The Sacramento Bee Dan Morain column

Sept. 21--Earlier this year, Dave Regan, president of United Healthcare Workers West, urged that I write about the rich pay and perquisites lavished on chief executive officers of nonprofit hospitals.

From what I could see, it's sweet to be a hospital CEO.

But at the time, United Healthcare Workers, an arm of the Service Employees International Union, was promoting initiatives that took aim at hospitals. The initiatives and story pitch were part of a negotiation strategy to push hospitals into playing nice with union organizers. So I didn't get around to writing about hospital executives' fat pay.

In May, a month or so after we talked, Regan and the head of the California Hospital Association, the trade group for hundreds of California hospitals, announced a truce.

Gone is the sniping about executive pay and grousing about strong-arm union tactics. Now, there is common purpose. The union and hospital association have joined in efforts to raise Medi-Cal payments to health care providers. That might improve patient access to care. It also would benefit workers and hospitals, not to mention doctors.

That's where Richard Pan and Roger Dickinson come in.

The Democratic assemblymen are running for the same Sacramento-area Senate seat being vacated by Darrell Steinberg.

Pan's and Dickinson's voting records differ ever so slightly. But you can tally those differences by counting the money being spent for and against them, and looking at which interests are backing which candidate.

There is the obvious. Pan is a physician. So the influential doctors' lobby is backing him. Dickinson is a lawyer. So plaintiff's lawyers, who have clout but not as much as doctors, help fund him. The differences go beyond what you might expect.

There aren't many Democratic politicians who have a stronger pro-labor voting record than Dickinson. In two decades in public office, Dickinson has marched in the Justice for Janitors demonstrations, organized by chanting, purple-shirted SEIU members. He has written letters exhorting building owners to negotiate with the SEIU, which represents janitors. He has championed in-home supportive service workers, many of them represented by the SEIU.

And yet the United Healthcare Workers West and its parent, the Service Employees, have spent $266,000 so far to elect Pan. It gets back to the labor-hospital deal struck in May.

"The issue we are fundamentally committed to working on with the California Hospital Association is the need to transform the Medi-Cal system," Regan said. "The system is in desperate need of a redesign and an overhaul. ...

"Our common support for Dr. Pan derives from that," Regan said. "He will be a key voice in the state Senate."

There might be a measure of competition, too. Dickinson's backers include the California Nurses Association, which represents registered nurses. The SEIU also represents nurses.

In politics, there are no permanent enemies or friends, or so it is said. The SEIU gave $630,000, and the California Nurses Association spent $65,000 on a $2 million campaign by organized labor to defeat Jerry Brown's longtime confidant, Steve Glazer, in an East Bay Assembly race.

Labor had claimed, falsely, that Glazer had cuddled up to the oil industry.

Consistency is not a prerequisite for playing politics. And Pan is no shill for big business. But the doctor did take the oil industry's side by ducking a vote on anti-fracking legislation last year. The bill fell nine votes short of a majority in the Democratic-controlled Assembly. Dickinson voted for the bill and against the oil industry's wishes.

Dickinson has health care supporters, although the desires of his health care supporters don't coincide with those of the physicians who support Pan.

On May 27, a political action committee controlled by optometrists spent $75,000 on radio ads supporting Dickinson.

On June 24, Dickinson voted for the California Optometric Association's highest legislative priority, a bill by Sen. Ed Hernandez, a Los Angeles-area Democrat, that sought to give optometrists the right to perform certain eye operations.

Optometrists are not physicians and don't go through a surgery residency, unlike ophthalmologists, who are physicians.

Hernandez is an optometrist who contends that there aren't enough doctors to go around and that optometrists should be granted greater authority. Dickinson agrees. Hernandez gave <money>$4,100 to Dickinson's campaign. Pan opposes expanding optometrists' privileges, as do lobby groups that represent doctors.

Hernandez is chair of the Senate Health Committee and says he intends to take the optometrists' bill up again in 2015. If Pan manages to win on Nov. 4, he likely would serve on the health committee, which would make for interesting theater when the topic of optometry comes up.

If the Nov. 4 election is about anything, it is about health care. It's the biggest of all businesses, consuming 18 percent of the United States' gross national product and providing more jobs in Sacramento than state government.

Proposition 45 would give the insurance commissioner control over health insurance companies. Proposition 46 would expand the right to sue over medical malpractice. The initiatives won't excite many voters. But health insurance companies, hospitals and doctors could spend $100 million to ensure their defeat.

Dickinson supports Propositions 45 and 46, as do lawyers, his main patrons. Pan opposes them, as do doctors, his main patrons, and the SEIU, United Healthcare Workers West and California Hospital Association.

The Dickinson-Pan race will be one of the year's most costly legislative races. Pan has raised $1 million; Dickinson has raised $650,000. But they won't be the big spenders. The real money will be spent by interests seeking to elect a senator who will help implement their visions. As they know, the implications are significant.

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