Jimmy Kimmel, Sick Babies, and the Forgotten Barrier to Medical Care
Supply-side restrictions like Certificate of Necessity leave people without the medical services they need, even if they can afford them.
The Internet lit up this week with Jimmy Kimmel's emotional and deeply personal opening monologue from Monday night, when ABC's late night host related the story of what happened after his new son, Billy, was born on April 21.
Though the baby appeared health and normal at first, things changed a few hours after the delivery when a nurse noticed the baby's skin was discolored. The baby was taken down the hallway to the hospital's neo-natal intensive care unit, Kimmel said, and the doctors realized that the baby's heart wasn't functioning properly.
After a scary night, Kimmel's son had a successful surgery to repair the hole in his heart and replace a valve. Although the baby will need a second surgery in a few months, the whole story seems to be heading towards a happy ending.
Kimmel ended the monologue with a bit of a political note, mentioning that President Donald Trump's budget plan to cut $6 billion from the National Institutes of Health (which he said would threaten children's hospitals like the one where his son had surgery, despite pointing out earlier in the monologue that Costco, Disney, and other major corporations support the hospital with private donations). He also made a plea, essentially, for greater government involvement in health care.
"If your baby is going to die, and it doesn't have to, it shouldn't matter how much money you make," Kimmel said. "No parent should ever have to decide if they can afford to save their child's life—it just shouldn't happen. Not here."
Coming as it did during the same week that Congress was debating reforms to Obamacare, Kimmel's monologue was credited with "transforming the health care debate" and as strong, personal evidence for why more government intervention into health care markets is necessary.
I'm not sure exactly what policy Kimmel is advocating here. Is he saying government should pay for all expenses relating to giving birth, at least for those who can't afford to pay, or is he saying, by extension, that government should cover all medical expenses in their entirety? I don't know, and likely neither does Kimmel. He's a comedian, not a health policy expert, and people who have recently experienced a traumatic and nearly tragic family crisis are probably not in the best position to give advice on how to structure a health care system.
Here's what he seems to be saying: Government should do what it can to make sure that babies don't needlessly die. Even hardened libertarians can probably agree with that sentiment on some level.
But Kimmel, like many people, is only looking at the problem from one side. He's making the assumption that the only barrier keeping people from accessing necessary, even life-saving medical care is their ability to pay. Granted, that's a major barrier for some people, but it's not the only one.
Supply-side restrictions on medical care—restrictions that are implemented and enforced by government, restricting what services can be offered and by whom—are another major part of that problem. Take, for example, what we reported in January about how a government regulation led to the death of an infant at Lewis Gale Medical Center in Salem, Virginia. The hospital did not have a neonatal intensive care unit like the one that saved Kimmel's baby's life because the Virginia Department of Health (at the request of a nearby, competing hospital) had denied Lewis Gale's application to build one.
Yes, it sounds crazy, but in many states hospitals and other medical providers have to get permission from the government (and, in practice, from their competitors) before opening a new facility or offering a new service. These rules are called Certificate of Necessity laws, and they artificially restrict the supply of medical care—in other words, you might not be able to get the care you or your child needs, no matter how much money you have or how many government subsidies are helping you pay.
Other parents who had similar experiences—though, like Kimmel, with happy endings—told their stories at a public hearing when Lewis Gale re-applied for permission to build a NICU after the infant's death. Again, they were denied by the state even though the competing hospital was the lone dissenting voice in the application process.
The infant's death at Lewis Gale is particularly acute, tragic example of how government-enforced restrictions on medical care can have real consequences, but it's not the only one. In a paper published last year by the Mercatus Center at George Mason University,Thomas Stratmann and Davild Wille argue that hospitals in states with CON laws have higher mortality rates than hospitals in non-CON states. The average 30-day mortality rate for patients with pneumonia, heart failure, and heart attacks in states with CON laws is between 2.5 percent and 5 percent higher even after demographic factors are taken out of the equation.
Yes, our health care system is often a complete mess and people don't always have access to the care they desperately need. Abandoning CON laws that restrict what medical services can be provided, and by whom, would demonstrably improve access to care and possibly even lower health care prices by increasing competition for medical treatments. Then there could be more happy endings to terrible stories like the one the Kimmel family went through last week.