Proceed with care

As Columbia County pursues its first hospital, be aware of the accompanying problems

We support Columbia County’s desire to have its own hospital.

As the fastest-growing county in the Augusta metro area – and the largest hospital-free county in the state – it appears to be ripe for a full-service health-care facility.

But there are at least two problems with the process required to fulfill that dream. One involves needless red tape. The other has to do with one of the aspiring hospitals.

First and foremost is that, to get someone to develop a hospital, the county must contort its way through the bureaucratic hoops of the state Department of Community Health’s “Certificate of Need” program, which dictates where medical facilities can operate based on its own criteria of “need.” Such programs, known nationally as CONs, are unnecessary in a free-market economy where consumers, not the government, establish the need for goods and services.

Three Augusta health systems are bidding for government permission to build in the county: Doctors Hospital, Georgia Regents Health System and University Hospital.

Again, why is “permission” even needed? What happened to free markets determining where business services, health care or otherwise, are most needed? Thank goodness there’s no Georgia Department of Auto Retailers. Car dealers might have to ask, pretty please, for state certification before expanding to a second location.

While the state will do what it will, Columbia County consumers, the people who actually would end up using the facility, at least will get the chance to have their voices heard. An 11-member citizen committee appointed by the Columbia County Commission will help evaluate the three bids and make a recommendation to the state.

Sadly, there are no CON public hearings, but residents are free to write directly to the state and have their comments become part of the public record.

If there ever was a time for Georgia’s CON program, it passed years ago. The program, and three dozen others like it across the country, is a remnant of a 1970s federal mandate that expired in 1987. Georgia, which decided to continue the Certificate of Need program after the mandate expired, has tweaked the program as recently as 2008.

Ideally, Georgia would join other states, such as California, Texas and Pennsylvania, in repealing it altogether.

CON laws restrict competition. The first health system to win approval to operate in a small or mid-sized population center is essentially granted state-sanctioned monopoly power. If such laws had been around in the 1950s and 1960s, Augusta’s downtown medical district would not have grown into the robust industry it is today.

And if Georgia would have let the program die in the 1980s, Columbia County probably would have had its own hospital by now.

CONs are a complex issue, no doubt. Advocates say health-care services are not like other products, and they do not obey the same kind of market forces. We’ve heard those arguments and many more. But it inevitably comes back to this: There is scant evidence that state-sponsored programs actually reduced health-care costs or improved the delivery of service during their 40-year-run.

Consumers all want the same thing from the health-care industry: quality care, convenience and lower costs. A competitive free-market system, not government planning, is the best way to fulfill those needs.

A second major concern with the CON process is the bid by the Georgia Regents University-affiliated health system, the last of the three to submit a proposal. Its ties to a state institution arguably creates conflict-of-interest issues in a contest whose referee is a sister state agency. We are concerned that the health system, which grew out of the 1950s-era Medical College of Georgia-owned teaching hospital, holds an unfair advantage because of its state backing.

The health system is, on paper, a private corporation. But it has been intertwined intricately with the university since 2010, when it was brought back into the government fold under the authority of newly installed university President Ricardo Azziz. System revenues, though separately accounted for, flow into university operations, and many physicians in its employ are on the state payroll as professors and administrators.

Just last year, the Georgia Supreme Court ruled in Shekhawat v. Jones that Georgia Regents Health System physicians are granted state immunity in medical malpractice lawsuits because they act “within the scope of their state employment in rendering the medical care.”

Georgia Regents Health System seems more government than not.

Though state Department of Community Health officials disagree Georgia Regents has any unfair advantage, we fear an uneven playing field and a real potential for conflicts of interest in this already-flawed bidding process.

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