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In the discourse of representative government, good politics often takes precedence over the prerogative of good public policy.  Good public policy works in the interests of all involved, is vetted, discussed openly and supported by majorities of elected representatives and ultimately stands the test of time.  Good politics is often the lubricant that’s applied in hurried, end-stage negotiations to resolve larger and more routine business like passing a state’s annual budget.  That’s the context for the politics articulated in the Des Moines Register’s April 28 front-page story and subsequent editorial on Cedar Rapids ophthalmologist Dr. Lee Birchansky.

The public policy questions at hand is two-fold, whether one believes: 1) that Certificate of Need (CON) improves health care in Iowa and 2) it is good public policy to grant political exemptions to an administrative process created by the Legislature (and in this specific decision affecting one individual, a decision upheld by Iowa’s Supreme Court).

IHA’s position is that the CON process is good public policy and the Legislature should not grant political exemptions to this process.  CON is good public policy because it has standards that, with the Legislature’s oversight, have evolved with the health care market.  CON requires collaboration between hospitals and physicians at the community level on the necessity of creating new services, discourages unnecessary capital expenditures and therefore supports delivery of high quality care in Iowa.

Illustrations of health care markets without strong CON statutes can be found along Iowa’s border in Wisconsin, Minnesota, South Dakota and Nebraska.  In Minnesota, a health care facility moratorium law is routinely skirted legislatively with lots of money thrown around in the process.  In Wisconsin, Nebraska and South Dakota, health care providers exercise individual prerogative at the peril of a relatively finite number of health care consumers.   More than one specialty hospital and/or ambulatory surgical center has opened in these markets only to be sold off to the highest bidder.  In the absence of strong statutes to stop the “cherry picking” and profiteering that CON restrains in the establishment of health care services, Congress in 2010 stepped forward to place a ban on further construction of specialty hospitals.

This debate isn’t about a perceived “injustice”, “the money”, a constituent “problem” or a “slanted process,” nor is it about “saving taxpayer money.”    This also isn’t an example of the proverbial David taking on the financial Goliath of hospitals.   The IHA political action committee takes no corporate contributions and is funded by Iowans who support their community hospitals in all their endeavors, some political, most not.  In fact, more than 800 Iowans voluntarily contributed to the IHA political action committee last year.

This is a story about giving an ambulatory surgery center that remains operational without the legal approval of the five-member, governor-appointed citizen board charged with making such decisions.  The net effect of granting this political exemption is not just to legalize the operation of one practitioner’s surgery center, but rather to create an economic franchise for one Iowan that could be legally sold to any surgeon performing any type of service, not just ophthalmology.  In effect, the Legislature would be allowing an end run of the process they publicly declare as “working,” which quite simply is not in the best interests of all Iowans.

If the General Assembly believes a more thorough discussion regarding the overall merits of CON is warranted, that is its legislative prerogative.  In fact, the Legislature has conducted several interim evaluations regarding CON over the past 15 years and has always concluded the process serves the public interests.

But end-running the process by inserting an amendment into a budget bill is simply wrong-headed.  Iowans expect and demand more from our elected officials.

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