Voters' penchant for maintaining the status quo was just as evident in most healthcare ballot initiatives across the country as it was in the presidential and congressional elections.
In California, voters soundly rejected two ballot measures that would have placed greater regulatory controls on managed-care plans and healthcare providers. Although the measures were sold to the public as populist tax and consumer safety initiatives, they also were tools in a classic labor battle between employers and employees.
In California, one of the country's most competitive healthcare markets, it was healthcare workers who are seeing their jobs evaporate vs. insurers and providers who are seeing their profits evaporate.
The most controversial of the two initiatives was Proposition 216, which was supported by the California Nurses Association and a Ralph Nader-backed consumer group. The measure would have prohibited the use of "gag clauses" by managed-care plans and imposed staffing requirements on healthcare facilities. It also would have imposed a tax on hospitals that reduced their bed counts and created a new public corporation to act as a patient advocate.
With nearly all the votes counted, Proposition 216 was losing by a count of 5,053,980 to 3,198,336, a 61% no vote.
Proposition 214, the other anti-HMO measure, went down to a similar defeat, rejected by 57% of voters.
Like Proposition 216, Proposition 214 would have barred the use of gag clauses by managed-care plans and imposed staffing requirements on institutional healthcare providers. It was supported by the Service Employees International Union and a coalition called Californians for Patient Rights.
The California Healthcare Association, the state's hospital association, was the largest contributor to the $7 million effort mounted by insurers and providers to defeat the two propositions, said Janet Maira, a spokeswoman for Taxpayers Against Higher Health Costs, a healthcare industry-dominated coalition.
The CHA spent $1.6 million, while Kaiser Permanente also was a big spender on the insurance side with a $1.3 million contribution.
Hospitals and insurers were successful in branding the propositions as expensive job protection measures for hospital and healthcare workers.
Proposition supporters attempted to sell the measures as consumer protection initiatives, bombarding the public with horror stories of patients victimized by greedy hospitals and managed-care plans.
After the votes were tallied, both sides continued to maintain that the issues were higher costs and patient safety rather than a labor battle between employers and employees.
"Californians have sent a strong message," Maira said. "They're saying `no' to more government involvement in healthcare, `no' to proposals that increase healthcare costs and `no' to proposals that increase taxpayer costs."