Certainly in most areas of American society, I stand tall for free-market principles. I always have. But when the conversation turns to eliminating what remains of the Certificate of Need Program (CON), I strongly oppose deregulation.
With deregulation, the potential for an increase in cost and decrease in the quality of health care is overwhelming.
I hope before votes are taken, lawmakers will think carefully about Rob Bradley's Senate Bill 676 and Alex Miller's House Bill 7 to kill the program -- and I mean think beyond the "regulation is bad, free market is good" ideology. Think instead about what effect it will have on patients if total deregulation becomes law.
Shouldn't the patient be every legislator's first concern?
In the first place, nothing in the CON system is broken. As John Couris, CEO of Jupiter Medical Center says, "I'm a free market guy, but in health care, appropriate regulation assures quality. We need the right balance to assure cost and access are right, and we've got that.
"Please tell me what problem exists today," he says. And I couldn't agree with him more.
Show me where in the world the free market in health care works. Go ahead. Show me. There are all kinds of successful health-care systems offering pretty decent care much cheaper than here, and they vary widely. But there are no examples of successful health care based on the principles of the free market for one simple reason: In health care, the free market just doesn't work. And people who say it does are ignoring overwhelming evidence.
What I'm saying is, "health" is not a commodity. No matter how often you hear the term "health-care market," there's no such thing. That's why "free market" doesn't apply. Those who believe that choosing a health-care product or service is no different than buying a car, television, or cell phone might feel differently after, say, contracting the Zika virus.
Chris Ladd, creator of PoliticalOrphans.com put it this way in a story in Forbes magazine: "As I lie unconscious under a bus, I am in no position to shop for the best provider of ambulance services at the most reasonable price. All personal volition is lost. Whatever happens next, it will not be a market transaction."
Senate Bill 676 calls for the Agency for Health Care Administration (AHCA) to develop licensure rules for new providers or facilities providing new services, and sets guidelines for the licensure of hospitals and hospice facilities. It's a little more nuanced/balanced than the House bill, but the result is the same -- it would allow hospitals to expand pretty much however they choose.
Under existing law, health care providers must obtain a Certificate of Need prior to constructing new hospitals, nursing homes, hospices or intermediate care facilities in the state, or to convert from one type of health care facility to another.
Bradley says, “By eliminating the state’s restrictive CON process, we’ll increase competition and drive down the cost of health care for Floridians.” Not true. Evidence of the opposite is all over the Internet.
What's well-documented is, the more an institution does something -- an organ transplant, for example -- the better it does at that thing. It becomes expert and the patient wins. Volume really does equal proficiency.
"Look at our situation," said Couris. "We have a 40 percent to 60 percent occupancy rate at our hospital. Where's the buildup of need for new beds? Access doesn't improve with more competition, it potentially gets worse. And certainly increased competition isn't going to lower cost."
Bruce Rueben, president of the Florida Hospital Association, said this: "If you let someone come in and develop a specialty hospital, then they can take the paying patients out of the hospital and leave those covered by government insurance or none. (Certificate of Need) was designed to make sure that didn’t happen."
In states without a CON process, the situation Reuben describes is a common and major problem.
I realize Republican leadership in both chambers embrace the Bradley and Miller bill. So does free-market-loving Gov. Rick Scott. In his statement of support, the governor said, "This session, I want to fight to make the healthcare system fair for families ..."
If he gets his way with deregulation, I'm not sure what families he's talking about.
Another thing: As part of the CON process, the public gets to weigh in on whether they want another hospital. Take away the process and you silence the public's voice.
David Ashburn, Greenberg Traurig, P.A. managing shareholder, reminded me the Certificate of Need law was simplified years ago; yet many people wrongly believe every CON applicaton still results in a multi-million-dollar, years-long litigation battle.
Liz Dudek, former, long-time secretary of AHCA now with Greenberg Traurig, agreed. "As a matter of fact, Florida is one of the least regulated states," she said. "You hear a lot of people say, 'You never get an approval if you apply.' I can tell you, yes you absolutely do."
Asked why she favors keeping the Certificate of Need Program as is, Dudek said, "The primary driver behind these decisions has to be the consumer" and the CON Program is the best way to assure quality, she said.
Don't do this, legislators. Think long and hard before you break what isn't broken.
Reach Nancy Smith at firstname.lastname@example.org or at 228-282-2423. Twitter: @NancyLBSmith