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Saturday, March 1, 2008
An archaic law ill-serves state and its patients
The Atlanta Journal-Constitution
Few topics being debated in the Georgia State Senate evoke tears.
But listening this week to State Sen. Ross Tolleson (R-Perry) stand and talk tearfully about a family history of cancer that, one after another, claims its victims — “I’ve seen them go out in peace and I’ve seen my sister go out in pain” — empathic sadness descends. “My sister [Laurie Ann Tolleson of Atlanta] died at age 52,” he said. “My 52nd birthday” is days away [April 26], so I am probably next. But that’s OK. I will be ready.” Two uncles, one 68, the other 64, and a grandfather died of cancer. His father is a lung cancer survivor. “The longevity is not there,” he said later.
Doc Thomas — State Sen. Don R. Thomas (R-Dalton), a physician — took the well, too. His 26-year-old granddaughter was diagnosed with leukemia in his office. With treatment, it went into remission. On Nov. 14, doctors found that it had returned. A year to the day from the original diagnosis, she died. Just before the start of the session, his wife, Emma Jean, found that she has lung cancer.
Both rose and revealed the horrible impact of cancer on their families’ lives by way of declaring their support for Senate Bill 433. It would allow Cancer Treatment Centers of America to locate a facility near Atlanta’s airport. Others did, too, including the bill’s sponsor, Senate Majority Leader Tommie Williams of Lyons, whose stoic father died slowly and painfully.
The insight into the personal lives, the vulnerabilities and fears, of public figures brings poignancy to a policy debate that goes to the heart and soul of what Republicans stand for — and how they will govern Georgia.
The key question is whether Republicans intend to reshape government in any meaningful way — or whether they are merely the next wave of politicians who sweep into town to enjoy the perks of power and tend the affairs of interest groups. At the core of this effort by Georgia’s hospitals and the Georgia Chamber of Commerce to keep competition out is a monopoly-protecting health care regulatory system that President Ronald Reagan recognized as a failure more than 20 years ago. It’s called “certificate of need.” When first imposed in New York more than 40 years ago, the premise was that health care inflation could be contained by controlling supply — the number of hospital beds, new equipment purchases, facility expansion. That regulatory system was created. It mostly didn’t work. But it did effectively give hospitals a license to limit their competition.
It’s the health care version of the conflict between those who want choice in public education and the alphabet-soup interest groups that bitterly defend their turf and the status quo. On education, though, the new legislative majority has begun to set a course that will eventually put parents in control of their child’s education. They’ll no longer be prisoners of a Clayton County, for example.
Certificate of need is a relic. It preserves the status quo to await the arrival of HillaryCare. That the Georgia Chamber of Commerce, an organization presumably devoted to the free enterprise system and to competitive markets, so readily joins forces to defend protectionist regulation and to block a legitimate company from opening a new business in Georgia is one of its most shameful performances.
Republicans really should be wary of going down that road, of casting their lot with a regulatory system that is a substantial barrier to competition — or with those who link arms to protect it. In the case of Cancer Treatment Centers, the company readily consents to put into law an agreement that they will pay $1 million into the Georgia Indigent Care Trust Fund if they do not live up to a promise to draw 65 percent of their patients from outside Georgia. And, furthermore, they agree to provide free care to the poor equal to 3 percent of gross revenues. The facility, expected to cost in excess of $150 million, is projected to employ 400.
Williams’ bill, which would create a “destination hospital” exception to the “certificate of need” regulations, passed 31-23. Six Republicans voted in opposition. The bill goes now to the House.
“I think we need to have a good look at CON to see if it is serving its purpose,” said Dr. Thomas. “The time has probably come when we need to do away with CON. …”
Yes. That time has come.
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