Few issues concern U.S. residents more than healthcare costs. Almost 40% of the population skips necessary care due to financial constraints, and about half of patients say they struggle to afford their medical bills. Regardless of anyone’s opinion on government-run health care vs. a free market approach, the fact remains that high costs will burden any healthcare system and affect all patients. 

In addition to cost, the invasiveness of some procedures deters patients who need them from receiving them. Almost half of patients who receive a positive result (indicating possible colorectal cancer) on a non-invasive stool sample test fail to get a colonoscopy to confirm the results. Again, many people list money as a reason, but they also cite fear of such an invasive process. 

These related issues indicate two reasons to get rid of certificate of need (CON) laws. Despite their purported intent to lower prices and increase accessibility, they have consistently proven to do the opposite. CON boards decide whether a medical practice should be allowed to open, expand, or buy new equipment. Their decision is based not on safety, but on their assessment of community needs. And their assessment is often very different from that of actual community patients, who suffer when the boards deny providers the chance to utilize efficient and innovative medical options. 

Patients Can’t Access Medical Machinery That Doesn’t Exist 

The first magnetic resonance imaging (MRI) machine began operating in 1974—ironically, the same year the federal government virtually mandated that all states enact CON laws—and since then, MRI machines have become 75 times stronger than the original. Cheaper and more portable versions are also hitting the market, which translates to lower prices for patients, as the machinery, travel, and hospital overhead costs shrink. And the more demand that exists for these machines, the more they will improve. Competition drives innovation.

MRI scans provide a relatively non-invasive way to see inside the human body, and they have revolutionized health care. But if a medical practice in one of the 35 states with CON laws wants a new one, it may well be denied that request if a CON board arbitrarily deems a new one unnecessary. Dr. Gajendra Singh could offer an MRI for $500 if the North Carolina CON board would allow him to purchase one for his practice, but instead, his patients must spend more than $2,000 on an MRI at a hospital allowed to buy one.

Not only do patients pay more in the short term in this situation, but when such CON denials occur on a regular basis, medical device creators turn their attention elsewhere. They will not spend money on research and development on products that people are not allowed to buy. 

Patients Can’t Access Care In Facilities That Don’t Exist (Or Remain Closed)

Eye surgeons can safely perform quick cataract surgery in their own operating rooms at a far lower price than at a hospital, where the overhead costs tend to be astronomically higher. Many doctors do it routinely, and Dr. Jay Singleton has all the necessary qualifications to do so. He even has the facility ready and waiting—and closed, by law. Due to North Carolina’s decision that local patients do not need him to offer this option, he is only permitted to complete the surgery at a hospital. He can legally begin in his office, but he must relocate the patient in the middle of the surgery and finish at a hospital, which charges $700 in overhead. 

He only makes $580 per surgery.

Dr. Singleton also does not enjoy the tax-free status that a non-profit hospital does (and which those hospitals often do not even complete the level of charitable care required), so he simply cannot run a business under these conditions. Repeatedly applying for a CON has required enormous amounts of time and money, both of which end up costing his patients as well. 

Patients Can’t Access Less-Invasive Care That The Law Forbids

As noted above, the mere idea of a “traditional” colonoscopy invokes feelings of dread in patients. But imaging machinery has mercifully eliminated the need for some invasive procedures. This was the case when doctors began utilizing computerized tomography (CT) scans as a virtual alternative to regular colonoscopies.

Unfortunately, a CT machine requires a CON in some states. When entrepreneurial Dr. Mark Baumel wanted to offer virtual colonoscopies in Virginia, CON laws prevented him from doing so. Despite being the only doctor even trying to offer the groundbreaking service, the CON board forbade him on the grounds that his services were not needed. Although nobody can ascertain how many lives might be saved if this alternative to a traditional colonoscopy becomes available, cancer victims almost certainly died without this diagnostic tool.

Patients have undoubtedly died due to a lack of medical choice caused by CON laws. They have also undoubtedly paid astronomically more than was necessary for medical care. The suffering caused by CON regulations is undeniable and inexcusable, and it has no place in any healthcare system.