What We Learn From Animal Care

They say that a dog is a man’s best friend. Maybe that’s why the way we manage medical care for dogs is better than the way we manage medical care for humans.

OK, I’ll admit upfront that there is one major difference I would not want to emulate: It’s not acceptable to decide to “put grandma down” if the costs of her treatment are too high.

There are several positive elements of animal care, including a client focus unseen in many human hospitals. Because veterinary medicine is not subject to certificate of need (CON) laws, new veterinary hospitals can open in one-twentieth of the time it takes to open a human hospital.

Remarkably, the video features a situation in one state in which people resort to circulating petitions to obtain official permission to open a hospital.

We need more ORs, we have too many, we need more

The one good thing about North Carolina’s efforts to control medical capital investment is that they don’t create five-year plans. In 2008, regulators thought Wake County (Raleigh and Cary, NC) needed four operating rooms (ORs). By the time they granted approval to a hospital and orthopedic center in 2009, state regulators said the county had too many ORs. For 2010, they now say Wake County needs three more ORs, plus another two for somewhere in the Wake-Orange-Durham Triangle area.

U.S. Index of Health Ownership 2nd Edition Is Here

Pacific Research Institute has published the 2nd edition of the U.S. Index of Health Ownership, the only ranking of health care in the states that uses criteria of individual choice.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.

Try Freedom for a Change

Kudos to the editors of the New Hampshire Union-Leader, who're able to see through the "false premise" and "nonsense" the Obama administration is relentlessly pushing to drive their oppressive health care agenda.

The free market in American health care is not kaput - nor is it the "status quo" – as the statist power-centralizers would have it. Market innovation and ingenuity has for decades been suppressed by government. Real reform, says the Union-Leader, starts by rolling back the powers of politicians and bureaucrats, not expanding them.

There are numerous health care reform options that don't involve massive government takeovers of health care. For example, reducing state coverage mandates could reduce premiums by thousands of dollars and allow people the option of buying basic, low-cost coverage. The Federal Trade Commission and the U.S. Department of Justice's Antitrust Division have both found that state certificate of need laws, which require state approval of new medical devices and services, don't keep costs down and can actually increase them.

There are many other reforms that could cut costs without expanding federal control. Obama would prefer that the public not hear about them. The media would do the American people a great service by making sure that they know about all the options, not just the ones the administration is pushing.

Meet the New CON, Same as the Old CON

The Chicago Tribune exercised itself into a commendable lather this week, once more vigorously, effectively — and probably futilely — punching out the State of Illinois' most odiferous low-hanging bag of corrupt bureaucratic dung.

Last we looked in, lawmakers in America's second-largest (or is it the third now?) failed state were trying to decide how best to varnish over their vindictive certificate-of-need soviet's crass history of villainy and incompetence. The legislative culmination of their elite and considered wisdom? Change the CON board's name, make it bigger and bombard everybody on it with generous paychecks.

"In the great Illinois tradition of spending money for nothing, legislators this year explored a useless, corruption-plagued, money-burning agency … and made it grow," a Trib editorial declared on Wednesday. "The lawmakers made it cost more too."

Actually the agency in question, the Illinois Health Facilities Planning Board, is about to perish. Or rather, the name will perish. Out of the ashes will rise … Ta-Da! The equally unjustifiable Health Facilities and Services Review Board! The Health Facilities Planning Board is an embarrassment. It is supposed to regulate hospital expansion in the state but has turned into a prime example of pay-to-play corruption(.)

…The old useless board had five members. The new useless board has nine. On the old board, members didn't get paid. At least above the table. On the new board, everybody gets paid. The chairman gets $90,000 a year. Commissioners get $65,000.

Periodically considered for euthanasia several times over the past few years, only to time and again be rescued by Gov. Blagojevich and his merry band of allied statehouse pranksters, the CON commission was supposed to die of sunset clauses this July 1.

But acting as usual in the interests of connected collectivists and privileged corporatists rather than free-market competition and patient choice, Illinois lawmakers decided instead to breathe unholy new life into the loathsome socialist abomination.

Why is this happening? Because the Illinois Hospital Association wanted it — and the association is a powerful lobby.

The Trib goes on with the obligatory call for Blago's replacement, Pat Quinn, to reject the bill and abort the new board because CON regimes inevitably result in "higher costs and less efficient care for patients."

The chances of a veto seem pretty slim, though. Back in April, Quinn's first choice to head the health-care infrastructure central planning board was a radical single-payer advocate. Supposedly picked to "restore integrity" to the crooked committee, Dr. Quentin Young — who was at one point Quinn's personal physician — shortly thereafter had to withdraw from consideration because he was himself intractably ensnared in a conflict of interest that made him ineligible for the post.

The reality is that Gov. Quinn, like a majority of politicians in Illinois (and 36 other states), might very well be ideologically incapable of seeing things so simply, rationally and morally as to let personal freedom and economic liberty guide the health care industry.

Health Ownership & Failing States

Today's Wall Street Journal noted yours truly's U.S. Index of Health Ownerhip in its lead editorial.  Describing the "Albany-Trenton-Sacramento disease" of high-rolling state governments, bloated with tax revenue but in continuous budgetary crises, the editorial fingered bad health policies as a key element of the problem.

New York, New Jersey, and California are all in the tank of IHOP's measurements of individual ownership versus government control over health care.  The editorial quotes IHOP's diagnosis that "New York suffers from government health programs that are out of control, a grossly overregulated private insurance market and almost completely uncompetitive provider markets."

IHOP edition 3 is due to be published later this summer.  I don't want to leak the results, but if you are a betting man, I would not recommend putting any money on New York moving up the rankings.

What’s in a Name Change? Nada.

I don't know how I missed it when it appeared last month, but I recently stumbled across this blistering full-frontal editorial assault on "the scandal-plagued, corruption-scarred, worse-than-useless Illinois Health Facilities Planning Board" from the Chicago Tribune (via Illinois Policy Institute).

Prairie State lawmakers would do well to pay it some heed as they prepare to, among other cosmetic and woefully inadequate "reform" measures, tinker with the board's titular nomenclature in hopes of ventilating the stench of corruption emanating from the unapologetically market-hostile certificate-of-need enforcement agency.

The Trib rightly suggested that, in fact, radical amputation and prompt disposal of the incurably infected appendage is the more prudent remedy: The Illinois CON resembles some backward bureaucratic relic of a collapsed 20^th Century totalitarian workers' paradise, rather than something one might expect to encounter in an ostensibly free society.

Another CON Game in Mississippi

Last week, the Mississippi Legislature voted to raise taxes on the poor, by increasing the state tax on cigarettes. But it failed to give its approval to a new hospital in the county that lies outside Memphis.

Under the state's certificate of need law, the building of new hospitals is restricted. (For an earlier report on the campaign to overcome the political process, see here.) Gov. Haley Barbour called for a pro-hospital measure in his call for a special session, but the House adjourned without taking up the question, leaving it dead.

(For more on certificates of need generally, see this report.)

No Competition Please, We’re Socialists

Want to know how to get a new medical facility approved by a certificate-of-need soviet? Don't do anything that might encourage people to seek out your services rather than those of existing cartels already anointed by government with the privileges of monopoly.

According to the Daily Journal in Kankakee County, Illinois, a $70 million local medical center modernization project that "could have a tremendous economic impact on the area — both in jobs and drawing patients in from outside (the area)" is looking like it's got a good shot at approval by the state's medical services central planning committee.

Why? Why, because it doesn't pose any sort of competitive challenge to any other vested interests, of course.

The Illinois Health Facilities Planning Board will be reviewing the project later this month, and hospital officials are confident approval will come easily.

(Riverside Medical Center CEO Phil) Kambic told the Kankakee County Board on Tuesday an affirmative nod by the state board would be the final step in finalizing plans for the project.

"That's the linchpin," said Kambic. "Hopefully it will be approved."

The project has progressed clear of opposition.

State records show there were no requests for a formal public hearing and the state board has received over 60 letters of support for the project. The official deadline for public comments passed on April 1 without a single note of opposition. The state board has rejected proposals in the past in areas such as Chicago's suburbs where there is tight competition among health care providers.

"No other hospitals have voiced opposition, and we have a lot of community support," said Kambic. "I'm hoping with the current environment it will be a nice stimulus for the economy."

Scrutinizing Success

An American Medical News article today explores the growing popularity of outpatient surgery centers, and the attempts by established hospital interests to weigh them down with stricter state-level government regulations, in particular more stringent certificate-of-need requirements.

American Medical Association Board of Trustees member William A. Hazel Jr., MD, said surgicenters give patients options for high-quality, cost-effective care while offering doctors flexibility and additional income in the face of dwindling federal payment rates.

"But frequently what you see is a large-scale effort [by hospitals] to use these laws to stifle competition," said Dr. Hazel, an orthopedic surgeon in Oakton, Va.

…Such pressures deterred Dr. Hazel's practice from pursuing licensure to become a freestanding ASC through the state's certificate-of-need process. Instead, he and his partners run a two-room outpatient facility through their orthopedic practice. However, it cannot accept Medicare or Medicaid patients.

The AMA continues to oppose CON laws over concerns the statutes hinder competition and fail to control health costs, and the U.S. Justice Dept. and Federal Trade Commission have generally backed that stance.