By Jeff Moore
A recent promotional release from an outfit named the Senior Resource Center ranked which states were the safest for retirees based on a range of metrics, including public safety and healthcare.
Surely, with the beauty of North Carolina, the idyllic beach and mountain towns, thriving metropolitan hubs, relatively low overall cost of living, and renowned medical institutions, North Carolina is a premier retirement destination where retirees can feel safe — right?
Wrong. The Old North State, is stuck in the bottom quintile, at No. 41.
While hardly a comprehensive assessment of the greatness of North Carolina, one of the metrics weighing our state down in this ranking is a relative lack of hospital beds. “No problem,” you might say if you’re one of the hundreds of thousands of new arrivals to the state in the last decade, “can’t we just add more hospital beds?”
Therein lies the rub. As has been covered in these pages and research publications for years, North Carolina maintains a restrictive regime of bureaucracy that gives central planners and special interests relative control over the healthcare services offered in the state. They are called Certificate of Need laws — or CON (an appropriate pun for the effect these laws have on our access to and relative cost for healthcare).
The stated purpose of CON laws is to control healthcare costs by restricting unnecessary expansion or duplicative services within an area. Already, you can see how duplicitous such initiatives could be within what is supposed to be a free market economy.
Healthcare providers wishing to establish or expand services in the state (see: Economic Liberty) must obtain a CON from the Department of Health and Human Services (DHHS) before developing or offering a “new institutional health service” (see: Authoritarianism), like a new X-ray machine, MRI, or (yes) hospital bed.
The authority covers:
- Hospitals
- Ambulatory surgical facilities
- Inpatient rehabilitation facilities
- Nursing homes
- Adult care homes
- Home health agencies
- Hospice home care agencies
The applications for a CON to expand, for example, a surgery center or imaging hub are weighed by a bureaucracy often populated by direct competitors to the aspiring provider. Analyses of these laws show states that are addicted to them have fewer hospital beds on average, contributing to our aforementioned lowly rank for incoming retirees.
More significantly, despite decades of the CON regime working to control costs by restricting unnecessary expansion of services, North Carolina has the highest healthcare costs in the nation.
For retirees, who are predisposed to higher healthcare needs for obvious reasons, this is quite problematic. For people of all ages, such elevated costs range from inconvenient to ruinous. And, for our state, largely led by politicians who campaign on conservative free market principles, it’s an utter embarrassment.
The cost of healthcare and health insurance have featured prominently in the news lately for tragic reasons, many with wider societal implications, and certainly related to our over-reliance on third party payer systems. But despite the relevance of actuarial tables, coverage mandates, and crony pharmaceutical incentive structures, no two factors are more important in this equation than supply and demand.
While the demand for healthcare is what it is, apart from of our individual lifestyle choices, supply is the more elastic side of the equation. Conservatives familiar with the truths of supply-side economics understand this. However, understanding the truth and having the gumption to defend it against high-pressure campaigns and contributions are two different things.
Consider that, through the CON regime, North Carolina’s government actively suppresses the number of options one has to get an MRI, see a doctor, get rehab, have outpatient surgery, secure visiting nurses, or obtain end-of-life care. It’s completely asinine. It’s a CON.
As 2024 wraps up, our state and nation look forward to a new year with new leadership. Many of us are contemplating New Year’s resolutions for 2025, which, if we’re being honest, we will mostly abandon by March, if not sooner.
Yet some commitments to better ourselves are simply too important for our wellbeing to let go. Taking concrete steps to lower relative healthcare costs, by simply allowing an increase in our competitive options for care, is one of them.
The true leaders of North Carolina should resolve to kick our debilitating CON habit in 2025 once and for all, as an unmistakable first step.
Jeff Moore is Carolina Journal’s deputy editor. Moore has worked extensively in conservative politics, policy, and media in North Carolina, including most recently as the North Carolina Republican Party’s communications director.
