U.S. DoJ slams CON laws

Fantastic! This was long overdue. If only the government stops meddling in the market place and lets doctors and hospitals compete with one another the prices for services will drop drastically, Sense will dawn into the market place. The CON is the most abused privilege. It is used effectively by corrupt lawmakers and has been used by the American Hospital Association to the detriment of health of public by making affordable alternatives to hospital based surgery so expensive. Of course the lawyers who deal with CON and the hospital will hate this. The insurance industry will be looking closely at this as the ambulatory surgical centers will also see their rates drop in relation to office based surgical centers. The insurance companies have traditionally paid ASCs more than office based surgery because they had to spend money for CON!

The next thing that needs to be done is to allow the government to negotiate the lowest price for drugs.

Two underlying issue are 1. whether demand for healthcare services is driven by physicians and other providers and thus whether the availability of services or facilities increases cost and utilization and 2. evidence that high volume centers and programs have higher quality than a myriad of competing low-volume facilites.

In Michigan several hospitals each proposed to install $100+ million proton beam radiation therapy equipment, and the state planning agency forced all of them to collaborate on one machine. Proton Beam Therapy provides only incrementatl benefits over IMRT, not in outcomes, but only in reducing side effects from spill over radiation. In Pennsylvania, the University of Pensyvlania is installing a PBT machine and Lehigh Valley Hospital has taken steps to create a $175 million PBT center only 55 miles away.

What is logic of spending $275+ million being spent on incremental improvements? Most healthcare in the US is financed by tax dollars: $450 Billion for Medicare, $350 Billion for Medicaid, and then private coverage for all federal, military, state and local employees, plus people employed in education. Given the extent of public financing for healthcare should there be a planning process to have a rational system of cost effective providers and services? portantly,