How Government Kills House Calls

by KEN BRAUN

“You can’t find a doctor who makes house calls anymore,” goes a common old refrain meant to emphasize how the fast-paced marketplace of modern America has cast aside the supposedly friendly personal touch from a bygone era. But according to an article posted by Reason.com, it is government that may be to blame when you can’t get a doctor to your doorstep. The reason why is probably just one of many factors driving up lots of health care costs, and a good example of the unintended consequences that follow when the federal government tries to “do something” about health care.

It profiles Melanie Lamar, the owner of an in-home medical care business in Washington, D.C., who wants to expand by hiring doctors, nurses and physical therapists so as to care for PTSD-afflicted and other disabled military veterans in the D.C. area. She is currently serving sick, disabled and elderly folks, keeping them out of hospitals or nursing homes. The staff at Walter Reed Army Medical Center and the D.C. Veterans Administration hospital both say their local military patients need more home-care options like hers, and that the existing providers are often doing a poor job.

Lamar is a registered nurse from a military family who owns a business perfectly situated to ramp up and fill this need. She just hires people and gets at it, right?

Wrong:

“[I]n 16 states and D.C., home health agencies that send skilled medical professionals directly to patients must get permission from the government. And when Lamar asked to expand the city’s health planners told her no.”

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At issue is a little known but widely used government road block called a “Certificate of Need.” In simple terms, it means that in those 16 states and D.C. a government planning board – sometimes called a “Certificate of Need Commission” - decides when there is a market demand for a particular medical service. Nobody is permitted to expand into that marketplace until the CON commission says it’s okay.

For example, Michigan’s CON Commission defines its mission as being “a state regulatory program intended to balance cost, quality, and access issues, and ensure that only needed services are developed in Michigan.” [Emphasis added.] That last phrase means otherwise talented and highly qualified hospitals, doctors and medical professionals in Michigan cannot perform new types of surgeries, purchase MRI machines, start an air ambulance service or even add a new patient bed without first convincing the state that there’s room for it in the marketplace.

To see how absurd this is, imagine if every entrepreneur who wanted to open a new pizzeria had to first prove to the government that local customers needed pizza. Even for such a simple operation, the government would be woefully inept at judging community “need” for pizza. And then there’s the obvious problem of some existing restaurant owners – pizzerias and otherwise – who might lobby the commission to protect their business by keeping out the new competition.

Clearly, this fiasco would swiftly lead to bad pizza, at high prices, that was hard to get.

And that’s just for something as low-tech as pizza. It’s a worse problem with health care. Just imagine if the hypothetical CON commission for pizza was further tasked with deciding which sorts of crust, sauce, mushrooms, pepperoni, etc… were “needed” in each community. Government planners don’t get any smarter just because the subject is more complicated.

Congress passed a law ordering states to create CON programs in 1974. Laughably, according to the Reason article, it was intended to restrain health care spending. Even Congress was able to figure out the horror it had wrought and repealed the command in 1987. Today, as noted, there are 16 holdout states plus the nation’s capitol still imposing these regulations.

Back in D.C., Reason says 46 of the last 49 applications for expanding in-home health care services have been rejected by the city, and all 21 over the last three years. Predictably and tragically, the medical professionals from the veterans and military hospitals say the existing in-home health care providers are too few in number and – without serious threat of competition – often provide poor and unreliable service.

And … they need somebody who will provide doctors to do house calls – just like Melanie Lamar wants to do – but no such is service is available.

If you’re a wounded warrior in the city where the Commander in Chief lives, you often can’t get a medical professional to do a house call because the government won’t let it happen. The inability to kill this bad experiment is something to think about when considering what other medical decisions should be made by government rather than the patients who need the care and the professionals who provide it.

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