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Friday, January 4, 2008
State should stop overseeing health care market
The Atlanta Journal-Constitution
For 9 1/2 years, Dr. Phillip Brown of Thomaston has been one of four general surgeons in his community called to provide emergency care at the local 100-bed hospital. Most times, he gets paid something.
But 15 percent to 20 percent of the time, he doesn’t.
The hospital doesn’t either. But the hospital and others across Georgia get tax breaks and reimbursement, indirectly at least, through a state fund intended to compensate them for the services they provide the uninsured. “In the last six months, we’ve worked something out with the hospital where they reimburse us something,” says Brown, a Blackshear native. For most of the decade, however, he got nothing. And, unlike hospitals or a hardware store that wasn’t paid for merchandise, he and other physicians got no tax break either.
My intent here, though, is not to make the case that physicians, whatever their practice or specialty, are in need of relief. It is, instead, to lament the horrid misuse of government authority that adds untold millions to our health care bills. In this instance, it concerns Brown’s livelihood, his freedom to compete in a perfectly safe and appropriate setting and the state’s role in a dispute between his specialty — general surgery — and the hospitals that want to prevent competition from free-standing ambulatory surgery centers.
At issue is whether general surgeons are considered a single specialty, as is the case with urologists, orthopedists, dermatologists and others. If so, they are permitted under Georgia’s archaic certificate of need law to open free-standing outpatient surgery centers. Every other state in the nation — every state except Georgia — recognizes general surgery as a specialty. Georgia is the lone holdout.
Legislation to declare general surgeons to be a distinct specialty would have passed the General Assembly last year but for a well-timed whisper campaign that, if approved, the outpatient treatment centers would perform abortions — something general surgeons don’t do. But it nevertheless served the purpose.
The board of the State Department of Community Health adopted a rule change in December allowing the centers. On Monday, the Georgia Alliance of Community Hospitals sued to block the rule.
All of this seems petty and bureaucratic — and it is.
Without question, general surgeons should be free to open centers. But opponents argue that allowing that would drive struggling hospitals out of business and make health care more expensive.
That is, in fact, the premise of “certificate of need” regulations, first enacted by New York state in 1964. A decade later, the federal government required all states to certify the need for a new hospital or nursing home. Before existing facilities could expand or buy expensive equipment, they were likewise required to get state permission.
At the time health care costs were running out of control. And every physician was a free agent in adding to the tab. Regulators and Congress decided the way to contain inflation was to control beds and equipment. Mostly it didn’t work, and, under President Ronald Reagan, the federal CON requirement was repealed. In the following decade, 14 states repealed CON laws, though, as the National Conference of State Legislatures notes, they retained some procedures for regulating costs and service duplication.
For free-market Reagan Republicans, the course for Georgia when the GOP took control of the Statehouse should have been to work aggressively to get the state out of the business of regulating the health care marketplace. Every bias and every action by the General Assembly and by the executive branch should be to back the state out of micromanaging health care markets and toward promoting competition. Battles like the one between hospitals and surgeons should not be before bureaucrats or the General Assembly in the first place.
Supporters of heavy-handed government regulation wish to force surgeons to subsidize hospitals by surrendering what should be their right to deliver their services in any safe setting patients might choose. So, in effect, they are singled out and forced by the state to leave their earning potential on the hospital’s balance sheets. Why not require that of the man who installs furnaces in hospitals, too?
On CON Republicans pick up where Democrats left off, policing markets and deciding arbitrarily how much competition a powerful and entrenched political player has to tolerate. Ronald Reagan? Who’s he?
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A 50-state GOP struggle
The Atlanta Journal-Constitution
In the morning’s light, last night’s outcome in Iowa means simply that to top six Republicans — Huckabee, Romney, Thompson, McCain, Giuliani and Ron Paul — are all alive and politically in play through at least the Super Tuesday primaries on Feb. 5. That’s when Georgia votes, along with some states like New York and New Jersey that should be strong for Rudy.
By that evening, we’ll have a pretty clear idea of whether it’s a brokered convention, especially if Rudy picks up a couple of hundred delegates or more, as he should. Then it becomes the survivor from the moderate wing of the party vs. the survivor from the conservative.
Georgia House Speaker Pro Tem Mark Burkhalter, chairman of the Romney campaign in Georgia, surveyed last night’s Iowa outcome for his guy. “Winning the silver medal is a good start,” he said.
“There’s no state where Governor Romney’s support falls off, like some of these candidates fall off region by region,” continued Burkhalter.” ” It’s the “first inning of a 50-inning game,” said Mark deMoss, a Georgian and a Romney campaign aide who worked the caucuses last night in Iowa.
Burkhalter thinks Romney has the strongest conservative base — and in the weeks ahead they’ll draw some contrasts between the first- and second-place finishers in Iowa. Examples: ”What’s your position, a real position, not a rose-colored glasses position, on cutting taxes? Are you going to make the Bush tax cuts permanent?” Illegal immigration and amnesty?
Those are not hot-button issues for the Reublican base in Iowa, but they are elsewhere — and on those Huckabee’s vulnerable.
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