California healthcare unions are taking another shot at “Big Dialysis” after their failed 2018 measure, and get ready for TV ads, as the franchise clinics are outspending the unions 16-1.

Those of you who watch old people TV shows like Jeopardy! and Judge Judy are probably getting a curious case of election season déjà vu — you are once again being bombarded with an advertising deluge of pensioner-types complaining about a new California ballot measure that’s “putting my life at risk”, and that “Prop. 23 would shut down many dialysis clinics.”  

They refer to Proposition 23 Dialysis Clinic Requirements Initiative, the latest attempt to regulate California’s $3 billion a year kidney dialysis clinic industry. But it was just two years ago that we went through what feels like the exact same political fight over kidney dialysis clinics.

Why the hell is another kidney dialysis measure on the ballot again? After all, this is a pretty niche medical industry, and the nation has a vastly more urgent health crisis on its hands!

The new dialysis measure is on the ballot because the unions fought to put it there. Just one day after the 2018 dialysis measure Prop. 8 was defeated by 20 points, the Service Employees International Union—United Healthcare Workers West put out a furious, sore-loser press release declaring  “This is only the beginning; we are in this for the long haul. We intend to re-file this initiative for the 2020 ballot in California.”

And that is exactly what they’ve done. This year’s new version hopes to “require chronic dialysis clinics to: have an on-site physician while patients are being treated; report data on dialysis-related infections; obtain consent from the state health department before closing a clinic; and not discriminate against patients based on the source of payment for care.” (The 2018 version attempted to reimburse dialysis patients for overcharging.)

That previous dialysis ballot fight was the state’s most expensive measure of 2018. (It will not have that distinction in 2020, now that the Uber-Lyft Prop 22 campaign is approaching $200 million in tech contributions.) But the dialysis companies have ponied up more that $100 million to beat it, compared to a mere $6 million for their union opposition.  

2020 No On Prop 23 print ad (left), 2018 No On Prop 8 TV ad

And as we see above, the dialysis clinics are using some of the same “volunteer spokespeople” in their 2020 ads as they did in their 2018 ads.

So certainly we’re watching a kidney dialysis sequel because the unions forced it, they and the Democratic Party are effectively the only donors toward the effort. But the big dialysis clinics do deserve to be held accountable, too.

For all their profits, SF Weekly reported in 2018 that clinics had “unsanitary conditions at centers, including issues of rodents and cockroaches.” One of the state’s biggest clinic franchises Fresenius Medical Care paid $231 million to settle foreign bribery charges just last year. California’s other big clinic chain DaVita, Inc. settled kickback charges with the Department of Justice for $350 million in 2014, then another $450 million in 2015 for defrauding the government, and a $383.5 settlement in 2018 for a slew of wrongful death lawsuits.

But for Jeopardy! viewers, the next month of No On Prop. 23 ads may begin to feel like passing kidney stones.

Related: What Are the California November Ballot Initiatives, and How Are They Polling? A Review [SFist]

Image:  No on Proposition 23 via Youtube