Economists and healthcare policy experts have weighed in on both sides of the debate over Question One. There are clearly compelling expert arguments on both sides. My analysis on this question to date (which can be reviewed here, here, here, and here) has been about how average voters ought to consider this and every other ballot question, especially those that involve issues not in their personal wheelhouses. Here I will lay out a political argument for voting YES on Question One. I am not, to be clear, claiming that a political argument for voting NO does not exist, rather that in my view the political dynamics of this ballot measure fight provide strong support for a yes vote.

Average voters are willing and able to make POLITICAL decisions. They are neither willing nor able to make complex public policy decisions. Ballot questions are often related to complex public policy questions, which leads many to suggest that ballot questions are a bad idea and therefore smart voters should always vote down ballot initiatives. Since the wisdom of ballot questions themselves is not on the ballot and actual ballot questions are, the larger process debate can reasonably be put aside here.

Ballot initiatives are the result of POLITICAL disputes between interested parties that were not resolved in the more conventional public policy making process. In the case of Question One on this year’s Massachusetts ballot the dispute is a labor-management dispute between hospital administrations and bedside nurses who have been arguing over nurse staffing ratios for decades. The fate of Question One will impact the ongoing relationship between healthcare workers and management in the state. Voters will liberal sensibilities and a belief in the importance of organized labor cannot pretend that this ballot question is merely a vote about a specific policy. In fact, it is also a vote about the ability of healthcare workers to compel employers to do the right thing by workers. In other words, it’s a POLITICAL question.

If Question One is defeated, bedside nurses’ leverage in negotiations with hospital management will be greatly reduced. Having successfully defeated the bedside nurses’ best play, the well-financed anti-labor interest groups who have to date prevented legislators from enacting the proposed nurse staffing ratios will have no reason to compromise with the Nurses union. If Question One is passed, however, both sides will have strong incentives to work together to solve whatever complications are created by mandated nurse staffing ratios. Effectively, all the dire predictions by opponents of Question One, even if entirely accurate, can be mitigated or eliminated by the legislature subsequent to the passage of Question One. Because the Massachusetts Hospital Association and its allies continue to have great sway over legislators, the political incentives to correct problems with enacted nurse staffing ratios are far better than would be the political incentives to find a pre-enactment compromise on this issue. Bedside nurses have been trying to do that unsuccessfully for decades. Only the leverage created by the threat of a ballot question has produced progress on this issue. In 2014, with the threat of a ballot question looming, a legislative deal was struck with the governor and state legislature to enact nurse staffing ratios in the state’s Intensive Care Units. Once such a ballot question is defeated, however, the balance of political power between healthcare workers and management groups tips decisively toward the already more powerful management groups.

The POLITICAL bottom line is this: If Question One passes, negotiations on this very important issue to bedside nurses will be energized and the ballot measure itself will have served one of the primary purposes of ballot measures in the first place, which is not to allow average voters to make complex policy decisions, but rather to allow the general public to exert POLITICAL influence on behalf of interests that would otherwise be at a severe disadvantage in getting their issues addressed by politicians who depend on the financial support of wealthy special interest groups. When proponents and opponents of ballot measures treat average voters like policy experts they are really manipulating them, which is why both sides on every ballot question supplement their “expert” arguments and endorsements with appeals to voters’ in-group loyalties, or as in the case of the opponents of Question One this year, to average voters’ irrational fears. Voters can and will happily choose sides in a political dispute and ballot questions, like any statute, are NOT set in stone. They can be amended or even repealed by elected policy makers, which means that despite the hype, voters will not have the final say on Nurse Staffing Ratios when they vote next month. Pretending that they will and that a “mistake” by voters will bring on the apocalypse is at best naive.

A YES vote will force hospital lobbyists, nurse’s union representatives, and the state’s elected policy makers back to the bargaining table. A yes vote will force all three groups to accept meaningful responsibility for dealing effectively with this issue. A NO vote will further empower and embolden the wealthy special interests whose outsized political influence has prevented the legislature from taking up the nurses’ cause, further weakening the ability of healthcare workers to resist exploitation by hospital administrators.

I am a political scientist and this is my expert opinion on Question One.