John Oliver: Dialysis

[Initech]

Posting this for California DUers to get the facts straight on Prop 8.

[California_Republic]

1. Proposition eight on the California ballot address is this

[Initech]

2. So is it for or against regulation?

I'm having a hard time deciphering the messages I'm getting for both sides.

[GregD]

3. my mother gets dialysis at Davita in a rural community in central Oregon.

They are great. They are polite and professional. John talks about how they purportedly push people through. Ever had to deal with dialysis? Do you have any idea how many folks depend (literally to save their lives) on this? The folks that I have observed at Davita are doing absolutely everything it takes to accommodate the very many patients they serve.

One time we needed the Davita in the next community south of them to fit Mom in so that she could attend a specialist in that town. It worked out great.

I have nothing but kind words for Davita.

[unitedwethrive]

5. No one is saying the employees are bad people, the proposition seeks to limit the amount of profit

that these 'for profit' dialysis companies make. The hope is that by limiting the outrageous sums they charge insurance companies, that the price for everyone will go down.

[Initech]

8. So would a no vote mean that you are for or against the dialysis clinics?

Because that's what I am trying to get a handle on.

[JI7]

12. yes means requiring a certain amount to be spent on patient care and limiting profit

so anything more than a certain amount of profit would be returned to insurance companies .

the logic is that they would most likely use the money on improving patient care and hiring more people. this is why unions support it. and it makes sense to me.

[Hoyt]

6. I was wondering how Davita clinics were. See post below about my Father-in-Laws treatment.

Glad to hear it. Sometimes we are quick to criticize corporations; but if they have a model that works, it's likely better than physicians running them independently as used to be the case.

Hope your mom does well.

[JI7]

13. unions are for a YES on prop 8 because it would mean hiring more people

because the law would require certain amount to be spent on care and limits profits.

[geardaddy]

15. My dad was on dialysis for years at Davita

He had nothing but good words for them.

[GregD]

16. another nice story about Davita

This weekend is Mom's 85th and she wants a tablet for use at dialysis instead of her smart phone. 3-4 hour treatments, 3 days per week, are driving her nuts. And before I go on, so cool to see her messing around on Facebook, texting some of us, and posting with friends. She's so clever!

Anyhow, I have the tablet, and it suddenly occurs that I should check with Davita to ensure they have public wifi. Called, yes they do, and more than happy to help her with it. She was enthusiastic as she told me.

The folks I have experienced on various visits that place simply rock. They are all really wonderful.

[Hoyt]

4. Don't live in California, so haven't really studied this. I would not wish dialysis on anyone, but

it is the only way for a lot of folks with kidney disease. My FIL was on it for about 3 years, before he died. Can't tell you how many times I literally had to drag him out because he was passed out after treatment. The treatment is extremely debilitating for all but the strongest, youngest patients. Even then, I saw strong 20 year old football players collapse leaving the treatment centers.

On the other hand, in areas without a lot of dialysis centers, you spend years arriving at 5:30 AM until you've put in enough time to get treatment later in the day. Only the strongest can drive themselves to the centers. Most are brought in by family 3 days a week, many by ambulance from nursing homes.

If someone has private insurance, they still go on Medicare after 2 years for their dialysis treatment. So there is some oversight by Medicare since so many people are on dialysis for more than 2 years. Payments are limited by Medicaid, Medicare and private insurers, so what the centers charge is practically meaningless. They can charge a billion dollars, but they aren't going to get much more than the $500 or so that payers allow unless the patient is wealthy and uninsured.

My main concern is if limiting profitability will impede growth of clinics. The few times we were able to take my FIL out of his home area, we had to go to clinics that were filled with violent prisoners. My FIL used to remind us not to tell them he was a deputy sheriff for 25 years. By that time, he was pretty sick and weak. Fortunately, they were heavily guarded, but still. . . . . . Other than that, the prisoners were friendly, often funny, and not a big concern since they were cuffed and closely guarded. But, the point is that other centers didn't have room to take out-of-towners. You took the "prisoner" clinics or didn't travel or just died, I guess.

Anyway, I'm fine with all kinds of regulation to improve quality, but need to be careful if limits on profitability impedes availability. Admittedly, I don't know for a fact that this initiative will. Plus, this was 15 years ago, so maybe things have changed. I do know that several large companies own most dialysis clinics nowadays. That can be good or bad. Back 15 years ago, most clinics were owned by local physicians. Some made sure their dialysis clinics were run properly. Others simply made excuses for problems.

Anyway, hope California voters get it right. They usually have better health care for the masses there than the red states I live in.

Would be interested in comments by folks who know more about it.

[JI7]

14. unlikely because they are pretty profitable and business for it is expected to grow because of rise

in unhealthy people due to bad diets.

[skylucy]

7. Lots of ads against Prop 8 on TV, but I am voting YES.

Democratic Party recommends a YES vote. Big money pacs are unfortunately at work to defeat it.

[apkhgp]

9. Big Money Lobbyists never go to sleep

They are always out, rounding up support for their cause.

[burrowowl]

10. K&R!!!

[BigmanPigman]

11. Here is prop 8 info from 3 Dem sources...

San Diego Free Press, City Beat and Indivisible San Diego

Proposition 8
Look, we’re usually all for any props backed by organized labor, but not when it comes to life or death matters. This prop would cap revenues at kidney dialysis centers in hopes that patients will save money and that dialysis clinics will spend more on patient care. The problem is that the clinics are much more likely to pass the costs and lost revenue onto patients, most of whom depend on dialysis just to live. There’s a reason this didn’t fly when labor tried to get the legislature to pass this and voters should also reject Prop. 8
****************
Proposition 8
Regulates Profits for Corporate Dialysis Clinics
Regulates Amounts Outpatient Kidney Dialysis Clinics Charge for Dialysis Treatment. Initiative Statute. (Put on the Ballot by Petition Signatures)
“Requires rebates and penalties if charges exceed limit. Requires annual reporting to the state. Prohibits clinics from refusing to treat patients based on payment source. Fiscal Impact: Overall annual effect on state and local governments ranging from net positive impact in the low tens of millions of dollars to net negative impact in the tens of millions of dollars.” Supporters: Californians for Kidney Dialysis Patient Protection | Opponents: California Dialysis Council

Ballotpedia Quote: Proposition 8 establishes a new front in the conflict between the SEIU-UHW West, a labor organization, and the state’s two largest dialysis businesses DaVita and Fresenius Medical Care. The SEIU-UHW West said workers at dialysis clinics have been attempting to unionize since 2016, but that their employers were retaliating against pro-union employees
*******************************
PROP 8: LIMITS ON DIALYSIS CLINICS' REVENUE AND REQUIRED REFUNDS INITIATIVE
Authorizes State Regulation of Kidney Dialysis Clinics. Limits Charges for Patient Care

What it does:
Requires dialysis clinics to issue refunds above 115% of the costs of direct patient care and healthcare improvements. This would cap profits and incentivize clinics to spend revenue on healthcare improvements.
Analysis:
Just two large corporations operate (and profit heavily from) most of California’s dialysis clinics. Patients with private insurance in particular can be overcharged by huge margins. This proposition seeks to cap those profits and require companies to spend money on patient care. It would require any revenue beyond the 115% cap to be refunded to the patients or their payers each year.
Who is for it:
Californians for Kidney Dialysis Patient Protection, SEIU-UHW West, San Diego Democrats,18 Statewide
Groups, 11 Healthcare Advocacy Groups, 29 Labor Unions, 24 Democratic Groups, and 60 Community Organizations. (See the whole list.)
Who is against it:
California Dialysis Council, Patients and Caregivers to Protect Dialysis Patients (Majority of funding coming from dialysis business DaVita and Fresenius Medical Care North America) California Medical Association, National Kidney Foundation, other Patient Advocacy, Health, Veteran Organizations, Community Clinics, and Business organizations.