CJ Details the Cronyism of CON Laws, the Bureaucratic Cabal that Works to Keep Healthcare costs High in NC

RALEIGH – The last year or so reminded many of us how seemingly wonky policy debates are often barely removed from fundamental issues of politics, individual rights, and personal freedoms.

While it is a tough way to learn that lesson, the silver lining may come in the form of renewed focus on those extant policy debates that seem wonky, but affect our lives in very tangible ways. In North Carolina, Certificate of Need (CON) laws definitely qualify as deserving of renewed focus.

If you’ve ever had to pick your jaw up off the floor after seeing your bill for an MRI scan; or wondered if you should take out a second mortgage to pay for the hospital bills associated with that 20-min outpatient procedure you received; or, maybe you even avoided what should be a simple healthcare procedure altogether because the cost was totally impractical; then, you have probably been the victim of a CON.

These antiquated laws are a quintessential in the sense that they came about for the purpose of protecting access to affordable healthcare, and have done little but artificially inflate costs and create scarcity ever since. Go figure.

Offering cheaper MRIs? Not allowed. Want to provide outpatient procedures without a shakedown from the local hospital? Don’t be greedy. Need to replace an old piece of equipment with a new one? Not so fast. A new office to treat more patients? Have you gotten permission from your competitors yet?

Yes; North Carolina has it’s very own regulatory regime that serves to protect incumbent business interests in healthcare a the expense of competitors and consumers, like you. It makes healthcare more expensive (some healthcare WAY more expensive) and arbitrarily limits how healthcare providers serve people in communities across the state.

Yes; North Carolina lawmakers have protected this racket for decades. Those special interests, the ones that use CON to keep competition out and medical billing as high as possible, have proven effective at greasing palms, funding campaigns, and demonizing honest physicians and providers.

Carolina Journal‘s Julie Havlak has an excellent piece detailing real life struggles of medical providers in North Carolina as they go to battle with CON cronyism. If you’ve ever wondered just why that 5 minute MRI scan was $1,500; you need to read this…and then call your state lawmaker to ask them why they support artificially inflated healthcare costs?

From Carolina Journal:

“A coal miners’ son. A powerful attorney. A defeated surgeon. Two college sweethearts.  

All of them became caught up in a powerful system known as Certificate of Need. Certificate of Need laws give the state control of medical resources. Twenty-five people, an advisory board appointed by the governor, oversee the supply of hospital beds, medical equipment, and a host of other resources.  

In theory, the system is supposed to guard patients’ access to health care.  

But the system offers a wealth of opportunities to crush unwanted competition and hamstring smaller doctors’ practices. Under CON laws, incumbent providers can take their competitors to court and force them to bleed money for months, years, or even decades.  

It may be easy to praise the system on the record. But those who criticize it do so quietly, and they fear retribution. Many declined to publish their names in this story or to speak on the record.  

“It’s human nature, so I shouldn’t be surprised, but I have clients who think it’s unconstitutional, it’s terrible, it’s an unfair restraint on trade,” said a CON attorney. “But once they get it, CON is great, it’s saving money, it’s good for the people. It’s incredible the metamorphosis they undergo.” 


Dr. Jay Singleton sometimes says he’s not the right man for the job. 

Singleton is the son of coal miners. He spent his childhood crisscrossing Appalachia in a trailer, always in search of another dying non-union mine. The good old days of mining were just a memory, and, more and more, the only thing left was strip mining, tearing the tops off mountains.  

Singleton is now the champion of those who would wage a war against the wealthiest hospital systems in North Carolina and against the state itself. [CONTINUE READING]

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