Where We Stand: Leave CON process to legislators.

Now that the Florida Legislature has concluded its regular session for the year, it’s no longer sharing the spotlight with the state’s Constitution Revision Commission, which launched its latest series of meetings Monday. But the two bodies are not exactly Tweedledum and Tweedledee.

The Legislature meets at least once a year to work through the details of state policy. It writes, rewrites and repeals state laws. Any mistakes it might make one year can be corrected as soon as the next year.

The commission convenes once every two decades in a year-long process to offer voters a short list of proposed amendments to Florida’s primary governing document. Its proposals, if approved by voters, can become permanent fixtures in the constitution.

There are some proposals among the three dozen or so the commission is scheduled to consider this week and next that don’t belong anywhere near the constitution. They deal with evolving areas of policy and regulation, rather than enduring governing principles.

One misplaced proposal could have a large, lasting — yet uncertain — impact, particularly in Central Florida: Proposal 54, which would eliminate the state’s certificate of need requirement for hospitals. Commissioners would be foolish to sideline legislators and regulators in this area.

Since 1973, Florida has required some health-care providers, including hospitals, to demonstrate there is an unmet need before they build or expand their facilities or services. The purpose is to prevent providers from duplicating services in the same market, which can erode the quality of those services and reduce access to other services.

For years, some Florida legislators have tried to eliminate the CON requirement. They have argued that allowing more health-care competition would bring down prices. It sounds like Economics 101, but health care isn’t a free market in Florida. Providers are heavily regulated, and would continue to be even if CON were abolished.

CON in Florida can be an expensive, cumbersome, time-consuming process. Yet Florida legislators intent on scrapping it have never persuaded a majority of their colleagues in both chambers to go along.

Gov. Rick Scott, a former private hospital executive, is not a CON fan. So one of the governor’s 15 appointees on the 37-member commission, Orlando lawyer Frank Kruppenbacher, has sponsored a proposed amendment that would effectively eliminate CON for hospitals in many Florida counties.

Proposal 54, as amended last week, declares the state may not prohibit a hospital from entering any county where any current hospital has an infection rate above the statewide average. But a hospital’s higher-than-average infection rate doesn’t necessarily mean its quality of care is substandard. It might be serving an area with poorer, sicker patients who are more vulnerable to infections.

Eliminating CON would open markets throughout Florida to hospital expansion. Fast-growing areas like Central Florida would be especially attractive. But if the entry of a new hospital spurs consolidation among other players to compete, prices could go up instead of down. If it reduces the number of procedures at an existing hospital, quality could go down. If it decreases the revenue a hospital has been using to subsidize otherwise unprofitable services, it could diminish access to care.

While most states have CON requirements, 14 don’t. It’s difficult to draw general conclusions from their experiences — each state is different — but CON supporters and opponents specialize in cherry picking data to bolster their positions. That’s too flimsy a foundation to justify changing the Florida Constitution.