Repealing ‘public need’ law would imperil Va. health gains
Covering indigent care and doing so in ways that do not undermine the entire health care system is central to existence of the COPN program
This is about the wonderful world of state regulation and here’s the deal: Did you like what they did for energy regulation in Texas — the cold, the dark, the massive bills?
Well, then, you’re going to love what they have in store for health care in Virginia, with the proposed repeal of Virginia’s Certificate of Public Need (COPN) program.
To define “they,” recall “The Producers,” with Zero Mostel screaming at the top of his lungs, “I want that money!” That gives you the rough, but accurate motive behind repeal.
Not that “they” yearn for such clarity, because on Thursday, in this newspaper, ran an op-ed pitch for repeal of the COPN on the basis that it would be a grand thing for “veterans.”
Nice. That’s a PR touch that emerges from fevered meetings on the selling strategy, after someone’s eyes light up and they say, “Oh, I know, we’ll say it’s good for veterans.”
That’s how that gets in there. Then they say, betraying a sense of humor, that “it’s about much more than money.”
Right, and the used car lot guy just wants you to be happy.
Of course, it’s about money. Health care is a sizable chunk of the national economy and the cost pressures and demands for control continue to grow.
But it’s also about healing and fixing in all weathers. Covering indigent care and doing so in ways that do not undermine the entire health care system is central to the existence of COPN.
It was established in Virginia in early 1970s during the NixonFord era. It was an attempt — imperfect at the beginning, imperfect now — to get a handle on expensive new technology, ensure access for all and bring reason to the myriad hospitals, clinics and services available to the public.
Order, rather than chaos, was the rough idea. The rules, for instance, say you don’t get to milk the affluent suburbs, while leaving inner cities and rural regions to fend for themselves.
Likewise, individuals are not left to confront the market alone. Today, because of COPN, if someone arrives at the emergency room of a local hospital — sans cash, sans insurance, sans any identifiable way to pay for their care — no one escorts them out of the lobby.
Why? Because the law does not permit it.
Provisioning — financing — health care is spectacularly complicated. There are many, many moving parts, conflicting demands and constant change. It defines “dynamic.”
Which throws open the door to simplifiers, people with easy answers, offering magic mixtures of ideology and avidity, hoping you’ll fall for it.
P.T. Barnum — who believed in an infinite American supply of the willing and was seldom disappointed — based his career on this one approach.
You can, as an alternative to COPN (or any regulatory structure), just throw it wide open and see what happens. Experience tells us that the genius of American enterprise and endeavor often gets more fully realized with fewer impediments, rather than more.
Like railroads. In the 19th century, we knitted the country together with steel rails and created a great, transformational industry. Then we almost undid the railroads with regulation, largely to check overbearing industry excess.
In a very real way, that’s when the regulatory push in this country really kicked in, with railroads — and only with regulatory reform in the second half of the 20th century did the railroad biz truly get back on its feet to prosper again.
I recall this only to underline that no one mentality at all times serves best. You have to regulate the regulation of anything, to constantly test the assumptions and amend the inner workings according to existing conditions. Easy to elucidate? No.
Easy to attack? Yes.
But go to the extremes on essentials — whether that might be medical care that keeps you going or the juice fueling the lights — and look out.
In Texas, with a deregulated electricity market, there would be more choices, more freedom,
the market would provide. There was much conjuring. Wizards abounded. Political sorcery ensued.
Adequacy? Reliability? Safety? Prudence? Not so much.
It’s been decades since I first wrote about COPN and it remains an amalgam: a hybrid mixture of tightly calibrated parts.
Does it work? The best answer lies in perspective.
If you know what was out there in Virginia during the 1960s — in the way of hospitals and medical services — and what exists today, then you know there’s no
comparison. It’s vastly improved — yes, vastly — and the COPN steered us forward.
After writing editorials for the Daily Press and The Virginian-Pilot in the 1980s, Gordon C. Morse wrote speeches for Gov. Gerald L. Baliles, then spent nearly three decades working on behalf of corporate and philanthropic organizations, including PepsiCo, CSX, Tribune Co., the Colonial Williamsburg Foundation and Dominion Energy. His email address is gordonmorse@ msn.com.