Politics is a cynical business. You can’t help but be a bit cynical when you see how laws are really made. It is frequently based on power politics, special-interest influence and pettiness, not the sanitized, romanticized versions of democracy or how a bill becomes a law described in grade school social studies textbooks.

But even for a cynic like me, who has covered California politics for about 20 years, Proposition 23 is among the worst examples I have seen of putting politics over people’s very lives. In an attempt to financially hurt an industry it has tried unsuccessfully to unionize for years, Service Employees International Union-United Healthcare Workers West has put forward yet another measure that would unnecessarily raise dialysis centers’ costs so much that a number of clinics would be forced to cut back services or close, disrupting the treatment of thousands of vulnerable patients suffering from kidney failure. In doing so, it is trying to use voters to do its dirty work and making a mockery of the initiative process.

If a ballot measure proposing mandates to micromanage dialysis clinic operations sounds familiar, it is because SEIU-UHW West put a similar measure (Proposition 8) on the ballot just two years ago. Voters recognized that, despite the union’s rhetoric about patient care, Prop. 8 was self-serving and would actually harm patients—and they soundly rejected it by a 60-40 margin.

And, just like Prop. 8 in 2018, every major newspaper in the state—from the Los Angeles Times and the San Francisco Chronicle to the Orange County Register and the San Diego Union-Tribune—has come out against Prop. 23, along with the California Medical Association, American Nurses AssociationCalifornia, Renal Physicians Association, and a wide variety of other physicians, nurses, patient advocacy and taxpayer groups (plus, of course, the dialysis companies that would be negatively affected).

The most significant provision of Prop. 23 is a mandate that a doctor be on site at all times, even though federal regulations already require each clinic to have a medical director who is a board-certified physician, and ensure that patients’ doctors visit them during treatment at least once a month. As the nonpartisan Legislative Analyst’s Office noted in its analysis of the measure (included in the Official Voter Information Guide), this provision “would increase each [chronic dialysis clinic’s] costs by several hundred thousand dollars on average.” Given that there are approximately 600 licensed dialysis clinics in California, this translates to hundreds of millions of dollars total. The LAO, further, notes that this will likely force some dialysis clinics to close and lead to higher health care costs—as dialysis clinics will be pressured to negotiate higher rates with insurance companies and Medi-Cal managed plans and the reduced access to care from clinic closures will force some patients to seek care at more expensive facilities, such as hospitals. This will add tens of millions of dollars of costs to state and local governments.

It is not as if there is some fundamental quality of care problem that Prop. 23 is trying to solve. In fact, dialysis centers in California receive more four-star and five-star marks for the quality of patient care from the federal Centers for Medicare and Medicaid Services than the national average. They also score very well in patient surveys, with approximately 65 percent of clinics receiving four or five stars (and a mere 6 percent receiving one or two stars).

The true motivation is simply the union’s interest in trying to hurt the dialysis companies financially—through both the provisions of the measure itself, if it passes, and by forcing the industry to spend tens of millions of dollars to protect itself every time the union qualifies one of these ballot measures—and facilitate the unionization of thousands of dialysis technicians, along with all of the union dues those new union members would bring in.

The state’s 80,000 dialysis patients, who, by all measures, receive better care, on average, here in California than in most of the rest of the country, should not be pawns to be sacrificed by union gamesmanship.

Proponents of Prop. 23 try to cloak their proposal in terms of aiding patient welfare, but it is really just a form of extortion and a disgusting abuse of the initiative process that would needlessly raise health care costs and harm thousands of dialysis patients across the state.