I t is my understanding that here in Northern KY the CON which enables a near monopoly by one hospital chain is what makes it possible for them to keep rates low and provide much charitable care. Can you please address this?
Thank you for your comment Frederick. Monopolies can indeed lower prices. A good example is John Rockefeller and Standard Oil. In the early 20th century he managed to control drilling, refining, the rail transportation of oil and the commercial retail distribution. The Taft Hartley act was implemented specifically to break up his monopoly on oil. He was devastated because he believed he was serving the American consumer by controlling all the prices in the full supply chain and so he would gain efficiencies and keep costs low.
In general, though, a benevolent corporation is not at the helm. The FTC web page lists many examples where corporations merged in order to drive out competition and then raise prices. Here is a recent anesthesiology group example where they did just that and the FTC sued to break up their stranglehold. https://www.washingtonpost.com/business/2023/09/21/usap-monopoly-ftc-anesthesiology-prices/
So sometimes a monopoly can result in lower prices. But I wanted to address the Problem I see is that monopolies can also choose to deny medical care for "ethical" reasons and if there is nowhere else to get care you are out of luck.
Women who have a c section often decide that they are done with being pregnant and would like tubal ligation. This contraceptive operation is performed under anesthesia and if the woman is already in the operating room it is the least risky time to do the surgery. Catholic and other religious hospitals are denying patients that option and forcing them to find a doctor elsewhere at higher risk from additional surgery.
I hope this is helpful. And thank you for reading the newsletter.
Thanks for your comments. Here is a link to an article in which the CEO of the Catholic hospital (as well as other execs) reply to those trying to abolish CON.
Erlanger becomes site of conflict over medical certificate of need - LINK nky
“He characterized St. Elizabeth’s as a “safety net hospital,” which is not an official, legal designation, but refers, instead, to St. Elizabeth’s policy of accepting all patients regardless of their ability to pay.
“Communities like ours greatly depend on access to safety net facilities like St. Elizabeth,” he said. “Certificate of need ensures that we’re able to provide these comprehensive, critical, top-quality services to the entire community. In fact, it’s only because of certificate of need processes that St. Elizabeth can be a safety net hospital. Without certificate of need, outside operators could come into our communities and cherry pick the most profitable services to offer.”
Most of the patients St. Elizabeth cares for are Medicare and Medicaid patients, he said, adding that the percentage of their client base on Medicaid matched the proportion of the region’s population on Medicaid, which he claimed fluctuates between 22% and 23%.”
It is telling that “Greg Proctor, a representative from the Kentucky branch of Americans for Prosperity, a fiscally conservative think-tank funded by Charles Koch, compared CON laws in Kentucky to “permission slips from a government board that hometown healthcare providers must receive if they wish to open new health care services or expand an existing service.”
I do recognize the paradox that this gives a Catholic healthcare operation a market-dominant position which is to the disadvantage of women’s reproductive rights.
So again I wonder if indeed there are two sides to the CON debate.
The denial of care for the CA woman undergoing a miscarriage in a Catholic Hospital was heartbreaking. As a retired ARNP, it is incomprehensible to me that giving a woman towels and a bucket for massive bleeding actually took place. It harkens back to the middle ages. The incident brought to light the draconian measures that are imposed by US bishops in Catholic hospitals. The ethical and religious directives (ERD's) have forced many states, such as CA, to enact laws to mandate care that must be given in emergency miscarriage treatment. Let me say this again, in this day and age we need laws to protect patients receiving care in a Catholic hospitals. The law did not protect this woman. And as we see, denial of care is still a reality in Catholic hospitals despite the law. The "agreement" that CA AG reached with Providence, very quickly I may add, is worded such that the woman's life is still in danger, loss of organ function, etc. This has to stop! Thank you Alan for your continued work on this issue. Guaranteed Comprehensive Health Care should be a right. It should be patient directed, with full informed consent, and driven by standard medical care. We are working in WA state to enact further legislation to protect patients.
I just followed the Resistbot instruction and see it will be sent to some electeds who are leaving office and at a time when the legislature is not in session. Should this action about certificates of need be pursued when it can better influence legislation?
I t is my understanding that here in Northern KY the CON which enables a near monopoly by one hospital chain is what makes it possible for them to keep rates low and provide much charitable care. Can you please address this?
Thank you for your comment Frederick. Monopolies can indeed lower prices. A good example is John Rockefeller and Standard Oil. In the early 20th century he managed to control drilling, refining, the rail transportation of oil and the commercial retail distribution. The Taft Hartley act was implemented specifically to break up his monopoly on oil. He was devastated because he believed he was serving the American consumer by controlling all the prices in the full supply chain and so he would gain efficiencies and keep costs low.
In general, though, a benevolent corporation is not at the helm. The FTC web page lists many examples where corporations merged in order to drive out competition and then raise prices. Here is a recent anesthesiology group example where they did just that and the FTC sued to break up their stranglehold. https://www.washingtonpost.com/business/2023/09/21/usap-monopoly-ftc-anesthesiology-prices/
So sometimes a monopoly can result in lower prices. But I wanted to address the Problem I see is that monopolies can also choose to deny medical care for "ethical" reasons and if there is nowhere else to get care you are out of luck.
Women who have a c section often decide that they are done with being pregnant and would like tubal ligation. This contraceptive operation is performed under anesthesia and if the woman is already in the operating room it is the least risky time to do the surgery. Catholic and other religious hospitals are denying patients that option and forcing them to find a doctor elsewhere at higher risk from additional surgery.
I hope this is helpful. And thank you for reading the newsletter.
Thanks for your comments. Here is a link to an article in which the CEO of the Catholic hospital (as well as other execs) reply to those trying to abolish CON.
Erlanger becomes site of conflict over medical certificate of need - LINK nky
“He characterized St. Elizabeth’s as a “safety net hospital,” which is not an official, legal designation, but refers, instead, to St. Elizabeth’s policy of accepting all patients regardless of their ability to pay.
“Communities like ours greatly depend on access to safety net facilities like St. Elizabeth,” he said. “Certificate of need ensures that we’re able to provide these comprehensive, critical, top-quality services to the entire community. In fact, it’s only because of certificate of need processes that St. Elizabeth can be a safety net hospital. Without certificate of need, outside operators could come into our communities and cherry pick the most profitable services to offer.”
Most of the patients St. Elizabeth cares for are Medicare and Medicaid patients, he said, adding that the percentage of their client base on Medicaid matched the proportion of the region’s population on Medicaid, which he claimed fluctuates between 22% and 23%.”
It is telling that “Greg Proctor, a representative from the Kentucky branch of Americans for Prosperity, a fiscally conservative think-tank funded by Charles Koch, compared CON laws in Kentucky to “permission slips from a government board that hometown healthcare providers must receive if they wish to open new health care services or expand an existing service.”
I do recognize the paradox that this gives a Catholic healthcare operation a market-dominant position which is to the disadvantage of women’s reproductive rights.
So again I wonder if indeed there are two sides to the CON debate.
Regards,
Frederick Warren
The denial of care for the CA woman undergoing a miscarriage in a Catholic Hospital was heartbreaking. As a retired ARNP, it is incomprehensible to me that giving a woman towels and a bucket for massive bleeding actually took place. It harkens back to the middle ages. The incident brought to light the draconian measures that are imposed by US bishops in Catholic hospitals. The ethical and religious directives (ERD's) have forced many states, such as CA, to enact laws to mandate care that must be given in emergency miscarriage treatment. Let me say this again, in this day and age we need laws to protect patients receiving care in a Catholic hospitals. The law did not protect this woman. And as we see, denial of care is still a reality in Catholic hospitals despite the law. The "agreement" that CA AG reached with Providence, very quickly I may add, is worded such that the woman's life is still in danger, loss of organ function, etc. This has to stop! Thank you Alan for your continued work on this issue. Guaranteed Comprehensive Health Care should be a right. It should be patient directed, with full informed consent, and driven by standard medical care. We are working in WA state to enact further legislation to protect patients.
Alan,
I just followed the Resistbot instruction and see it will be sent to some electeds who are leaving office and at a time when the legislature is not in session. Should this action about certificates of need be pursued when it can better influence legislation?
Good point, Gary. This one will be done over and over.