health care

Georgia's Health Care Regulations Limit Access to Women's Health

State Supreme Court will hear challenge to Certificate of Need laws on Monday.

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BSIP/Newscom

The Georgia Supreme Court on Monday will hear oral arguments in a case challenging state regulations that limit access to essential health care for women and babies.

In Georgia, as in other states with Certificate of Need laws on the books, health care providers have to get permission from state bureaucrats before opening or expanding their medical facilities. In theory, these laws exist to allow the state to balance the needs of the public with the interests of hospitals and other health care providers, but in reality they often allow larger providers to veto unwanted competition.

In 2016, the Federal Trade Commission and the U.S. Department of Justice issued a joint statement calling for state governments to roll back CON laws in order to free health care markets and lower prices.

"CON laws raise considerable competitive concerns and generally do not appear to have achieved their intended benefits for health care consumers," the agencies concluded, warning that these laws have been exploited by competitors seeking to protect exclusive markets by raising the cost of entry.

That's what Dr. Hugo D. Ribot Jr. and Dr. Malcolm Barfield, owners of the Women's Surgical Center, LLC, say happened to them.

The two doctors perform hundreds of non-emergency outpatient OB/GYN surgeries every year. They wanted to add a second operating room—with the intention of renting it out to other surgeons who needed space—in order to serve more patients.

Three hospitals, including the Cartersville Medical Center, located across the street from the Women's Surgical Center, objected to their CON application. The Georgia Department of Community Health sided with the hospitals and denied the application.

The two doctors, represented by attorneys from the Arizona-based Goldwater Institute, a free market law firm, are asking the Georgia courts to strike down Georgia's medical CON laws so that licensed doctors are able to offer their services to the public without first complying with anti-competitive restraints.

Lower courts have upheld the state's CON laws, which have come under attack in recent years across the country. Many states added CON laws to their books in the 1970s, when they were mandated by Congress as part of an ill-advised effort to reduce health care costs. Congress reversed the mandate in the 1980s after the Congressional Budget Office found that CON laws often had the opposite effect on prices and the availability of care.

But more than 30 states still require medical providers to get state approval before opening new facilities or expanding existing ones. Those laws persist because of legislative inertia and because of the influence of the special interests—hospitals, mostly—that benefit from a time-consuming and bureaucratic process that blocks potential competition.

The consequences can be disastrous. In January, Reason reported on the years-long fight between two Virginia hospitals over the construction of a new neonatal intensive care unit. While the regulators were deliberating, a baby died at a hospital that had sought to build an NICU that might have saved the child. After the death, the state Department of Health still refused to grant a CON to the hospital.

The costs of CON laws aren't always obvious. 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.

Dumping Georgia's CON laws would allow Ribot and Barfield to expand their practice, giving women in Fulton County, Georgia, more options and greater access to non-emergency OB/GYN surgical care. If the state Supreme Court decides to keep those laws on the books, hospitals will win and women and babies will lose.

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  1. “…In theory, these laws exist to allow the state to balance the needs of the public with the interests of hospitals and other health care providers…”

    OK, EZ IQ test:
    Anyone believing that steaming pile, raise your hand!

    1. Politicians can’t raise their hands without taking them out of somebody else’s pocket.

  2. No one needs my competitor’s services!

  3. Many states added CON laws to their books in the 1970s, when they were mandated by Congress as part of an ill-advised effort to reduce health care costs.

    I’m sure that made perfect logical sense at the time.

    1. Back in the days when payers (the Blues, Medicare, etc.) paid whatever was billed (or a straight percentage of whatever was billed) it did (sort of) make sense.

      Because facilities are largely a fixed cost, and that cost would then be spread out among billed services regardless of whether the facility ran at capacity or at 10% capacity the propensity was towards an oversupply in the ‘market.’ Providers had little if any incentive to run at or near capacity.

      (Which, as is obvious, was already not much of a functional market due to the governmental forces (Medicare, the way health insurance was subsidized/fattened by the tax code, etc. making the payers not very price sensitive)

      So, in that sense, the CON laws were attempts to impose restrictions on pre-existing market distortions. And, inevitably, they have proved both ineffective and costly.

    2. Look, there was a lot of cocaine around in the ’70s.

      1. Cocaine Obligated Narcissism laws.

  4. Many states added CON laws to their books in the 1970s, when they were mandated by Congress as part of an ill-advised effort to reduce health care costs. Congress reversed the mandate in the 1980s after the Congressional Budget Office found that CON laws often had the opposite effect on prices and the availability of care.

    Holy shit. So you’re telling me that Congress had to be told by the CBO that restricting competition did not lead to lower prices and better service – and perhaps even to this day Congress may not realize that such an outcome is not limited to this one specific instance but is in fact a readily foreseeable and completely to-be-expected outcome? Competition is what drives lower prices and better service. That’s just a plain indisputable fact, it’s the very essence of our economic system. Are we really letting retards run the government?

    1. I mean, Jesus, you got Bernie and his “nobody needs 23 kinds of deodorant”, but we can all laugh because we all know Bernie Sanders is a chuckle-headed nincompoop. But this suggests your average Congressman isn’t laughing at Bernie, they just disagree on what number of deodorants is the proper number of deodorants.

      1. no fewer than 42.

        /Stannis

      2. It’s chuckle-headed nincompoops all the way down.

    2. The only surprising thing here is that Congress apparently listened to CBO and repealed the stupid law.

      1. Which, nearly 40years later, has had minimal effect on the the results of the initial mandate. Also not surprising.

    3. Are we really letting retards run the government?

      Who else could possibly be interested?

    4. Are we really letting retards run the government?

      Yes.

    5. At the time, income of hospitals was largely “cost +”, & the trend was for it to become increasingly so. Like public utilities. Competition was thought to be a dead letter. Had the “right” not gotten going in the late 1970s with the tax revolt & evangelics, that trend probably would’ve continued, & when socialized medicine came in as was expected, all these money sinks would’ve expected to continue to be serviced w $ in the manner to which they’d become accustomed. So the idea was to forestall the construction of more of those expensive facilities who would’ve demanded a return on their investment.

  5. So progs don’t care that CoN limits economic freedom, options, or just health in general. No, they only give a rats ass since it’s about “women’s” health.

    Sorta that Hillary line (or some other prog) about how war is bad because of it’s impacts on Women.

    If there was a meteor that hit the earth tomorrow, these idiots would write “meteor strikes earth, women and minorities hardest hit”

  6. “Essential health care for women and dead babies”.

    FTFY

  7. Cartersville, Georgia is in Bartow County, not Fulton County. Bartow County isn’t even adjacent to Fulton County, Cobb and Cherokee Counties are in the way.

  8. “non-emergency outpatient OB/GYN surgeries ”

    Euphemism much?

    1. It’s just stuff like when your mom goes in and they use an angle grinder to remove some of those growths from her vajay.

    2. Procedures to remove abnormal cells from the cervix fall into this category and are fairly common.

  9. In theory, these laws exist to allow the state to balance the needs of the public with the interests of hospitals and other health care providers

    Because plainly there is a conceivable “public” need for fewer hospitals and the like.

    What even is market information?

  10. Dumping Georgia’s CON laws would allow Ribot and Barfield to expand their practice, giving women in Fulton County, Georgia, more options and greater access to non-emergency OB/GYN surgical care.

    It won’t do a damn thing for women in Fulton County and isn’t intended to. It’s 40 miles away – in a upper-middle-class white-flight exurb in Bartow County. White women in Atlanta have closer facilities – and black women are hardly gonna flock to get healthcare in a county where cops post This year we lost two gorillas. One is in heaven, and one is moving out of the White House. One will be missed, one will not be. online.

    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.

    Nor will this facility do a damn thing to change mortality rates in GA. This facility is on the wrong side of Atlanta to do that. Even within NW Georgia, this is not creating a facility that distributes healthcare closer to those who need it but merely concentrating it into the typical pill-hill stuff. I suspect that this dynamic is the reason why bureaucrats put the CoN nonsense in place. Serious question here – is there some other incentive (tax, land, financing, etc) creating this dynamic?

    1. so your gorilla thing made me wonder who the gorilla in heaven is supposed to be. After spending 15 minutes googling it, the question is not answered but I did find

      https://www.gofundme.com/dn66x7-chrissys-corner

      haha, 3 months and no donations

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