Proposition 23 and the politics of big money

A dialysis nurse checks his equipment. (Photo: Saengsuriya Kanhajorn, via Shutterstock)

Close your eyes. Think about all the problems facing California. Think about the top 10 problems. Now think about the top 100 problems. Now open your eyes. We doubt anyone reading this thought about staffing in kidney dialysis centers.

Yet this year proposition 23 was asking voters in California to have a say on the staffing requirements for kidney dialysis centers.

Proposition 23 showed how the system for getting propositions on California’s ballot favors those who are willing to spend money at the expense of issues that have a larger impact on more people. ​California’s government is completely broken​.

There is a reason that patients are not flocking to Somalia despite its completely unregulated, competitive market for kidney dialysis.

Proposition 23 came from the SEIU (Service Employees International Union) which has been in an acrimonious dispute with Davita and Fresenius, the two companies that control 70% of kidney dialysis in California. According to the SEIU, they were ready to spend $93 million on Proposition 23. ​The kidney dialysis cartel spent more than the $111 million they spent in the 2018 version of this same bill.

Money is drowning out the voices of ordinary people. Most people whose lives are affected by kidney dialysis are not shareholders in Davita or Fresenius. They are not employees of the SEIU. ​The vast majority of people affected by kidney dialysis are patients. ​When the government is focused on the companies or the unions and not patients, the government is ignoring the people it ought to serve.

Entities with market power have excess profits they can “invest” in altering the regulatory system. This is true for the SEIU which seeks a monopoly on the supply of labor, as well as Davita and Fresenius. Eventually, buying control of government becomes a way to rig the game for the benefit of one side or the other. Economists call this rent seeking. When rent seeking replaces innovation and cost savings as the easiest way to increase profits, ordinary people suffer.

We aren’t advocating for completely unregulated markets. There is a reason that patients are not flocking to Somalia despite its completely unregulated, competitive market for kidney dialysis. It is unreasonable to expect all patients will be able to determine adequate staffing levels for dialysis centers and choose properly staffed centers. ​

However,​ ​it is even more unreasonable to think that the average voter could determine adequate staffing at a dialysis center​. We need some regulation. We need regulation to be even handed and to take into account the needs of patients. Even if patients are not throwing huge amounts of money at the system.

Ballot propositions were meant to give Californians a way to force the politicians to address issues important to the public. That is not a bad thing. We should not get rid of propositions. We should find a way to align their focus with the concerns of the public.

Getting a proposition on the ballot requires collecting signatures. In California there is an industry that pays people to collect signatures.

If the SEIU wants something on the ballot they pay somebody to collect enough signatures to get the issue on the ballot. We should make it illegal to pay people to collect signatures.

If an issue is so important to ordinary people that they want a proposition, they should be willing to invest and volunteer the time and effort required to get the issue on the ballot. Organizations would have to buy access to the ballot with volunteer effort not money. Propositions on the ballot because of volunteer efforts are much more likely to be focused on issues critical to citizens.

The bottom line is simple. Go back to the 10 problems you thought about at the beginning. We want government to be prioritizing those problems​,​ ​even if nobody is buying their attention and ​not parochial needs of those with money to spend.

Editor’s Note: Jason Fike is the California coordinator of TakeBack.org and Paul Lichstein is the New Jersey director of TakeBack.org



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