge amounts of money have been spent to advocate/oppose clinic regulations, with SEUI-UHWW support amounting to over $27 million and DaVita/Freseniius dropping more than $215 million over the past two elections. Currently there is roughly $45 million floating around aimed at this election.

Although there have been differences in the language used in each of the three initiatives, the desired result has been the same. And advocates for reforming the industry have failed to make their point in a big way.

So they’re fighting the same battle over and over again and expecting different results? 

I don’t know about you, but this sounds kind of crazy to me. 

PS– I’ll vote for Prop 29 for the same reasons I won’t cross a picket line –solidarity,– while muttering to myself about all the good things that could be done with all the money being thrown around. 

The clinics could make themselves safer; the union could promote candidates who support single payer healthcare OR oppose candidates who would restrict a woman’s right to choose.   

Oh, well…

Next up: Proposition 30 – We’re All Still Waiting for Flying Cars

Previous voter guides:
(More coming soon)

California State Officials
California’s DC Delegation
State Senate Races
State Assembly Races
SD County Supervisors
County Sheriff, Assessor, and Treasurer Races
SD Measure B: Cash Meets Trash 
SD Measure C: Reach for the Sky! Or Else?
SD Measure D: Righting a Wrong to Build a Future
SD Measure H: It’s for the Children (And Their Parents)
CA Proposition One: It’s About More Than Abortion
CA Propositions 26 & 27: Betcha Can’t Pick Just One
CA Proposition 28: Arts & Music for a Sane Future

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Boards of Education Contests:
Analysis by Thomas Ultican

2022 School Board Contests, Part 1
The County Board, San Diego Unified, Sweetwater Union, Poway Unified
2022 School Board Contests, Part 2
Chula Vista, San Marcos, Vista, Grossmont
2022 School Board Contests, Part 3
Oceanside, Escondido, San Dieguito
2022 School Board Contests, Part 4
Coronado, Carlsbad, Escondido Union

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Email me at WritetoDougPorter@Gmail.com