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CON Reform Begins At The Top
In the first of what may be several more public hearings regarding legislation to repeal the Michigan Certificate of Need process, state senators were given resounding advice to keep the program, as were their peers in the state House last month. Some of the same issues that cloud the success of the CON process, however, also are evident in the move to repeal it. The Senate committee hearing the testimony opened the door last week to listening — and perhaps actually hearing — suggestions to improve the process, which all agree has at times impeded medical care. It’s not that hard.
First, some legislators’ preconceived notions and opinions clouded judgment at the start of the review process. As the facts have been borne through a multitude of state House and now Senate hearings, businesses may expect that the real problems will be attended. Chief among those problems are managerial inefficiency. Throughout the hearings Michigan’s largest employers, the Big 3, provided reams of comparisons of health care costs in states using the CON process to those that do not. “There’s no doubt — CON states do a better job at controlling dollars,” testified Mark Gendregske, director of integrated health care and disability at DaimlerChrysler. House members heard no differently from Ford and smaller businesses like Lacks Industries.
Health care providers themselves and the Grand Rapids Area Chamber of Commerce are among the nearly 200 businesses in West Michigan alone that protested the CON repeal. To CON opponents who suggest “competition” within the health care industry is impeded by the process, Delphi Automotive System’s director of health care benefits noted the traditional economic theory of supply and demand does not work because consumers pay only a portion of the bill and demand is driven by necessity, not choice.
In the face of such overwhelming support and the facts that created such support, one hopes legislators can now spend their time being effective. While Grand Rapids Business Journal applauds gubernatorial candidate Sen. John Schwartz for opening that door, it seems insincere when considering his comment that “everyone interested in CON should be put on notice — you are going to have to sit down at the table, and you are going to have to do it soon.” He then blames what amounts to every person in the state, those affiliated with business associations, labor unions or health care, as the “problem” with CON. While noting his entire constituency belongs to one or another of those “groups,” we ask, who among them ran the program or is responsible for its implementation?
What has been ineffective is the staffing of the department, and a bureaucratic limit on the number of times the CON commission has been “allowed” to meet to hear CON requests and appeals. After House hearings began, some changes were made in staffing. The Department of Community Health is in charge. The buck stops there.
The business community and health care experts have indeed offered varying solutions for repair. It is now time for the bureaucrats to get to work.