Hospital’s five-year fight to move shows health care isn’t free market

By David McElroy · May 22, 2013

We’ve been told over and over that problems with health care in this country prove that the free market has failed. But what if the medical industry is already so regulated that its problems have nothing to do with the free market?

There hasn’t been a free market in health care for a long time, certainly not in my lifetime. Probably not since sometime in the 19th century. An item in the local news this week is a stark reminder of that to me.

In 2008, Trinity Medical Center in Birmingham proposed relocating from an older part of town to a fast-growing area along U.S. 280, very close to affluent southern suburbs. A major hospital company (HealthSouth) had built a state-of-the-art building already, but the company was hit hard in an accounting scandal involving the company’s founder and former CEO. The company unloaded various properties around the country just to survive, including this hospital which was about 90 percent complete. (That’s the new building above, framed by a nice sunset I shot last year.)

Trinity is currently in an older part of Birmingham near downtown that’s declining. The hospital was founded as Baptist Medical Center-Montclair many decades ago, but the Baptist system sold that hospital to a private company a decade or more ago. Before too long, the new management was looking to relocate to a newer facility closer to a suburban population that didn’t have a hospital close by.

In the current location, the hospital competes with various huge hospitals downtown. Although most people don’t realize it, Birmingham is a major center for medical research and health care. The medical industry — clinical and research combined — is the biggest in the area by far.

After an aborted plan to move to the suburb of Irondale, Trinity decided that moving to the unused HealthSouth building was more economical and would provide access to a better market. There was only one problem.

In Alabama — as in every other state, as far as I know — a hospital needs what is called a “certificate of need” in order to operate. Whereas a restaurant or dry cleaner can just pack up and move to a new location (or expand) with nobody’s approval, a hospital or nursing home needs the approval of a state board to operate.

The State Health Planning and Development Agency has a Certificate of Need Review Board. These people have the power to decide who gets to operate a hospital or nursing home (and what types of services they can offer) in order to “protect” the interests of the public. The board is composed of three “consumers,” three representatives of the medical industry and three representatives of the governor, but the governor appoints all of them.

The Certificate of Need Board ended up approving Trinity’s application to move, but then we see how dedicated the other health providers in the area are to the free market. Brookwood Medical Center and St. Vincent’s Hospital both sued to stop the move. Here’s what the CEO of Brookwood said when the suit was announced:

“We’ve been the primary provider of services down the 280 corridor. We have been adding services and expanding our campus to address the needs of that population. This is not the right time, for many reasons, for a market share grab like this one to be permitted and for an unnecessary duplication of services to be added in that same corridor.”

In other words, “Those are our customers. How dare someone try to compete with us?”

This is the environment in which the medical industry has operated for many decades. Doctors were regulated starting more than a hundred years ago — for the public’s health and safety, of course — and then hospitals and other health facilities were tightly regulated. Who could possibly think it had anything to do with protecting market incumbents from competition?

Nobody was allowed to operate without state permission. Nobody was allowed to offer services without state permission. Nobody was allowed to build a bigger facility without state permission.

This is how things work in a socialist system. This is not a free market.

After five years of wrangling, Trinity has finally won permission this week — from the State Supreme Court — to make the move that it wanted to make five years ago. How can we expect a medical system that can quickly respond to market forces and serve its market if it’s forced to operate at the will of a slow-moving state, while its competitors work hard to prevent it from competing.

I’m certainly no fan of Trinity or of the details of this particular move. The city of Birmingham is kicking in $55 million in tax rebates over the next 20 years to subsidize the move. Since the hospital was already in the city limits and it still will be after the move, why are city taxpayers subsidizing the move? (Why would they even if it were a net gain to the city, anyway?) Who knows? Nobody seems to ask such questions.

There aren’t any good guys in the fight. Trinity comes the closest, but I figure if the tables were turned, they’d be fighting tooth and nail to prevent competition, too. This is simply the culture of the sick health care industry today. They’re creatures of the state. They expect protection from government and they generally get protection — in the name of “the public good,” of course. Why would they have any incentive to operate more efficiently or compete more effectively?

When you hear people tell you that our mess of a health care system means that the free market has failed, remember this tiny story of one hospital in a mid-sized market. And multiply it a million times to account for all the horror stories that prevent effective and free competition.

We don’t have a free market in health care. Government has created this mess — in many different ways — and it’s about to get even worse as ObamaCare kicks in. If you want a real solution, we need to dump the socialist “certificates of need” and attempts to avoid competition and vague mumblings about “the public good.”

Let the market do its job. And quit blaming government failures on a free market that doesn’t even exist.

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I received the first dose of a COVID-19 vaccine Monday — and I’m happy to report that I’m neither dead nor a zombie controlled by Bill Gates and Co. Eligibility was recently opened in Alabama to everyone who’s 16 or older, so I signed up for the Pfizer vaccine at a site run by a local university. I know this is a political issue for a lot of people, but that honestly baffles me. We can disagree about whether such a vaccine should be mandatory — which I’m against — but as a voluntary choice, it seems like an easy choice now that it’s been safely given to millions of people. Is it a perfect preventative? Of course not. But the decision seemed obvious to me when looking at the statistics and evidence. I haven’t had any of the side effects that some people have experienced, but that’s supposed to be more of an issue after the second dose, which I’ll get on May 3. In the meantime, I’ll let you know if I grow a third arm — or if the secret microchip kicks in and someone starts trying to control me remotely. All kidding aside, getting the vaccine seems like a rational voluntary choice to me.

I get a lot of email from readers. Some of it is fascinating and useful. Some of it is full of confessions that people want to share with a stranger. Some people write to ask advice. What’s really surprising, though, is the small percentage that seems to come from mentally unbalanced people. When I started using the metaphor about being an alien — the tagline at the top of each page here — it never occurred to me that I’d start hearing from people who took it seriously. But every few months, I get a strange email — such as the one above from a few months back — from someone who seems to think I’m claiming to be an actual alien. The first time it happened, I laughed. By the time it became a semi-regular thing, I was simply appalled. For the record, I can provide no proof that I’m an alien, because … well … it’s just a metaphor. I do feel like an alien among human beings, but as far as I know, I’m just as earthbound as you are. It’s just a metaphor. Honest. Or at least, that’s what my lizard-beast overlords told me to say.

After Tampa Bay, Fla., musician Colt Clark had all of his gigs canceled last year for months on end, the entire family felt trapped at home as most of the world was on quarantine lockdown. His wife, Aubree, had an idea that would let Colt make music and involve the whole family in making music videos to share with their friends and family on Facebook. Aubree is a photographer and homeschooling mom to a daughter and two sons, who range in age from 6 to 11. After their friends started asking to share the videos, they made the performances public — and a few of them are now on YouTube, where they go by the name of Colt Clark and the Quarantine Kids. The younger son, Becket, is on drums. The older boy, Cash, plays keyboards, strings and guitars. Dad supplies lead vocals and plays guitar, while 6-year-old Bellamy mostly dances but sometimes does backup vocals. There’s even a dog who makes an occasional appearance. The Clark family has just raised the bar for what I need to create with my future children. And best of all, they seem to be having a great time together. I hope they make you as happy as they make me.

Have you ever wondered how the social media world works for so-called “influencers”? I find it comical, so I thought I’d share with you. I frequently get offers such as what I’m about to describe. And if I’m getting such offers — as a relative nobody in the online world — you can only imagine what people with huge audiences are offered. It starts with an email appealing to my ego: “We came across your online presence and we LOVE your style. We’d love to have you as one of our Brand Ambassadors. To celebrate our new [Brand Name] collection, we want to give you a FREE Watch so you can post a picture of you wearing it and drive more exposure to our brand.” Did you hear that? They love me. They want me to be seen wearing their cheap $59 watch so other people will think, “If this amazing influencer wears that, surely I should buy one.” They even offer me commissions on the watches sold from people clicking from my site. So the next time you see some alleged “influencer” touting something online or on social media, remember that this is what it’s probably all about. It’s laughable.

Modern culture is going insane. The latest evidence comes from the effort to redefine children’s author Dr. Seuss as a racist whose books should be banned. Why? Because a few images in those books don’t meet modern political standards. The drawing you see here is one of those “dangerously racist images,” and it comes from the Dr. Seuss classic, “And to Think That I Saw it on Mulberry Street.” The book catalogs all the wild diversity seen by a child on one street, including the offending drawing of a Chinese boy. What’s racist about it? Apparently, it was racist to show the boy eating rice, wearing a funny hat, using chopsticks and (worst of all) having eyes represented by a slit. (The bearded man near him has dots for eyes, but that’s apparently OK.) In other words, the stereotypes are considered racist today. (Oddly, the culture warriors who fret over such things are never concerned if a white southerner is depicted as ignorant trash living in a trailer. Some stereotypes are great, especially if the left hates those people anyway.) Theodore Geisel — the name of the real-life Dr. Seuss — was a product of his time and nobody at that time would have seen any of this as racist. Using stereotypes and exaggerations is how artists depict differences in simple ways. You can argue that it’s better to achieve the end result in a different way, but it’s insane to pretend that everybody from the past should have his work erased because it doesn’t match the preferences of modern leftists. Unfortunately, the company that publishes Dr. Seuss books has caved to the insane people — and six of his popular works will no longer be published. The world has simply gone insane.

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