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这项限制令让美国人在疫情中得到惨痛教训

这项限制令让美国人在疫情中得到惨痛教训

Shawn Tully 2020年05月01日
近一半美国人所在的州都有限制医院床位数量的硬性规定,这种情况实际上妨碍了新医院的建设和现有医疗设施的扩建。

新冠疫情让美国得到了惨痛的教训:限制医院床位数量无疑是一种糟糕做法。

在美国,近一半的州都有限制医院床位数量的硬性规定,这实际上妨碍了新医院的建设和现有医疗设施的扩建,甚至会限制术后恢复科在流感高发季节增加病床用于治疗激增的患者。这种需求认证法律人为限制了医院的床位数量,导致这些州的床位数量远远低于其他执行自由市场策略的各州。

当致命疫情爆发时,那些病床数量受管制州的医院就会陷入困境:大批感染者需要床位,但因医院早已人满为患,根本就没有床位可用。CON法律导致医院面对患者数量激增的情况时,束手无策。

鉴于这种由法律所施加的限制,你或许会以为,新冠疫情会使美国医院体系彻底崩溃,迫使医疗服务提供商拒绝收治患者,并且会加快疫情传播。甚至许多专家早在几周前就已经提出了这种“末日”情景的预测。但这种情况并没有发生。原因不止是因为民众很好地遵守了社交隔离措施,能够避免灾难的发生的另一部分原因是,一些州取消了对床位数量的管制,即允许医院在官方规定的“床位数量”以外进行扩建。因此,之前一直施行严格管制的纽约州也变得与得克萨斯州等没有施行CON法律的州一样自由了。

允许医院自由扩张带来的显著的效果,或许会促使各州考虑永久取消CON法律。如果这种预测成真,各州将取消数十年来一直施行的管制,医疗服务提供商也能在正常时期通过新增加的床位盈利。而就算未来再次发生疫情,他们也能成为防控疫情的屏障,而不是像现在一样脆弱且不堪一击。

但如果各州重新执行“需求认证”法律,一旦未来再次发生疫情,医院将不堪重负。来自菲尼克斯的外科医生、卡托研究所研究员杰弗里·辛格表示:“我希望各州州长们说:‘我们不要再次冒这种风险。’与实行CON法律的州相比,执行自由市场策略的州床位更充足。各州应该以这些州为榜样,以保证未来美国有足够多的床位。”

什么是“需求认证”法律?

需求认证法律是指,各州由州议会表决后,通过法规执行需求认证。但最初这是一项在全美执行的联邦措施。1974年,美国鼓励各州组建政府部门,对于医疗保健服务施行严格管制。这种做法背后的理论是,自由竞争会导致医疗服务集中到富裕的城郊,而贫穷的城市和农村社区医疗水平将会落后,并且医疗服务提供商会在美国兴建大量核磁共振成像和透析中心,导致低质量的医院泛滥。而最终,这些过度投资的成本都将由医疗保障体系和患者买单。时至今日依旧如此。

1987年,美国国会废除了这项联邦规定,在之后的三十年间,有15个州先后取消了CON法律。在保留管制的35个州,州政府机关有权批准、否决或修改医院、门诊中心和其他医疗服务提供商新建或扩建医疗设施的申请。各州对于管制服务的规定也有所不同。在新泽西州,医疗保健设施许可/认证署有权批准或拒绝各类医院、诊疗中心、疗养院以及十多种其他服务的需求认证。

其中最常见并且受限制最多的是医院。执行CON法律的35个州中,有28个州要求新建或扩建医院必须通过政府部门审批。各州经常会禁止在同一家连锁医院体系内,将一家医院过剩的床位转让给床位不足的医院。实行管制的28个州中包括纽约州、马萨诸塞州、康涅狄格州、华盛顿州和伊利诺伊州等疫情最严重的州。值得注意的是,没有执行CON法律的州包括宾夕法尼亚州、加利福尼亚州和得克萨斯州。

CON法律并没有达到预期的效果

人们以为人为限制任何产品或服务的供应就能提高医疗普及率并降低成本,这种观念值得怀疑。许多研究显示,CON法律破坏了市场竞争,其所带来的结果可想而知:更高的价格、更高的整体成本和更低的普及率。问题在于,现有的医院、疗养院和诊疗中心都有强烈的动机,阻止低成本竞争对手进入他们的市场,并避免价格下降。乔治梅森大学莫卡斯特中心高级研究员马特·米切尔说:“这就是各州的保护主义。”米切尔发现,执行CON法律的州提供的门诊手术中心、透析设施和核磁共振成像设施远少于其他州。

美国劳工部、财政部和卫生与公众服务部部长在2018年致总统信中警告:“各州限制医疗服务市场准入的政策,会限制人们的选择、竞争和创新。”这三个部门与联邦贸易委员会和司法部的反垄断部门建议各州考虑取消CON,或者缩小这类政策的规模。辛格说:“就好像一个州的政府部门告诉所有零售商,每家商店只能有四个货架摆放厕纸,但实际上消费者会抢光六个货架上的厕纸。这时就会出现厕纸短缺,而消费者只能高价购买。”

执行CON法律的州,床位供应量远远低于其他州

有人认为这种限制措施会大幅提高医疗普及率,增加人们的选择。但事实恰恰相反,莫卡斯特中心发现,在执行自由市场政策的州,人均床位数量比执行CON的州高出30%,无论城市还是农村都是如此。全美每千人的平均床位数量是2.77个。相比之下,意大利为3.18个,中国为4.3个,韩国为12.3个,日本高达13.1个。执行不同政策的州之间的区别非常明显。莫卡斯特中心的研究发现,执行CON法律的州每千人的平均床位数量比其他州少1.31个。

其中许多州都有庞大的城市区,它们提供的空床位数量非常低,因此一旦被新型病毒攻击,这些州将没有缓冲的余地。城市研究所弗雷德里克·布莱文对2018年美国50个州居民空床位数量进行了研究;从疫情爆发到现在,这些数字恐怕也没太大变化。全美每千人的空床位数量为0.80个,但康涅狄格州只有0.45个,马萨诸塞州为0.51个,华盛顿州为0.57个,纽约州为0.58个。

出人意料的是,供应紧张并没有导致严重短缺

在此需要提醒读者的是:我无法充分协调纽约州、疾病预防与控制中心、华盛顿大学健康指标和评估研究所等提供的住院患者数据。因此无法确定不同数据来源所统计的床位类别。这是本文对于美国和个别州没有出现预想中的床位“短缺”之后说法的理解。

IHME网站上显示,美国“所需床位”约为66,000个,“短缺”13,400个,其中ICU床位缺口为8,900个,普通病床缺口为4,500个。这些数据表明,在疫情已经爆发或预计将爆发的地区,主要是纽约城区等热点城市区域,在疫情爆发之前提供的床位约为52,600个。这些数字与城市研究所的数字一致,表明纽约、新泽西、马萨诸塞、康涅狄格和罗德岛的空床位总数不足24,000个。而这五个地区占到美国新冠肺炎总确诊人数的一半左右。

24,000个空床位远远低于国家标准水平。例如,长岛拿骚县每千人空床位数量只有0.34个,布鲁克林所在的金斯县为0.32个,康涅狄格州的费尔菲尔德县为0.42个,都远低于美国的平均水平0.8个。

但别担心,美国已为需要住院治疗的所有新冠肺炎患者都找到了床位。66,000个病床的需求已全部到位。IHME网站显示,纽约州共收治了20,300名新冠肺炎患者,比该州床位数多出7,200人,这显然代表了纽约州在疫情之前的空床位水平。五个州的医院总计为新冠肺炎患者提供了38,500个床位,较危机前的床位数量高出60%。

美国是如何做到无视CON法律规定,大幅增加医院床位的呢?

各州放宽规定,帮助医院应对患者的激增

一个重要因素是发布关于选择性手术的禁令,即将本应分配给康复手术患者或髋关节置换术患者的床位,安排给新冠肺炎重症患者。但各州也为全面取消管制做出了重要贡献。包括纽约州、北卡罗来纳州和肯塔基州等在内,超过18个州已取消CON法律,或缩小了CON法律对医院床位数量的管制。辛格说:“在实行CON法律的州,医院无法为急诊室和康复病房增加床位。亚利桑那州的医院在流感高发季节总会遇到这种状况。但如果各州能取消CON限制,医院就可以增加大量病床。”

取消CON法律的限制,提高医院的灵活性,已取得了很好的效果。但如果总住院人数的峰值不止于7万人,而是IHME和其他机构在几周前所预测的20万,医院又该怎么办?

在这种情况下,即使各州再次取消CON法律,填补床位短缺将变得更加困难。CON法律的目的是严格限制床位,但这种政策却直接妨碍了疫情防控。对于各州来说更好的选择是,取消CON法律,允许创业者和新竞争对手提供床位。这将一方面满足消费者对于医疗保健服务的床位需求,同时还可以额外提供充足的床位,应对下一次未知的疫情。(财富中文网)

译者:Biz

新冠疫情让美国得到了惨痛的教训:限制医院床位数量无疑是一种糟糕做法。

在美国,近一半的州都有限制医院床位数量的硬性规定,这实际上妨碍了新医院的建设和现有医疗设施的扩建,甚至会限制术后恢复科在流感高发季节增加病床用于治疗激增的患者。这种需求认证法律人为限制了医院的床位数量,导致这些州的床位数量远远低于其他执行自由市场策略的各州。

当致命疫情爆发时,那些病床数量受管制州的医院就会陷入困境:大批感染者需要床位,但因医院早已人满为患,根本就没有床位可用。CON法律导致医院面对患者数量激增的情况时,束手无策。

鉴于这种由法律所施加的限制,你或许会以为,新冠疫情会使美国医院体系彻底崩溃,迫使医疗服务提供商拒绝收治患者,并且会加快疫情传播。甚至许多专家早在几周前就已经提出了这种“末日”情景的预测。但这种情况并没有发生。原因不止是因为民众很好地遵守了社交隔离措施,能够避免灾难的发生的另一部分原因是,一些州取消了对床位数量的管制,即允许医院在官方规定的“床位数量”以外进行扩建。因此,之前一直施行严格管制的纽约州也变得与得克萨斯州等没有施行CON法律的州一样自由了。

允许医院自由扩张带来的显著的效果,或许会促使各州考虑永久取消CON法律。如果这种预测成真,各州将取消数十年来一直施行的管制,医疗服务提供商也能在正常时期通过新增加的床位盈利。而就算未来再次发生疫情,他们也能成为防控疫情的屏障,而不是像现在一样脆弱且不堪一击。

但如果各州重新执行“需求认证”法律,一旦未来再次发生疫情,医院将不堪重负。来自菲尼克斯的外科医生、卡托研究所研究员杰弗里·辛格表示:“我希望各州州长们说:‘我们不要再次冒这种风险。’与实行CON法律的州相比,执行自由市场策略的州床位更充足。各州应该以这些州为榜样,以保证未来美国有足够多的床位。”

什么是“需求认证”法律?

需求认证法律是指,各州由州议会表决后,通过法规执行需求认证。但最初这是一项在全美执行的联邦措施。1974年,美国鼓励各州组建政府部门,对于医疗保健服务施行严格管制。这种做法背后的理论是,自由竞争会导致医疗服务集中到富裕的城郊,而贫穷的城市和农村社区医疗水平将会落后,并且医疗服务提供商会在美国兴建大量核磁共振成像和透析中心,导致低质量的医院泛滥。而最终,这些过度投资的成本都将由医疗保障体系和患者买单。时至今日依旧如此。

1987年,美国国会废除了这项联邦规定,在之后的三十年间,有15个州先后取消了CON法律。在保留管制的35个州,州政府机关有权批准、否决或修改医院、门诊中心和其他医疗服务提供商新建或扩建医疗设施的申请。各州对于管制服务的规定也有所不同。在新泽西州,医疗保健设施许可/认证署有权批准或拒绝各类医院、诊疗中心、疗养院以及十多种其他服务的需求认证。

其中最常见并且受限制最多的是医院。执行CON法律的35个州中,有28个州要求新建或扩建医院必须通过政府部门审批。各州经常会禁止在同一家连锁医院体系内,将一家医院过剩的床位转让给床位不足的医院。实行管制的28个州中包括纽约州、马萨诸塞州、康涅狄格州、华盛顿州和伊利诺伊州等疫情最严重的州。值得注意的是,没有执行CON法律的州包括宾夕法尼亚州、加利福尼亚州和得克萨斯州。

CON法律并没有达到预期的效果

人们以为人为限制任何产品或服务的供应就能提高医疗普及率并降低成本,这种观念值得怀疑。许多研究显示,CON法律破坏了市场竞争,其所带来的结果可想而知:更高的价格、更高的整体成本和更低的普及率。问题在于,现有的医院、疗养院和诊疗中心都有强烈的动机,阻止低成本竞争对手进入他们的市场,并避免价格下降。乔治梅森大学莫卡斯特中心高级研究员马特·米切尔说:“这就是各州的保护主义。”米切尔发现,执行CON法律的州提供的门诊手术中心、透析设施和核磁共振成像设施远少于其他州。

美国劳工部、财政部和卫生与公众服务部部长在2018年致总统信中警告:“各州限制医疗服务市场准入的政策,会限制人们的选择、竞争和创新。”这三个部门与联邦贸易委员会和司法部的反垄断部门建议各州考虑取消CON,或者缩小这类政策的规模。辛格说:“就好像一个州的政府部门告诉所有零售商,每家商店只能有四个货架摆放厕纸,但实际上消费者会抢光六个货架上的厕纸。这时就会出现厕纸短缺,而消费者只能高价购买。”

执行CON法律的州,床位供应量远远低于其他州

有人认为这种限制措施会大幅提高医疗普及率,增加人们的选择。但事实恰恰相反,莫卡斯特中心发现,在执行自由市场政策的州,人均床位数量比执行CON的州高出30%,无论城市还是农村都是如此。全美每千人的平均床位数量是2.77个。相比之下,意大利为3.18个,中国为4.3个,韩国为12.3个,日本高达13.1个。执行不同政策的州之间的区别非常明显。莫卡斯特中心的研究发现,执行CON法律的州每千人的平均床位数量比其他州少1.31个。

其中许多州都有庞大的城市区,它们提供的空床位数量非常低,因此一旦被新型病毒攻击,这些州将没有缓冲的余地。城市研究所弗雷德里克·布莱文对2018年美国50个州居民空床位数量进行了研究;从疫情爆发到现在,这些数字恐怕也没太大变化。全美每千人的空床位数量为0.80个,但康涅狄格州只有0.45个,马萨诸塞州为0.51个,华盛顿州为0.57个,纽约州为0.58个。

出人意料的是,供应紧张并没有导致严重短缺

在此需要提醒读者的是:我无法充分协调纽约州、疾病预防与控制中心、华盛顿大学健康指标和评估研究所等提供的住院患者数据。因此无法确定不同数据来源所统计的床位类别。这是本文对于美国和个别州没有出现预想中的床位“短缺”之后说法的理解。

IHME网站上显示,美国“所需床位”约为66,000个,“短缺”13,400个,其中ICU床位缺口为8,900个,普通病床缺口为4,500个。这些数据表明,在疫情已经爆发或预计将爆发的地区,主要是纽约城区等热点城市区域,在疫情爆发之前提供的床位约为52,600个。这些数字与城市研究所的数字一致,表明纽约、新泽西、马萨诸塞、康涅狄格和罗德岛的空床位总数不足24,000个。而这五个地区占到美国新冠肺炎总确诊人数的一半左右。

24,000个空床位远远低于国家标准水平。例如,长岛拿骚县每千人空床位数量只有0.34个,布鲁克林所在的金斯县为0.32个,康涅狄格州的费尔菲尔德县为0.42个,都远低于美国的平均水平0.8个。

但别担心,美国已为需要住院治疗的所有新冠肺炎患者都找到了床位。66,000个病床的需求已全部到位。IHME网站显示,纽约州共收治了20,300名新冠肺炎患者,比该州床位数多出7,200人,这显然代表了纽约州在疫情之前的空床位水平。五个州的医院总计为新冠肺炎患者提供了38,500个床位,较危机前的床位数量高出60%。

美国是如何做到无视CON法律规定,大幅增加医院床位的呢?

各州放宽规定,帮助医院应对患者的激增

一个重要因素是发布关于选择性手术的禁令,即将本应分配给康复手术患者或髋关节置换术患者的床位,安排给新冠肺炎重症患者。但各州也为全面取消管制做出了重要贡献。包括纽约州、北卡罗来纳州和肯塔基州等在内,超过18个州已取消CON法律,或缩小了CON法律对医院床位数量的管制。辛格说:“在实行CON法律的州,医院无法为急诊室和康复病房增加床位。亚利桑那州的医院在流感高发季节总会遇到这种状况。但如果各州能取消CON限制,医院就可以增加大量病床。”

取消CON法律的限制,提高医院的灵活性,已取得了很好的效果。但如果总住院人数的峰值不止于7万人,而是IHME和其他机构在几周前所预测的20万,医院又该怎么办?

在这种情况下,即使各州再次取消CON法律,填补床位短缺将变得更加困难。CON法律的目的是严格限制床位,但这种政策却直接妨碍了疫情防控。对于各州来说更好的选择是,取消CON法律,允许创业者和新竞争对手提供床位。这将一方面满足消费者对于医疗保健服务的床位需求,同时还可以额外提供充足的床位,应对下一次未知的疫情。(财富中文网)

译者:Biz

The coronavirus outbreak should be teaching an important lesson. Capping the number of hospital beds is a bad idea.

Around half of all Americans live in states governed by iron-fisted regulations that effectively block the construction of new hospitals, the expansion of existing facilities, or even the addition of beds in recovery rooms to treat an overflow of patients in a bad flu season. Those certificate-of-need laws, or CONs, artificially hold the number of hospital beds at far lower volumes than providers would supply in a free market.

When a deadly outbreak strikes, hospitals in the regulated states are handcuffed. The flood of infected patients need unoccupied beds, but those beds aren't available because the hospitals are tightly packed. The CONs hobble their flexibility to handle a surge.

Given those constraints, you’d think that the coronavirus pandemic would have swamped America’s hospitals, forcing providers to turn sick patients away, and accelerating COVID-19’s spread. Indeed, many experts were predicting that doomsday scenario just a few weeks ago. It hasn’t happened––and not just because the remarkable adherence to social distancing flattened the curve of new infections much sooner than forecast. In reality, the U.S. escaped disaster in large part because restrictive states suspended their caps, allowing hospitals to expand far beyond their official “capacity” and so that tightly controlled New York became just as free as such non-CON peers as Texas.

The remarkable results from letting freedom ring should prompt the states to weigh permanently scuttling their CONs. If that happens, states constrained for decades would add all the new beds providers could profitably fill in normal times, as well as a cushion for future outbreaks that’s now a thin, fragile buffer.

If the CONs are reinstated, American hospitals could well get overwhelmed when the next pandemic strikes. “I would hope the governors would say, ‘Let’s not risk this again,’” says Jeffrey Singer, a surgeon in Phoenix and fellow at the Cato Institute. “The free-market states have a lot more capacity than the CON states. They should be the model for ensuring America has the right hospital capacity in the future.”

What are certificate-of-need laws?

CONs are all imposed by individual states via regulations voted by their legislatures. But it was a federal measure that first spread the regimes from coast to coast. In 1974, the U.S. offered big incentives to states that created agencies empowered to establish tight controls on health care services. Then, as today, the theory ran that unfettered competition curbs care in poor urban and farm communities in favor of affluent suburbs, and that providers would flood America with MRI and dialysis centers and low-quality hospitals forcing Medicare and patients to pay extra for all the over-investment.

In 1987, Congress repealed the federal mandate, and over the next three decades, 15 states have scuttled their CONs. In the 35 that kept them, state agencies hold the power to approve, deny, or alter applications from hospitals, ambulatory centers, and other providers for new or expanded facilities. The list of regulated services varies widely by state. In New Jersey, the Healthcare Facility Licensing/Certification Agency grants or withholds CONs for all types of hospitals, as well as diagnostic treatment centers, nursing homes, and a dozen other services.

Among the most commonly and heavily restricted categories are hospitals. Of the 35 CON states, 28 require their agency’s approval for construction of a new hospital or additions to an existing one. States regularly ban hospitals in the same chain from transferring beds from a site that has too many, to facility that needs them. The restricted 28 encompass most of the states hit hardest by the coronavirus, including New York, Massachusetts, Connecticut, Washington, and Illinois. Notable non-CON states are Pennsylvania, California, and Texas.

CONs don’t deliver the promised benefits

The idea that artificially constraining the supply of any product or service would expand availability and lower costs is suspect. And in the case of CONs, many studies show that the practice cripples competition with predictable results: higher prices, bigger total costs, and less access. The rub is that incumbent hospitals, nursing homes, and diagnostic centers have a strong incentive to block lower-cost rivals from invading their markets and forcing down rates. “It’s protectionism on the state level,” says Matt Mitchell, senior research fellow at the Mercatus Center at George Mason University. Mitchell found that CON jurisdictions offer far fewer ambulatory surgery centers, dialysis facilities, and MRIs than non-CON states.

In a letter to the President in 2018, the secretaries of Labor, Treasury, and HHS warned that “state policies that restrict entry into provider markets can limit choice, competition, and innovation.” The three departments, along with the FTC and antitrust arm of the Justice Department, advise states to consider repealing or scaling back their CONs. “It’s as though a state agency told all retailers that each store could devote only four shelves to toilet paper, when customers would be buying out six shelves,“ says Singer. "You'd have a shortage of toilet paper, and consumers would pay much higher prices for it."

The supply of beds is a lot lower in the CON states

Contrary to the claims that restrictions greatly improve access and choice, Mercatus found that the free-market states have, on average, 30% more hospitals per capita than do the CONs, and that edge holds for both urban and rural facilities. Across the U.S., the average number of hospital beds per 1,000 people is 2.77. By contrast, Italy has 3.18, China 4.3, South Korea 12.3, and Japan 13.1. The divide is stark between the two categories of states. According to Mercatus' research, the CON states have 1.31 fewer beds per 1,000 people than the non-CONs.

Many of the CON states with large metro areas offer extremely low levels of empty beds, and hence lack a crucial buffer if a new virus attacks. The Urban Institute’s Fredric Blavin conducted a study of unoccupied beds per 1,000 residents in all 50 states in 2018; those figures are likely little changed since just before the outbreak. While the national average stands at 0.80 free beds per 1000 population, Connecticut registers 0.45, Massachusetts 0.51, Washington 0.57, and New York 0.58.

Miraculously, tight supply didn’t cause crippling shortages

A warning to the reader: I was unable to fully reconcile the hospitalization numbers coming from such sources as New York State, the CDC, and the University of Washington’s Institute for Health Metrics and Evaluation (IHME). It’s unclear precisely which categories of beds different sources are counting. Still, here’s my best take on the predicted “shortages” that didn’t materialize for both the U.S. overall and for certain states.

On its website, IHME shows “beds needed” for the U.S. at roughly 66,000, and a “shortage” of 13,400, split between a shortfall of 8,900 ICU and 4,500 regular beds. Those figures suggest that the areas hit, or expected to be hit, by the virus, dominated by urban hotspots such as the New York metro area, offered around 52,600 available beds before the outbreak (66,000 beds needed minus the shortage of 13,400). Those figures square with the Urban Institute numbers showing total unoccupied beds in New York, New Jersey, Massachusetts, Connecticut, and Rhode Island of less than 24,000, since those five account for around half of all coronavirus cases.

Those 24,000 free beds are an incredibly lower number compared with national norms. For example, Long Island’s Nassau County had just 0.34 empty beds per 1,000 people, while Kings County, home to Brooklyn, had 0.32, and Connecticut’s Fairfield County 0.42––all far below the U.S. average of 0.8.

But wait! The U.S. found beds for all the coronavirus patients who required hospitalization. All of the 66,000 “beds needed” were supplied. According to the IHME site, New York State alone is lodging 20,300 coronavirus sufferers, 7,200 more than the state’s capacity, apparently meaning the level of unoccupied beds prior to the pandemic. All told, hospitals in the five states are supplying 38,500 beds for COVID-19 patients, 60% more than their pre-crisis capacity.

So how did America defy the CONs and create such an on-the-spot gusher in beds?

States loosened the regs to help America’s hospitals handle the surge

A big factor was the ban on elective procedures, opening up beds that would have gone to patients recovering from or hip replacement surgery to folks gravely ill with COVID-19. But the states also helped big-time with what amounted to a sweeping wave of deregulation. No fewer than 18 states waived or scaled back the CONs restricting more hospital beds, including New York, North Carolina, and Kentucky. “In non-CON states, hospitals couldn’t bring in more beds fill part of the ERs and recovery rooms,” says Singer. “That’s what the Arizona hospitals always do when hit by a bad flu season. But when states lifted their CON restrictions, the hospitals were able to add lots of beds.”

Granting hospitals the flexibility that the CON laws normally deny them worked beautifully. But what if total hospitalizations hadn’t peaked below 70,000, and had hit the roughly 200,000 that the IHME and other organizations believed possible just a few weeks ago?

In that case, making up for the shortfall, even if the states once again lifted their CONs, would be a lot harder. The CONs are designed to keep capacity tight, and that policy runs directly counter to fighting an epidemic. The better option is for the states to scrap their CONs and allow rising entrepreneurs and new rivals to provide all the beds America’s health care customers want, and ample extra capacity to tackle the next attack.

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