By Rob Roper
The Burlington Free Press just ran an excellent article on the legal dispute between the Green Mountain Surgery Center and the Green Mountain Care Board (GMCB), the six-member panel appointed by the governor to oversee health care in the state. At the heart of this particular kerfuffle is a certificate of need, or CON, which is essentially a permission slip from the government to operate a health-oriented business or service.
GMBC’s purpose is to “contain costs, and make sure everyone has access to high-quality health care services in Vermont.” It supposedly does this by “prevent[ing] unnecessary duplication of health care facilities and services.” In other words, it eliminates competition, and, if you’ve been paying attention to your health insurance premiums lately, you know exactly how well this approach works.
This is a case of the Surgery Center, after spending two years and a bucket of money to go through the certificate of need processes and, after thinking it had its CON, investing another $11 million in their new facility, the GMCB is now saying not so fast. The Surgery Center argues the GMBC is going back on its word, and GMBC says that it never agreed to allow what the center is now attempting to do. All in all, it’s a colossal waste of time and money that could have been spent treating patients.
But the big question here is why should doctors need to get permission at all from a half a dozen bureaucrats, most of whom have no real experience in the health care business, to treat patients who, by all accounts, are desirous of being treated? These doctors are clearly addressing a “need” — patients waiting for service in their communities. The Center believes (and has evidence to show) that they can provide equal or better service for a lower cost to the patient. The bureaucrats, perched in Montpelier, say there is no need, so you’re prohibited from providing the service (that, if there were no need, there would be no occasion to provide). Yes, that’s how stupid government managed health care is.
Why not just let the market work? If there is a need for a service, let these doctors meet it without having to jump through these bureaucratic hoops. If the doctors are right, they will benefit as will their patients. If they are wrong, they close up shop. That’s a risk they voluntarily choose to take.
If the Surgery Center can treat patients for less money and more conveniently than their competitors can, great! GMBC, whose mission it is to lower cost and improve access, should be all over this, right? But that’s not really its mission. Its mission is to protect politically connected and preferred providers from competition, granting monopolies, which, of course, ultimately drives up costs and restricts access for patients.
Vermont has more areas of health care subject to certificate of need laws than any other state, and we have some of the highest health care costs. This is not a coincidence. We should get rid of our CON laws, and, while we’re at it, the Green Mountain Care Board.