Jeffersoniad Gets COPN and Health Care Completely Backwards

The case for genuine health care reform in Virginia took a hit from badly aimed friendly fire this morning, courtesy of the Jeffersoniad. That hurts to write, because Shaun Kenney is not just a fellow contributor to BD, he’s also a friend (at least I consider him one, what he thinks of me is his call).

He deserves points for efficiency, though, going right off the rails in the first sentence:

COPN — or Certificate of Public Need — is a complicated acronym used to describe something very simple: a patch or turf where only one hospital can offer services determined to be a “public need” such as radiology, MRIs, and the like.

Except that it doesn’t apply just to hospitals, but to all health providers. Indeed, Delegate Chris Peace revealed how the law’s restrictions nearly kept a health care facility (that was not a hospital) out of New Kent, which would have forced his constituents to find care in Powhatan.

Moreover, the notion that hospitals are so economically vulnerable as to need regional monopolies just to survive says more about them (and their new defender) than anything about those of us looking to bring real competition into health care at last.

Shaun continues to confuse with this whopper:

First, there is a general acceptance by civil society that health care is a public need. If one walks into a hospital and drops to the floor, that hospital is legally required to treat you regardless of your ability to pay (you can talk to Medicaid later). This is why COPN exists — so that health care in a region is provided with the full spectrum of available tools to every citizen.

Except that’s not what COPN does. Try telling the folks in New Kent that their “full spectrum” must stretch as far as Powhatan. COPN is not designed to “provide” care, it is designed to restrict care options. Indeed, the Mercatus Center has shown that COPN laws mean fewer beds available, and are tied to higher death rates. If that’s the “full spectrum,” I’d hate to see what a limited spectrum is.

Moreover, slapping a “public need” label on health care does not make the microeconomic realities of the health care market disappear. Health care is a service, and a service market. No two markets are alike, of course, but the notion of the consumer getting service before payment is delivered is hardly unique (unless home mortgages, car loans, and various other credit uses were banned while I slept).

To be fair, the health care market essentially throws credit checks out the window (and indeed, federal legislation had a hand in that), but all markets have unique risk factors. That doesn’t make us assume mini-monopolies are the only way out for all of them, unless Shaun has decided markets are no longer acceptable for anything that get “public need” plastered onto its description.

In effect, Shaun would like us to believe health care is “different.” That is, however, the same argument the left uses for demanding government-monopoly “single payer” care, and frankly, it’s the kind of thinking that has us stuck in our current morass…

…which Shaun makes worse by focusing on health insurance rather than health care. Health insurance rates (and coverage issues) are driven in no small part by health care prices – the very thing COPN reform is designed to address. Shaun’s insistence that health insurance is the core of the problem has it exactly backwards.

Of course, this being Shaun, he couldn’t help but throw in a Planned Parenthood reference to stoke the flames: never mind that the law PP is accused of breaking (profiting off dead preborn children) has nothing to do with COPN reform, and that COPN reform would allows providers that become de facto retailers for PP to be challenged in the market by providers who would do no such thing.

In short, Shaun would like us to believe that health care is uniquely vulnerable as an industry, and thus deserving of heavy government regulation and corporatist protection.

How very Hamiltonian of him.

  • D.j. McGuire

    Further making the point that hospitals are hardly in dire financial straits…from the Thomas Jefferson Institute:

    “Since 2012, hospital profits have risen from $1.58 billion to $1.89 billion, hospital net worth has risen from $14.75 billion to $17.8 billion, and the number of hospitals operating at a deficit has fallen from 42 to 27.

    “‘These are not the numbers of an industry in desperate financial trouble,’ said Michael Thompson, president of the Thomas Jefferson Institute and author of the study.

    “‘This year’s study, Virginia’s Hospitals: Doing Well in a Sluggish Economy, shows that the hospitals enjoyed an overall profit of basically the same as last year — $1.89 billion. And, as profits remained stable, the net worth of our hospitals increased by 6.6% or over $1.1 billion,’ said Thompson in a statement.

    “The Virginia Hospital and Healthcare Association (VHHA) argues for the continuation of monopoly services through the Certificate of Public Need laws, and advocates for an expansion of Medicaid because it says that its membership is on shaky financial ground.

    “However, this year’s annual study shows that the overall hospital industry here in Virginia continues to get stronger and stronger.”

  • So quick poll: Would Planned Parenthood be able to take advantage of COPN “reform” as currently construed? Yes or No?

    HINT: The answer is yes.

  • 6Proverbs16

    I served regional and local COPN review boards. We were conservative generally hoping to strike a balance between the goal of letting health care services emerge, develop and expand as part of the ‘market’ of services and the goal of restraining costs. Although that, by now, was many years ago I don’t recall many conversations in those meeting that didn’t include bemoaning ‘how can we keep costs down for everyone! …. while ensuring the everyone has equitable access’. D J McGuire does a good work of helping to explain that but it would help to illustrate by a particular example or two. For example, imaging services. In meetings that I recall we heard many requests to develop and expand imaging services. Competition in have more imaging service did not seem to do what the ‘market’ is theoretically supposed to do: lower costs for everyone. Our reasonable suggestions to applicants to find ways to lower costs were not realistic to them BECAUSE insurances would pay; they would charge what the insurances would pay, and perhaps they’d charge higher because then the patient would pay that out of pocket. SO, sadly it began to seem that providers were gaming insurance to make more money, because insurances would then explain to the insured patients that they had a higher and higher and higher co-pay, and the uninsured or poorly insured would go into debt or bankruptcy. The uninsured/poorly insured always seemed to be subsidizing the revenue plans of the providers, the profit motive of the insurance companies, and the grumbling of the insured. There was never a virtuous cycle of lowering costs and increasing quality for all.

    BUT now that Republicans own the Congress and the White House (at least the part not already promised to Satanic Lord Putin) Republicans must NOW keep their golden promise to lower costs for all and increase quality for all and provide insurance for ALL – 100% – AMERICANs. Because that is what Trump promised. GOLDEN-y WONDERFUL. That is what he promised: GREAT. WONDERFUL. As GOLDEN as the toilet fixture in Trump Tower.

    And, oh, btw, Mr Keeney it is unethical to favor or disfavor moral risks of a particular industry provider – Planned Parenthood – without declaring justification under COPN regulations. And why would any person with moral concern for unborn human infants not have same moral concern for born human beings?

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