My Turn: Health care shouldn't be a consumer good

Posted: Tuesday, February 12, 2008

While I applaud Gov. Sarah Palin's efforts to provide tools to Alaskans to access information on the quality and cost of health care, I take issue with one of her assumptions.

To quote her Web site: "Recognizing that health care must be market-and business-driven, rather than restricted by government, Governor Palin is proposing a repeal of the Certificate of Need program."

Most consumers of health care have never heard of the Certificate of Need process, which is designed to ensure that capital and technology investments in the health care industry are in the best interest of the people of the community. It is a review process used to promote responsive health facility and service development, rational health planning, health care quality, access to health care and health care cost containment.

The state of Alaska has a vested interest in new health care construction projects and equipment purchases as the state spends significant funds for Medicaid directly, and through union health care trusts indirectly. Local citizens are also stakeholders through their support of area hospitals.

But I want to address the governor's rationale for recommending a repeal of the CON - recognizing that health care must be market and business driven. I don't believe that most Alaskans benefit from health care as a consumer good.

Market and business driven health care has brought us insufficient flu vaccine supplies while simultaneously keeping us awash with erectile dysfunction medications. Recent graduates of our heavily subsidized medical schools apply in greater numbers to residencies in plastic surgery than family practice. Commercial television is filled with advertisements for several drugs that are better addressed by proper diet, exercise and a healthy environment.

Uncontrolled economies are characterized by boom and bust. They thrive on creating the demand. When the market is saturated, the entrepreneurs and their profits disappear.

Health care should be a community right, not a consumer good. Certainly, each of us must be responsible for making healthy life choices.

Manufacturers of expensive imaging equipment are motivated to sell their product. They know that some medical procedures generate large profits; doctors know this, as well. Manufacturers of this equipment want a proliferation of free standing, outpatient surgery and imaging centers incorporated into uber group practices. In the short-term, costs for these procedures may decline, but the long-term outcome is a reduction of medical access for many urgent but less profitable procedures and services.

I recently visited an affluent suburban community in the Midwest. Driving around, I was immediately struck by the number of free standing medical facilities; so many, that I became rather concerned about the health of the inhabitants. It was awash with imaging centers, bone and joint and gastrointestinal day surgery centers, and plastic surgery reconstruction shops.

I also noticed signs at the entrance to each parking lot, "this facility maintains no emergency or urgent care center." Three community-based hospitals in this county closed in 2007, and it has the highest health care costs in the state, all within two years of weakening their CON process.

Hospitals are not blameless in the high cost of health care, but most hospitals, especially hospitals in Alaska, are community based, with a board of directors accountable to their constituency. Hospitals that operate in our capital-driven health care system need diverse revenue streams just to survive.

The for-profit health care industry sees no need for the Certificate of Need program. It has been characterized by some in the industry as antiquated and socialistic. What the CON process does is regulate.

Regulation is not bad. Whether managing a fishery for sustainability, regulating criminal behavior for safety, or planning health care to assure access, the future is served rather than the profiteers.

It is imperative that Alaskans speak out on issues of access, quality and costs of health care. Check out the state's CONdocumentation at

• Gail Smith is a Juneau resident.

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