ICU bed shortage exposes Alabama’s anti-market Certificate of Need laws

Over the past few weeks, Alabama Hospital Association head Dr. Don Williamson has appeared alongside State Health Officer Dr. Scott Harris, sounding the alarm over -66 ICU hospital beds or some other unimaginable statistic.

Perhaps, the hope is it will inspire the reaction, “Wow, this is serious. I better go out and make sure my loved ones and I are vaccinated against the COVID-19 virus!”

The negative number, as best as it has been explained, is that the available ICU beds are full, and other beds must be converted to ICU beds, which would be 66 beds generally used for other purposes are now ICU beds. Indeed, that is an alarming number, but it is not as if 66 individuals are lying on the floors in hospital hallways waiting for space to free up because there are no available beds.

For now, you cannot make people get vaccinated. Maybe some of you would like to live in an Orwellian world where the government can tell an untrusting public they must do something, but we are not yet there. On the other hand, since the vaccine has been hyper-politicized with CNN and MSNBC talking heads sneering at the stupid toothless unvaccinated red staters, there will be a sizeable portion of the population insistent upon “owning the libs” by not getting vaccinated.

This is a conundrum that the state of Alabama is ill-equipped to handle. But it didn’t have to be this way. Like 27 other states, Alabama has so-called Certificate of Need laws, which regulate the quantity of health care services in a given area, including the number of available hospital beds. We have lived under this system for decades.

Proponents of these laws argue we need to limit the number of health care services because our goal is quality over quantity. If we enabled a free-for-all system, it could diminish the quality of those health care services given the resources required to compete.

You hear this story repeatedly as the existing health care entities in this state use their clout in Montgomery to influence state government to fight a turf war for them. That system has failed us. We relied on a Certificate of Need board to regulate supply and demand, and it failed the public.

“But how could they have foreseen a global pandemic?”

Fair, only once every 100 years do we face a pandemic of this magnitude. However, we have learned that we are not equipped for the challenge. Furthermore, every so often, the hospital lobbyists are calling for the state to expand Medicaid. Medicaid is medical coverage offered to low-income individuals and families, paid for by state and federal governments.

Since the passage of the Affordable Care Act in 2010, state governments have been given the option of changing the criteria for Medicaid enrollment so that people below a certain poverty level would have some health care coverage.

Alabama is among a handful of states that have resisted Medicaid expansion. It would put the state on the hook for financing the expansion to receive the matching federal funds. Lawmakers have been reluctant to support Medicaid expansion because it would mean they would have to cede more control of money the legislature has at its discretion.

According to Medicaid expansion proponents, which ironically are typically the same people content with an anti-market Certificate of Need system, an expansion of Medicaid would go a long way in solving the state’s rural hospital crisis.

It is remarkable that in a state like Alabama, with an electorate we are told is one of the most conservative in the country, a health care system exists with such a high level of government involvement, which is easily swayed by hospital and health insurance providers’ interests.

Suppose the underwhelming COVID-19 preparedness and push to create more government dependency by expanding Medicaid were not enough to persuade you against the status quo. In that case, the other aspect of the Certificate of Need system is susceptibility to corruption.

The federal government successfully prosecuted former Gov. Don Siegelman and HealthSouth founder Richard Scrushy for abusing Alabama’s Certificate of Need laws. Whether you think that prosecution was rightful or wrongful, it does not go up any higher than the governor. The aftermath of the Siegelman era should have been a call for action to a minimum change the law so that politics could not interfere with the Certificate of Need board’s decisions.

But it was not. Instead, we face a legitimate public health crisis with COVID-19, and comparatively speaking, Alabama’s public and private health care institutions are not up to the challenge. We have hard-working medical staff at our hospitals, but they work for a flawed system that benefits the powerful.

Once society gets a handle on COVID-19, the first thing Alabama must do is rethink the cronyism in health care that underserved the public during this crisis.