One of the top priorities of the folks on the Right this legislative session is to unleash the power of the free market to solve all of our health care problems.
That’s the way they tell it anyway and their target is the state certificate of need laws that were designed to keep some stability and order in the availability of health care services and where they are offered.
Companies looking to build medical facilities must demonstrate a public need for the services they will provide and get permission from the state. The idea is that we don’t need a glut of services available in one part of state while people in other areas have no access to important procedures.
Thirty-six states currently have certificate of need (CON) laws and there’s a national movement on the Right to repeal them, to let people open up specialty centers and clinics anywhere they want, allegedly to give patients more choices and introduce more competition to the health care system.
Never mind that allowing the cherry-picking of profitable services currently provided by hospitals would make it even harder for hospitals to survive, especially in rural areas.
Or that the shiny new specialty profit centers may not be required to provide care to people who walk in their doors and are uninsured and unable to pay.
Hospitals in North Carolina on the other hand are required to treat everyone who walks in whether they can pay or not—thank goodness—and in 2013 provided close to $2 billion in uncompensated care.
Also lost in the much of the debate is a fundamental point—the health care system is not a free market and taking care of people is not a commodity that you can treat like selling shoes or potato chips.
Everyone needs health care services at some point. It’s not a luxury item people can choose to live without.
And health care providers like hospitals are not free to serve only people who can pay or even set their own rates for the services they provide.
Those are set by federal and state agencies for patients covered by Medicaid and Medicare. The Affordable Care Act reduced some payments to hospitals that were supposed to be offset by the expansion of Medicaid that would reduce the number of people who showed up for care with no way to pay their bills.
But the U.S. Supreme Court ruled that expanding Medicaid was up to the states, not the federal government and North Carolina is one of 19 states that has chosen not to expand it and is leaving billions of federal dollars on the table and several hundred thousand people without coverage.
Add it all up and it’s a long way from a free market whether we have a certificate of need law or not. Many of the folks clamoring for CON repeal claim it’s all about improving health care and reducing costs and making care more available to people who can’t afford it.
But the same people are vigorously opposing Medicaid expansion every day. It’s not expansion of health care services they are really fighting for, it’s wringing more profit out of the health care system.
The leaders in the movement to repeal CON are the usual suspects, the think tanks and advocacy groups on the Right funded by the Koch bothers or part of the Pope universe of North Carolina groups.
They incessantly cite their own research like a study from the Mercatus Center at George Mason University, an institute founded and funded by the Koch brothers, that purports to show that CON laws decrease the supply and availability of health care in North Carolina as well as other pseudo studies claiming health care costs are higher in CON states.
But two studies from the health care firm Ascendient reach far different conclusions, finding that states with CON laws have more access to hospitals for the uninsured and that CON has not restricted the creation of stand alone services in the state like ambulatory surgery centers.
The studies also find no clear correlation between CON laws in states and increased health care costs.
None of that has slowed what has become a crusade on the Right, with all the buzzwords like monopolies and liberty and websites with names like “Restore Health Care Freedom.”
Making it harder for hospitals and other providers like hospice to survive isn’t the answer and doesn’t provide much freedom for patients who are uninsured or have sketchy policies with impossibly high deductibles or copays they cannot afford.
We don’t need to restore more freedom for people to cherry pick services and milk more profit out of the health care system. We need to protect the fundamental institutions that provide care in our communities and increase access to care by expanding Medicaid.
Certificates of need are not the problem. And inflated claims and ideological talking points about the free market are definitely not the solution.