An article published by the Kaiser Family Foundation on Wednesday showed the United States ranked eleventh in the world in per capita distribution of hospitals. That article pointed out that the United States had a "lower hospital density than almost all comparable countries." Predictably, there are a slew of other hospital-related resources in which the United States is lacking, including the number of hospital-employed nurses and the number of physicians. Although the Kaiser article does not detail the cause of these shortages, I do so in my book, The Case for Free Market Healthcare. The reason is actually quite simple and predictable: government intervention.
Although the details of the dynamics are too extensive to cover in this forum (I therefore urge you to explore them further inThe Case for Free Market Healthcare), there are a few observations that can be gleaned regarding the degree of error with which we have approached healthcare delivery in our country. First, government has been openly hostile to hospitals, particularly private hospitals, viewing them mostly as vehicles for greedy investors to make money off the sick and the poor. This hostile and destructive attitude led to the passage of the Health Planning Resources Development Act in 1974 that actually rewarded states for implementing "certificate of need" programs to restrict the abilities of entrepreneurs to build hospitals.
Within a few years, forty-nine states enacted CON laws, and their models for governmental interference have since been shown not to lower prices for inpatient services and not improve hospital financial investment in communities as had been touted by the bill's advocates.
But the damage still persists. To this day, despite the certificate of need program's total failure, only thirteen states have rescinded it demonstrating the difficulty of undoing misguided legislation after it has been past.
Government also has and continues to manipulate the market in ways that have destroyed projects aimed at improving the availability of hospital emergency rooms. In 2018, the Medicare Payment Advisory Board advised Congress to cut reimbursements to freestanding emergency rooms operating within 6 miles of their parent hospitals by 30%. Why? Because, according to MedPAC, such systems would encourage providers to treat lower intensity rooms rather than urgent care centers." Which begs the question: what business is it of Medicare, an insurance company for seniors and the disabled where the market decides that it is more efficient to treat urgent and emergent patients?
But I digress. As a result of MedPAC's misguided market manipulations, over 250 shovel-ready or unfinished projects were canned, robbing America of greater healthcare access.
To be sure, the federal government has also engaged in a wide variety of activities that favor hospitals over other models, but in each of unnatural interventions the consequences are the same: government continues to impose delivery models upon the population and with it, its bias of how healthcare upon the consumer. As a result, the market is not free to respond to consumer demands and cost-saving opportunities in an efficient manner. Thus, we are never given the opportunity to develop the right number of hospitals and the correct number of physicians, and nurses, and physical therapists. . . . you get the point. Now, we are faced with the challenges of a pandemic where many, including President Trump, have observed that we were not ready with a coordinated response mechanism. In point of fact, we weren't even ready with a baseline set of operating resources with which to handle the larger numbers that would present themselves, and the blame lies squarely on government for attempting to impose its ideas of what those numbers should be upon us, instead of allowing the market to settle upon them by itself.
Dr. Julio Gonzalez is an orthopaedic surgeon and lawyer living in Venice, Florida. He is the author of The Federalist Pages andThe Case for Free Market Healthcare. He can be reached through http://www.thefederalistpages.com/contact.htmlor at firstname.lastname@example.org.