Cronyism Created The Hospital Bed Shortage
It's disgusting when we see protectionist licensing laws that keep people from earning a living, like the laws that require thousands of hours of cosmetology school -- to learn white people hairstyles -- for black women doing hair braiding who will never use any of their lessons in their work.
Who's in favor of these laws? People and companies already in business who want barriers to entry to artificially keep out the competition.
This happens in the medical arena, too. (Yes, I'm fine with licensing requirements for doctors, though I'm also fine with people, say, choosing to go to homeopaths instead of simply lighting their money on fire.)
Now, in these days of coronavirus, a good deal of the cronyist protectionism in health care could end up being deadly.
Eric Boehm writes at Reason:
America simply doesn't have enough hospital beds to handle the expected influx of patients suffering from COVID-19. In many places, that shortage of beds is the result of state-level regulations--known as "certificate of need" laws, or CON laws--that artificially limit the supply of medical equipment. Those laws help politically powerful hospital chains limit regional competition and inflate health care costs, but they also create shortages of medical equipment that could prove disastrous during a pandemic.Certificate of need laws are on the books in 35 states, but they differ from place to place. Their stated purpose is to keep hospitals from overspending, and thus from having to charge higher prices to make up for unnecessary outlays of capital costs. But in practice, they mean hospitals must get a state agency's permission before offering new services or installing a new medical technology. Depending on the state, everything from the number of hospital beds to the installation of a new MRI machine could be subject to CON review.
"There have been artificially imposed restrictions on the number of beds, ventilators, and facilities in general that can exist. Some states might find themselves having a real problem," says Jeffrey Singer, a medical doctor and a senior fellow at the Cato Institute, a libertarian think tank. (Singer is also a contributor to Reason Foundation, which publishes this website.)
In 28 states, hospitals must get state regulators' permission before adding beds, according to data collected by researchers at the Mercatus Center, a think tank at George Mason University. Bed space in nursing homes and long-term care facilities are subject to CON regulations in 34 states. CON laws limit long-term acute care services--the sort of thing that many coronavirus victims may need as they recover--in 30 states. Specific medical equipment, such as ventilators, could be subject to CON laws covering the purchases of new devices.
Those laws are one reason why America has fewer hospital beds than most other developed countries.
The United States has only 2.8 hospital beds per 1,000 people, according to data from the Organization for Economic Cooperation and Development. That's even less than the 3.2 hospital beds per 1,000 people in Italy, where the COVID-19 outbreak has been particularly devastating. In China, the figure is 4.3 beds per thousand people, and South Korea (whose response to the virus seems to have been the most effective so far) has a whopping 12.3 beds for every thousand people.
After the coronavirus outbreak in Wuhan, China, a new hospital with 1,000 beds was built in less than two weeks. It would be nearly impossible to duplicate that feat in America, says Singer--not because America lacks China's top-down authoritarian structure, but because regulations (including CON laws) routinely prioritize protectionism over health. In recent years, a CON board in Virginia has blocked a hospital from building a needed neonatal intensive care unit because a nearby hospital complained about unwanted competition. A similar board in Michigan tried to restrict cancer treatments for reasons that had nothing to do with medical efficacy or patient safety.
http://blueberrytown.com/index.php/2020/03/15/the-question-of-hospital-capacity/
Seems a bit like fake news.
Isab at March 16, 2020 5:26 AM
Bravo! This reform combined with a full repeal of ObamaCare and its replacement by, say, allowing anyone to buy insurance across state lines, would improve both outcomes and satisfaction to the point that the left would never be able to sell single-payer. This is a legacy Trump should go for.
jdgalt at March 16, 2020 7:29 AM
Michigan had well into the noughts if not still has a law that restricts the ability for a new hospital to go up at a greater distance from existing hospitals without some act of the state government. I believe it was two miles. The action required often involved buying a hospital elsewhere in the state and migrating it.
Although this has done things like caused McLaren Health System to slide down into Pontiac to take over the existing buildings rather than expanding east/west of Flint, it also meant that when things happened - like the Durand emergency that had an operating room closed - it is a barrier to putting in new hospitals in that county, because, once things drop to zero, you can't be within two miles of the existing one when none exist.
El Verde Loco at March 16, 2020 8:12 AM
I've seen a number quoted of a total of 925,000 hospital beds in the U.S. Of course, not all of those are critical-care beds. Then again, every Wuhan virus patient does not require a critical-care bed. In fact, most of them don't. Some so-called experts are running around in the media saying that if you have symptoms, you must go to the hospital immediately. No you mustn't. You must go to the hospital if you have life-threatening symptoms, or if you have an underlying health condition that will exacerbate the disease. Most healthy adults who get the disease will only experience symptoms similar to the flu.
Cousin Dave at March 16, 2020 8:18 AM
"Their stated purpose is to keep hospitals from overspending ..."
Do we need laws to keep Walmart from overspending? The New York Times? Shell? Home Depot?
Even with CON laws and other regulations poorly managed hospitals will still go out of business. Law can't force management to be competent.
Here in Houston we had months by one of our hospital chains spamming radio adds complaining about the mean insurance companies that wouldn't use their facilities or services. After my experience with them I say good job the insurance companies wised up. They did have the nicest facilities in Houston, and charged the highest prices too. Much of it completely unnecessary. Wood paneling in your sick room may look nice, but I don't want to pay for it, and especially for the high maintenance costs to clean it. For a standard vaginal birth they wanted $30k. And that was just for the room. Medicine, doctors, equipment was all extra. No wonder the insurance companies don't want to pay for it anymore.
The market defines need far better than any bureaucrat can. And will still do so even after the bureaucrats have made a mess of the place.
Ben at March 16, 2020 8:20 AM
Some so-called experts are running around in the media saying that if you have symptoms, you must go to the hospital immediately.
Deer lord, why? do they want people to overwhelm the hospitals? and needlessly expose hospital employees to corona? do they want people to be exposed to the other sicknesses that come into a hospital? somehow, I don't think the current strain of the flu cares if you have a different virus in your system.
I R A Darth Aggie at March 16, 2020 8:30 AM
Desperate for their 15 minutes of fame IRA.
Ben at March 16, 2020 10:16 AM
BTW:
Yes, it's silly to buy more than one economy size pack of toilet paper, as a rule. Or a large amount of anything that's perishable. Or to act as if you need to buy a year's supply of anything when the supermarkets clearly will not close.
They seem to be quite good at filling up the shelves in a hurry, so far.
But one thing they CAN'T seem to order/replace quickly is powdered milk. I got lucky a few days after the store claimed to have run out and I found the last bag on a top shelf, which would make 2 gallons of liquid milk. (I don't buy it much, since it's not the money-saver it used to be; I only wanted it for a bulk granola recipe - it gets mixed into the granola before you bake it.)
Anyway, since I expect things will get quite repetitive here for weeks, I expect I won't be posting for some time. (In the meantime, I feel fine.)
lenona at March 16, 2020 12:40 PM
sorry. I am not buying this "America is bad" "doomsday" article.
I have seem other numbers quoted for the number of beds per population, especially ICU beds, and the US is way ahead of the curve. Not this bogus number this article quotes.
Further, China did NOT build a hospital in less than two weeks. That hospital has been shown to be more of a Potemkin village than a functioning hospital.
This article's author needs to go do some real research to back up these claims.
charles at March 16, 2020 1:24 PM
> things will get quite repetitive
> here for weeks
Why would you think so? What's the dynamism you seek?
Crid at March 16, 2020 6:09 PM
I don't know if other governments are doing this, too, but Switzerland has stopped giving us updates on the numbers. We've been at 2200 since Sunday. Now we're at "more than 2200" which is certainly technically true but gives us no sense of scale.
If all the governments are doing this, it must be much worse than it actually is. If they're intentionally hiding this information from us.
NicoleK at March 16, 2020 10:47 PM
I meant that it'll be virus talk over and over. I don't even have the time to read that, never mind respond to it.
Lenona at March 22, 2020 5:46 PM
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