EDITORIAL: The Florida Legislature’s health care hypocrisy

May 14--If the federal government approves, as President Trump seems to have promised, Florida will soon be able to import cheaper pharmaceuticals from Canada. That's one of the Legislature's few good deeds this year.

In one of the worst, the session repealed most of the certificate of need law that aimed to hold down medical costs by limiting potentially wasteful competition from new hospitals, surgical centers and other expensive facilities. Those who would build them no longer will need to prove they're necessary. That means staffing more beds and taking on more pricey equipment, like $3 million-dollar MRI machines, even if they're not fully utilized. Who'll pay for them? You will.

The paradoxical inconsistency brings to mind what has often been said about hypocrisy being the mother's milk of politics.

Prescription drugs are more expensive here than in Canada -- insulin 10 times more so, for example -- because Canada strictly regulates their prices. Most nations do.

United States politicians don't have the guts. They're hooked on Big Pharma's campaign money. The enactment of Gov. Ron DeSantis' Canadian import bill was a rare defeat for the drug lobby.

What it means, though, is that the same Florida politicians who asserted free market ideology for scrapping hospital regulations had no objections to piggy-backing on Canada's tough drug price regulations.

Inconsistency is too nice a word for it.

Health deregulation was House Speaker Jose Oliva's highest priority for the session. Senate President Bill Galvano's goal was to authorize three rural toll roads needed by no one but the landowners who'll profit from them. So a deal came down: Galvano's boondoggle for Oliva's free market crusade.

Sen. Tom Lee, R-Brandon, said the trading, which essentially bypassed the committee process, was so brazen that it "stinks to high heaven." On the way, the Senate scrapped its own committee-approved hospital bill, which was significantly more responsible. The only bright spot was that new or expanded nursing homes and hospices, initially listed along with hospitals, will still need to apply for certificates of need.

DeSantis should veto both the hospital and highway bills. Let's hope that he wasn't involved in brokering the deal.

One of the key changes concerns specialty hospitals -- for such single purposes as cardiac catheterization and open-heart surgery. Specialties tend to be profit centers, helping to support other functions of the general hospitals that offer such services. The legislation does not require the specialty hospitals to accept Medicare and Medicaid, as the Senate bill would have. That virtually guarantees significant red ink for older general hospitals.

The staff report on the House bill relied heavily on a 15-year-old joint statement by the Justice Department and Federal Trade Commission that debunked certificate of need laws nationwide and on a short paper last year from a conservative institute at George Mason University.

The gist of the federal paper was that certificate of need laws hadn't controlled medical costs. It suggested other ways that would, none of which happen to be politically feasible.

The Florida staff report overlooked a strong rebuttal from the American Health Planning Association, which said the 2004 federal document "is replete with problematic assertions and assumptions, many of which are doctrinaire and unsupported by demonstrated fact or cogent analysis. The common theme is opposition to planning, regulation and government intervention in the health care system."

The nation's exorbitant health care costs -- the world's highest per capita -- would probably be even higher but for the restraints imposed by certificate of need laws. It is illogical to blame them for not doing enough.

"Nothing has significantly restrained costs. There were always people getting significant exceptions," says Linda Quick, former head of the South Florida Hospital Association. She is a former president of the planning association and an advocate for certificate of need legislation.

She points to the reasons why health care defies the assumption that competition cuts costs.

"Most consumers know more about how their cars or cellphones work than about their bodies," she says. When someone needs hospitalization in a hurry, they rely on their doctors' recommendations. "Comparison shopping is the last thing you do."

Meanwhile, excess hospital beds and technology need to be staffed and maintained even when no one is using them. An airline can drop a route when planes fly with too many empty seats, but it's not so easy for a hospital or surgery center to shed excess capacity.

There's a public health risk in the unlimited growth of new surgical facilities. The more often a surgical team performs a procedure, the better it gets. Conversely, says Quick, "When you have too many providers, it is certain that none will do enough to maintain proficiency.

The Florida Legislature might at least have tasked the Agency for Health Care Administration with monitoring what happens to costs -- and to patient safety -- in the brave new world of unlimited competition. But it didn't.

There was no room in the deal for common sense.

Editorials are the opinion of the Sun Sentinel Editorial Board and written by one of its members or a designee. The Editorial Board consists of Editorial Page Editor Rosemary O'Hara, Sergio Bustos, Steve Bousquet and Editor-in-Chief Julie Anderson.

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