March 11, 2020
By Lindsay Killen and Naomi Lopez
Concerns over the potential
impact of the coronavirus on the U.S. populace and economy are growing. In the
event of a widespread outbreak, the nation’s hospitals will become ground zero,
absorbing the massive responsibility of treatment and containment.
Unfortunately, the availability
of hospital beds in 38 states is limited by arcane laws called
“certificate of need.” Rather than allowing a hospital to be built,
adding beds to an existing hospital, or offering some types of new
technologies, many states require that these additions be approved by a board
of existing competitors with every incentive to restrict new competition from
opening or expanding.
Imagine if an Aldi or
Whole Foods wanted to build a grocery store or begin offering some new products
in your community, but Publix and Kroger were in charge of deciding if the new
store’s plans would be approved. As absurd as this situation would be, this is
exactly what happens when it comes to hospital capacities in more than
two-thirds of states nationwide.
In a new study released this week by the Regulatory
Transparency Project of the Federalist Society, Christina Sandefur points out
that “38 states still have [certificate of need] laws on their books, and
continue to require government approval before building or expanding a
healthcare facility or service — approval that can hinge on whether existing
hospitals are willing to allow others to enter the market to compete against
them.”
We shouldn’t have to
wait until there is a looming public health threat to recognize that these
crony laws serve to artificially prop up hospitals’ bottom lines at the expense
of public well-being and preparedness. As China’s construction of a 1,000-bed
isolation hospital in 10 days made international news, leading analysts in the
U.S. acknowledged that our bureaucratic system would prevent from responding
with similar urgency.
The United States has
approximately 900,000 hospital beds, of which the CDC claims about two-thirds
are regularly occupied. The World Health Organization estimates “about 80% of
coronavirus cases are mild, with others serious or critical”, according to
Robert Cyran of Reuters. “So if just 1% of America’s population of 330
million contracted the virus at the same time, there wouldn’t be enough
hospital beds. An uneven outbreak could lead to more overcrowding in some
cities and critical-care units.”
Indeed, this dynamic is
exactly what’s being blamed for the disproportionate impact of the coronavirus
in Wuhan, China, where the death tolls have been much higher than other parts
of the country. “Stretched medical systems will kill more patients… countries
with poor medical care will be hit harder,” explains Cyran. “They lack the
ability to find clusters of disease and dampen the outbreak, while patients
won’t be treated.”
Yet even as consensus
builds towards assuming that certain high-density areas in the U.S. like New
York City are nearly guaranteed to be at risk of real public health threats as
a result of the coronavirus contagion, city officials weighing hospital bed
capacities are demonstrating an apathy towards proactive reforms that would
better assure their treatment facilities are ready. The New York Times recently questioned Mayor Bill De Blasio about
what would happen if the 1,200 beds currently available to treat affected
patients were filled, and he responded, “We’ve got a long time to ramp up if we
ever had anything like that.”
State lawmakers have
both the authority and the duty to put patients first. They should do so by
bringing urgent legislation to immediately remove certificate of need laws,
allowing healthcare providers to fully examine how they may expand to meet new
demands. Lawmakers shouldn’t wait until there is public health emergency to
respond. They must act now.
Lindsay Killen is Vice President for Strategic Outreach at the Mackinac Center for Public Policy. Naomi Lopez is Director of Healthcare Policy at the Goldwater Institute.
This article originally appeared in the Washington Examiner.
