As Georgia Debates Health Care Reform, Children Wait for Relief
There are many things to love about working as a pediatric dentist in Savannah. Watching children wait six months or longer for oral surgery, while suffering, is not one of them. Yet this is sometimes the reality.
Across Southeast Georgia, patients of all ages face a backlog for anesthesia services. Access to hospital operating rooms and surgery centers has also decreased during the past decade, which can lead to antibiotic use and temporary solutions that are neither equitable nor fair.
Families with limited payment options feel the pain more than others. Young dental patients, for example, might need care in an operating room under general anesthesia because they lack awareness to hold still during delicate procedures. This arrangement also allows dentists to complete all necessary treatment in a single appointment, reducing the need for multiple visits.
Benefits include less trauma and fewer school absences. Yet some families cannot afford the expense or wait for a hospital opening, so they make the difficult choice to use physical restraints during oral surgery as a substitute for general anesthesia.
The practice where I work, Dentistry for Children, has diligently explored the possibility of opening a multispecialty surgery center to increase equitable access to care at significantly lower costs. We have served our community since the late 1950s, so we understand the market.
We know a need exists. Yet Georgia largely blocks new providers from opening.
A regulatory tool called a “certificate of need” or “CON” forces health care providers to prove to the state’s satisfaction that more care is necessary before a provider can scale up or enter a new region. The CON application process has nothing to do with health care quality or safety. Other processes already exist for consumer protection.
CON laws are strictly about money. They help big hospitals earn revenue by blocking competition. If newcomers represent a threat to the status quo, Georgia allows established providers to intervene in the CON application process and argue for denial—despite the obvious conflicts of interest.
If similar regulations existed in other industries, The Home Depot could stop mom-and-pop hardware stores from opening nearby. Planet Fitness could shield itself from other gyms. And McDonald’s could block startup burger joints.
Hospital associations reject these comparisons. They say federal reimbursement rules and other factors make health care unique, so the normal rules of economics do not apply. Without CON oversight, they argue, redundant investment and oversupply would drive up costs and force some providers out of business, reducing access. Their solution is to funnel patients to their own doors, helping themselves at the expense of would-be rivals.
The problem with this upside-down logic—besides being self-serving—is that it falls apart in the real world. CON laws have never worked as advertised, which federal regulators figured out decades ago. “By their very nature, CON laws create barriers to entry and expansion to the detriment of health care competition and consumers,” U.S. antitrust agencies warn in a 2008 joint report.
California, Texas, and 10 other states looked at the evidence and voluntarily repealed their CON laws. Other states gutted their CON laws, most recently on Oct. 3, 2023, in South Carolina.
Health care providers elsewhere have fought back in court. The Institute for Justice, a public interest law firm that opposes economic protectionism, has filed constitutional lawsuits on behalf of CON victims in Iowa, Kentucky, Nebraska, Virginia, and elsewhere.
The most recent case is headed to the North Carolina Supreme Court, yet Georgia does not have to wait for judicial intervention. State lawmakers can act now. They established two special committees to explore CON repeal in 2023, and hearings are ongoing. I took my turn testifying to the Senate Committee on Oct. 16.
The next step is bold legislative action, preferably full CON repeal. Beneficiaries would include health care professionals like doctors and nurses, who would see increased employee mobility. Health care entrepreneurs would also win. But the primary beneficiary would be patients, including children waiting for dental surgery.
These stakeholders are too young to understand complex bureaucracies and the fight over money. But if they had a voice in the CON debate, their message would be clear: “First, do no harm.”
Byron Colley is a pediatric dentist at Dentistry for Children in Savannah.
