Thursday, January 11, 2018

Representative fights to abolish CON law

This column is reprinted from State Representative Robert Foster's Facebook page with his permission.

Everyone hears about how corrupt Mississippi is and how low we are ranked in healthcare, but most do not know just how corrupt or why our healthcare is so bad. Healthcare corporations are some of the most powerful lobbyists in this state, who also have very deep pockets. They will not like what I am about to share- and will provide manipulated statistics and false information in an attempt to discredit me. None of that matters because the truth is the truth and I answer to the people of Mississippi, not to them.

I am about to try and explain to you just how corrupt our healthcare system is and how we can make healthcare better for every Mississippian. This is a rather long post, but there is a lot to explain. I need this message to get out and I need your support.

First, an example: What if Mississippi had a law that only allowed one car dealership in a region of our state and that particular dealership also owned most of the repair and maintenance shops in that region? Most of the mechanics in that region have no choice but to work for that one dealership and accept their terms, or be put out of business because even though they are qualified to do the work they are not allowed by the government to operate unless they work for the profit of the dealership holding the certificate of monopoly.

How expensive would a car be?

How expensive would parts and labor be for repairs and maintenance, and how terrible would the service be if you did not have any other dealerships you could take your business to without driving a very long way? Even if you drove a long way within the state to another dealer they also have a monopoly in their region of the state, so it is not any better there either. You could go out of state for better service, but your insurance probably wouldn't pay for that. Thankfully we do not have this type of law on car dealerships but unfortunately this is the reality of our healthcare system in Mississippi - the "Good Ole Boy" system.

Mississippi has a set of healthcare laws called Certificate of Need laws, or CON laws. I call them Certificates of Monopoly because this is what they are. We have some of the most restrictive CON laws in the entire country. Many states have very minimal CON LAWS, if any. For the most part they have many competing healthcare providers with high access to care, more competitive pricing and better service. They also have healthier people in their state - imagine that.

These CON laws give large corporate healthcare providers regional monopolies on healthcare in our state. These laws prevent doctors and other healthcare professionals from being able to open competing healthcare services against healthcare giants. You may be professionally trained to provide a service, licensed to provide that service, and have a facility which meets all of the requirements to do the service- but, a monopoly board gets to decide if there is a “need” for your service before you are allowed to provide it. Not only that, but the large corporate healthcare company that you want to compete against can sue you into oblivion in a “hearing” carried out by the monopoly board where they will claim there is no “need” for any additional healthcare services in that region. These large healthcare companies claim that without these laws to restrict competition all of our rural hospitals will go out of business, which is ludicrous. Without these laws, yes, some badly run hospitals or healthcare facilities may go out of business. However, since there is no shortage of sick people or people in bad health in Mississippi many more will open up in their place and compete for your business like in every other state. The competition will make them offer better service, higher wages to their workers, and will drive prices down.

These monopoly holders falsely claim that free market principles do not work in healthcare because they need to be able to make large profits off of the services they provide to the insured/cash patients in order to pay for all of the charity/un-insured patients they care for. To that point, we have Medicaid and a trauma care fund to reimburse them for those services. If those payments are not enough to cover those costs then we should have a debate about the amount of those payments. This, however, is a separate issue from whether or not we should allow competition in healthcare in our state, like in most every other state.

I have seen evidence of how CON laws restrict access to healthcare, suppress the wages of healthcare workers and how they hinder the quality of healthcare in Mississippi. I’m not saying we don’t have some great hospitals and healthcare facilities in our state that are providing top notch service, but everyone has room for improvement and competition is the best way to bring about innovation. CON laws suppress the wages of healthcare workers in our state because those workers have no choice but to work for the one big monopoly company in many regions of our state. I have spoken to many Doctors and other healthcare providers about this. Many are scared to speak out because they may lose their “privileges” to work at the hospital, or get fired for speaking out against these large healthcare monopoly giants.

The Federal Department of Justice and the Federal Trade Commission have stated that CON laws go against the Federal Anti-Trust Act, are monopolistic and should be repealed. If I had millions of dollars to take this to Federal Court - I would - but since I don’t, I am going to need your help to change these corrupt laws.

Do your own research, find out the truth, spread the truth. Call, message and email the Governor, the Lt. Governor, the Speaker of the House, your state Senator and your State Representative and tell them to support the Mississippi Access to Care Act. Share this post with your family, your friends, media contacts and especially your medical providers. I need doctors, nurses and medical technicians who have experienced the ill effects of these laws firsthand to reach out and contact their elected officials in support of this bill. You don’t have to make a public stand, although I welcome it, but you can make some phone calls to your elected officials and tell them to support this common sense piece of legislation.

This Mississippi Access to Care Act does three things:

1. It removes the requirement for a healthcare professional from having to get a CON to provide any service that they are already qualified and licensed to perform. Yes, our CON laws are so restrictive that they even restrict trained healthcare professionals from providing their services across our state. Some of their services (which varies on the region) can only be provided under the umbrella of a CON holder and for their profit alone.

2. It removes the requirement for a healthcare provider to get a CON to purchase a piece of healthcare equipment that they already have a qualified and licensed professional ready and waiting to operate.

3. It removes the requirement for a multi-specialty Ambulatory Surgery Center (better known as a same day surgery center) and for dialysis centers from having to get a CON in order to compete against a major medical facility. Stand alone medical facilities run with less overhead, reach further out into rural communities, have less wait times, and offer a wide range of specialty services at very competitive prices.

In other words, if a highly trained healthcare professional wants to open a privately owned center to provide healthcare and provide access to care in small towns across Mississippi, or compete and offer better pricing and service across the street from a major medical facility then they can without being denied by a board of monopoly, just like they do in most every other state but ours.

There are many other issues in healthcare that need to be addressed, but the reform of our CON Laws is one of the major hurdles before us. We need to break up these state mandated monopolies, and after doing this many other things will start to fall into place.

I have spoken to countless individuals all across our state and improving healthcare in Mississippi seems to be a top priority for all - from the young to the elderly, from the poor to the middle class. With us ranking last in health out of all 50 states it should also be a top priory for every elected official in this state. I have dropped a CON repeal bill the last two years. This is my third year to push this piece of legislation. Demand that your elected officials get this bill to the floor for a debate and a vote - and then hold us all accountable for our votes on this very important issue.

Session starts Jan. 2nd this year. The time to act is now.

Robert Foster
MS State Representative, Distrcit 28


Anonymous said...

Bravo rep. Foster. Every pol in the state should have to speak yean or nay on this issue NOW.

Anonymous said...

Apparently, Rep. Foster doesn't have a problem taking campaign contributions from "big healthcare corporation lobbyists." Check his campaign finance report. Just sayin.

Anonymous said...

Beth won’t let Mims move this out of his committee.

Anonymous said...

Unfortunately CON it will remain this way for some time.

Anonymous said...

Great work, Rep. Foster! Glad to see someone taking this on.

Anonymous said...

removing the CON would devastate certain hospitals across the state. areas that are underserved would become more so. that's why we have a CON. there most likely is corruption just like there is corruption anywhere there is money. but the basic premise is sound.

Anonymous said...

11:55, no, the basic premise is not sound. Did you even read the post? The basic premise is that of government dictating how and where people are served. This is one of the reasons our healthcare is so expensive!

Anonymous said...

11:55; would your theory hold water if the removal of the CON premise were restricted to metropolitan areas only? How could you manage to defend it then?

How does your 'underserved' diversion apply to land owned in Madison by Baptist with no ability to put hospital beds there? Or to land further up in Madison County owned by St Dominic with the same restriction?

I'm afraid you have lobbed a red herring out onto the operating table.

Anonymous said...

Don't be fooled the hospital industry loves the CON process. It is what keeps them from going bankrupt.

Anonymous said...

11:55 – That makes no sense at all. No competitor is going to try to enter an “underserved area” unless they see opportunity for profit. If a competitor believes that entering the market of “certain hospitals” is worthwhile (profitable) the underserved area will gain an additional med resource in the “underserved area”. If “certain hospitals” cannot keep up with the new competitor, they will go out of business. Or they will pull their practices in line with the new competitor. Thus, better and/or more service for the “underserved area”. Corruption has little chance when the free market is allowed to exist.

Anonymous said...

11:55, let me see if I can wrap my mind around this.

Area is underserved, but beds and facilities can't be added because lack of CONs prohibit it. Removing the prohibition would mean beds and facilities could be added...perhaps promoting the area to served vice underserved. Are hospitals chomping a the bit to add beds and facilities to lose tons of money? The greedy corporations, with their evil love of money might see an underserved market as an opportunity to satisfy those underserved and thus reap the benefits. You don't care about that. You just want to make sure all the Boss Hoggs keep Hazzard under their thumbs.

Your less than stellar understanding of economics gets, at it's best, poor Marx.

Anonymous said...

The Corporate Healthcare Players also use the mandate for ambulatory surgical centers to obtain transfer agreements with local hospitals to kill competition.

Louis LeFleur said...

Thanks, Rep. Foster. I knew a little about the CON process before and thought it was a sham based on what little I knew. Now I KNOW it's a sham. Our Republican legislature should be all about free trade so I hope you can get this through, but change is hard no matter how much sense it makes a lobby money still trumps logic.

Anonymous said...

Business is Business....Free Trade....Competition....if someone wants to build a hospital, I say let them do it and if they fail, so be it.

CON is exactly how it is spelled----con. Dictionary says: To defraud; dupe; swindle.

Anonymous said...

Rep. Foster doesn't give a damn about women's healthcare, being a proponent to ban abortion in Mississippi.

I am leery of any angle he takes on healthcare in Mississippi.

Anonymous said...

CON applies unless your UMC. They don’t have to have a CON. Mississippi is really not populous enough to support 2 Gamma Knife radiosurgery units. Dr. Bob Smith left UMC after years of practice there because they wouldn’t get one. He went to CMMC and brought this technology to Miss. UMC physicians utilized the unit at CMMC with welcome. They wanted their own Gamma Knife. Under CON rationelle they shouldn’t be able to get one. No other hospital could. However, because they don’t have to play by the same rules, they went ahead and duplicated this service. Their acquisition of a Gamma Knife may actually result in CMMC having to close their unit due to too few patients. UMC is actively competing for private patients but doesn’t have to play by the same rules. This is a great injustice that should be remedied.

Fitty Cents little brother Foety Cents said...

How many times have you heard "All these uninsured people are driving up the cost of MY insurance!"? Well, once upon a time a few years ago, I found myself uninsured with a family physician type of Doctor urge me to go for some procedures at St. Dominics Hospital. Not only did he urge me to go, he set up the appointment for 2 hours after I left his office. Once at St. Dominics, I sign up for financial aid and have the procedures done. They tell you right there on the back of the bill in so many words "the most you will pay is 40% of the charges". So immediately after an $800 procedure that turns up nothing, I'm in the financial office with a lady pushing buttons and pulling levers on an adding machine. "You've already paid the initial 20% of the full charges, can you pay us $160?" I reply "and that covers it all?" "Yes, would you like us to set up a payment plan?" "No. Do you take a credit card? I'll pay it all right now!" Now, what does that tell you? Do you think The Pope picked up 60% of my tab? I'm not even Catholic! I did however once upon a time find my self in a relationship with a lady that worked in the billing department of a Doctor! A Doctor that had a very hard time getting paid by tah-dah......the insurance companies! Typical routine: We want our money. Well, you'll have to submit the claim paperwork. We did that last week. Well, we didn't get it. Please send it again. Month later...still no money. Where is our money? We still haven't received your claim. Month later....well, we got SOME of our money, where is the rest? Oh, we only pay X amount of those charges and Y amount of those.

So whats the moral of the story? At least one area Hospital will gladly accept 40 cents on the dollar, cash in hand, to cover their expenses with a profit margin, because they inflate the billing to the insurance companies by 250% to get dicked around for months only to settle for the same amount of coin I paid them in cash!

The Papal Palace of Death said...

Look at dem dere commies talkin ‘bout dat dere free market librhul heebie jeebie. Plottin’ to usurp our medical cartel and all.

Anonymous said...

The basic false premise is that everything should be about profit.

For thousands of year mankind understood that some things are so vital to society that they can't be left to greed. We distinguished those things as " professions".

Indeed, " tradesmen" and " money lenders" were near the bottom of the social totem pole in every society and the charges of greed at the expense of others was a primary charge used to persecute the Jews.

Even in our capitalistic society, we once still had some sense of the difference between a profession and a trade. But, then the money was used for propaganda and the propaganda became easier to disseminate. And, with the propaganda working, the politicians were sure to be more easily bought as there was no price to pay for their greed if they people were blind to the notion that greed was bad.

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