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More questions for those slow to endorse hospital move

May 23, 2004|by Thomas A. Firey

When the Herald published my May 9 op-ed "Certificate of Need is indeed a CON," I expected some heated responses, and sure enough they came quickly: The Herald-Mail published rebuttal op-eds by Maryland Health Care Commission Executive Director Barbara McLean and Hagerstown Councilman Kristin Aleshire.

Both claimed my op-ed reflects a lack of knowledge about the issues involved, and Aleshire offered to provide me more information. I welcome his offer, and ask the following questions:

Both Aleshire and McLean devoted considerable space to discussing the importance of holding down hospital costs. Curiously, they gave much less attention to the importance of improving quality of service and patient outcomes. Building a new hospital at Robinwood would promote those goals, in turn lowering overall costs.

Placing the hospital next to the Robinwood Medical Campus is a strong move toward combating inefficiency because it brings together so many medical services in one place. Health professionals could spend more time with their patients and less time driving back and forth between the facilities; patients would have more immediate access to both facilities' services; and new services and expertise may emerge because of the synergy.

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Do those gains do not offset the slight cost savings from a downtown hospital location?

McLean defended the CON process, saying it benefits Marylanders. Several recent studies have examined the CON process and the effects of competition in health care, and they've found that at best, CON keeps prices and patient outcomes about where they would be without CON, and at worst CON increases prices and worsens outcomes - as we would expect in any situation involving artificial scarcity. Does McLean discount those studies, and if so, why?

Aleshire claimed the city wants the new hospital to be provided in the most cost-effective manner possible. We've all read the city's "proposed requirements" for dropping its opposition to the Robinwood location. Can he explain how requiring the hospital to make contributions to various organizations, transfering ownership of the hospital's parking garage and parking lot to the city, and giving the city right of refusal over the future use of the current hospital location will make the Robinwood site more cost-effective?

Aleshire also justified government involvement in the hospital decision because the "saturation of such facilities over time requires governing bodies to eventually subsidize to some degree maintaining the operations of such needed public services." Does he believe Washington County is at risk of market saturation in health care, and can he explain why a Robinwood hospital would fall prey to that risk but a downtown hospital would avoid it?

Aleshire pointed to the county sewer plant as an example of why politicians and bureaucrats should be heavily involved in a major service project. Can he explain how the sewer plant is anything but a cautionary tale about the results of such involvement?

Aleshire lamented the cost the city incurs in providing public safety services to the hospital. Will he thus vote against annexing the new hospital into the city, and instead have the city only provide sewer and water services to the facility at cost?

Aleshire spent considerable time describing how, at one meeting of the hospital's site-selection committee, a majority of the members preferred locating the new hospital in Allegheny Power's Friendship Technology Park. Does that mean Aleshire prefers the Friendship Park location over the city's downtown proposal?

Aleshire dismissed my criticism of the city's proposed use of eminent domain to force dozens of city residents from their home so as to create a downtown location for the hospital, saying such a move would affect "less than a dozen owner-occupied dwelling units." Does his dismissal reflect the belief that renters are second-class citizens?

McLean, apparently in an effort to show the MHCC is qualified to make this decision that uniquely affects the future of Washington County, noted that "Marc Zanger . . . has represented Western Maryland on the MHCC since its creation." Can McLean provide me Zanger's Washington County address and phone number, as well as the Washington County numbers for other commission members and staffers?

Thomas A. Firey, a Washington County native, is senior fellow for the Maryland Public Policy Institute and managing editor of the Cato Institute's Regulation magazine.

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