The Futility of Trying to Grow
Daily Observer
Snodgrass
wanted to build a hospital. He spoke to Lapius directly, because he knew I didn’t have the money to
invest.
“What
do you say, Simon, will you come in with us?”
“With
who?”
“We
have a group of about 20 doctors. We can
get the financing from the bank. The
plans are drawn. Would you like to see
them?”
“No.”
“Simon,
that’s not like you. You know we could
use another hospital around here.”
“Sure
you do. Sure we do.”
“So
look at the plans. Join us.”
“No.”
“Why
not?”
“You
are wasting my time.”
Snodgrass
was hurt. Lapius
had never spoken to him that abruptly before.
“You are not consistent, Simon.
Why would it be a waste of time?”
“Because
they won’t let you build a hospital.”
“Who
won’t?”
“They.”
“Who
is they?”
“How
do I know who ‘they’ are? All I know,” Lapius said emphatically, “is that you can’t build it. It’s against the law.”
“Against
the law?”
“Whatever
law says that you have to have a certificate of need to build a hospital.”
“So
we’ll get a certificate of need. Surely
a formality.”
“That’s
what you think. It is a very difficult
thing to obtain.”
“We
can prove there is a need.”
“But
no one asks you to prove that. The state
government will tell you whether or not there is a need. They don’t want you to compete with the
present hospital.”
“Why
not? The competition will do them good.”
“The
government and the insurers. Medicare
and Blue Cross don’t want competition.
They don’t want empty hospital beds.
They don’t want you to build a hospital near the present hospital
because with empty beds the per diem cost per patient goes up. They are afraid that your hospital will take
only paying patients and leave the other hospital with welfare patients.”
“Can’t
we promise to take all patients who apply?”
“Sure. But they won’t believe you.”
“Can’t
they pass a law that says that all hospitals have to take all patients that
apply? That hospitals can’t discriminate
on the basis of a means test.”
“There
are those that say such a law would be unconstitutional.”
“But
preventing us from building a hospital also seems to be unconstitutional. That smacks of restraint of trade.”
“Of
course it does.”
“We
can fight that.”
“Sure
if you are willing to spend $20,000 or more in legal fees. After all, a chicken farmer upset the NRA
under
“Well
then, maybe we should fight that in the courts.
Would you join us then?”
“I’ll
contribute $1,000 for the lawyer. Now
get the rest from your partners. But
short of a law suit, you’ll never get the certificate of need.”
“Why
should the community be robbed of extra medical services, Simon. The whole thing is unfair. We are short of beds, every patient lying on
stretchers in the halls knows that.”
“Yes
but there aren’t enough of them to create a stir.”
“Do
you mean to tell me, Simon, that the government is subsidizing a monopoly in
health?”
“Yes.”
“That’s
outrageous. Why are they doing
this? The community knows it needs more
services.”
“Because
the community isn’t paying the bill. The
government is.”
“But
it costs them more to administrate the system than it would to allow
competitive health institutions to exist, even if some of them lose money. I can’t believe an unreasonable system such
as this would be sanctioned by the government.
Surely there must be a way out of this.”
“There
is, Snodgrass, there is.”
“Good
old Lapius, I knew you were only pulling my leg. I knew you had something up your sleeve. How can we get around it? What’s the gimmick?”
“The
three mile limit. Buy one of the surplus
hospital ships that are in mothballs.
Modernize it and anchor it three miles at sea. We can have hydrofoil ferry service to and
from the ship, and helicopters for emergencies.”
“Lapius, a brilliant idea,” Snodgrass gasped in admiration.
“Only
it won’t work,” I interjected, annoyed at having been ignored for so long.
“Ah
yes, Harry is right,” Lapius said, robbing me of my
moment of glory. “It won’t work. The government wants to extend the coastal
limits to 12 miles.”
“And
there is talk of 200 miles,” I added.
“That
wouldn’t be too bad,” Snodgrass said thoughtfully. He was undeterred. “We could anchor the hospital to an oil
drilling tower.”