The voters of Massachusetts will have the opportunity to weigh in on on three ballot questions Nov. 6, the scope of which could shape the Bay State for years to come.

Question 1 would limit the number of patients a single nurse can be responsible for at any one time. Hospitals that don’t hire to meet the new ratios would be fined $25,000 each time they break the rules.

The union pushing the measure, the 23,000-member Massachusetts Nurses Association, says it will increase the quality of patient care by ensuring that front-line nurses aren’t overworked.

While it appears a no-brainer at first blush -- after all, who doesn’t want to support nurses? -- we urge a no vote on the proposal, for several reasons.

First, it takes medical decision-making out of the hands of professionals and gives it to the voters of Massachusetts. Many aren’t familiar with the wording of the proposed law, which runs almost 4,000 words on the ballot. The average resident doesn’t have the background to determine whether the proposed law’s ratio of, say, one nurse per every five visitors to the emergency department, or one nurse for every four adults in a psychiatric ward would guarantee better treatment for patients.

A similar law went into effect in California several years ago, to mixed effect. Even then, California gave its hospitals five years to phase in the ratios; Question 1 would require Massachusetts institutions make that happen by Jan. 1 of next year. 

There is a real concern the measure, if passed, could force cash-strapped local hospitals to drastically cut other needed services in order to hire, train and manage the 3,000 nurses needed to meet the new ratios statewide.

Earlier this month, the Massachusetts Health Policy Commission estimated the law would cost between $676 million to $949 million a year to implement, not counting roughly $58 million in start-up costs.

“If the proposed initiative becomes law,” the commission wrote in its report, “the increased costs to hospitals may result in impacts such as reductions in hospital margins or assets, reduced capital investments, closure of unprofitable service lines and reductions in non-health-care workforce staffing levels.”

Most hospital administrators agree there is a conversation to be had about nurse staffing levels. That discussion, however, should be at the bargaining table, not the ballot box. 

Question 2 would create a citizen commission to explore an amendment to the U.S. Constitution regarding money in politics. The measure is part of a larger, nationwide effort to reverse the Supreme Court’s decision in the so-called Citizen’s United case. In that 2010 case, justices ruled there could be no spending cap for corporations, unions and nonprofits looking to influences amendments.

Question 2 would not weigh in directly on Citizen’s United. Rather, it would create an unpaid, 15-member commission to take testimony, issue a report on the impact of political spending on Massachusetts, and consider proposed amendments to the Constitution. The commission’s report would be due by Dec. 31, 2019.

We favor such a commission, if it makes political spending patterns clearer to the state’s voters. It remains to be seen if the effort, here or across the country, will lead to a constitutional amendment, or if such a measure is necessary.

Question 3 puts to a statewide vote a 2016 law that bans discrimination against transgender individuals in public places.

We urge citizens to vote yes, which would keep those protections in place.

The law prohibits discrimination on the basis of gender identity in public accommodations. It allows people to use restrooms or locker rooms based on their gender identity, not necessarily their anatomical gender.

While opponents of the so-called “bathroom bill” say their concerns are about safety and privacy, there have been no issues in Massachusetts since the law went into effect. The only thing the law has done is give transgender individuals the same measure of dignity, safety and privacy as enjoyed by those who are not transgender.

The law has made allies of all political persuasions. It was passed by Democrats in the Legislature. Republican Gov. Charlie Baker signed it into law (and recently donated $500 to the “Yes on 3” campaign). Local chambers of commerce have come out in favor, as has the Associated Industries of Massachusetts, which noted North Carolina lost an estimated $3.76 billion in business when it overturned a similar law.

“The question poses both a civil rights issue and an economics issue,” the industry group said in a release, adding that “our coworkers, our neighbors and our friends” deserve basic protections.

We agree.


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