Credit: Free Press Pics / / CC BY-NC-SACredit: Free Press Pics / / CC BY-NC-SAHome health agencies in Washington, D.C. must obtain a “certificate of need” from the district’s State Health Planning and Development Agency (SHPDA) before they are allowed to offer new or expanded services. And to receive that certificate, applicants must convince SHPDA that there is a public need for the services they propose to provide—an impossible task because SHPDA has decided that the city’s 27 existing providers are satisfying all demand. As John Ross reports, certificate of need rules in D.C.—and 16 other states—needlessly restrain competition in the health-care industry and therefore hurt patients in the name of protecting them.