Proposition 8 and the Cost of Staying Alive

Proposition 8 and the Cost of Staying Alive

The Journal of the American Medical Association reported it has become “frighteningly clear that Chronic Kidney Disease (CKD) is exacting a greater and increasing toll on American lives.” CKD is now ranked as the seventh greatest risk factor for death and disability adjusted life years in the nation. Disability adjusted life years is defined as a measure of a disease’s overall burden, expressed as the number of years lost due to ill-health, disability or early death. 

When a patient’s kidneys no longer work effectively, dialysis basically circulates the patient’s blood through a machine to filter out impurities/waste products and then returns the filtered blood to the patient.  

Sadly, like most other things in America, the dialysis treatment individuals who suffer with CKD depend on to stay alive has become just another American commodity. As a result, this treatment has succumbed to the greed of privatization. Proposition 8 presents the egregious nature of such privatization to the conscious of California voters. 

Proposition 8 causes voters to first, stop and question why it is that two private, for-profit chronic dialysis clinics (CDC)  have been allowed to monopolize at least partial ownership of the majority of  CDCs in the state; and secondly, why these same private, for-profit CDC owners are allowed to charge group and individual health insurers rates that are significantly higher than what they are allowed to charge Medicare and Medi-Cal for the very same treatment. 

Proposition 8 is seeking to place controls on these for-profit monopolies by capping their annual profits and requiring them to rebate to insurers any excess in profits that exceed the recommended cap of 115 percent of specified direct patient care services costs. In addition, they would also be required to pay a five percent penalty on the excess profits to the California Department of Public Health.   

Although the CDC’s are crying foul, the 115 percent cap is well above what they can and do currently charge Medicare and Medi-Cal whose costs are determined by regulation. 

Approximately 80,000 patients in California depend on dialysis treatment each month to stay alive. Many are covered by individual health insurers. As CDC’s charge these patients’ insurers higher rates for dialysis it is obvious those higher rates are ultimately passed along to the insured in higher premiums and/or co-payments. 

Sadly, although the moral choice seems obvious, it is also clear the for-profit entities who have cornered this market leverage a lot of power. What will happen when California voters weigh-in against them? Will they shut down and pull out of the market leaving patients with no place to turn to for treatment, or will they figure a way to charge desperate patients willing and able to pay any amount to stay alive, out of pocket fees for their treatment. 

Finally, what will happen to those who make too much to qualify for Medi-Cal and are too young for Medicare and can not afford to pay any additional out of pocket charges for treatment?

Life sustaining/saving treatment should not be left to the whims of “whatever the market will bear.” Health care is a human right. 

This is an issue that is too easy to ignore until the day you or someone you love may come face to face with it like those suffering with CKD today. Yet, it is also emblematic of what many families around the state face on other healthcare issues daily.

Something must be done to make healthcare work for everyone, not just for those who stand to make a profit and those who can afford to pay to stay alive. 

Of course, this is just my opinion. I’m keeping it real.

S.E. Williams

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