Why California voters have to weigh in on kidney dialysis for the third time in six years

The relatively thin crop of ballot questions going before California voters in November should encourage those who have tried to restrain the state’s overused initiative process, which typically forces the electorate to make policy on a wide range of often arcane issues. But too many of this fall’s initiatives nevertheless concern controversies among special interests and detailed fiscal questions that should be answered by politicians and policymakers, not voters sorting through long lists of sometimes obscure issues in their spare time.

The seven propositions on the ballot are the fewest put to voters in an election year since 1916, just five years after Hiram Johnson spearheaded the advent of the initiative, the referendum and the recall as a means of empowering voters. That the number is near a historical low speaks to the sheer volume of such questions typically put to the state’s electorate. The 2020 ballot featured a dozen questions, and a few election years have confronted voters with more than 40.

Reforms proposed by Sacramento Mayor Darrell Steinberg in 2014, when he was the leader of the state Senate, helped trim this year’s ballot by giving lawmakers an opportunity to pass legislation on the questions instead. Two proposed initiatives, on medical malpractice and plastic pollution, were withdrawn from the ballot thanks to eleventh-hour deal-making in the Capitol. The negotiations yielded a major bill requiring plastic producers to substantially increase recycling rates over the next decade, an encouraging example of progressive policy made by the people voters elected to do the job.

Of the questions that will appear on the ballot, the first, which would enshrine abortion rights in the California Constitution, is the sort of matter of general public interest and constitutional protections that should be going to voters. The other six, not so much.

Two questions concern the latest high-stakes battles over gambling, with Native American tribes, sports betting websites and Las Vegas casinos jockeying for control. Two others would add more ballot-box restrictions to the state budget to direct revenue to school arts and music programs or electric vehicle incentives and infrastructure. The latter, backed partly by the ride-share company Lyft, would raise taxes on the state’s wealthiest to subsidize the transition to zero-emission vehicles.

One of the worst examples of the genre on this fall’s ballot stems from a long-running dispute between kidney dialysis companies and Service Employees International Union, which has been trying to organize the clinics’ workforces. For the third straight election year, California voters are being asked to impose stricter standards on dialysis clinics through a ballot measure backed by the union, whose previous two initiatives lost resoundingly.

The only less edifying exercise on the ballot is a Big Tobacco-backed referendum to overturn the state’s ban on their flavored products.

Despite incremental progress toward a less bewildering ballot, the bulk of this year’s initiatives show that this supposed instrument of direct democracy functions mainly as a means for wealthy interests and individuals to work their will. Lawmakers should ensure that the next ballot gives voters a chance to rein in a process that was supposed to work for them.