California physicians pay close attention to policies that negatively impact patients and decrease access to quality health care. Proposition 8 would be as bad for patients as anything we have seen in a long time.
Proposition 8 would put the lives of vulnerable dialysis patients at extreme risk by causing severe cutbacks in services and even outright closure of dialysis clinics statewide.
To stay alive, dialysis patients need treatment three times a week for three to four hours at a time. Dialysis is so critical that just one missed treatment increases the mortality risk by 30 percent.
If this initiative was to become law, they would have a harder time accessing a clinic for their life-saving treatment.
That’s why Proposition 8 has drawn the condemnation of my organization, the 43,000-physician-member California Medical Association, and numerous health care leaders, including the American Nurses Association/California, California Hospital Association, emergency room physicians, renal physicians, dialysis caregivers, patient advocacy groups, community groups, veterans and others.
Proposition 8 would set severely low limits on what insurance companies are required to reimburse to dialysis clinics for treatments. These limits are arbitrary and would not cover the cost of providing high-quality care in a clinic.
Proposition 8 would specifically prohibit clinics from billing for necessary expenses such as physician medical directors, nurse managers, nurse clinical coordinators and other staff positions and services critical to running a safe and efficient clinic.
A study by the former California Legislative Analyst estimated that 83 percent of clinics would be operating in the red if Proposition 8 passes. If clinics can’t cover their necessary operating costs, they would have to cut back services or shut down. Dialysis patients would lose access to life-saving care.
Living with kidney failure and being dependent on dialysis treatment is serious. The U.S. Centers for Medicare & Medicaid Services report that the average age of a dialysis patient in California is 62.
In addition to having failed kidneys, many have other diseases such as hypertension, diabetes, heart disease or cancer.
Without outpatient clinics nearby to provide life-saving treatment, the only other option for patients to get dialysis three times a week would be in crowded hospital emergency rooms, where the same treatment costs significantly more and would unnecessarily burden the entire health care system.
In California, quality and patient satisfaction in dialysis clinics rank among the highest in the nation. California dialysis clinics are highly regulated at the federal and state levels to ensure quality. Facilities undergo rigorous reporting and review. California clinics outperform the national average in clinical quality and patient satisfaction, the Centers for Medicare & Medicaid Services reports.
Proposition 8’s supporters refuse to acknowledge that this irresponsible initiative would force dialysis clinics to operate in the red, which would trigger layoffs, clinic closures and a dangerous diminution in access to quality dialysis treatment.
You may be wondering why Californians are being asked to weigh in on such a personal and complicated health care issue that will harm dialysis patients.
There is no good reason this is on the ballot. To be clear, patient care is not the motive of supporters as they claim. The motive is political, and a spokesman for the United Healthcare Workers West union, which is funding Yes on Proposition 8, admitted as much recently to the San Francisco Chronicle.
In our view, there is no acceptable scenario to put patients in harm’s way to achieve a political objective.
We must protect dialysis patients’ access to life-saving dialysis treatment. Please vote no on Proposition 8.
Dr. Theodore M. Mazer is president of the California Medical Association and a board-certified otolaryngologist who has been working in a solo practice in San Diego for more than 25 years. He wrote this commentary for CALmatters.
