From Morris News Service
By Walter C. Jones
ATLANTA -- A seemingly simple question has put top Senate leaders in a conflict with one another: Does having more medical clinics raise or lower the price of care.
For a lot of Republicans who favor getting the government out of the way of private enterprise, the answer is obvious that more competitors would naturally result in lower prices and better service. On the other hand, some veterans say the opposite is true when it comes to health care because of unique economic circumstances.
The clash was been played out sporadically on the Senate floor last week. The vote on the matter will likely come one day this week.
What's bringing it to a head is a heavily lobbied proposal, Senate Bill 433, that would relax regulations enough to allow the construction of a for-profit cancer hospital near enough to the Atlanta airport to serve out-of-state patients. Atlanta's existing hospitals object.
Ironically, the Georgia Chamber of Commerce objects, too. The consequences of the debate aren't restricted to Atlanta, though. Sen. Seth Harp, R-Midland, told his colleagues Tuesday about some Columbus physicians who were so discouraged by state regulations on new clinics that they decided to take their plans for a facility -- and its jobs -- across the state line to Alabama. "Economics doesn't recognize artificial boundaries such as a state line," said Harp, chairman of the Senate Higher Education Committee and vice chairman of the Senate Judiciary Committee Another Senate heavyweight, Majority Leader Tommie Williams, took Tuesday to ridicule the current medical-facility regulations with a tongue-in-cheek description of a new regulatory body for restaurants called the Georgia Authority of Gastronomic Suppliers, or GAGS.
In elaborate detail that drew snickers from a contingent of like-minded senators, Williams described how no new restaurants could be built or existing ones expanded without GAGS satisfaction that no competing restaurant within 60 miles would be harmed commercially. He included several exaggerated regulations like limits on the types of foods served, nutritional rules and the ability of any existing restaurant to block construction of new establishments.
"While I have long been a proponent of capitalism, the Georgia Chamber of Commerce has shown me the error of my ways, and I ask you to also abandon the ridiculous idea that a free and open market will lead to lower prices, better quality and a stronger economy," he quipped.
In a parting shot, Williams says that his modest restaurant in Lyons, Ga., could make him as rich as the non-profit hospital CEOs. "Doesn't this just make you want to GAG," he said.
That brought to the floor Senate Rules Chairman Don Balfour, R-Snellville, who also works in the restaurant industry.
He explained that he used to have a free-market attitude toward health care facilities when he was first elected to the Senate 16 years ago. In the mean time, he's concluded normal economic rules don't apply to medicine.
"There's a huge difference," he said. "People don't just walk into my Waffle House and just get fed" the way the uninsured are legally guaranteed treatment in hospitals. Without some state regulatory protections, he said, conventional hospitals can't compete with for-profit specialty clinics that siphon off the patients who have money, leaving the charity cases and those covered by government plans like Medicare that pay less than the full cost of treatment. That's why it makes sense to limit new facilities to markets that have a provable need for more services, a process nicknamed C.O.N. for the coveted certificate-of-need.
"You think we have a problem with indigent care today, get rid of C.O.N. and see what we'll have," Balfour warned. Balfour headed a committee that studied the C.O.N. process which never reached agreement on whether to abolish it or not. It did agree to dozens of recommendations to streamline the process, suggestions Balfour drafted into a bill last year that he says has been highjacked by those under the sway of the well-heeled lobbyists for the for-profit clinics. He sounded just a peeved as Williams sounded sarcastic.
Supporters of maintaining the C.O.N. process note that the states that have recently repealed it have seen their community hospitals struggle financially due to a loss of paying patients to a flood of new specialty clinics. In the nearly two-dozen states that don't control construction of new facilities, the number of physicians is capped as a way to limit competition.
Lawmakers have long known that the traditional economic forces are constrained in the medical field. Some feel it's time those forces be unleashed, and others think there's a good reason for keeping the market in check.
With the advice of dozens of lobbyists on both sides, the legislators will soon get to find out who's in the majority in the General Assembly. But it may take actual experience in the market place to answer the question of which.
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